Once upon a time, there was a man who couldn’t sleep.
Oh, he could fall asleep at the drop of a hat. Anywhere and everywhere, at all hours of the day. But he never made it into deep, restorative REM sleep, because throughout the night he would stop breathing. His oxygen levels would plummet, his heartbeat would ramp up, and he’d gasp or snort in order to start the breathing process again. This wouldn’t quite wake him up, but it left him on the edge of consciousness all night long.
When morning came, he’d wake up exhausted. Not even slightly refreshed, despite the fact that the lights may have been out for 8 or 9 hours. He couldn’t keep his eyes open in the shower. Getting ready for work, eating breakfast, driving to the office – all were done in a mechanical, going-through-the-motions fog. 7:45 AM, pulling into the parking lot at work, his eyes were leaden and heavy. At his desk, he found it difficult to concentrate on his work at hand. Even while sipping on a cup of coffee, he’d find his eyes growing heavier and heavier, until they’d inevitably give in to gravity’s pull and close.
He was exhausted and ready for bed at 9:00 in the morning.
That was nothing compared to the period after lunch. Most people experience a mid-afternoon slump; it’s part of the body’s natural circadian rhythm. His was much worse; not a day went by where he didn’t catch himself drifting off to sleep in his cubicle, eyes closed, an occasional snore escaping from his mouth. Trying desperately to will himself awake, but failing – afraid all along the job he loved would be in jeopardy, that his coworkers would catch on. On at least one occasion, they did. He would force himself to stand up and stretch. To walk around the office. To chew on ice. To step outside and let the cold winter wind shock some consciousness into him. None of these tricks worked for long.
He looked forward to evenings most, because it meant bedtime was right around the corner. Meanwhile, he dreaded evenings most, because he could not keep his eyes open past 8 PM. He’d fall asleep during his favorite sitcoms and dramas, would never know which chef had been voted off or whom Judge Judy had sided with. Upstairs in bed, he’d try to read for a while, but his Kindle constantly slipped from his grasp and landed on his chest, jolting him awake. Just one more paragraph and I’ll put it down, he vowed. But it took ten minutes and countless attempts to get through that paragraph, and it didn’t matter anyway, because the next day he wouldn’t remember what he’d read the night before.
He’d fall asleep within seconds, and the cycle would start all over again.
In some ways, weekends were the worst. He had no energy, would find himself dozing on the couch an hour after coming downstairs, his fingers curled (ironically) around a cup of coffee. At least on the weekends naps were sometimes an option, but they did no good. Though he’d fall asleep within seconds and might be out for an hour or two, he’d wake up feeling just as tired as when he’d fallen asleep, rendering the nap a meaningless waste of time. On the occasions when he and his significant other went out in the evening – say, to catch a movie – he grew tense, knowing it would be a chore to keep his eyes open, even while immersed in the latest big-budget Hollywood thriller. Bright lights, booming explosions, 3D spectacles: none of these things mattered. He nodded off during The Hobbit, couldn’t stay awake through World War Z. Sleep ruled his world and took over his life, but it was never enough. He could no longer drive for long periods, because drowsiness would kick in and he’d find himself drifting. Literally. He once fell asleep in the middle of sending a text. As his sleep deficit grew, his symptoms worsened. His eyes began watering excessively throughout the day, his lids drooping. They were tired eyes, the eyes of someone who had been struggling for sleep for a long time. How much longer he could live with this condition, he did not know.
In case you haven’t guessed, that person was me.
I’m sharing my story to bring attention to a sleep disorder that affects an estimated 18 million Americans: obstructive sleep apnea (OSA). People with this condition are unable to sleep normally because their upper airway becomes blocked during sleep, and they stop breathing. A narrow airway is usually the result of bulky or excessive throat tissue, but could also be caused by enlarged tonsils and adenoids, a deviated septum, or another type of obstruction. These pauses in breathing occur repeatedly throughout the night, hundreds of times in some cases, lasting anywhere from a few seconds to two minutes. Meanwhile, oxygen levels drop precipitously, making your heart work harder. Breathing finally resumes with a gasp or snort, as the chest muscles work to open the obstructed airway and pull air into the lungs. As a result, you are never able to achieve deep and restorative REM sleep. This leads to the drowsiness and mental fog I mentioned, and slows down your metabolism, robbing you of energy and leading to weight gain. Worst of all, it puts you at risk for serious medical complications including heart attack, stroke, diabetes, and high blood pressure. In addition, people with untreated OSA are much more likely to experience car accidents. It’s a potentially deadly condition no matter how you slice it.
I was in a unique position because, as a copywriter responsible for penning articles for ENT clinics, I am very familiar with OSA. I write about it all the time: the symptoms, the health dangers, the treatment options, etc. As my own symptoms worsened with each successive sleepless night, there was no doubt in my mind I had obstructive sleep apnea. All the signs were there, not to mention the loud snoring reported by Tara, my kids, my MIL, and house guests. Looking back, I’d guess I’ve had OSA for a number of years. When I was in the hospital recovering from my gall bladder surgery, several nurses questioned whether I’d ever been tested for it. I guess they witnessed the same things Tara reported on a nightly basis: loud snoring followed by a cessation in my breathing. Once, I woke myself up wheezing and gasping for breath. I leaped out of bed and stumbled to the bathroom, unable to suck enough air into my lungs. It was the scariest sensation ever. I didn’t put two and two together at the time, but it’s obvious now that I’d stopped breathing long enough to jerk myself awake. For a long time I figured I would stubbornly live with my condition since my health was otherwise okay, but during this past year it became increasingly impossible to carry on as normal. The daytime drowsiness and fatigue were unbearable, my complete lack of energy both disturbing and depressing. Just a few years ago I was an avid hiker, but now even short jaunts would wipe me out. When I’d doze off in the evenings, sleep would hit me so hard it felt like I’d been knocked out, felled by an uppercut in a boxing ring. I can barely describe the feeling – an intense, sudden, overwhelming sleepiness I was unable to resist, no matter how hard I tried. I have never felt so helpless in my life. This is a condition I would not wish on my worst enemy. And I knew eventually it would kill me.
So last December, during a routine doctor’s appointment, I mentioned my sleep issues and told the doc I was positive I had sleep apnea. She asked me a few questions, examined my throat, and referred me to a specialist. There, I was given portable equipment for a home sleep study. One night in January I hooked myself up to wires and electrodes and went to sleep. The next morning I returned the equipment, which had compiled enough electronic data to deliver a result. The only problem was, the backlog was 4-6 weeks. I had to wait nearly a month and a half to find out what I already knew. Meanwhile, the closer I got to a solution, the more paranoid I became. People with OSA can theoretically drop dead in an instant, thanks to an overtaxed heart. I would close my eyes at night, half convinced I’d never open them again. “Relax, you’re not going to die tonight,” Tara would assure me, and I knew she was probably right. But that’s a heavy “probably” to have hanging over your head. Finally, one day last week, the results came back. Not the least bit surprisingly, I was diagnosed with severe OSA. My AHI (apnea hypopnea index) was 85.6 and my oxygen levels dropped to 63%. I won’t go into a lot of detail or medical jargon, but this means I stopped breathing or had very shallow breaths 85.6 times per hour. If you do the math, that’s about once every 45 seconds. All night long. No wonder I was feeling so miserable! For reference, a normal AHI should be less than 5. 5-15 is considered mild OSA, 16-30 is moderate, and anything over 30 is severe. I was way over 30. And, normal oxygen levels should be between 95-100%.
Would those results scare you? They sure did me! I found out by email on February 17th, and had an appointment for treatment on the 24th. That week felt like an eternity.
Finally, Monday rolled around, and I had an appointment with a small group of newly diagnosed OSA sufferers to receive a CPAP machine. CPAP (continuous positive airway pressure) is the preferred and standard treatment for OSA. It consists of a machine that delivers controlled bursts of air into your nose all night long, keeping your airway from collapsing. This allows you to breathe normally and, as a result, snoring is eliminated. It’s not fun to use; you have to wear a mask attached by a 6′ long coil of plastic tubing. Many people cannot tolerate it. Compliance rates are something like 50% after one year. And it’s hardly sexy. I joke with Tara that she’s sleeping with Darth Vader now. But for me, it was a godsend.
I guess I’m one of the lucky ones. Or maybe I’m too familiar with the health risks associated with OSA not to use my CPAP machine religiously. All I know is, I hooked myself up that first night, and had no problems falling asleep. The machine is state of the art, with a heated humidifier to prevent your nasal passages from drying out, and automatic titration to adjust the pressure as needed, depending on your breathing. There is a built-in digital display that records data including AHI and hours slept. I was actually able to fall asleep pretty easily that first night, and woke up Tuesday morning feeling like I hadn’t in years: refreshed. And no wonder – according to the machine, my AHI that first night was 1.8. Keep in mind, prior to CPAP therapy, it was 85.6. This, after a single night on the machine. The results were instantaneous. Granted, this is all still new to me – I’ve used it a total of 4 nights to date – but the improvement has been dramatic. When I wake up in the morning, I feel like I’ve actually gotten rest. I do not have any of the annoying side effects of OSA, such as a dry mouth or sore throat, and my eyes are back to normal – no longer watery or droopy. My snoring is gone: Tara is able to sleep without earplugs for the first time since moving in with me. My energy level has increased tremendously, and I am no longer battling daytime drowsiness. I have been alert and awake at work, morning and afternoon, and my productivity has ticked up. In the evenings, I am no longer nodding off in front of the TV within half an hour of finishing dinner. In short, I feel like a new person. CPAP has changed my life.
It can change yours, too. But you’ve got to get help first, and must be motivated to stick with it! It’s estimated that 90% of people with obstructive sleep apnea are not being treated for their condition. They are either unaware of it (if you sleep alone, chances are you don’t even know you snore at night, let alone stop breathing), chalk their symptoms up to something else, or choose to ignore it. While snoring doesn’t automatically mean you’ve got OSA – not everybody who snores stops breathing in their sleep – no type of snoring is natural. It’s one of the first symptoms to look out for. Other signs include daytime drowsiness, fatigue, lack of concentration, memory loss, and weight gain. Take my story as a cautionary tale. If you can relate to any of what I’ve written, do yourself and your loved ones a favor and ask your doctor about getting tested for sleep apnea.
This is not my usual funny ha-ha-guess-what-happened-to-me-today post, and was a difficult one to write. It’s not easy sharing personal medical details, especially considering friends and coworkers who will read this and have no idea what I’ve been suffering through. But I feel the message is too important to ignore. If even a single person recognizes him- or herself in this blog entry, I’ll consider my work here a success.
Thank you…and have a good night.