Friday, November 16, 2012

Sleep Apnea - A Thief In The Night

For a number of years now I've had difficulty sleeping soundly.  In truth, it's been going on as long  as I remember.  I've always been a very light sleeper - waking up at the slightest sound or movement and sometimes waking up from my own breathing.  (Yes, I sometimes snored heavily - to the point where it would wake me.)  I am normally awake 4 to 5 times a night.  Usually I go back to sleep, but not always.  I do not recall the last time I slept for 5 straight hours, let alone 8.  But I adjusted to it long ago and it didn't really become a problem until the last 12 years or so.  Then it took me that long (and Arden) to finally do something about it.

Soon after we got together, Arden mentioned to me that I stop breathing for long periods of time when I'm sleeping.  She said it worried her and asked if I would see a doctor and get checked out.  She had heard the stories about sleep apnea and read that it could significantly shorten someone's life if they don't do anything about it (which is absolutely true.)  Sleep apnea robs your body and brain of oxygen.  It seems Arden wants me to be around for a long time and she's not going to allow me to die prematurely without a fight.  She had a good ENT doctor who I had met so I agreed and went to see him.

After looking into my nose and throat the doctor pronounced that I had a deviated septum (something I already knew), that my uvula was a bit large and that there was excess tissue growing on either side of it that assisted in blocking my airway when I sleep.  He suggested a sleep study to determine the extent of my apnea.  I was scheduled to spend a night in a sleep clinic where they would monitor my breathing, heart rate, brain activity, eye movement and oxygen saturation while I was sleeping.  Arden said she had once done that herself and it wasn't terrible.  And since I already knew I had sleep apnea, I figured I may as well get this over with and find out how bad it was.

I went to the clinic on a Tuesday evening in early October.  I had to be there by 8pm and be ready to sleep.  They told me no alcohol but that I could use an over-the-counter sleep aid if I so desired.  There was a TV and I was allowed to read to help me go to sleep.  There was also a camera mounted over the door but Brian (the technician) told me while they normally video the patient during the night, the camera wasn't working at the time.  (I don't know if he was telling the truth or not but I wasn't planning on doing anything weird so I wasn't worried.)  What they didn't tell me was that they were going to wire me up with more monitoring devices than a patient in ICU. 

They put electrodes on my legs, my arms, my chest, and my head.  They taped a sensor to my upper lip to monitor my breathing and put a strap around my upper body for the same purpose.  Then they tied all of the wires together and attached them to a telemetry unit that laid beside me on the bed.  Brian hooked everything up and said once he was done he wouldn't bother me again unless, for some reason, he lost the signal or a wire came loose or something. 

So here I am in a strange place, wired for sound and expected to go to sleep as I normally would.  I don't know about any of you but I don't sleep well in a strange bed anyway, regardless of how tired I am.  I have to be in a hotel for at least a second night before I can even think about sleeping well.  And having to worry about wires coming loose and/or getting tangled just made it worse.  I took my sleeping tablet and got my book out.  I finally started dozing about 11pm and turned the light off.  Of course, as soon as I did that my brain started looking for other things to keep it occupied.

About 12:30am (best guess), I may have been asleep for half an hour and in comes Brian.  He was very apologetic but said one of the electrodes on the side of my neck (oh, yeah - forgot about those) had come loose and he needed to change it.   Not just put it back but change it.  It took several minutes and he politely apologized again and went back out of the room.  Then I had to try to sleep all over again. 

About 2:30 here came Brian again.  Another wire had come loose and he was not getting proper transmission of the signals.  Again he was very apologetic but I told him not to worry - I wasn't sleeping much anyway.  This one took a little longer and he went out about five minutes later with another apology and a third "Good night".  Around 4am history repeated itself. 

Right at 5am, just when I had finally fallen into a decent sleep, Brian came in and said "OK - you made it through the night.  Your test is over.  You can get up and we'll get all those wires off of you!"  I can't tell you how happy I was about that!  Certainly I wanted out of there but I really wanted to finally get some sleep.  Except it was now too late.  I was being sent home.

While he was getting me unhooked from everything he asked if I wanted coffee, orange juice, a cookie or muffin, or anything else.  I asked if he had some good coffee and he said he'd have to make it.  I told him not to worry about it - that I'd have some waiting for me at home.  He said "Oh¸ that's good because I don't drink coffee and I'm not even really sure how to make it."  I thought about showing him but didn't have the energy.

Have any of you ever had an EEG?  The paste they put on your head to hold the electrodes feels like silicone.  Now just imagine blobs of that stuff in eight different places around your head.  I'm glad it was dark as I drove home so on one could see me.   Brian had told me to get into the shower and let the hot water run on my head for several minutes and it would come right out.  He was right but what a pain.  The  whole test was something I'd rather not do again.

Brian also told me the results of the test would be sent to my doctor and he would call me with the results in a few days.   I don't remember what I did the rest of that day - I probably took a nap in the afternoon.  But at least it was over. 

Two days later I got a call from the sleep clinic's home office.  They told me the tests showed that I did not actually qualify for the diagnosis of sleep apnea because even though I did stop breathing for up to 10 seconds at a time while sleeping, I didn't do it often enough to meet the clinical definition of sleep apnea.  Apparently you have to stop breathing at least 12 times an hour to qualify and I only did it an average of five times an hour.  She said the test showed I actually was asleep for five hours, which isn't true at all.  I may have laid still for a couple of hours but I certainly didn't sleep that long.  So I spent a couple hundred dollars to find out that although I do stop breathing while sleeping, it didn't quite qualify as sleep apnea.  Great.

My doctor's office called the next day to make me an appointment so we could go over the test and the treatment options.  It was about a week later and Arden went with me.  The doctor said even though I didn't exactly qualify according to the test, he's convinced I have sleep apnea and there are several treatment options.  First, I could start using a CPAP (Continuous Positive Airway Pressure) machine when I sleep.  I don't know how many of you are familiar with these but my dad wore one for about the last ten years of his life.  He started with the mask type and eventually, as technology advanced, was changed to a smaller device that forced air into his nose but I can tell you now - I won't be using one of those unless I have absolutely no choice.

For those unfamiliar with them, CPAP machines blow air and oxygen through a hose into a facial device that either fits over your mouth and nose or just into your nostrils to insure that you get enough oxygen while you're sleeping.  It makes up for the temporary cessation of breathing caused by sleep apnea.  Just imagine trying to sleep with a fan a inch from your face all night long and being unable to roll over or to even turn away from the air.  No thank you.

Anyway - as far as I was concerned the CPAP was the last alternative.  We then discussed surgery.  The doctor said he could repair my deviated septum (thus opening the other side of my nose and giving me more air), remove my uvula and remove some of the extra tissue that was causing the airway blockage during sleep.  It was a fairly simple procedure, my insurance would cover most of it and it should greatly reduce my episodes of sleep apnea.  Of course, there was no guarantee that it would eliminate it but that was possible as well. 

I opted for the surgery.  It was scheduled for November 9th.  I'm recovering right now but that's another story - part 2 of my adventure.

"Why is he blogging about this?" you may ask. 

I tell this story because sleep apnea can be very dangerous and can seriously cause people to die young.  When you stop breathing while sleeping your blood oxygen level drops, often causing your blood pressure to increase in order to get oxygen to your body.  The more severe your sleep apnea, the greater the risk of high blood pressure.  However, obstructive sleep apnea increases the risk of stroke, regardless of whether or not you have high blood pressure.  If there's underlying heart disease, these multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.  Studies also show that obstructive sleep apnea is associated with increased risk of atrial fibrillation, congestive heart failure and other vascular diseases.  It can also cause liver damage.  People with sleep apnea need to be careful with medications (including alcohol) that depress respiration.  You could accidentally kill yourself with medication. 

Part 2 - The Surgery and Recovery - tomorrow.  (Or Saturday, depending on whether or not I get it done...)  :)

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