My life as a zombie
Sleep apnea, left untreated, can turn your life into a low-budget horror film
I’d always figured that when it came to snoozing, I was a regular Rip Van Winkle.
My wife, however, knew otherwise—and after her surprise elbow shots to my rib cage became a nightly occurrence, it was painfully obvious that something about my, ahem, refined sleeping technique might be bothering her.
“You snore,” she’d sputter before heading to the couch or, worse, booting me out of our bed. “I mean, you snore bad. Ever think about doing something about it?”
After half-heartedly trying some mouthwashy-tasting spray from Walgreen’s, and then some tape strips she brought home that took the skin clean off the bridge of my nose, we were back at square one, and she had another suggestion.
“What do you know about sleep apnea?” she asked. Sorry, nada.
“Well,” she continued, “I think you might have it, because you sound like you stop breathing when you’re snoring, or like you’re choking to death.”
This was news. Sure, upon awakening I often felt like I’d tumbled out of a passing boxcar into a pile of oily rags and Thunderbird empties among the weeds, which isn’t supposed to happen to teetotalers. And, yes, there were those recurring, “Uh, sorry, I’m kinda brain-dead today” excuses that wore thin with everybody, which came up about as often as I yawned and rubbed the bags under my eyes.
My wife recommended that I contact the sleep lab at Kaiser Permanente’s North Area facility on Morse Avenue, which is to say she harped on me daily until I made the call. Fortunately, Kaiser had a waiting list; they would be contacting me sometime after Jeb Bush was selected to replace his brother in the White House. I was safe.
The alien mask
Months later, someone from Kaiser did call, and I went to a noon appointment and walked out with a recording device with sensor wires, which I was instructed to tape onto various parts of my body before falling asleep—which, I soon learned, was close to impossible with the wires attached to my chest and finger. After I returned the infernal device the next morning, Kaiser called me back a week later to pick up a Continuous Positive Airway Pressure (CPAP) machine.
This is where it got strange. The CPAP was a box with a bunch of hoses connected to a nose mask, along with a wire whose light-sensor end was taped to a fingernail. Lying on my back at bedtime, I hooked everything up, hit the button and tried to go to sleep. Unfortunately, the CPAP sounded like a Volkswagen microbus running through the gears up a mountain road. Eventually, though, I managed to doze off.
Then, in the thick darkness of my bedroom, something was shining a red light in my eyes. Was I dreaming? A huge octopus-like tentacle was coiling around my neck and tightening. Then the red light turned into a bindi on this little gray alien that looked like a shaved cat whose wheezy breath sounded like … like a Volkswagen engine. Once fully conscious, I realized I’d gotten tangled in the CPAP’s tubing when I turned over.
I hauled the CPAP back to Kaiser and told the sleep lab attendant that I was dog tired and hadn’t slept much, and asked about other options. “Someone from Atria Healthcare will contact you about picking up your CPAP,” she answered. “You mean I have to sleep with one of these damned things from now on?” I asked.
A few weeks later, I was sitting in the lobby of a nondescript office near the old Arco Arena, with a CHP officer, a couple of chunky Hispanic guys and a roly-poly Englishman. Like me, all of them had been diagnosed with sleep apnea; most of us had the risk factors—male, over 40, at least slightly overweight.
We were ushered into a large room stacked high with boxes of paper and seated at a long table; on it in front of each chair was a new CPAP machine. We were offered a choice of masks: one, a triangular plastic piece that fit snugly over the nose, with a hinged port for the plastic hose that connected with the CPAP; this was held in place by cloth straps connected by Velcro, with a separate chin strap connecting above the head, to keep the mouth from opening during sleep. The other option was a plastic, cloth and Velcro contraption that looked like a prop for one of the Alien films that artist H.R. Giger might come up with—the hose strapped over the head and hooked into a snorkel piece with two “nasal pillows” that plugged directly into the nostrils. All of us opted for the first, less-scary-looking mask.
The word “apnea” means “without breath”; people with sleep apnea literally stop breathing when they’re sleeping. The most common form of sleep apnea is a result of the soft tissue in the back of the throat collapsing during the act of sleeping, which chokes off the airway passage. Then, when the brain instructs the muscles around the lungs to draw in air, the fitful sleeper wakes up. This process repeats itself, often hundreds of times a night.
Which is why we people with sleep apnea are a cranky bunch of zombies—and, according to the National Institutes of Health, there are over 12 million of us in the U.S. And if mere crankiness isn’t enough, left untreated, sleep apnea can result in a number of complications: hypertension, cardiovascular disease, weight gain, depression, memory problems, impotence, morning headaches and occasionally falling asleep during waking hours among them. If those waking hours happen to occur behind the wheel of a car, an accident may happen. And, sometimes, people with sleep apnea stop breathing … and stay stopped.
Fortunately, there are treatment options. One is surgery, the most common being something called uvulopalatopharyngoplasty, or UPPP for short. This unpronounceable procedure involves shortening the uvula, that fleshy thing that dangles in the back of the throat, along with removing the tonsils and adenoids, if they haven’t been taken out already, and part of the soft palate, better known as the roof of the mouth.
Another procedure, with the trade name “Repose”—a term that calls to mind a condition typically brought about by embalming—involves sinking a small screw into the jawbone, with stitches under the tongue. Paging Dr. Frankenstein. Other, newer, less-invasive procedures use lasers and radio waves. And, if all else fails, there’s always the ever-popular tracheotomy.
However, most HMOs won’t pay for these surgeries, especially when they can lease a CPAP machine from a third party.
Dreaming in technicolor
So, do CPAP machines work? That first night, I slept with the mask and woke up feeling thoroughly refreshed, better than I’d felt in years. Unlike the clunky test model from Kaiser, this machine operated silently. The mask fed a constant flow of air into my nostrils. The air pressure kept the flap of flesh in my throat from closing off, which enabled me to sleep continuously. I dreamed for the first time in recent memory—vivid, colorful dreams.
Unfortunately, after that wonderful first night, the results became more hit and miss. I could fall asleep with the mask on, but if I turned or moved during sleep, the mask’s air seal would be broken. Sometimes I would remove the mask during sleep.
After a few weeks, I read a personal account of a sleep apnea patient at the American Sleep Apnea Association’s Web site, sleepapnea.org. His facial hair had made it impossible to get the mask to make a proper seal, and so he switched, successfully, to a snorkel with nasal pillows. At the time, I wore a full beard, so I called Apria and asked to switch to the snorkel.
Oh, well: No more amusing midnight imitations of Dennis Hopper’s Frank Booth character from Blue Velvet to piss off my wife. Instead, I looked like an alien. At least I was sleeping like a human.
Unfortunately, it didn’t take time for problems to develop with the snorkel. One morning, upon awakening, my wife pointed out that I appeared to be seven months pregnant. Apparently, with all the air the CPAP and snorkel were ramming down my windpipe, I swallowed a lot of excess. Yoga postures brought mild relief, but not enough to avoid a long, agonizing day of embarrassing flatulence. Then, when I strapped the alien gear on my head one night a week later, the dog flipped out in a barking and snarling fit. That was enough.
The first mask was better, and the only way to enjoy its benefits was to shave. So I did. Since then, my sleep life—and a good portion of my waking life—has improved. It isn’t perfect, but it sure beats walking like a zombie.
The deprivation club
What’s most surprising is how many of us there are out there. After I started using CPAP to sleep, I started seeing sleep apnea mentioned in a number of places—a link on a music-industry bulletin board online led to an article in the conservative magazine National Review about cottage-industry capitalism; the writer had hooked up with a folksinger to help her sell CDs on the road, and at the end of the piece he joked about scaring groupies in his hotel room with his CPAP machine.
The next night, while reading posts on another bulletin board, one person confessed that he suffered from sleep apnea. Four or five people posted after him that they, too, were prescribed a CPAP machine, with varying results.
When I tell people that I sleep with the mask, instead of a look of revulsion, it’s more likely they’ll say something like, “Oh, my brother has that, too.” Which is followed by, “You know, it’s weird; he says he’s never felt better.”
You know, I’m inclined to agree.