Aging gratefully

The Thinker by Rodin

Another birthday rolled around yesterday. For once the first of February felt like it should: bitterly cold and snowing. I am not much on celebrating birthdays, which is probably why I scheduled an outpatient procedure on my birthday. Specifically, I had a colonoscopy, a distasteful but necessary procedure for us insured humans age fifty plus. This being my second time, I knew what to expect. When I had my last one at age fifty, I could get it done in a local surgical center. This time, because I was subsequently diagnosed with sleep apnea, it meant going to the hospital instead. It also meant arising at three a.m. to down a second dose of medicine guaranteed to empty your digestive track, not to mention spending the day before at home on a liquid only diet, trying to make a bottle of white grape juice substitute for solid food.

Happily the procedure went well. One reason I was repeating it after only five years instead of the normal ten years is because polyps run on my mother’s side of the family. She never had a colonoscopy and as a result due to a huge polyp had to have part of her large intestine removed. Sure enough, yesterday my gastroenterologist found a polyp, but it was easily sliced off and removed. By ten a.m. I was home eating solid food none the worse for the experience but with lovely color photos of my large intestine showing the emerging polyp.

That’s kind of how it should go at age 56. You have given up chasing immortality and have made peace with conforming to the practices of modern medical science instead. Few men or women my age can credibly claim they have the strength and stamina they had when they were in their 20s. Perhaps I could get the illusion of it if, like some foolish and better moneyed people my age, I ingested steroids and got shots of HGH (human growth hormone). Along with the HGH, regular injections of testosterone probably would make me feel manlier. Marketers think they know what I need and lately it’s been testosterone supplements. I can rarely go to a web site without seeing ads telling me about the benefits of testosterone therapy. I remain skeptical. Estrogen replacement therapy for women has proven to have more minuses than pluses for most women. I doubt testosterone supplements and shots are without serious risks as well. Perhaps it will keep my hairline from receding, or suddenly make me attractive to women half my age, but I doubt that is worth any of the potential complications.

Or perhaps I should do what has worked so well for my father, age 86, still reasonably healthy and walking around. Perhaps I should simply give up on the silly pseudo science, ignore the multitudes of marketers of immortality and pragmatically get regular exercise and regular checkups instead. My father has been battling precancerous melanomas for decades, but he is still alive. This is thanks to regular trips to the dermatologist, which often results in skin removal or replacement. It doesn’t appear that I have inherited that particular condition, but it does look like I have my mother’s tendency toward polyps in the large intestine, so I best better bear the indignity of these colonoscopies every five years.

I also inherited her family’s tendency toward tallness, narrow throats and a large uvula, all of which contribute toward a tendency to snore and which eventually lead to a diagnosis of sleep apnea. For a whole year now I have been sleeping with the aid of a BPAP machine. It regularly fills my lungs with air, even when my body would prefer to stop breathing for a while. For a month or two using the machine was more torture than restful until I figured out how to put the mask on properly so it did not hiss at me during the night. Now the BPAP allows me to get genuinely restful sleep, and many nights I sleep like a baby. Waking rested gives me more energy than any shot of testosterone is likely to provide.

Maybe there is something unmanly about depending on regular checkups and medical science. Real men in their fifties, if you believe the ads, are supposed to be climbing mountains, roping steer, running marathons and bedding women in their twenties. What most real men my age are doing appears to be quite the opposite, at least according to my observations: eating too much crap and limiting their exercise to changing cable channels with their remote controls. I confess to eating too much crap myself, but I also eat plenty of healthy food, and since 1981 I have been getting regular aerobic exercise. My health is obviously not perfect, but it is better than most men my age. I can’t seem to go see any physician without getting blood drawn, so I have constant opportunities to tweak Vitamin D deficiencies, check my cholesterol or measure my triglycerides.

So at age 56 I remain a work in progress. I am realistic enough to know I won’t live forever but stubborn enough to insist that as much as feasible I will enjoy those years that remain. If that means sleeping with a BPAP machine for the rest of my life or having to endure the indignity of having my colon probed every five years, so be it. At least I am still here, in reasonably good health, and with (I hope, no guarantees) much more good life ahead of me. My testosterone levels may be receding like my hairline, but with luck the next thirty years of my life will be happier years with less heartache and struggle.

I’ll keep my physician on speed dial to make it so.

Life under the mask

The Thinker by Rodin

There are things in life that really, really suck, like finding out you have terminal cancer. Then there is stuff that really sucks, like losing your job. There is also ordinary stuff that sucks, like missing a connecting flight. Then there is stuff that you wish you could say sucks but you might get a reputation for being whiny for saying it sucks. For those of you who suffer from sleep apnea and are having treated it the typical way (by trying to sleep with a mask over your nose and/or mouth while mechanically pumped air zooms down your windpipe), you will relate to my opinion that the experience really sucks.

Most sucky experiences though are transitory. Using a CPAP (continuous positive airway pressure) or BPAP (bi-way positive airway pressure) machine while sleeping is the way those of us with sleep apnea should sleep for the rest of our lives. The result of not using it could be, not to mince words, deadly. When you have sleep apnea, your lungs decide to shut down while you sleep, causing carbon dioxide buildup and increased blood pressure. This can cause various heart ailments including heart attacks, blocked arteries, strokes and maybe waking up dead.

So it is truly remarkable that given the potentially deadly consequences, so many patients prescribed a CPAP or BPAP simply stop using it. They’ll take their chances with sleep apnea and sudden death, thank you very much. Because when you have to do something annoying for eight hours when you crave uninterrupted sleep, your CPAP or BPAP (a branded version of a BPAP is a BiPAP) is going to feel more like an enemy than your friend.

Is there no pill I can take? Alas, none is available, and it appears there never will be one either. No pill and your remaining choices are chancy at best. If you are very overweight or obese, sometimes losing the weight will cause the sleep apnea to go away. Or not. In my case, I am not a whole lot overweight, so the sleep doctor doubts it will do much good. Even so I may give it a try. Trying to sleep with my BPAP is so annoying it may be worth taking off that weight and more and hope for the best. Then maybe I can fully sleep again.

There is also a dental appliance you can try. My brother, who also suffers from sleep apnea, tried it to bad effect. He may need orthoscopic surgery to correct his jaw alignment. You can also have your uvula, tonsils, adenoids and some throat tissue removed. Even with all that radical surgery, it only cures sleep apnea about a third of the time. And it is quite expensive, painful and could have side effects.

Of course, the reason you use a CPAP or BPAP is to get sleep you are not getting, the vital REM (rapid eye movement) sleep that makes dreaming so vivid. In my case two sleep studies confirmed I got no REM sleep at all. Presumably I am at least getting some of it now. However, my BPAP is hardly conducive to sleeping. Let me count just some of the ways:

  • Your mask probably won’t seal very well. Cleaning the mask nightly helps by removing oils from your skin that accumulate on the mask’s seal. To really get a good seal you have to lock the mask down. This means pulling the mask’s head straps quite tight and locking down the screw that connects the mask with your forehead. This in turn means indentations on your forehead in the morning and maybe a headache. You do this to avoid the whistling noise that results when the extra pressure from your machine finds a way to escape. In any event you, try a little of this, a little of that and at least in my case it never seals perfectly. In my case, with every breath some cold air hisses out near the bridge of my nose and that keeps me awake.
  • Even if you think your mask is sealed, it will start whistling in the night. This is because the machines are usually programmed to start off at a low level, hoping you fall asleep before it really cranks up the air pressure. It needs to do this to keep the windpipe open. This whistling will usually wake you up. You will probably reach for the button on the machine that turns the air pressure down a bit, but it will be back at full pressure in an hour or so.
  • If your nose is disjoint because it was broken, like mine, then the top of the mask won’t seal well. Worse, it irritates the bridge of the nose. When I complained I was sent a jelly-like piece of plastic that is draped over the bridge of the nose. It definitely helps but is hard to get on correctly, because you have to tip your head up while you try to don the mask, so the plastic won’t fall off.
  • When you sleep, you expect your body to relax. It should be natural for your breathing to slow down. Not with your machine on. Your lungs expand and contract, sometimes like you are in a brisk walk. That does not stimulate sleepy feelings.
  • The mask feels claustrophobic. Particularly if you sleep with your mouth open, you will breathe out warm air from your body into the mask and thus on your face. Had I grown up in a tropical climate, maybe this would feel okay, but it feels weird instead.
  • With the BPAP machine that I use, the cycle varies. As you exhale the pressure drops. The machine doesn’t necessarily get the cycle right. So you either feel like you are breathing too much or, worse, that you are not breathing enough. Particularly if you rise to go to the bathroom, then reconnect the mask to the machine, and the machine restarts at a low level, you may feel like you are not getting enough oxygen, and it’s hard to suppress the shortness of breath feeling. Which means, you stay awake and feel a bit panicky.
  • You both hear and feel your breathing. The mask amplifies your breath. The mask itself expands and contracts a bit while I breath, making a crinkling noise and potentially unsealing the mask. This also means that if you do get to sleep you might sleep through your alarm because you won’t hear it. Instead, you will be listening to yourself breathe.
  • Since you are tethered to the machine with a hose, the hose is a constant distraction while you shift in bed. So you spend a fair amount of your rest time pushing the damn hose out of the way.

I hope I can get used to it. I’ve talked with other sleep apnea sufferers who say they have, but I imagine it takes years, if it happens at all. After thirty days of use my sleep doctor will look at the metrics collected by the machine and adjust my settings. I sure hope she will drop the pressure a notch or two. It seems excessive at 3 AM.

Using a CPAP or BPAP is really like spending every night in an iron lung. It may be that an iron lung is really what we sleep apnea sufferers need to get a decent sleep, providing we can fit a bed inside one. An iron lung however is likely prohibitively expensive, and it’s doubtful your spouse wants you sleeping in one. So it’s a CPAP or BPAP instead.

So forgive me for venting. Whining is good for my system. And while I realize I am just whining, it really sucks.