Breathing easier

The Thinker by Rodin

I’ve spent three years now connected to a machine while I sleep. This is because I suffer from sleep apnea. Until recently much of that sleep was restless. For the first couple of months it was downright annoying. This was because while the respirator that controls my sleep apnea made sure I breathed regularly, it was loud and noisy.

In response, I plugged my ears with silicon to try to deaden the noise, but it didn’t work that well. Sound still leaked in. In addition it took months to get the air pressure adjusted right. Too little and the machine could trigger sleep apnea. Too much and it was hard to sleep. It’s like sleeping while taking a brisk walk.

When I could tune out its noise, I did sleep pretty well and I enjoyed all sorts of vivid dreams I had been deprived of for years. But it’s hardly natural to sleep connected to a tube and a machine. For example, if you turn in bed then the tube comes with you, and it sometimes drapes over your face, so you wake just enough to push it out of the way.

My respirator merely helps me cope with my sleep apnea. It does not solve the condition. Sleep physicians have all sorts of suggestions for maybe curing the problem. One involves losing a lot of weight. Even if you are successful the success rate is problematic at best, particularly since most people who lose weight eventually put it back on. Another involves trimming the uvula (the thing that hangs in the back of your throat) and various tissues in the back of the throat to improve airflow. This requires surgery and is no guarantee of success. There is also a dental appliance that forces the lower jaw forward to improve airflow through the throat. My brother tried it for his condition and found it painful and impossible to deal with.

The real problem may simply be the width of my windpipe. It’s inherited of course, and if that is the real issue I can’t make it wider. In this case, I will have to just deal with the problem. Moreover, the root of sleep apnea is really in the brain. During sleep it periodically stops sending signals to my lungs to breathe regularly. So far I’ve not opted for any surgery, mainly because of its poor success rate. And given my brother’s reaction to the dental appliance, I ruled out that approach as well.

So I’ve become accustomed to dragging around my respirator with me when I travel. It means I probably won’t be doing any camping, unless I have power source sufficient to keep my machine running overnight.

A couple of months ago I noticed that my machine occasionally rebooted itself during the night. It beeped when it did this, which at least let me know about the problem. After a while it was happening regularly. This is a bit alarming since without the machine on you don’t get a whole lot of air through the vents in the mask. When I went to see the sleep doctor, I asked for a new machine. Fortunately, my insurance paid for it. Since February I’ve been using the latest ResMed bi-level machine.

There are no more nightly reboots of my machine. But the real startling discovery was how quiet the new machine is. It’s nearly silent, even when wearing the same masks over my mouth and nose. With the old machine the vents in the masks typically hissed noisily during exhalation. With the new machine, there is no hiss at all. What I had thought was an issue with the design of the mask was actually due to the way my old machine was pushing air through it. The new machine seems to scale up the air pressure more evenly and naturally, presumably doing a better job of mimicking the way lungs take in air. It’s the difference between driving a noisy car and a Cadillac. It’s the difference between getting some sleep and sleeping very well most nights.

What a relief to be breathing (and sleeping) easier.

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.

Perchance to dream

The Thinker by Rodin

We are such stuff
As dreams are made on

The Tempest Act 4, scene 1

Do you look forward to sleeping? The evidence suggests that most Americans do not. There are too many modern world temptations, like your smartphone. In a way, perhaps it is good that modern life is more tempting than sleep. It suggests that life, however harsh it may be at times, is engaging.

Like it or not, sleep (or attempting to sleep) is how we typically spend a quarter to a third of our lives. Arguably, sleep is not productive at all. During sleep we cannot create anything, except possibly in our subconscious, and you don’t get paid to sleep. Perhaps you can learn a foreign language in your sleep. It sounds iffy to me. I suspect like most of us that when I sleep I want to sleep deeply, dream vividly and wake up rested and reinvigorated.

I actually attempt to get eight hours of sleep a night. More typically it is seven, and that includes the time it takes to get to sleep, rising to use the bathroom and trying to tune out my wife’s snores three feet away (earplugs help). I’ve attributed some of my success in life to following this strategy. The only problem was I was fooling myself. It turned out that when I thought I was sleeping, I mostly was not. More specifically, I was not dreaming. I have sleep apnea. It’s a condition where your brain goes so far into hibernation during sleep that it forgets to tell your lungs to continue breathing. This cannot go on too long before other parts of your brain detect the rise in blood pressure and reduced oxygen. It then sends a mini-jolt of adrenaline through your endocrine system that restarts your breathing and wakes you up, or at least kicks you out of an attempt to get REM (rapid eye movement) sleep, the sleep where you actually dream. Waking up so often, even when most of the time I was not aware of it as such, had lots of side effects. I still don’t know all of them. It may have caused my arrhythmia. It has also meant rising to use the bathroom four to six times a night, a tendency to nod off in conference rooms in the afternoon and, perhaps most importantly, little in the way of dreaming. My dreams, when they occurred at all, tended to be short and full of untimely interruptions. I rarely felt rested, even after eight hours of “sleep”. No wonder: sixteen times an hour on average my body was kick-starting me awake.

That was then. Today I sleep with the help of a breathing machine, a common solution (but not a cure) for sleep apnea. It pushes measured amounts of air into my lungs when it detects I am done exhaling. To make it work, I wear a mask over my nose and mouth and then connect the mask via a tube to a machine next to my bed. Sleeping is not necessarily perfect with my BiPAP machine. There is the incessant noise, both the motor and hearing your breathing echoing inside the mask. After a month or so of struggling, I was able to get the mask working so that it does not usually leak air. It helps to clean my face and mask before bed so skin oils won’t interfere with the mask’s adhesion to the face. It also helps to have a flexible, clear plastic nose bridge so my nose does not become pinched by the mask. Just as I am aware of my wife’s snoring, I am also aware of the presence of my mask and the hose while I sleep. It’s hard not to brush against the hose when I turn in bed.

I can attach or detach a humidifier to my unit. I need it in the winter when the humidity is low. I don’t need it in the summer, except for now. Right now I am recovering from having my deviated septum fixed. My surgeon does not want high pressure air surging through my nose all night long, and possibly undoing my sutures. So I cover my nose with gauze and tape and breathe through my mouth instead. My mouth turns into the Sahara Desert anyhow, but less quickly with the humidifier plugged in.

As for dreaming, dreams are coming back, just slowly, almost with some prodding. I thought that once I was using the masks, my dreams would return automatically. Perhaps they have returned and I wasn’t aware of them. Instead, what I discovered is that my fragmentary dreams slowly became longer. Now nearly six months into treatment I often get long, languorous, florid, sometimes even glorious dreams. I also get the occasional nightmare. However, nightmares don’t hold the same terror that they used to. I find I can wrestle and talk back to my nightmares. As for my pleasant dreams, I am easily seduced to stay inside of them. Indeed, rising in the morning to plug into the Internet is often quite a letdown. It is so much more fun and nicer to stay in dreamland, if I can.

The effects of years of chronic sleep apnea are hard to measure. I coped as well as my body could while having little idea that I had an underlying condition. It’s not quite the same as torture, as no one was torturing me. However, in a way it is like being forced awake regularly all night. While now I hardly start the day with the energy I had in my youth, my days are definitely brighter now. I rarely feel the need for a middle of the day nap. I have more energy and can concentrate easier. In some ways I feel more connected with my soul. Sleep theory suggests we dream to incorporate experience into long term memory and to file away lessons learned during the day. REM sleep may be fantasy and nothing more than the mind unfettered, but having it again strikes me as fundamentally healthy and natural.

Do you have sleep apnea? Snoring can suggest sleep apnea, but many people snore without having sleep apnea. My experience suggests that if you awake three or more times a night, you have sleep apnea. If you find yourself falling asleep at your chair at work, it could suggest sleep apnea. (It could also be that you need a more stimulating job.) General tiredness and lethargy, particularly after getting what appears to be a good night’s sleep, could mean you have sleep apnea. Being overweight or obese are often associated with sleep apnea. In my case part of the problem is congenital: my throat is narrower that most people’s and my uvula is unnaturally large. Some health care specialists are suggesting that sleep apnea is being over-treated. Perhaps. I still think that if you have some of these symptoms and can afford it (sleep studies are not cheap, but usually are covered by insurance); it is worth the time, hassle and expense. It might save your life, as many cases of people dying during sleep can be attributed to sleep apnea. Perhaps the best reason is, to quote the Bard, perchance to dream. For me, this alone was worth the effort.

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.

Aging: this ride is not an E ticket

The Thinker by Rodin

Another birthday rolled in today. Curiously, what also came in my mailbox on my birthday was my new drivers license. Before I shredded my old license I looked at its picture, taken ten years earlier. Comparing the two photos was rather shocking. I was ten years older and I looked ten years older. Maybe I looked older.

Drivers’ license pictures have this knack for making you look old and/or ugly. The DMV gloriously succeeded with me, making me scrunch down to get into the camera’s frame. The new photo is in black and white, which by itself is guaranteed to make you look older. It also gives prominence to my receding hairline, something I had not noticed before. I seem to be developing a sag under my chin. Perhaps its worst feature is the dark looking circles under my eyes, something I never see when I look in the mirror, but which a black and white picture adds. I look grandfather-like, sort of like Grandpa from The Munsters. The horror!

It’s a brave new world that I inhabit as I cross a boundary in time between my lower fifties and my upper fifties. In the novel Brave New World, it seemed everyone was on an antidepressant known as soma, which made life feel blissful. Thankfully, I am not on an antidepressant but slowly over the last ten years my medicine cabinet expanded with a host of prescription medications. In order to keep my aorta from getting too big I am on two heart medicines: Flecainide and Simvastin. (The men in my family have enlarged aortas, an effect of Marfans-like symptoms.) To control cholesterol, I am on a statin, specifically Simvastin. To reduce high triglycerides, I was put on a pricey drug that is encapsulated in fish oil called Lovaza. Then there is the nasal spray (Nasonex), which seems to help with the chronic stuffiness and nasal discharge. Plus there is one optional medicine: Terbafine, which is supposed to kill toenail fungi.

So I take six prescription medicines in all, plus a couple of supplemental ones if I need them, including a muscle relaxant for the sciatica. And speaking of supplements, I take a daily Vitamin D supplement because we middle aged people just don’t absorb much of it naturally, no matter how much time we spend in the sun. There is also a silver multivitamin, because I’m over fifty. There are also fiber capsules to make certain things move more predictably. I also take a baby aspirin to reduce the likelihood of blood clots as well as a daily Zyrtec, which I may give up.

Here is a list of the medicines I took at age twenty: nothing. I didn’t need any but that’s because my body mostly worked like clockwork back then and, of course, I had no health insurance. Now, it gets crankier and I feel creakier, resulting in really annoying conditions like sciatica and numerous trips to my chiropractor. All this plus you try to exercise as much as you can with a sedentary job and mind your doctors’ insistent urgings (only partially successfully) to refrain from all the foods you enjoy and eat all the stuff that vegans love but leave you taste deprived.

However, nothing says “old” better than using a BiPAP machine. A BiPAP machine is a close cousin to a CPAP machine, and is used by the millions of Americans like me with sleep apnea. After two sleep studies, the doctor of sleepology sort of knows what’s going on with me, and she is insistent that every night when I sleep I must wear an ungainly facemask and attach it to my BiPAP. What it does is make my breathing regular while sleeping. Thanks to the power of durable medical equipment it pushes air into my lungs while I sleep, preventing snoring and (hopefully) sleep apnea. If you have sleep apnea, you have lungs that like to sleep along with you. They can’t be bothered to provide all the oxygen you need and will even shut down, until your unconscious brain realizes something is wrong, shoots some adrenaline into your blood and you abruptly start breathing again.  This should wakes you up, although most of the time you are too sleepy to notice. Instead you usually arise in the morning feeling tired and tend to want to nap during the afternoon.

If I had been prescribed a CPAP machine, a steady stream of air would go down my windpipe all night, but that’s not the best fit for an old coot like me. Instead, I get the BiPAP machine, which works with my natural breathing. It knows when I am inhaling and pushes extra air into my lungs in a scientifically controlled and measured manner. To accomplish this I wear a large tightly sealed mask over my face and nose all night. The air is delivered through a sealed plastic hose attached to the BiPAP machine. The mask does not seal perfectly because a couple of years back I broke my nose, making wearing the mask somewhat uncomfortable and with some loss of pressure due to mask leaks. But hopefully while I am tethered to this machine the sleep apnea is gone but at least so far my sleep is not comfortable. I hope that I will get used to it in time. It seems I have no choice. Yet, something must be working, as I run to the bathroom in the middle of the night much less than I used to. I have yet to wake up feeling refreshed like a baby after a night on my BiPAP machine, something I hear happens, but perhaps that is coming.

In any event, all these medicines, minor ailments and durable medical equipment simply reinforce the obvious fact revealed in my drivers license: that I am aging, I know it, people who know me know it, and that the black and white camera at the DMV has documented it in its database and on my license. A much different future than my youth awaits. I’d best settle in for the ride. It sure won’t be an E ticket.

A study in sleep

The Thinker by Rodin

Over the years, I’ve slept in some strange places. A year or so back, I spent an uncomfortable night in a sleeping bag behind a partition in a church sanctuary. Last Friday night found me trying and mostly failing to fall asleep in a comfortable bed in a bedroom wedged inside a modern office building.

It can be tough to fall asleep when you are wired head to foot with sensors (including sensors on your eyelids), there is a belt around your chest and waist and air pressure sniffers are slipped inside your nostrils. How are you supposed to turn over comfortably in bed when all those wires are tethered to a device on the side of the bed? How are you supposed to even sleep with a video camera always watching you?

It’s unnatural, but maybe it will improve my health. All I knew is that my sleep for the last few decades has felt very restless. The problem was one I assumed was familiar to most middle-aged men: the need to pee in the middle of the night. My bladder wakes me up more times a night than our daughter ever did when she was an infant. There wasn’t much I could do about that so I learned coping mechanisms. It typically took me an hour or more to fall asleep. If I woke around four or five in the morning, I could likely count on the rest of my sleep being restless as well.

In fact, I felt like I hardly slept at all except on weekends. I’d hear my wife doze off fifteen minutes or so after the lights went out while I just lay there in the dark hoping for an elusive knock out sort of sleep. Not true, my wife told me. I was often snoring shortly after going to bed. That’s impossible, I told her, because I hear you snoring and I am not asleep. No, you are snoring, she said, and moreover you need to get checked. Sometimes at night you stop breathing altogether, then resume breathing with a start.

That’s how I ended up at the Comprehensive Sleep Care Center in Chantilly, Virginia last Friday night. I needed to be wired up and monitored while I slept, or didn’t sleep, so a doctor of sleep medicine could determine what if anything was going on with me. The likely cause is a rather common condition, particularly among the middle aged, called sleep apnea. Sleep apnea is a potentially dangerous form of interrupted sleep characterized by abnormal breathing while sleeping. I have many of the classic symptoms including what I assumed was a natural condition of middle age: difficulty in staying awake in the afternoon, particularly in a conference rooms with bright overhead lights.

At any age you should be able to sleep well enough so you can get through the whole day without feeling sleepy. Granted, many Americans deliberately choose to deprive themselves of needed sleep. That was not my case. I usually spend eight hours a night in bed. I can only guess how much of that time is productive sleep. Lately, I guess it averages four to six hours a night.

In any event, I have a brother with sleep apnea, so with my wife’s prodding I reluctantly decided I should get tested, but punted until my annual physical. My primary care physician all too happily signed the referral form and within a couple weeks I found myself in a sleep lab mostly not sleeping. There is nothing natural about sleeping while tethered with dozens of wires. As unnatural as going to the bathroom in the middle of the night is, it’s even more unnatural when you have to summon help to do so, and carry your instrumentation with you.

I could not complain about the high platform bed, comfy mattress and pillows, but I could complain about my sleep study neighbors, one of who brought her mother with her. There was much nervous and frequently shrill laughing from the room next to me. I thought her mother would never leave and she would never shut up. The guy next to me was more polite. He dropped off right away and I soon heard his snores coming through the wall. Meanwhile, I lay there and tried desperately to sleep. Unsurprisingly, sleep seemed to elude me.

Sometime after midnight, feeling a bit desperate, I tried one of my recipes for insomnia. It doesn’t always work but it involves concentrating on a past memory and then concentrating on the random links my brain makes from it to other images. It must have worked for a few hours until around three a.m. when my ever-thoughtful bladder decided to wake me up. When I finally shuffled back to bed the trick would not work. Instead, my mind was counting the minutes until 5:30 a.m. when they woke you and sent you home.

After that interruption, I did not feel like I had slept at all, but the technician said I had, just not a deep sleep. He removed many sensors from my body, including some that snaked down my shirt and pants and attached to my legs. My scalp was covered in splotches of white sensor glue, glue the technician told me that would come out with a hot shower.

Shortly after 5:30 a.m. I was pulling out of my parking space and forcing extra vigilance on my drive home. The drive felt as surreal as the sleep study, with hardly a car on the road so early this Christmas Eve, but one perhaps insomniac runner dutifully running down the street. The cat greeted me on my arrival, but seemed puzzled as I headed to bed at 6 a.m. instead of coming out to greet him. I stumbled through a hot shower, and shortly thereafter crawled into my bed to the only real sleep I felt I got that night, which began right around dawn.

Tomorrow I get the verdict. It’s not hard to infer I have sleep apnea; the only question is to what degree and then what to do about it. Most likely I will be sleeping better soon, and won’t suffer the embarrassment of falling asleep during afternoon meetings. However, I will likely have to wear a CPAP (continuous positive airway pressure) device while I sleep, which itself means a machine will be needed to push air into my mouth all night. It sounds uncomfortable, but is probably better than the alternative of doing nothing. While relatively rare, complications from sleep apnea can be dangerous.