Better sleep for better health
My dad snored. So it came as no surprise to me when I found out I was a snorer. It was easy enough to dismiss this with a laugh. I didn’t recognize the possibility that my snoring might be indicative of a problem. I simply considered it to be part of who I was.
Like so many of us, I became less active and started to gain weight. I also noticed that I was tired all the time. It didn’t seem to matter how much I slept. Upon awakening, I was always ready to go back for a few more Zs.
Life goes on, and I didn’t give it a lot more thought. In 1998 when I was 39, I mentioned to my doctor that I felt tired all the time. He ran some tests (thyroid, etc.), but the results were normal. He suggested I go in for a sleep study.
After some weeks, I finally scheduled the study. This particular study simply involved monitoring me while I slept through the night. The doctor told me I definitely showed signs of sleep apnea.
I then went in for a second study, this time being monitored while I wore a CPAP (continuous positive airway pressure) device. I didn’t feel any better rested when I woke up, and the doctor later told me that I might have “restless leg” syndrome. Because I didn’t feel any better with the CPAP, I was skeptical, and didn’t pursue it any further.
Finding a Sleep Specialist
Fast forward four years. I moved to San Diego from Chicago in October 2002. Since I just started a new job with new health insurance, I had to pick a primary care physician. I knew of Scripps by its reputation and found a doctor at Scripps Clinic.
At the first visit with my new doctor, I mentioned my fatigue. He suspected sleep apnea and referred me to Lawrence Kline, MD, at the Scripps Clinic Sleep Center. I was able to make an appointment to see him the next week.
Dr. Kline took my blood pressure and pulse, weighed me, measured the circumference of my neck, looked down my throat, listened to my lungs with a stethoscope, and then discussed my symptoms with me.
As I recounted them, I realized that the quality of my life was dramatically affected. The most obvious problem was the constant fatigue. This had all sorts of manifestations, from falling asleep at my desk (I’m a computer programmer) to falling asleep at meetings (Vince, are we boring you?). Scariest of all— I would nod off while driving.
I regularly visited friends in Los Angeles on the weekends, returning to San Diego on Sunday night. Before I returned, I typically loaded up on caffeinated beverages to ensure I’d stay awake for the drive. This wasn’t always enough, though.
On more than one occasion, I dozed off at the wheel and awoke to find myself drifting into another lane or off the road. If that’s every happened to you, you know how frightening that can be. I read later that sleep apnea can greatly increase the likelihood of automobile accidents.
I was also experiencing a host of other symptoms which, though less dangerous, were still annoying. I was waking up several times a night to go to the bathroom, but I attributed this to the aging process and just dealt with it. I also kept a bottle of antacid tablets by my bed because I would often awake with heartburn. And more often than not, I would wake up with a headache. I also found myself shifting my day— I would sleep longer, get up later, then go to bed later, and so on. I got to the point of starting my day at 2 p.m.
Dr. Kline didn’t seem the least bit surprised. In fact, he mentioned a couple of other symptoms such as a sore throat. He then wanted to test me for sleep apnea.
Testing for sleep apnea
The first step was to wear a pulse oximeter while sleeping. This is a neat little gadget that can determine the percentage of oxygen saturation in your bloodstream noninvasively. It clips gently to a finger, and then a lead runs to the base unit, which is about the size of a large cell phone. It displays both your oxygen saturation and pulse rate.
The great thing about this test is that you do it at home. You turn it on when you go to bed and turn it off when you wake up. That’s all there is to it. When you bring it back to the office, they upload the data to their computer and print out a time-based chart of your sleep. The chart will show if you had any “events,” which indicate that your breathing was either partially or substantially obstructed.
On my first pulse oximetry, I had about 700 events in eight hours of sleeping. If you do the math, you’ll see that that’s about one every 40 seconds. In essence, this meant that I was waking up every 40 seconds. Gosh, I can’t imagine why I felt tired in the morning!
The mechanism for obstructive sleep apnea (that’s the most common kind, meaning there’s a mechanical obstruction to breathing during sleep) is pretty simple. While sleeping, the muscles in the throat relax, causing the airway to collapse (think of a balloon with just enough air in it to give it form; that’s a normal airway). The brain senses that it’s not getting enough oxygen, and it commands the body to wake up and take a breath. That’s the night of someone with sleep apnea.
One of the oddest things is that you have no memory of this. If you’d asked me how many times I wake up during the night, I might say three or four. It’s sort of subtle, because you go right back to sleep. Your partner might hear you gasp as you take in that needed breath. In fact, that’s one of the most common symptoms of sleep apnea.
The sleep study
So it’s now clear that I have sleep apnea. Dr. Kline then scheduled me for a sleep study at the Scripps Clinic sleep lab. I had a “split study,” which means the night is split into two parts.
The first part consists of monitoring only. The technician will fit you with a bunch of sensors so they can see what’s going on in your brain and body while you sleep. It doesn’t hurt at all, but you do feel a little like Frankenstein’s monster. Halfway through the night, the technician gently awakes you (hey, I’m used to waking up during the night), and you’re outfitted with a CPAP mask. Masks come in various forms. Some just cover the nose, some the nose and mouth, and some (like mine) are nasal cannulae. Then you go back to sleep.
The technician can now monitor your sleep and see how you’re responding to the treatment. The main variable is the pressure. If the pressure is too low, the CPAP will be ineffective. If it’s too high, you can end up feeling bloated from swallowing air. When the technician is satisfied that the correct pressure has been achieved, you’ll probably be monitored for a while longer, then awakened. You’ll fill out a short survey about your sleep (you also filled one out before you went to bed) and go on your way.
Sleeping with CPAP
A week or so later, I went back to the clinic to get my very own CPAP. The technology has advanced rapidly in the last few years, so that modern devices are smaller, quieter, and more comfortable than ever. The device itself is typically about the size of a couple of small loaves of bread, side by side. Attached to it is a hose, usually 6 feet long, to the end of which is attached the mask. Once you’ve attached the mask, you turn it on (some turn on automatically) and it begins to pump air. The magic of CPAP is that it pumps air only when you need it.
Unless you are a very rare bird, the first few nights with the CPAP will be a challenge. You might feel claustrophobic, or constricted, or just plain weird. These are all normal reactions. It’s hard to believe at this point, but you’ll get to where it’ll become second nature.
Everyone is different and we all have our own levels of tolerance and adaptation. The only advice I can offer is, “Stick with it!” There are a lot of resources on the Internet that describe people’s experiences with CPAP, and sometimes it helps just to know that other people have gone through what you’re going through.
by Vince Star