Sleep Apnea

Obstructive sleep apnea is caused by loose tissue (turbinates, tonsils, uvula, soft palate, etc.) blocking the airway. The problem appears during sleep because that’s when everything relaxes, and it gets worse with age because that’s when everything relaxes more. There are five treatments: tracheostomy, surgery, dental devices, weight loss (if the patient is fat), and a breathing machine called the CPAP. Trachestomies are for when nothing else works. Surgery and dental devices aren’t terribly effective, and surgery also has some curious side effects like making the patient talk like a duck and drop food from his nose. With another surgical method, the patient’s jaw is broken and pulled forward throwing his teeth out of alignment. I’ve already had two sleep-related surgeries. One was for a deviated septum, the other for the same thing plus chiseling bone from my sinuses and tissue from my turbinates. Without the second surgery, I couldn’t have gone as long as I have without a CPAP.

The CPAP (continuous positive airway pressure) does pretty much what it sounds like it does: it pumps air down one’s throat continuously so the airway remains open. How much air varies. Most machines pump a steady amount, but I have a “smart-PAP” that adjusts from a low of ten (cm H2O) to a high of sixteen. Sixteen is one shit-load of air.

The patient wears either a mask or a fat cannula. The first mask I tried created a pressure sore on my nose, and the next three leaked, so I’m using a cannula. The problem with both masks and cannulas—even when they fit—is that they occasionally allow air to escape, especially when the patient turns over. This requires a certain delicacy of movement and considerable adjustment and readjustment throughout the night. Otherwise, the wind that is supposed to go down my throat is blowing loudly across my face or into my eyes, creating the risk of an eye infection.

I try to think of my CPAP affectionately, but that is like thinking of a wheelchair affectionately. On the one hand, I am glad I have it, but on the other, it is noisy, bulky, ugly, bothersome, expensive, requires daily cleaning, and makes it impossible for me to wander from an electrical outlet. This last part is the worst of all because I don’t trust technology to always be there, and because I have a powerful need to escape it occasionally.

I often lie in bed listening to my CPAP, and trying to understand why it behaves as it does. Last night, just as I was getting to sleep, the pressure started going up and down at regular intervals, as if the machine was a large beast breathing on its own. The trouble was that its breath didn’t match mine. It would force me to inhale for too long, but not allow me enough time to exhale, so I felt like I was suffocating. I tried to breath normally in the hope of forcing it to breath with me, but this required that I work really hard, and I soon lost sense of what a normal breath felt like.

I didn’t know what else to do, so I took the same ineffective steps over and over, things like rerouting the six-foot hose, readjusting the cannula, resetting the switch, and even repositioning the machine. I also wondered if I was imagining the problem. After all, it takes some people weeks to work up to using a CPAP for one whole night, yet I’ve used mine all night every night, so maybe the strain was getting to me. I thought and thought about it—which wasn’t easy while struggling to breathe. After awhile, either the machine or I settled down, and the rest of the night passed peacefully.

The main difference I notice with the CPAP is that I dream A LOT. This was even evident in the sleep lab. Without the machine, I dreamed little (and those dreams were often about suffocating). With the machine, I have one colorful and richly detailed dream after another. Maybe I had built up a dream deficit. My theory is that apneas would end whatever dream I was having, and it would take me awhile to settle back into REM sleep, only to be hit by more apneas as soon as I did.

I’ve also noticed that I don’t wake up headachy and exhausted. Instead, I wake up with my nose raw and achy due to the cannula pushing upward against my nostrils. I also wake up with a devilishly itchy throat if I don’t sleep with a harness that keeps my mouth closed. Since I also use a toothguard to prevent me from grinding my teeth to powder, getting ready for bed is tedious, although it’s not the work I mind, but the thought that I will have to do it for the rest of my life.

My father preferred death to pills because—along with his belief that the pharmaceutical industry was ripping him off—he felt that a life that had to be permanently preserved out of a pill bottle was beneath his dignity. I understand his point, and a CPAP strikes me as worse than a whole boatload of pills, but dignity is subjective and death extreme. I don’t know how Dad felt about the indignity of snot, shit, and the bizarre appearance of human genitals, but he survived all of them. This leads me to suspect that—in his mind—the indignity of pills consisted of the dependency he felt upon the despised industry that provided them.

Food for life, he could, and usually did, grow for himself, but pills for life were from an alien source and made of alien materials. They made him feel powerless in a way that congestive heart failure did not, and by choosing death, he regained his power. It was his choice, and I respect it. Most of us never acknowledge that there comes a right time to die. We say we long for heaven, but we will spend any amount of money and put others to any amount of trouble just so our sorry carcasses can breathe for one more day. Like my father, I believe there comes a time when dignity demands that a person say “no more.” I am closer to being there than I was even five years ago, but I hope to tarry a while longer.