The Rambler Takes a Breather: Apnea Anxiety

So who would have thought I had sleep apnea?  That is a rhetorical question for anyone who has heard me sleeping or perhaps noticed that I might be overweight.  When you live alone it doesn’t seem like a big deal.  But I no longer live alone; I live with Sara and Kate. And while Sara had earplugs to combat the problem early on, once Katie arrived and we needed to listen for her at night, earplugs weren’t an option. So I slept in the other room so that she could hear the baby.  This was the impetus I needed, so I went to doctor, who agreed that I had all the likely signs of having apnea, so a sleep study was scheduled.  And I thought nothing of it.  Many people I know, including my Dad, my father-in-law, and several other friends, have done sleep studies and subsequently gotten sleep machines (CPAP: continuous positive airway pressure or BiPAP: bi-level positive airway pressure).  I am also good at sleeping.  Even on nights where the worries of the world keep sleep away, I’ve trained myself to focus my thought on some inane and innocuous scenario (like spending lotto money or designing my own house) that reigns in a runaway brain and usually lets me sleep.  So I was ready.  Bring on the sleep study and breathing machine and let me get some appropriate, apnea-free sleep.  Unfortunately, that is not what happened.

The study I was going to do was called a split sleep test.  The first half of the night I’d sleep as normal, the second half I’d be given an apparatus as needed.  The first thing that happens is that I get wired up.  I had expected this, with electrodes on my chest, head, face, throat, and legs.  My mother had suggested (as she often does when my hair gets longer) I get a haircut so that the probes on my head would be less bothersome.  Well, since I wasn’t going to shave my head, whether it was short thick hair or long thick hair, would still be a mess and a haircut wouldn’t help, so I went as my shaggy self.  So starting about 10PM on Saturday night I got wired up.  Probes everywhere, conductive wax sticking all over me.  The probes didn’t faze me too much.  Just a bunch of wires picking up electrical signals.  They were slightly uncomfortable and cumbersome but nothing that really was going to upset my sleep.  And so it went, the first part of the night I fell to sleep without too much trouble.  First part done, no problems (except the apnea, which of course was the whole reason for being there in the first place).

Enter phase two: sleeping with a breathing mask.  There were three different kinds suggested, nose plugs, nose only mask, and nose/mouth mask.  I am a mouth breather.  Especially at night while I’m sleeping I tend to breathe though my mouth.  However, the nasal masks need you to breathe through the nose.  Given that they are less obtrusive, I tried the nose only model first.  What followed was what I can best describe as the worst night of sleep in my life that didn’t involve a life or death situation.

Getting the masked strapped on wasn’t too bad.  It didn’t hurt or pinch, it fit pretty well over my nose with no leaks.  So after the tech had it all set up, I set about getting catching some Zs, which would ultimately prove very elusive.  Let me describe how it felt for me to breathe under the continuous positive airway pressure.  Take a wet rag and put it over your nose, then get an air hose a turn it on full blast through the rag up your nose during every inhalation, and take it away so it’s only rag during the exhalation phase.  That is how it felt to me.  The only way I felt I could breathe was to take deep breaths with hard exhales, like those deep breathing exercises.  So I was lying in bed, fully wired up, masked, and in the dark with many blinking LEDs.  For someone who has had some serious surgeries in their life, this was a bit of a nightmare scenario.  But I just shut my eyes and focused on the breathing, hoping that the rhythm of breaths would rock me to sleep.   It did not.  What happened was, that every time my thoughts drifted from directing my breathing, trying to fall asleep, I would dream for a moment, then consciously remember something was wrong with my breathing and start awake in a panic, only to find myself in a strange dark room with blinking lights, attached to a bunch of apparati.  Conscious understanding that the situation was safe and monitored battled deep seeded unconscious fear and anxiety.  Coupling this with the physical impact of the breathing, a “restful” sleep did not arrive but rather a roller coaster battle between physically forcing myself to relax falling briefly asleep and awaking in an anxiety fueled panic.  To add to this I was trying to only breathe through my nose so that the machine would work as intended. If I tried to breathe through my mouth I would get into this loop where the CPAP would force air through my nose and out my mouth like I was continually blowing out great big breaths.  After a couple of hours (maybe? I didn’t have a clock) I gave up and pulled off the mask.  It was too much.  At that point the technician calls in to make sure things are OK, which they are not, but I say yes, I just need an adjustment.  He suggest maybe the full mask (nose and mouth) would be easier.  Thinking nothing could be worse than what I just did, said sure lets go with that.   I thought that with that mask, at least I can breathe in through the nose and out through the mouth.  Nope, that didn’t work at all.  It was like just moving the rag to cover both mouth and nose.  I couldn’t breathe through my nose at all, and exhaling still felt like an effort.  This of course let to what I will call a relaxation-anxiety loop.  I lay in the dark trying to relax, following my breath, in and out, but it still felt labored so that even though I was getting plenty of air I still felt like I needed pull the mask off to breathe.  (Right now I guessing this would have thwarted my young teenage dreams of becoming a fighter pilot – if my height, weight, non-super human hand-eye coordination, and brain surgeries hadn’t already).  So after a much shorter stint with this mask, I had to pull it off and take some deep breaths.  The tech came in again and I took a bit of a break from trying to sleep.  I got up and moved around, turned on the light. I looked at myself in the mirror trying to give me a little pep talk.  I looked like a wired up mess in a fright wig (my hair was going every direction including up).  I got past that, and was ready to try again.  I know I need some sort of sleeping apparatus, to cut down on the snoring and help me be healthier, so I gave it another try despite my anxiety fueled misgivings.  The tech came back in and we decided to give the nasal mask another try.  The tech, who was a very nice and very talkative guy, made what I’m sure he thought were some helpful comments.  I am paraphrasing here:  “man, you have some of the worst obstructive apnea I’ve ever seen”, “you had more scorible events than I’ve ever encountered”, “you are really going to need this or you are going to start seeing health problems”, “man, your oxygen saturation was down into the 80s, you need this mask”, “How are you still a functional human being”, “how are you still alive”.  OK, those last two were hyperbole but for someone having some anxiety issues those were just the kind of words you need to hear before you strap for another session.  But I pushed on. wired up

Unfortunately, that last session didn’t last the night or lead to any type of good sleeping.  The relaxiety rollercoaster continued, but this time with the added bonus of the continuous conscious reminder that I “NEEDED” this to work so I could be healthy and live a longer life.  After some time just staring at the blinking lights on the ceiling and trying to breathe “normally” I gave up.  I was ready to just yank all the wires and run out.  I resisted the urge, but I did pull off the mask, and wait for the tech to return.  He came in and said that they needed six hours of recording time so that if I could just sleep without the mask till 5AM they could call it a good study.  I said sure, and lay down amongst the wires.  By this time adrenaline had kicked in and that made sleeping even without the mask tenuous.  I lay there letting the time pass till I could get unwired.  Pulling the probes and wax off my skin and hair was unpleasant, but I hardly noticed.  The tech gave me some more “useful” information from my evidently abominable normal sleep patterns, ask again how I scored so low on their questionnaire but had such terrible sleep apnea, had me fill out some paperwork.  He also said that likely I would have to do another study, this one with sedation (AKA drugs) and sent me on my way.  Fully rattled, adrenalized, and aggravated I hit the road.

I left and was home just before 6AM.  I checked in the Sara and checked on Katie and found my way into the shower.  The hot water and shampoo got rid of the excess probe wax, but did little to calm my fractured nerves.  It took me the rest of the morning to recover.  I got some actual sleep, I held and played with Katie and I talked with Sara, all of which did more to make things better than anything that had happened the previous night.

In the cold light of day I realize a breathing apparatus will help me live a longer and healthier life.  I also realize that it will require some adjustment period and that just strapping in on and expecting it work did not, and will not, happen.  I also know for sure that I will never take sedatives or sleeping mediation of any type.  I’m sure they work wonders for other folks, but they will not be for me.  I’m not anti-pharmaceuticals (they keep me working as an aquatic toxicologist, having several of my research manuscripts focused on drugs in the environment).  It is that for my own person I am anti-neuroactive drugs.  I have fought long and hard for my cognitive function. Through schools and surgeries I have won each and every synapse.  And because of that I want to feel each firing, good or bad, as that is the only way I know that they are working properly.  So with that it looks like it will be old fashion practice that helps me drive down the anxiety associated with the sleep mask.  As things progress I’ll let you know.

Just as a final aside.  I didn’t write this so that anyone would feel bad for me or offer me suggestions.  I wrote it as personal catharsis, and published it as resolution.  Getting things out of my head and into written form helps me.  The act of writing it as story provides both clarity and catharsis.  Publishing it, or making it public sets it free.  These thoughts and feelings that should be fleeting and meaningless for me, keep internally can snowball, gaining weight and momentum in my thought processes.  Saturday night was a bad night of sleep, that is all. By putting on paper I put it in perspective.  In perspective, doesn’t even register on the worst-night-o-meter.  I was never in actual danger, my health wasn’t threatened by this procedure.  Writing it, and publishing it on my blog, helps me realized the supercilious nature of all that angst and fretting.

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