“You need to get out,” she said. I could tell she was serious.
I always had a bit of a snoring problem, but in the five years we had been married, my wife had come to a breaking point. It was just too much. Not only was I snoring loudly enough to keep her awake, (she’s convinced the volume could have attracted extra-terrestrial intelligence), but I was – apparently – periodically gasping for air. Loudly. Desperately.
That isn’t normal.
She lovingly kicked me out. Our son was only two months old, so having a gasping creature in the bed alongside a regularly waking infant doesn’t help. I was banished to my office, where the trundle bed slowly dug its crooked and jagged supports into my back. Truthfully, as I lay there alone, I knew there was a problem. A pretty serious one.
I had been falling asleep at work. During an important meeting with several key leaders, I drifted off for what only seemed like a second or two. How long had I been asleep? Did anyone notice? Oh god, did I snore during a meeting? I’ve always been one of those “tired” people. But I chalked it up to lifestyle. Hey, I work 50 hour weeks. I do a lot of extra stuff outside work. I have a baby!
But this was different. I couldn’t make it to 2pm without having to actively fight off sleep. I was making small, stupid mistakes that could have been avoided. Mistakes that surprised me. So I lay there, in the trundle bed, in the dark, my feet hanging over the edge. And I decided to get something done.
Sleep Apnea Is A Big Deal
It’s a really big f**king deal.
This isn’t just about getting enough sleep. Or waking up a frustrated wife. Sleep apnea, when left untreated, is life threatening. High blood pressure, heart irregularities, headaches and memory problems are the lightest of the consequences. Higher risk of heart attacks and strokes come after that. It gets worse.
Recent research suggests untreated sleep apnea in elderly people is associated with accelerated cognitive decline by a factor of 10 years. “Among older people who developed mild cognitive impairment or Alzheimer’s disease, those with untreated obstructed sleep breathing began to experience mental loss at an average age of 77, compared to age 90 for those without breathing problems.”
Then there are the simple risks of just being tired all the time. There’s a reason people are told not to operate heavy equipment or drive while tired – 20% of deadly road accidents involve fatigue. Sleep deprivation is used to torture people. The worst part? One in four men over the age of 30 have some degree of sleep apnea.
I didn’t know that before I went to get diagnosed. I wish I had. Maybe I would have gone sooner.
Sleep Apnea Is A Big F**king Deal
My father was diagnosed with sleep apnea during his 40s. He was a hard worker – still is – and usually blamed that for his tiredness. He’s the type of guy who, when he does something, loves to do it right the first time. He’s thorough. So of course, he’s going to be tired. Growing up I began to associate tiredness with accomplishment. If you’re tired at the end of the day, you know you’ve done something right.
But it gradually became apparent normal people don’t fall asleep so much during the middle of the day. Normal people don’t fall asleep during church -- well, maybe scratch that last one. I told this to the young sleep specialist across from me as he considered my condition. Sleep apnea can be hereditary, he said. Combined with the noises my wife was wearing and my own personal experiences of tiredness, it was likely I had sleep apnea.
Getting diagnosed is a process with many steps. First up is a test used to diagnose how many “events” I experience during the night. (How many times I stop breathing). There are multiple ways this can happen, but ultimately the back of your throat – the soft palate – is blocking your airway. Your body is literally stopping you from breathing – until the brain kicks in before you die. Hence the gasping. The real danger is that sleep apnea stops your natural sleep cycle.
There are four stages of sleep. The ultimate goal is to experience a flow through the stages, concluding in REM sleep – that’s when you dream - before cycling back again. Each cycle has you experience progressively longer amounts of REM sleep – that’s when you dream. Babies spend 50% of their sleep in REM, compared to only 20% for adults. I wasn’t really thinking about this as I was getting wired up for my home sleep test. It’s a complicated test.
The doctor swaps you with a special glue and attaches pads to your skin for various wires – on your head, your chest, stomach and thighs. A piece of wire with an attachment fit under my nose. It was a little awkward.
All the wires connect to a box which transmits the data to a computer at the clinic. I was explicitly told to make sure everything stays on. If anything came off during the night, I would have to get wired up and do the test again. As I left the clinic, I looked like some sort of awkward robotic experiment gone wrong.
I drove through McDonald’s just to freak people out on the way home. My wife laughed at me. I looked ridiculous. Then I went to sleep. On that little trundle bed in my office. Alone.
"We Need To Get You Started On Treatment Straight Away"
As I walked into the doctor’s office, I could tell something was a little off. He was nice enough, but curt. Not rude. Serious.
I sat down. He went through the spiel – reviewing what the process was, how they measured how many times I actually stopped breathing during every hour. Up to about five events would be considered normal. Between five and 15 is mild. Moderate is anywhere from 15 to 30. You definitely need to address the issue in this range. Severe is anything above 30. I knew my father’s diagnosis was severe, and his was around 70 events per hour.
“So, what did I get?” I asked the doctor. I think I was grinning like an idiot. Like this was some sort of game. He took a pause.
114. I stopped breathing 114 times every hour. That’s nearly twice a minute.
He showed me the chart. Not only did I not even dip into REM sleep, I wasn’t even reaching stage four. My body was not regenerating as it should have been. I could tell in his eyes – still and narrowed – that he had no time for hyperbole. “I legitimately do not know how you are awake right now.”
He went on to say that not only was I at risk of a heart attack or a stroke, if left untreated, this severe sleep apnea would make either or both events likely by the time I reach 40. I immediately thought of my son. “We need to get you started on treatment right away.”
A Few Different Ways To Treat Sleep Apnea
Contrary to what you might think, being overweight exacerbates sleep apnea, but losing weight won’t stop it. I wasn’t exactly obese, but I was overweight. I could lose some, the doctor said, but ultimately, it won’t stop anything. You can elect for surgery to remove your tonsils. This is the worst option said. It’s expensive, invasive, and there’s no guarantee it could actually work.
No thanks. The third method is the most popular. And, I was surprised to learn, it’s 100% effective. CPAP. Continuous Positive Airway Pressure.
CPAP therapy involves wearing a mask, connected to an electronic pump, every night when you go to sleep. For the rest of your life. The air basically pushes your throat open and forces air down your neck Not only should I do that, the doctor said. But I should go to the CPAP retailer and buy a machine in the next few days. Preferably that day. And start using it.
Oh, and by the way, he said. My sleep apnea was so severe that I couldn’t just use a nasal mask, which is what some CPAP machines have. I’d have to use a full face mask. I suddenly realised the impact of what this diagnosis meant. I would be reliant on a machine to not only sleep properly, but to regulate my health. Forever.
Imagine what you do before you go to sleep. You snuggle up in the covers, get comfortable, and drift off. Not me. I have to slip my mask on. Make sure the hose is connected properly. And then sleep on my side or back. Never my stomach – the mask doesn’t work that way. Whenever I travel, I have to keep my CPAP machine with me. Forever.
The Science Is More Robust Than It Used To Be
Even 10 years ago, CPAP machines were fairly basic. You’d just have them set to the pressure you need to sleep properly, (I had to take a second sleep test in order to figure this out), slip on the mask, and away you go. The connected device boom has changed that. Now, CPAP machines are digital, robust and able to track more information than ever.
A lot of the old machines couldn’t retain data on whether they were actually working or not. You could use them, sure, but there was no way to track their effectiveness. Was the right pressure actually working in reducing the number of apnea events per hour? Was there air leaking somewhere? You just don’t know.
I use the Resmed Elite 10, which tracks statistics like how many apnea events occur per hour, whether my mask is leaking, whether the seal of the mask is actually tight, and how many hours it was used. The device contains a mobile connection which uploads all of this data to a server, which is then provided to me through an online “MyAir” account.
Every day, I get a report showing all of these statistics, tallied into a score out of 100. The higher the score, the better quality of sleep. My doctor can access these statistics at any time. I got an email last week telling me that my air leakage was a little high – I should probably check to make sure nothing broke.
As far as perpetual treatment goes, this is pretty easy. The only hard part is the mask itself. The doctor told me some people don’t like using the mask, so they take it off. They don’t use it. Don’t do that, he said. Your life is at risk – you’re lucky you caught it at 27 years old. This isn’t a complicated issue. CPAP therapy is 100% effective.
Just use the mask, he said. You’ll be fine.
I Don't Exactly Remember What I Felt The First Night
But I remember how I felt the next morning. There are moments in life when you suddenly discover a new horizon. Things you never thought were possible. Like those videos on YouTube where you see people switch on a hearing aid for the first time and listen to music. Or people who have corrective eye surgery and can finally see the face of a loved one. It’s literally a new world.
Before CPAP, I didn’t know what it was like to be awake. But the first day after using the machine, I was a new man. I had never felt more invigorated. My eyes weren’t hanging, begging me to close them. I had the mental capacity to have longer conversations. I’m an early bird. I love getting up at 6am. The first day I woke and felt like I could run a marathon. And I’m not exactly fit. I worked a 10 hour day and felt like I could go for a long run. My productivity improved. I could work long meetings without feeling the need to nod off.
Is this what normal people feel like? I was awake. I was alive.
A Lot Of People Complain About Being Tired
I meet a lot of people who often complain about snoring, or being tired. Sometimes I recommend they see a sleep specialist or take a test. Maybe they could benefit from CPAP therapy. “Nah, I don’t want to wear a mask,” they might say. “Yeah, maybe I should.” “Can’t be bothered.” Snoring is a part of life. We deal with it. We’re adults. We’re tired because we’re busy and god damn it, we’re important.
But you’re not just dealing with your lack of sleep, here. You’re dealing with your life. Your heart can only sustain so much strain for so long. By the time you hit 40 years old, that snoring could be putting you at risk of a heart attack. Like any type of activity required to improve your life, you need a little bit of short-term effort for long-term gain. It’s an effort to remember to use CPAP every night. To take it with me while travelling. And I still get tired. We all get tired. But when I’m tired, I know that it’s not my body’s way of crying for help – my heart isn’t straining to pump blood through my lungs.
I feel alive. More than I’ve ever felt.
When my son wakes up in, my wife usually brings him into bed with us. Especially if it’s too early for her to get up just yet – she loves her sleep. Shortly after I began CPAP therapy, I woke one morning to find my son moving the hose connected to my mask around like a joystick. He was laughing to himself. I took my mask off and lifted him in the air. He giggled uncontrollably. We went to the living room to play.
My eyes were open.
I was awake to enjoy it.