(Originally posted to Toast­mas­ters at EraBlog on Thu, 24 Apr 2003 06:08:36 GMT)

I gave the following speech to Toast­mas­ters on March 5th, 2003, as Speech #3, "Organize Your Speech".

SLEEP APNEA

My wife is a cyborg.

That’s not to say that she’s the Terminator. Nor even that she’s the six-million dollar woman, although I do value her greatly. She calls herself a cyborg because she sleeps with a breathing machine. At night, she wears a mask over her nose to force air into her lungs.

When I first met her, she complained of being tired all the time, of not getting a good night’s sleep, of feeling stupid. When she drove for any length of time, she’d have to pull over for a short nap every hour. It was that or fall asleep at the wheel.

Once we started spending the night together, I quickly learned that she snores. Loudly. But it was a different kind of snoring than I was used to. In my experience, most people snore steadily, in a seesaw pattern like this: <snore in> <whistle out> <pause> <snore in> <whistle out>

Not so Emma. She would be very quiet for a minute or so, hardly breathing at all. Then she’d breathe in very loudly, almost gasping for air: <SNNNNORKKK!!> She’d go quiet for a minute or so, then snore loudly again. And so the cycle would repeat. All night long.

Naturally, I didn’t enjoy this much. Sometimes, it would keep me awake for hours, and I’d have to move to the spare room just to get some sleep.

After one such episode, when I snarled "I can’t take this anymore!" at her, she decided to see her doctor about it.

Emma’s doctor thought that her symptoms sounded like sleep apnea, even though she didn’t fit the stereotype of being an overweight, middle-aged man.

Apnea is Greek for "without breath". Sleep apnea is a breathing disorder, where the sufferer repeatedly stops breathing during sleep. After a minute or two without breathing, which leads to a reduction in blood-oxygen saturation, the brain forces the upper airway muscles to open the airway. Breathing resumes, usually with a loud snoring sound or gasp. These frequent arousals means that the sufferer doesn’t get much deep, restora­tive sleep: the REM sleep that you need to be well-rested.

The effects of this lack of deep sleep build up over time. The sufferers often feel very sleepy during the day. Their con­cen­tra­tion suffers. They lack energy. They become irritable and they have difficulty learning things. They may fall asleep while driving and they are sig­nif­i­cant­ly more likely to have accidents. Oc­ca­sion­al­ly, they may even die in their sleep.

Sleep apnea occurs in all age groups and both sexes. It’s estimated that four percent of middle-aged men have sleep apnea, and two percent of middle-aged women, with perhaps twelve to eighteen million Americans suffering from it. Most cases go un­di­ag­nosed.

The primary kind of sleep apnea is due to an ob­struc­tion in breathing. This can be due to a physical ab­nor­mal­i­ty in the nose, throat, or upper airway. Many, but not all, sufferers are overweight and have an excess of soft flesh in the airway. When they sleep, the muscles in the soft palate, at the back of the roof of the mouth, relax, closing the airway. This can make breathing difficult, or it can stop it altogether.

One analogy is that it’s like putting your hand over the nozzle of a vacuum cleaner. Your hand blocks all air getting in, like the upper airway collapses, even though the vacuum cleaner is still applying suction, just as the body continues to try to breathe. The vacuum cleaner is straining and so is the human body.

Under managed care, Emma’s doctor couldn’t send her for a sleep study directly. Instead, she was referred to an ear-, nose-, and throat-specialist. He also joked that she didn’t fit the stereotype of being fat, fifty, and male. He looked at her small mouth and nose and her undershot jaw, and he agreed that it probably was sleep apnea. He referred her to a sleep specialist. The sleep specialist also trotted out the line about her not fitting the stereotype, but he did schedule her for a sleep study.

She spent a night at the sleep clinic in Swedish Hospital in Ballard. They attached electrodes all over her head and torso, as well as other in­stru­ments that made her look like the Bride of Franken­stein. The in­stru­ments were hooked up to a plotter that graphed all kinds of body functions con­tin­u­ous­ly. When I came back in the morning to collect her, the plotter had produced a pile of fanfold paper that was a foot thick.

When Emma went back to the sleep specialist for her follow ap­point­ment, he told her that she had stopped breathing about twenty-six times an hour. It was no wonder that she had such difficulty in getting a good night’s rest.

He told her that she could either have surgery or learn to sleep with the help of a breathing machine. The surgery would have involved removing excess tissue at the back of the throat and moving her jaw further forward. Emma was not keen on that, especially as the success rate of surgery is only about fifty to sixty percent.

She opted for a CPAP sleep machine instead. She straps a nose-mask around her head. This nose-mask is connected by a hose to a continuous positive air-pressure machine. This forces air through her nose and into her lungs.

She had to have a second sleep study to calibrate her CPAP machine for her breathing. It starts out at a low pressure and ramps up to the right pressure over a twenty-minute interval.

It took her a few weeks to get accustomed to the CPAP machine. It’s not a very natural feeling to have air forced into your nose con­tin­u­ous­ly. She now sleeps far better with it than she did before. Sometimes, she doesn’t bother to put on her mask before taking a nap, and she usually regrets it, because she wakes up feeling less rested.

It took me a while to get used to the CPAP machine too, because it makes white noise all night long, as it’s huffing away. It’s a little like sleeping beside Darth Vader, and it’s not very romantic, but it certainly beats her snoring.

When we travel, we bring the CPAP machine in an overnight case, along with an extension cord and a selection of adapters for foreign electrical outlets. The CPAP machine means that we can’t go camping for more than a night or so, or Emma doesn’t get enough rest.

In retrospect, Emma probably had sleep apnea for many years before it was diagnosed.

Now, not everyone who snores has sleep apnea. Only if they also have difficulty in breathing and chron­i­cal­ly can’t get a good night’s rest, are they likely to have sleep apnea. Most un­di­ag­nosed sleep apnea sufferers are unaware that they repeatedly stop breathing because they don’t wake up far enough to realize it.

If you know someone who may have the symptoms of sleep apnea, please, urge them to see their doctor. You could save their life.