and what to do about it:
When I was in my early 20′s, in good shape and not in the least bit overweight, my partner asked me one day, “Did you know you stop breathing when you sleep?”
No, I didn’t.
“What do you mean? How can you tell,” I queried.
“You stop breathing, and then about 20 seconds later, you make this <insert very strained, dramatic returning-to-life gasping sound> sound.”
Odd, I thought. I knew I snored badly (“Have you considered suicide as an alternative to your snoring,” a very unrested Judy asked one morning,) but nobody had ever said anything about not breathing. Back in those days, nobody seemed to be saying much about sleep apnea, and I figured so long as I didn’t stop permanently, it really didn’t much matter. What could I do about it anyway?
As the years went by, lovers of any consequence became accustomed to the snoring and didn’t object, and the revelation was forgotten. Then I started nodding off very easily, pretty much anywhere and everywhere, at any time. I’d even sometimes find myself with closed lids at a long stoplight on warm days… but hadn’t run off the road or anything, so it’s okay, right? I mean, people do nod off while driving, that’s why they teach us to pull over and stop and take a nap if we feel tired… right?
Jump on ahead to my later 40′s. The love handles stopped coming off the following spring/summer back around 33, and I became more portly, even though I was active… and the snoring got worse. Now people WERE talking about sleep apnea, thanks to the Internet. And doctors were saying that it takes 10 years off of your life, increases your risk of heart attacks, etc. — and that’s IF you don’t fall asleep at the wheel, get into a wreck and kill yourself and half a dozen other people first. So I was taking it seriously. I checked into those CPAP machine thingies, but it seemed the AMA had a firm fist wrapped around them, even though it’s just a little bit of air being pushed into your mouth/throat to keep the airway open. Frankly, SCUBA diving (another activity of mine, NAUI, for those who know who they are,) is far more dangerous a machine like that. So why the fist-lock? Why the prescription necessary? To be honest, there is no GOOD reason why, except that they are the gatekeepers, and you must pay to enter.
Now for a bit of info: Sleep apnea (ceasing to breathe while sleeping) has two causes:
- One, the less common, is called Central, and refers to one’s central nervous system (CNS) not sending the right signals while one is sleeping, causing you to stop breathing, until such time as the blood oxygen level gets low enough that the body sends a much more urgent signal, “BREATHE, DAMN YOU!”
- The other, called Obstructive, refers to the airway becoming blocked as your throat relaxes while sleeping. Your tongue or other parts of your anatomy contribute to the blockage, which causes snoring as well. Not all who snore stop breathing, but all who have obstructive apnea snore. And from time to time, we get really loud about sucking air back in, especially after not having breathed for anywhere from 10 seconds to a minute. Breathing is important.
As one experiences apnea, the body is not getting enough oxygen, and each time one stops breathing, one wakes a bit (though the waking is not remembered.) The lower oxygen is already bad, but the lack of deep and proper restful sleep is huge. Together, these two traits of sleep apnea cause hypertension (high blood pressure), heart failure, stress, irritability and a shorter lifespan. Sleep apnea has also been linked to type-two diabetes (anther gem I now deal with) and can be said to decrease one’s health overall.
There are a few different treatments for this disorder. The most commonly prescribed is losing weight and a CPAP machine, which supplies constant air pressure to your airway, keeping it open. Also employed are surgery (about 40% success, and often recurs within 4-6 years, having made matters worse), a dental piece that changes the position of your mouth as you sleep, and a “collar” to do the same thing. There are always advancements on the horizon, but that’s what we’ve got at this time.
Now back to the journey I’m sharing with you: So I checked into all of this, and was told that a doctor would need to write me a prescription for a CPAP machine, which is the de facto treatment for 0bstructive sleep apnea (OSA). To do that, I would have to have a Sleep Study done. But OSA only happens to people who are obese, I thought, and I’ve had this since I was young and lean, so it can’t be me. Mine must be Central.
But I kept on nodding off anywhere and everywhere, and became more concerned with the snoring and shortening of years. So how much is that sleep study, anyway? $2500. “Could you say that again?” Twenty-five hundred dollars. “For one night of monitoring my breathing? I can already tell you that I stop breathing when I sleep! I may as well have been objecting to the Great Wall of China — from here in Colorado. I did eventually find out that Canada’s sleep studies run about $500, and are separate of their medical system, so that settled it. No way was I giving those greedy bastids $2500 (even if I had it) when the Canadians can do the exact same thing for a far more sane $500. I’d just wait til I could take that trip to Canada and get it done there. The Canadians were much nicer about everything anyway.
Meanwhile, I find an old CPAP at a garage sale for $20, and some med tech guy gives me a hose and mask for it, and I’m ready to go. My friend Pete told me that he felt the effects immediately, the very first night, so I figured this would solve the question once and for all. I set it up pretty well, and the mask didn’t bother me all that much, but aside from a dry throat from all that dry air, I didn’t notice anything. Besides, I’ve had this since I was young and thin. See, mine is Central, so a CPAP won’t help anyway, even if I could afford it or insurance. Hell with it. And that was that.
Until my current partner and I couldn’t even sleep in the same room because the snoring was so bad. Still didn’t have $500+ a month for insurance anyway, let alone all those deductibles and such. Just deal. There are lots of people with sleep apnea and they’re not dead yet. (Yeah, and then there’s my cousin, Artie, a jock all his life, dropped dead at 40 of a heart attack, and nobody back then knew why… but I digress.)
Another effect of aging is that health insurance costs go up, even if you’re healthy as a horse. Get the dreaded D diagnosis (diabetes) of ANY kind, and the insurance companies ran from you and refused to insure you, even if you’re Type-Two and your medication amounted to less than $20 a month. They lumped Type-Two diabetics in with the $1600 a month Type-Ones. Not at all the same disorder, but why take any chances, right? Enter the Affordable (Health)Care Act. In the initial stage, which kicked in last year, the insurance companies were prohibited from refusing to insure someone or show bias based on Pre-existing Conditions. But the insurance was STILL over $500 a month for this non-smoker, non-drinker technically Single over-50 male.
Then came January 1, 2014, and the next stage of the implementation of the GOP-hated “Obamacare.” (Ain’t it funny how all of the 500+ members of Congress “worked” on the bill for over a year and a half, and yet they tried to make it a bad thing by naming it after the Democratic POTUS?) I knew I HAD to get health insurance now. But for some reason, even though I’m poor as a church mouse, the website was insisting that I made too much money for any discounted programs, and would have to come up with $467 a month. This is insane, I thought. No wonder everyone is so up in arms. That’s my RENT, how the hell can anyone afford that rate for ONE person, let alone a full household? Finally, in desperation, I phoned in and got ahold of someone. Twice. The first time, though she acknowledged that it didn’t make sense and I SHOULD qualify, she didn’t shed any light on the actual problem. The second lady figured it out. The software was doubling my income, and then deciding that I could afford up to 10% of THAT amount, so I was on my own! A few quick keystrokes correcting the error, and I was set! The papers came in the mail a few days later, confirming that I was now eligible for coverage — at no cost!
Until you’ve been dealing with diabetes, a compressed Ulnar nerve relocation surgery, a smushed AC joint, the effects of aging, and the like, and doing it all without any sort of healthcare insurance, you really have no clue how frightening the future can be. Getting the Ulnar Nerve relocation surgery was a big deal, but if I didn’t do so, I would lose the use of my left ring and pinkie finger altogether. For a writer and life-long musician, that is absolutely terrifying. Then the diabetes (which happened as a direct result of that surgery,) and not being able to get into a doctor at all for months, and then having to figure out ways to pay the $400 initial office visit, etc. … Let’s just say it’s been a real nightmare, and cost me even more sleep than I was already losing. In hindsight, it’s a wonder I could function at all.
Next step? Find a physician who would accept Medicaid. That was daunting. Many of them won’t take it at all (presumably because it doesn’t pay them enough.) The few that did, they had waiting lists a couple months long, because they could only afford to treat so many Medicaid patients at a time without becoming an unfunded charity. FINALLY, a lovely lady at Dr. Waln’s office heard the frustration and desperation in my voice, and talked with her boss for me. She called back the next day, asking if I’d be able to come in to see the doctor next Monday. “In five days? ABSOLUTELY,” I exclaimed, nearly pinching myself. An Internal Medicine doc was going to take me? I have been dealing with diabetes for over five years now without even once seeing an Internal Medicine specialist, and they’re properly the ONLY type of doctor a diabetic should have in charge of his care.
In short, Dr. Curtis Waln, his staff, and all of Banner Health (a non-profit medical group, imagine that) have been not one bit shy of amazing. Dr. Waln forgot more than the past 5 years of docs and Physician’s Assistants (PAs) combined. Sharp, quick, and experienced, he got to the heart of the matter, ordered the tests, referred to the specialists, and didn’t miss even one complaint or concern in seeing me onto the road to healthy. His staff arranged for other specialists to accept my coverage, and Banner Healthcare opened their arms to me just because I’m one of his patients. Thank you, very sincerely and from the depths of my heart on up, all of you. And thank you, President Obama and Congress, for the years of life and health and potential for prosperity. I won’t let you down; I’ll make good use of the time and health. Okay, we’ll put away the tissues now; time to get back to summing this up.
The sleep study performed by Banner at the request of Dr. Waln documented that I stop breathing 56 times an hour, for anywhere from 10 to 46 seconds at a time, and that my blood oxygen level goes down to less than 75 percent. It is mostly obstructive. (I also learned you don’t have to be overweight to have obstruction,) with 5 or less Central apnea events per hour. In short, very severe OSA, and the doctor who reviewed the test results prescribed a self-adjusting CPAP machine. I picked it up two days ago, slept with it for the first time last night.
Yep, it will take some getting used to. But as I awoke, even my muscles felt energized, pumped up from the 100% oxygen that I was getting while sleeping for the first time in 40 years! Still tired? Yes I imagine it’ll be at least a couple of weeks before I catch up from all of that lost sleep. Waking up once a minute plays hell on your REM state!
Thinking on it, I wonder what I was thinking of, waiting for so long to get a proper diagnosis and treatment. And then I realize that I wasn’t really thinking of anything. I was simply accepting the reality that I couldn’t afford the healthcare insurance or the treatment, so I soldiered on without it, like so many other millions of people in this, the greatest, most powerful country on earth.
How many of us have lived with unacceptable standards of health, without proper care and treatment, because we just couldn’t afford that AND food and rent, car insurance, utilities, and all the rest? If it doesn’t come with your job chances are good that you don’t have health insurance either. Or you didn’t until Obamacare. And the GOP and Tea Party folk say that like it’s a BAD thing — unless they’re the ones benefiting from it, of course.
Sleep apnea is the very loud killer. It stresses and kills relationships. It shortens lives and tempers. It leaves about 5 percent of the country sleep-deprived, irritable, unhealthy, stressed, and desperate for a nap any time they can get one. It even causes memory loss. I have no idea how much better I’ll eventually feel, but I know that I already feel better after just one night with the CPAP. If that’s any sign of things to come, now that I’m actually getting real sleep and health, I should be taking over the world by the end of summer. And that, too, is good for these United States of America.
Which begs the question: WHY is the GOP so opposed to “Obamacare” when it will result in a better country? Certainly a healthier citizenship is going to be more productive, and even pay more taxes. And all that newfound health will also spur the economy. But wait, wasn’t it Romney who implemented nearly the same thing in Mass., where he was governor? Maybe, just maybe, they’re so opposed to it because it will be a MASSIVE success for the Democrats, and they couldn’t possibly allow that, even if it means we all suffer. They wouldn’t stoop that low, would they?
Don’t wait. Get it checked out. Get Affordable Care. The life you save most definitely is your own. Your loved ones will thank you. You will thank you. And life will be much better. That’s it. Gonna go put on my mask and get another full, sound, full night of sleep. Good night!