New adventures in sleep deprivation: obstructive sleep apnea edition

I was fascinated by sleep as a kid and wrote at least one grade school science class report about it. It struck me as both mysterious and frustratingly inefficient that we become unconscious for one-third of our lives. Perhaps some part of me knew that for many periods in my future I wouldn’t.

Even as I suffered with and overcame* insomnia a few years ago (about which I’ve written a great deal here and elsewhere), I served on an ICER committee to evaluate diagnostic and treatment devices for obstructive sleep apnea (OSA). “Oh, how much more awful it would be to have that,” I thought at the time. Maybe the saints or the fully enlightened have voided their minds of all traces of instinctive revulsion at the thought of disease or disability, but I haven’t.

I should. Experiencing the affliction is not the same as imagining it. Human nature though it is, projecting discomfort at any level on the afflicted is unkind, even unjust.

I’ve come to learn that OSA exacts a different kind of sleep deprivation than insomnia and not quite as terrible as I feared (but still no walk in the park).

“You have mild obstructive sleep apnea,” the doctor told me last week. This was just after my in-lab sleep study, which followed two home studies that ended inconclusively due to equipment failure. “You wake up nine times per hour on average, thirty times during REM sleep, of which you get too little.”

“In what sense is that mild?” was my obvious question. My other, unexpressed thought was, “I don’t think ‘wake up’ means what you think it means. Believe me, were I to wake that much, I would damn well know it.” My subjective experience is that I only wake a few times, tops — each with a loud and startling snort — and most nights not at all.

This started around Christmas. During the few months of waiting for appointments, experiencing inconclusive home tests, and waiting for insurance to cover the lab sleep study, I had seen an ENT. His hypothesis was that my symptoms might be due to intermittent and otherwise benign, mild inflammation. Good theory, but, as it turns out, incorrect.

Fewer than 15 OSA events per hour is considered “mild.” Also, my oxygen level only drops three percent, another indicator of a mild case. Mild though it may be, it does’t play nice with insomnia, should one lean that way. For a fragile sleeper like me, being awakened even a few times in succession can translate into just staying awake for hours.

Yet, it turns out, it is possible to be a relatively high functioning and productive member of society with mild OSA, at least for some time. Witness I keep cranking out Upshot posts and getting my regular job done too.

Still, it’s been getting harder. The diagnosis probably also explains why it’s become increasingly difficult to exercise as much as I used to, and I admit I am tired frequently.

“Do you feel tired,” the doctor asked.

“I’m 46. How am I supposed to feel?”

There’s also memory loss, I guess due to less REM sleep. Perhaps it’s no coincidence that several of my Upshot posts over the last few years have focused on memory and memory aids.

These are the early days, between diagnosis and treatment. The health system being what it is, it’ll be at at least a month before I start treatment, probably with an oral appliance (which sounds like a toaster in the mouth). According to anecdotes and the interwebs, these can also reduce or eliminate snoring. Awesome! Some are over-the-counter. Are those any good? (I will get a prescription one made by a dentist, nevertheless.)

I have lots of other questions. I want to write more about this topic (here and at Upshot, editors permitting). Those that pertain to my own health I will ask of my own doctors. Those that pertain to the topic more broadly, I would love to talk to clinical experts. If you are one and want to chat, let me know.

* One doesn’t really overcome insomnia. “Recovering insomniac” is more apt. The tendency is always there.


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