Reindeer Games

So which of Santa's reindeer are you?
It seems I'm Cupid. Somehow this doesn't surprise me.

You Are Cupid

A total romantic, you're always crushing on a new reindeer. Why You're Naughty: You've caused so much drama, all the reindeers aren't speaking to each other. Why You're Nice: You have a knack for playing matchmaker. You even hooked Rudolph up!

Which of Santa's Reindeer Are You?

Goodbye, Leo

First off, I want to mention the passing of John Spencer. Who, you say? He played Detective Lipranzer in "Presumed Innocent", which starred Harrison Ford and Raul Julia. His part was small, but important. He then went on to play Tommy Mullaney for a few years on "L.A. Law". The part I'll always remember him best for, though, was Leo McGarry, the Chief of Staff to President Jed Bartlet (Martin Sheen) on NBC's "The West Wing". I liked Spencer, and loved what he brought to Leo's character. He gave the show some of its trademark depth, seriousness and soul. R.I.P, John. May your memory be for a blessing.

Now onto this week's post:
I’m approaching my 1 year anniversary at work. I had my performance review this week, and it dawned on me that before this, I hadn’t had a review of any kind in well over 5 years. Perhaps 6. I was laid off in the spring of 2001 from a software training company that was imploding in on itself, and from there I took on a couple consulting/contracting gigs. When you’re a contractor, you’re not perm/full-time, and therefore you’re exempt from the standard employee review process. Since this is the first full-time/permanent position I’ve had since 2001, it’s the first time in ages that I’ve had a boss say “ok, this is what you do well, and this is what I think we should work on” and be able to discuss it.

It’s a pretty good feeling, actually, even talking about the stuff I hadn’t done terribly well (there wasn’t all that much of that, and no, you don’t get details). It helps immensely that I have a terrific boss and this is an outstanding company, but it also speaks to something that had been nagging me for a long time. As long as I can remember, I’ve had a profound need to work for a grown-up company where I can grow roots. In 10 years of slogging through the soul-sucking world of retail, I endured a series of positions that existed for no other purpose than to pay the bills. I wasn’t advancing for the most part, and really didn’t have any desire to. Work was just a means to an end, in some cases facilitating my way through my undergrad degree. During the last retail hell (where I found myself in charge of the establishment) the light dawned for the first time and I figured out that training was what I had wanted to do all along, it was what I did best and enjoyed the most. From there, it was just a matter of finding the right fit.

There are entirely too many companies out there that lose sight of what really matters, if they ever had idea of it in the first place. When you’re hunting for a job, you don’t feel that you have the luxury of asking “does your staff enjoy working for you, or do they just endure their time in their pathetic little cubes, praying they don’t crack and kill everyone in sight with automatic weapons that are outlawed in most civilized countries?”. In addition, it would be good to know “are you really fiscally stable and profitable or is your CEO actually only one or two payroll cycles away from filing for bankruptcy protection and fleeing to an exotic South Pacific atoll with the pension savings of your entire staff?”. Having worked for my share of companies that would have been uncomfortably found out by one or both of those questions, I feel these would be important queries to delve into in the interview process, if only you could expect honest answers.

In about a month my company’s having our annual meeting. By a quirk of scheduling it was the 2005 company meeting where I was introduced to my new work family for the first time, even before I had technically started as an employee. I knew before I left the meeting that day that I had found the home I’d been looking for for so long. Finally, I can say with a straight face, “Ya know, I really love my job, and I fully expect to be able to say that next year, the year after that, and in another 5-10 years, too.”

It’s all about Life is Good’s motto: Do what you like. Like what you do.

Signs of sleep apnea

So how can you tell?
First, as it says on the cover of the Hitchhiker’s Guide to the Galaxy, don’t panic. Always good advice, really. Not everyone who snores automatically has OSA, but it’s safe to say everyone with untreated OSA snores. “Hey, David”, I hear you ask, “how do I know if I, someone I love or someone else I want to smother with a firm pillow, has sleep apnea?”
(pausing while you ask the question out loud…..)
I’m so glad you asked!
Some signs and symptoms that can alert you to sleep apnea:
•Frequent cessation of breathing (apnea) during sleep. Your sleep partner may notice repeated silences from your side of the bed. Sure, they’re grateful as hell that you’re not snoring to wake the dead at the moment, but this part’s the most important. They should pay attention here
•Loud snoring. Really loud, like cartoon window-rattling loud
•Choking or gasping during sleep to get air into the lungs. It probably sounds as bad as it really is
•Waking up sweating during the night
•Feeling unrefreshed in the morning after a full night’s sleep
•Headaches upon awakening. If the morning routine HAS to include aspirin or Tylenol even before the first of 30 obligatory cups of coffee, that’s a bad sign
•Daytime sleepiness, including falling asleep at inappropriate times, such as during driving or at work. My commute home from work when I was diagnosed was about 20 minutes. Sometimes that was about 10 minutes too long, especially in the dark, after daylight savings time ended. See below for more about that.
•Lethargy, which often leads to sleepiness, etc.
•Rapid weight gain. Lack of REM-level sleep disrupts metabolic processes, increasing the risk for obesity
•Memory loss and learning difficulties (especially noticeable in children with OSA)
•Short attention span (see learning difficulties)
•Depression

A personal note about depression: Dr. Thomas had related to me that upwards of 80% of new patients he sees with OSA are on anti-depressants of some kind, and that CPAP therapy frequently allows them to reduce and even sometimes eliminate their SSRI (Selective Serotonin Reuptake Inhibitor, such as Paxil, Prozac, Wellbutrin, etc) and other anti-dep. meds entirely. I used to suffer from ferocious Seasonal Affective Disorder (SAD). Winters were hell for me as daylight, especially here in New England, disappeared. What we found as a happy by-product of CPAP usage for me was that the SAD was greatly reduced, almost completely. I still don’t like cold and winter to be sure, but it’s no longer debilitating for me. Getting better sleep resulted in dramatic improvement in my moods and ability to function during the deadly dark months between October and March. Sure, this is anecdotal, but I’m not alone in this. Dr. Thomas and my primary care physician at the time echoed that it made perfect sense, and it does. The brain obviously functions better with proper sleep, especially cognitive and mood centers in the frontal lobe. It stands to reason that the delicate chemical stew of neurotransmitters that professionals point to as the root of clinical depression would re-balance as well. Dr. Thomas did show conclusively in followup MRI studies after I started treatment that during cognitive tests, the frontal lobe of my brain was lit up like a Christmas tree compared to the same scans and tests pre-CPAP. That’s got to be significant, no?

If you’re concerned about OSA, have your sleep partner keep a sleep diary. They should especially note:
•How loud the snoring is
•How long it lasts (constant or intermittent?)
•Whether you appear to be asleep or not, and for what percentage of the time
•Whether you are having trouble breathing (choking, gasping, etc.)
Alternately (especially if you don’t have a sleep partner handy or they’ve dumped you because of your incessant snoring), see your doctor and ask for a sleep study. It’s completely painless, though admittedly not the best time you’ve ever had in a bed. However, it just might save your life. Google “obstructive sleep apnea” for a ton of good resources. Sweet dreams!

Sweet Dreams

In the winter of 2000-2001, I was (almost literally) cured overnight. There are a few different kinds of treatment scenarios available for sleep apneacs. If the condition is mild, there are behavioral elements that can be addressed (weight loss, change in diet, pillows or bed, etc). After that are small operations that can be performed, such as using a laser to shave the soft palate and the tissues at the back of your throat. For me, none of that would have made any difference. Instead, I had a machine prescribed that used a steady stream of air as a kind of stent to keep my throat open while I slept. It’s called CPAP (Continuous Positive Air Pressure). The thing’s a miracle. It’s set at a certain pressure which is effective at maintaining an airway but still allows me to sleep. The right therapeutic pressure is different for everyone, since everyone’s throats and the tissues surrounding them vary. Within two nights of getting my CPAP I was sleeping just fine, and experiencing dreams again!! During my sleep test, Dr. Thomas saw one period of REM sleep, and that was for only 15 minutes. Most people have hours (plural) of REM-stage sleep. Not everyone can tolerate CPAP, since you have to wear a mask over your face (nose, really), and if you’re claustrophobic, or sleep on your stomach all the time, it can be problematic. Some people find it uncomfortable to the degree that they tear the mask off their head in the middle of the night and don’t even realize they’ve done it. For me, it was an immediate and total cure, absolutely free of side effects. I love the damn thing. All of a sudden I can stay up as late as I want (or not, as the case may be), watch a TV show without nodding off, or drive for hours perfectly safely. And no more falling asleep during ridiculously boring meetings at work. At bedtime, I kiss P goodnight, turn the machine on, put the mask on, and go to blissful sleep. For our two dogs, it’s a perfect cue that it’s sleepy time. Daddy’s machine is on! The CPAP’s not loud, either, even though it’s essentially a small air compressor. I’d say it’s about as loud as a room fan, and much, much quieter than anything as noisy as an air conditioner. When I wake up in the morning, I don’t feel like I’ve been struggling to swim upwards through 100 feet of thick jello just to awaken and get out of bed. In fact, I generally feel great (though I’m still not a morning person. The machine is terrific, but it’s not an all-powerful wizard or anything) And did I mention dreaming? I hadn’t experienced dreams in years, though I didn’t realize it until I got them back. Dreams are really cool. Great invention, I think. Nice to have them re-installed in the ol’ hard drive.

This Tuesday I’ll take delivery of a brand new, remarkably miniaturized CPAP unit for the first time since I started treatment 5 years ago. My insurance company allows for a new unit every five years. I’ve been replacing the mask every year, but that’s become more generous as well, and I can now get a new one every few months, if I want.

Basically, P and my CPAP saved my life. P would actually prefer that she get sole credit, which I certainly can’t argue with, but the treatment is absolutely remarkable in its simplicity and effectiveness. The cascade of disorders that arise from untreated, severe OSA reads like a laundry list of Things Nobody Wants: insomnia, depression, hypertension, irregular heartbeat, heart disease, stroke, diabetes, impotence, sexual dysfunction....and that's assuming you don't die from falling asleep at the wheel on the highway!

One very chilling and so far unverified but extremely real possibility: Dr. Thomas told me that he and many of his research colleagues in the sleep disorder community are gathering increasing data to suggest that I and other sleep apneacs are adult survivors of SIDS. That’s right. Sleep researchers are coming to believe that an unknown, but possibly large number of cases of Sudden Infant Death Syndrome are tragic instances of infant sleep apnea. The *easiest* way for the throat to close up is if you’re on your back, and in most cases the infant brain wouldn’t be maturely enough developed to wake the baby when it stopped breathing. Then again, a baby on their stomach can suffocate, so it’s hard to know what to do. Sleep apnea all by itself can’t be diagnosed at autopsy, and certainly not on an infant. It would leave no signs whatsoever, and it would appear to everyone that a perfectly healthy infant would suddenly be dead for no apparent reason. No trauma, no obvious disease, no underlying cause.

Snoring might be funny (somewhere I’m sure one of my family members has that goddamn tape), but OSA is undeniably serious stuff, and doctors really don’t know how many untreated cases of OSA are still out there, suffering needlessly. Their bed partners and people in the next county are probably also suffering just as much!

A bedtime story

I used to snore. Ok, not just snore. My oldest niece once said I sounded like a 747 about to land. Many years back during a weekend family reunion, my brothers thought it would be hysterical to put a tape recorder in the room with me while I slept, then play the tape at breakfast. Everyone in the family had a grand laugh over David’s Stupid Human Tricks. I had never heard myself before, obviously, and I was appalled. Of course, I didn’t think there was much to it other than that I was very, very loud. That is, until one night many years later when I woke up to find my girlfriend (now wife) who had a long career as a health professional, feeling my wrist for a pulse. She hit on something that nobody else I had ever been with had bothered to notice, which was that when I wasn't doing my famous Boeing impression I wasn't actually breathing. Over time, she convinced me that my sleeping patterns weren't at all normal (as if the rest of me was?). Mind you, I hadn't been all that symptomatic other than the whole snoring/not breathing deal. I wasn't falling asleep at inappropriate times, I was doing well at my job and had just gotten promoted when suddenly I *did* become grossly symptomatic. I *did* fall asleep or get groggy, a lot. Watching TV, driving, and, uh, other times that I needn't get into here, I’d just start conking out. P insisted I get checked out by a real live doctor who could explain this. At her urging, I finally did.

I met Dr. Robert Thomas at the Beth Israel Deaconness Medical Center Sleep Disorders Clinic in Boston. Terrific guy, and an excellent doctor. He did an examination, asked me a bunch of questions, and immediately got me in for a polysomnogram, better known as The Test. It’s an overnight examination that takes place while you sleep. My head, face, chest, arms and legs were connected to dozens of wires, straps, microphones, cameras, cables, cuffs, and all kinds of devices that measured what my brain, lungs and various muscles were doing while I *tried* to sleep. I told the technician that I was sure in the morning I would have some memory of being eaten by an octopus. Other than the wires and cords which constricted movement pretty effectively, my chief recollection of that night was a loud, frequent buzzing noise from a machine right next to my bed. When I was awakened after about 5 ½ hours of “sleep”, the sleep tech dude looked at me with a very worried expression and said "Man, people got what you got, they die in their sleep." I'm pretty sure he wasn't supposed to say that to a patient first thing in the morning, but at least it confirmed what P had suspected all along. Dr. Thomas would later diagnose me with severe Obstructive Sleep Apnea (OSA). I asked the sleep tech what the buzzing thing was. He said it was the alarm that alerted him to dangerously low oxygen saturation in my bloodstream. Right now, as you’re reading this, the oxygen saturation (O2 sat) in your blood is probably close to 100%. 95-100% is normal. The monitor at my bedside was beeping loudly when I dropped below 85%, and my O2 sats had bottomed out at about 60 not once, but half a dozen times during the night. So my bloodstream had 40% less oxygen than it needed. That can’t be good.

So what IS sleep apnea? It’s what happens when you’re asleep, and the tissues in your throat relax and collapse to the point that air is no longer getting to your lungs. No air, no oxygen. No oxygen, game over. That not breathing part is called an apnea. My apneas ranged between 15-45 seconds every minute. If I remember correctly I averaged around 80 apneas an hour. So yes, I was definitely suffering from severe OSA. Try holding your breath between 15-45 seconds every minute, and do it 80 times an hour. Now, try to do that while sleeping. You get the idea. You certainly won’t wake up rested, if you sleep at all.

What Dr. Thomas couldn't understand was how I was able to function with a condition that he was sure I had had for a good 20 years or so (I was in my mid-30's at the time). At the point of diagnosis, though, my brain and body had determined that I had gone on like this long enough, and I really began to break down. I no longer had any stamina. I was getting drowsy all the time. I fell asleep in meetings at work, in the car, on the couch, pretty much constantly. All the OSA chickens were coming home to roost, and they were making a mess all over the place. Oh, and P and I were getting married in a matter of months.

Next: Treatment