Part 1 of this series discussed how men rationalize their denial about having “Sleep Apnea“.
Today, in Part 2, the discussion revolves around starting to recognize that you might actually have sleep apnea, and the transition from denial to accepting the possibility.
Two new factors took me from absolute denial to grudging acknowledgement of the possibility:
- Meeting a new doctor at age 50
- Discovering that all my siblings either had or suspected they had Sleep Apnea
Meeting a New Doctor at Age 50
For a doctor-phobic, middle-aged, suddenly less-healthy man to be forced to select a new doctor, you begin to have visions of midlife crisis and a sudden need to buy a Ferrari. After all, new car pride should make any man feel better.
Fortunately, my wife was insistent on me having a new doctor, and the Ferrari wasn’t really in the budget.
So, the easiest solution was to call the most convenient doctor’s office and find out whether any of their three physicians was accepting new patients. They all were, but there was more:
- The first was a distinguished-looking man who was also the owner of the clinic. While he was certainly qualified, it was also evident that he would merely be a temporary solution, and another change would be needed in a few years.
- Next was friendly woman with good credentials and references, but not many middle-aged men feel comfortable being examined by a woman doctor, and that was the case with me.
- The last choice was a man in his late thirties or early forties and that was perfect. He was old enough to be experienced, and young enough to work with me long-term.
So, I had a new doctor. Unfortunately, even after I transferred my medical records from the last doctor, and swore that I’d been healthy enough to pass a life insurance exam two years prior, the new doctor insisted on a full checkup. He used words like “turning 50“, “baseline EKG” and “elevated blood pressure.”
The higher blood pressure was the most worrisome: After more than a decade of proudly testing at “120 over 80,” this test showed about “150 over 105.” Because of the higher numbers, the new doctor started asking questions about every aspect of my life, and zeroing in on any recent changes.
Grudgingly, I admitted that recently I was always feeling exhausted, but I pointed to an expanded workload and added stress due to a number of situations.
Then it happened: He asked if anyone ever said that I stopped breathing while sleeping, or whether I had ever been been tested for Sleep Apnea.
Time stood still for awhile as my potential responses passed through my mind:
- Take the easy way out by denying that anyone ever suggested that I stopped breathing. After all, he had never met my wife. What would it hurt?
- Tell him that I have been tested numerous times by nosy doctors who also misdiagnosed this condition.
- Bolt for the door and find yet another new doctor who might not be as thorough.
Suddenly, my lips failed me as I heard my own voice saying, “Yes, my wife has complained for years about me stopping breathing throughout the night.”
WHAT!!! – WHERE DID THAT COME FROM?
He next asked, “Do you fall asleep during the day?” GULP! Well, not unless you count waking up face down on your keyboard. So I admitted to finding it harder and harder to stay awake throughout the day.
That was it! He scheduled me for an overnight test at a local sleep lab. DOOMED!
After the rest of my exam, the blood pressure dropped some, and the doctor explained that he was prescribing immediate blood pressure medicine – instead of sending me to the hospital. That got my attention!
All in the Family
During the time between the doctor’s examination and my appointment at the sleep lab, I traveled to a family gathering back in my hometown.
Naturally, my wife pipes up that I am going to be tested at a sleep lab for Sleep Apnea.
To my surprise, one sister admits that she and her husband have Sleep Apnea and sleep with breathing machines. My other sister and our brother chimed in that they have always suspected that they had Sleep Apnea too, but had never been tested.
Could it be true?
There it was! – The Indisputable possibility that I actually could have Sleep Apnea.
Okay, MAYBE I could have Sleep Apnea, but that doesn’t mean that anyone will ever convince me to use a breathing machine with a mask at night.
In the Part 3 of this series, you’ll learn what a sleep lab is like, and what kinds of data is revealed by the test results.
For faster information, read “The Perils of Sleep Apnea–An Undiagnosed Epidemic: A Layman’s Perspective“.
Do You Fall Asleep During The Day But Deny You Have A Sleep Disorder? I Did And It Almost Killed Me!
Hello, my name is Steve and I have sleep apnea.
My wife diagnosed this more than five years ago, but I was in denial. The only reason I’m alive today is because my doctor died and my wife is VERY persistant.
What you say? – Alive because my doctor died? – How does that work?
Well, it goes like this: I’ve been mostly healthy all my life – the kind of guy who eats anything, does whatever I want, and avoids the doctor like the plague. My family doctor also treated my parents and knew the whole family health history. That means he knew that I’m never sick, so every few years I’d show up to prove I’m still alive. We had this GREAT arrangement, where he’d leave me alone until I asked for help.
In fact, the last time I saw him, I drove to his office to discover it was now an office for Psychiatric Therapy. My self-diagosis on that subject was very positive, and I since I didn’t want another second opinion from my wife, I picked up the cellphone and called my doctor’s number. The reply – after a few giggles from the receptionist – was that they’d moved seven years earlier, and I needed do drive east for a couple of blocks.
As a typical guy, I generally figure that any problem short of broken bones will go away with time, and often, time will mend those too. In fact, I’ve broken ribs on multiple occasions, and the doctor just prescribed pain pills and said “you’re tough and have great chest muscles to holdem in place, so call me in a few weeks if you haven’t gotten any better.”
So, since I was convinced that sleep apnea was just a made-up disease by doctors conspiring to take more trips to Tahiti, and since my doctor wasn’t likely to send the authorities to drag me into his office for a physical examination, my expert opinion was that I was in perfect health.
My belief was that my wife just needed a new hobby – and maybe ear plugs. After all, my dad’s snores could shake the house, but he lived to be 77 years old.
Unfortunately, or fortunately depending on how you look at it, my wife was not deterred from her insistance that I not only snored, but I was continually stopping my breathing throughout the night. I assured her that I just reverted to a more shallow form of breathing during parts of the night. Heck, if I wasn’t breating, I wouldn’t be perfectly fine each morning. RIGHT?
After three years of this verbal dance, I was blind-sided by a need to renew a prescription for a special hand cream. When I called my doctor’s office, I was told that he would not renew my prescription without seeing me in person to prove I was alive and still needed the medication. I said something like: “What? You know my voice. Of course I’m alive, and I’ll need this stuff for as long as I live – if not longer!”
How dare my doctor to dare challenge my self-diagnosis! And, given that I was just turning 50, he insisted on checking out my overall health. So, I decided that procrastination was my best friend, and maybe the doc would foget about this unreasonable demand and accidentally fill my prescription.
Well, after a two month delay, I decided to bite the bullet and make an appointment. To my surprise, the receptionist informed me that my long-term, usually reasonable doctor had passed away. My response was to say something comforting like: “That’s terrible! … Can someone else fill my prescription?“
Natually, no doctor was going to give me a prescription without EVER seeing me in person, and this was an even bigger problem because I had moved to another state two years earlier. This had been fine until then, because of the wonders of the telephone and fax. Now I needed a new doctor in my own community. How unreasonable!
In part 2, we’ll review the joys of meeting a new doctor – in person – at the age of 50.
Part 3 will cover the wonders of spending the night in a sleep lab, and hearing the truth about Sleep Apnea.
Later, we’ll explore the ongoing saga of living [yes, living] life with Sleep Apnea, and how it is actually better than gradually dying in denial.
For those of you who want to know more facts about Sleep Apnea, here is my current definition – minus the Tahiti part:
Sleep Apnea “A condition characterized by temporary breathing interruptions during sleep. The pauses in breathing can occur dozens or even hundreds of times a night.”
- loud snoring
- a gasping or snorting sound when the sleeping individual starts to breathe again.
Although the individual may not be aware of having sleep apnea, the condition can:
- disrupt the quality of sleep
- result in daytime fatigue
- raise your blood pressure
- cause permanent brain damage
- result in sudden death over time
The most common type, obstructive sleep apnea, occurs when the tongue or other soft tissue blocks the airway.
Enough with these boring technical details. We’re still too early in this story to believe this kind of non-sense.
So, if you absolutely need to know more facts before the next installment, go ahead and check out this 5-star book about Sleep Apnea.
For more information about how to get a better night sleep, read my wife’s recent post about Sleep Apnea and many other sleep challenges.
Chronic Insomnia, Stress, Depression, Sleep Apnea: Why Has Getting a Great Night’s Sleep Become an Elusive Dream for Baby Boomers? And What Can You Do to Help Yourself?
Remember how much you played when you were a kid? Likely you had so much energy you played outside after school, and maybe even headed outdoors again after dinner; coming in only after your parents repeatedly hollered for you to come home. And didn’t they usually have to holler at least three times — because you pretended not to hear them?
Perhaps your favorite games were: “Tag,” “Red Rover,” “Kick the Can,” “Hide and Seek.” Or maybe kickball or softball in someone’s back yard. Then again, maybe you played that slightly more strategic and mentally challenging game, “Mother, May I?”
No matter what games you preferred, chances are:
- Once you got home, you fell asleep as soon as your head hit the pillow, totally spent.
- When you woke up in the morning you were alert, refreshed, and ready to get right back into it.
- Nobody gave any thought to having problems with sleep.
Could Playing “Mother, May I?” Have Anything to Do with Sleep?
Maybe not, but let’s give the question some thought.
In that game, in case you forgot, one kid was the “mother” and the other kids were her “children.” The game started out with the kids all an equal distance away from mother, with their goal being to gain access to her. The first to reach her became the new “mother” and won the game. The “mother’s” goal, therefore, was to maintain her role by allowing some forward motion, while preventing any kid from totally reaching her. The rules, went something like this:
- Each kid took turns asking “mother” if he or she could take a certain number of steps toward her.
- It could be something as small as five baby steps, or as large as three giant steps. Your more creative friends might have even jazzed things up by suggesting more unusual options like ballet, backward or bunny steps.
- The “mother,” in her infinite wisdom, would reply, “Yes, you may,” or “No, you may not.”
- You and your friends found infinite fun in figuring out the type of steps that might get you across the finish line, but your biggest challenge was in remembering to ask the all-important question, “Mother, May I?“
- If you forgot to ask permission, Mother would force you to go back to the starting line and you had to start all over again.
- Forgetting to ask permission felt sort of like drawing the “Jail” card in the more sedentary game of “Monopoly” (“Go back to the beginning. Do not pass go, do not collect $200”) in that you were highly unlikely to win the game at that point… Take about extreme frustration. Starting over was the worst!
The Games You Play These Days Are Different – And As an Adult, Your Most Extreme Frustration Doesn’t Come From Forgetting to Ask Permission, But Might Possibly Result From Failing to Get a Good Night’s Sleep!
First of all, we all sleep less than we used to, according to a recent Japanese study. The research showed that in 1970 we slept an average of 7.5 to 8 hours a night. In 1990, we slept an average of 7 to 7.5 hours a night.
Nobody knows why this is so, but if you had to hazard a guess, it’d probably be due to our faster-paced “24/7” lifestyle, which offers you less time for play, and in which you have to juggle so many more responsibilities.
But if you want to know how all-pervasive insomnia has become, try gathering together two or three Baby Boomer-aged couples and challenging them to a game of “Truth or Dare.” Or, less dramatically, just mention your recent sleep problems and ask your friends if they have any advice or suggestions.
- Don’t be surprised if the flood gates open, and you find out that most of your friends are also sleep deprived. Sort of surprising, since you all once thought your sleepless nights would end once your kids were old enough to sleep through the night!
- The fact is, most Boomers either regularly experience personal trouble sleeping or they know someone who does. Many will even tell you about couples they know who’ve resorted to sleeping in separate bedrooms due to sleep problems
- If you aren’t bold enough to ask your friends directly, all you have to do is watch TV commercials for a few hours, and you realize you’re not alone when it comes to being challenged to get a good night’s sleep
- The reasons your friends are losing sleep are many and varied: Everything from snoring to restless legs syndrome, narcolepsy, teeth grinding, night sweats, sleep walking or talking, nightmares, stress, depression and reaction to meds
- Of course, the pharmaceutical companies suggest all sorts of solutions, but you’re not sure if that’s right for you.
- And don’t get people started on their fears about sleep apnea and having to wear a mask unless you’ve got a whole evening! That’s a major conversation (Though if wearing a sleep mask can keep you or your spouse from dying of a heart attack or losing your brain function due to oxygen deprivation, isn’t the mask a no-brainer (easy) solution?)
It’s not possible to return to your carefree childhood days when sleep came easily. But, it is possible for you to get a better night’s sleep. And as with your old “Mother, May I?” game, there are dozens of ways you can successfully get yourself to the goal line to win yourself that bliss and energy that comes from experiencing fantastic sleep. Guess it turns out that Mother really did know best…
The first thing your mother would advise you would be to try non-pill solutions first, since all medications have some potential for side-effects. So just like you did with the game, now is when you need to look at the more creative – and successful sleep inducing – steps you can take…
If You Asked “Mother, May I Get Better Rest?” She’d Suggest You First Take These Baby Steps to Improve Your “Sleep Game:” Minor Lifestyle and Environmental Changes
- Prepare yourself for sleep
- Follow a sleep schedule, and
- Get the “sleep vampires” out of your bedroom!
These are solutions that can be extremely effective, and are a great place to start solving your sleepless equation. Here’s how to start:
Take Action to Prepare Yourself for a Better Sleep
Just as your mother had you follow pre-bedtime routine (remember, it probably went something like this: take a bath or wash up, get into your PJs, brush your teeth, story time and prayers, kiss goodnight and lights out) you can still get your mind and body into “sleep mode” with a regular routine that send a message to your brain that it’s time to wind down. Here’s the grown up version:
- Find ways to relax your body: First, avoid physical exertion just before bedtime. Your goal is to reduce any muscle tension you may have acquired over the day. Try relaxation techniques such as massage, meditation, progressive relaxation, or even taking a warm bath or shower.
- Unwind mentally: About a half hour before going to bed, stop whatever else you’ve been doing – including watching late night TV – and replace it with an enjoyable low-key activity, such as reading or listening to music. There are even some sleep promoting recordings available, which you might find effective.
- Drink a glass of warm milk before bed: It turns out there’s a scientific basis for your mother’s old-fashioned remedy. Milk contains tryptophan, a chemical that may promote sleep in some people. And if a solution actually pops into your head while you’re relaxing, make a point to get up and write enough of it down so you’ll remember it tomorrow, then return to bed
- If you’re hungry at bedtime, try a high-carb snack: It’s harder to sleep if you’re either hungry or overly full. But if you are hungry, select a light snack that is high in carbohydrates, such as a crackers, pretzels or a plain bagel
- Avoid eating heavy, spicy, or high-sugar foods late in the evening, they activate your digestive system, which keeps you from relaxing into sleep
- Stop drinking caffeinated beverages after noon: Amazingly, caffeine can interfere with your sleep for up to twenty hours after you consume it. Caffeine is also present in colas, chocolate bars, and cocoa. Even headache remedies and diet pills contain caffeine. Instead try drinking herbal teas or to other energy boosters like ginseng, ginger, and licorice. At night, use calming herbs like valerian, hops, and passion-flower
- Reduce your alcohol consumption: Alcohol temporarily depresses your nervous system making you sleepy, but it’s rapidly metabolized, which creates a rebound effect just a few hours later, waking you up with a start. So that nightcap you’ve taken for better sleep is actually not a good idea
- Cut out your cigarette usage: Nicotine alters your energy patterns, locking you into a pattern of stimulation. Perhaps worse, cigarette smoke contains high amounts of carbon monoxide, which replaces the needed oxygen in your body. Both cigarettes and caffeine, can leave you “wired but tired”
- Consider adjusting your prescription drugs: Many prescriptions, like steroids, asthma medications, thyroid hormone, and decongestants containing stimulants, cause sleeplessness as a side effect. Also, some long-term meds can cause nutritional deficiencies that result in sleep problems. If you adjust the dosage or the time of day these drugs are taken, sleep will often return naturally
- Don’t get in bed until you feel tired enough to go to sleep: If you find that you’re still awake after lying in bed for 20 minutes, go into another room and do something relaxing, such as reading a book. Return to bed only when you’re sleepy
- And finally, once you’re in bed, try not to spend time worrying: Don’t allow your mind to dwell on problems – or challenge it to find solutions for them – while you’re in bed. Instead, before going to bed, make a list of problems and “next steps” for the following day
Follow a Regular Schedule
Again, Mother had it right when she tried to keep you on a daily schedule:
- You’ll find it’s worthwhile to work at going to bed and getting up at the same time every day — even on weekends.
- Once you make a habit of regular bedtimes and wake-up times, you’ll find that your mind and body become conditioned to expecting to go to sleep at “bedtime.”
- Once you achieve some success with this strategy you’ll find keeping to a schedule doesn’t seem too confining.
- Also, plan for regular times to exercise. Ideally, exercise in the morning or afternoon, but avoid exercise in the final four hours before bedtime. (Yeah, getting to sleep’s a lot harder now than when you were a kid!)
Check Your Bedroom for “Sleep Vampires”
When you were a kid, your parents may have helped you eliminate any bogeymen, ogres or monsters who were hiding in your closet or under the bed. These days you can make your bedroom more sleep-friendly by eliminating the “sleep vampires” that are robbing you of your “daily eight.” For example:
- Block out noise:. Or better yet, eliminate it. Even if you fall back to sleep after noise wakes you, the quality of your sleep is compromised because you need time to get back to sleep. Don’t play radios, televisions, or stereos in the bedroom while you’re trying to sleep, and if sounds “bleed through” your bedroom walls from other parts of the house, silence them as well. If you can’t control the noise, try earplugs or use some sort of white noise emitter to block the sound. This can be as simple as running a fan in your room, or try a white noise machine, which creates a consistent, smooth humming designed to mask other noises
- Reduce the light in your bedroom: The issue isn’t merely how light affects your eyes. Light also affects the way your brain produces hormones that regulate your sleep cycle. Even a tiny amount of light can disrupt your sleep. Possible solutions: Ask your sleep partner to read in another room; wear a “sleep mask”; use blackout shades or other window treatments to make the room very dark. More on this later in the post…
- Adjust the room temperature: If you’re physically uncomfortable, you won’t sleep as soundly as you might. Correct the temperature by adjusting the thermostat, your sleepwear, or bedding. Or install a ceiling fan, open or close a window.
- Hide the clock: If you have insomnia, looking at the clock can make you anxious. Try keeping it out of your line of sight
- Try banning pets (and children) from your bed: If your dog or cat sleeps in your bed, your chances for sound sleep are jeopardized. Try having your pets sleep on the floor, giving them their own bed in your room, or keeping them in another room. As for any young children or grandchildren who may have wandered in due to their own anxieties, work at getting them to stay in their own beds
- Don’t talk about problems or challenges you’re facing either at home or work while you’re in your bedroom. Your goal is to get your brain to understand that the bedroom is where you go when you are ready to sleep
- Don’t use your bedroom for an office or project area: As tempting as it might be to set up your bedroom for multi-tasking, it’s not a good idea. When you use your bedroom for a home office or hobby room, your mind is confused as to the purpose of the bedroom. If space is tight and you MUST allow the bedroom to do double-time, try visually separating your work or task areas from your sleep areas with a partition of some sort
- Beyond what you do in the room, pay attention to what you do – or don’t do – in or on your bed: Ideally, you don’t want use your bed to watch TV, pay bills, work or read. That way, when you actually get into your bed your body knows it is time to sleep. Sex, of course, is an acceptable exception
- Finally recognize the impact of your partner’s sleep problems. A bed partner who snores, tosses and turns a lot, talks while sleeping, or gets up often can affect your sleep, even if the activity doesn’t totally awaken you. As mentioned above, earplugs or “white noise” can help. If your partner gets up a lot, make sure he or she sleeps closest to the door. If your partner tosses and turns frequently, consider a larger bed, or even resort to separate beds or bedrooms
You Need to Realize That Your Sleep Problems Are More Than Just a Nagging Frustration, They Are Actually a Health Issue.
When you don’t sleep well, it affects how well you function, how you feel emotionally, and may even affect how well your immune system fights off disease.
Besides that, your health may be affected simply because more accidents happen at night, when our innate circadian sleep patterns would prefer that we are sleeping. Take a look:
- Every nuclear accident reported so far anywhere in the world has occurred on the night shift, when people are tired
- Most highway accidents take place between midnight and 6:00 am and are fatigue-related. Their rate is nearly triple that of accidents occurring at noon or 6:00 pm
- People who suffer from severe sleep apnea have more than twice as many car accidents as the general population
- Fifty thousand car accidents a year occur because drivers fall asleep at the wheel
- About 25 percent of American workers have work shifts that are not nine-to-five
- The most difficult schedule for the body to adapt to is a “swing shift,” the work shift that cycles between the various day-parts. This challenge is similar to “jet lag,” the difficulty the body experiences during travel
Even if you aren’t flying off to Asia or working the night shift, it’s possible that you may have a profound sleep disorder called Circadian Rhythm Insomnia, simply because you live in the city or the suburbs. Why? Urban living there forces you to live and work under artificial light. As a result of unavoidably being exposed to so much light at night, you may actually suffer the same disrupted rhythms and light deprivation that a night worker suffers from. That’s because the natural cycle of the body seems to be about twenty-five hours. (Which is why you get a boost in the fall when we set the clocks back one hour.)
What Can You Do If You Think You Might Be Experiencing Circadian Rhythm Insomnia?
- Try to work by day under natural light, in an office with windows. If you are an urban dweller, make sure your shades blot out the city lights at night. This will allow your brain the peace of total darkness
- If you are a shift worker, try to change to an earlier shift. If that’s not possible, try to work regular hours
- Consider taking melatonin extracts at night. Studies show this may help regulate your body clock. One study of individuals flying to Europe found that of you take melatonin for several days before your flight you can eliminate much of the impact of jet lag. However, not all medical professionals are convinced.
- A newer treatment for circadian shift problems is simple, safe, and effective: Exposure to light that simulates sunlight. This is the same treatment commonly used to treat seasonal affective disorder (SAD). We’ve now learned that your inner body clock can be selectively manipulated by using bright light
Do You Need to See a Sleep Specialist?
OK, if you’ve removed your sleep robbing activities, put yourself on a sleep-promoting schedule, rid your bedroom of sleep vampires and STILL can’t sleep, you probably realize it’s time to take bigger steps.
Your first step will be to recognize that the sleep problems you or your partner are experiencing could be symptoms of an underlying illness or a complication created by medications you might currently be taking. So if you’re still playing the “Mother May I?” game, you’ll want to call your primary healthcare provider and make an appointment to discuss your situation.
You’ve probably heard that in recent years health-care professionals have become increasingly aware of the importance of sleep. So much so that professionals from a wide range of disciplines — including neurology, pulmonology (lungs), psychiatry, psychology, and otorhinolaryngology (ears/nose/throat) — have developed secondary specializations in the area of sleep. But trying to take a giant step there directly will get you nowhere.
Most certified sleep specialists require referrals from your primary care physician, so that’s why your best plan of action is to see your regular healthcare provider first. If he or she suspects a serious sleep disorder or feels testing would be beneficial, you will be referred to a specialist. And depending on the symptoms you report, that referral can happen lightening fast, so don’t try to bypass the referral step!
You’ve probably realized that some sleep specialists operate free-standing sleep centers sleep centers or sleep labs designed to diagnose sleep disorders while others work from hospitals or clinics. Maybe you’ve even heard that some testing can be done in the comfort of your home.
Where you end up will depend on what sort of issues you’re experiencing. Some centers are geared toward assessing breathing-related sleep problems, such as sleep apnea while other centers address a broader range of sleep disorders, including problems related to
- Restless legs syndrome
- Teeth grinding
- Night sweats
- Sleep talking
- Medications or other health issues which can impact your sleep
So To Sum It All Up, Here’s the Final Way Sleep Problems Are Related to That Old “Mother, May I?” Game:
There are a lot of ways to get to the goal line – once again getting a good night’s sleep. But your first step, once you’ve tried the suggestions listed above, needs to be to contact your primary care practitioner, and get a referral — the ol’ “Mother May I?” permission — to see a sleep specialist.
And if the worst case happens? If for example, it turns out you have sleep apnea and you’re advised that you ought to wear a sleep mask to bed every night? Here’s the great thing about that: Your neurologist will explain that if you wear the mask, you’re instantly and completely cured.
Which means you’ll have a lot more energy to go out and play with your friends! How wonderful is that!