The joy of diagnosis: Sleep apnea (Guest post)

Testing for sleep apnea

Testing for sleep apnea

I’m sick…. ill, and I’m really happy about it! I’m relieved to know that I have sleep apnea, and especially that it’s severe. Although my treatment hasn’t started, good treatment is available. Also, there is a definite physical reason behind some of the problems I’ve had in recent years, even though it’s an extremely serious condition. The regular interruption of breathing that defines apnea can cause serious strain on the heart in addition to some of the other symptoms that are more easily observed and that have troubled me. Obstructive sleep apnea (OSA) is common, often arising in middle age (I’m 48), though less in women than men. Mine may be encouraged by allergies, sinus problems, a small jaw, and body weight. (Non-obstructive or central sleep apnea (CSA) is due to problems with how the brain controls sleep.)

In recent years I’ve known something was wrong with me. I seem always tired, lethargic, and have trouble concentrating. I can nap pretty much any time of the day. I may be more irritable too. I thought I was being lazy, not trying hard enough, failing to manage my time. It was hard not to beat myself up. Or perhaps this was related to my migraines or tension headaches. Maybe I was depressed?

I worked on my organization, I got more exercise, set multiple alarms for the morning, put inspirational notes next to the bed to help me get up, and treated my headaches more seriously. They all helped, but I’m still tired most of the time, and the stress of the situation actually did make me depressed. Another problem seemed to be my recent dramatic snoring. Sometimes the dog even left the bed! I live alone and so have little idea how I sleep, but when there was occasion, others observed not just the horrific noise but that I seemed to have trouble breathing.

I tried sleeping on my side, which helps my snoring but also aggravates my shoulder and hip problems. It turns out that I have mild apnea on my side, and severe (stopping breathing about once a minute) on my back where I prefer to sleep mostly. That was the diagnosis from the sleep study, in which the patient gets all hooked up with electrodes of various sorts (including glue in the hair,) a snoring microphone (!), and a breath monitor. (In a private room like a tiny institutional hotel with a shared bathroom.)

Now I have the choice of the very effective CPAP machine (standing for Continuous Positive Airway Pressure) which would normally be the obvious choice since I have adequate health coverage.  Many of my friends find the machine has changed their lives — yeah, they say that, almost all of them.

Sure, some complain that it’s embarrassing to have to wear the mask to bed, making one an unattractive bed partner, like Darth Vader. But it must be better than the snoring, to be sure; and if that’s a deal breaker, it’s not much of a “deal.” Also, some people find the mask uncomfortable, and while they’ve made big improvements in design in recent years nobody wants to wear an apparatus on their head if they don’t have to; so sometimes people refuse to use it or don’t use it regularly. My problem is that I have a rare genetic vascular condition (HHT) that manifests in ways that mean that I can’t scuba dive, of all the odd things, because of the forced air; I suspect the positive air pressure of the CPAP may pose a similar problem. I’m waiting for advice from my specialist, but it may be best for me to try the alternative dental appliance; it’s not typically best for severe sleep apnea, but it may be best for me.

One downside of this diagnosis is the complication to my body image: weight loss can eliminate sleep apnea. I would certainly love to lose some weight. Yet of course, as the sleep specialist understood, I’d have done that already if I could.

On the other hand, people do lose weight sometimes as a result of addressing their sleep apnea. More energy makes them more active, I suspect, and less inclined to seek energy in food; though an improvement in mood might help too. Anticipating this reminds me of the perverse pleasure so many of us have when an illness makes us lose weight: “because of the flu last month I can get into my old jeans!” Although if I should lose weight from treating my sleep apnea, it would be due to improved health. I just need to resist letting that possibility fuel weight loss fantasies that take up time I could be spending actually enjoying my life.

Time and energy are the real promise of treatment. In my homemade efforts to fight the energy loss from sleep apnea I got more active; now — with treatment — I should be able to perform and recover better (running-walking with my dog and yoga, recently the quite ambitious ashtanga style), and I’ll have the time to exercise more. I’ll keep repeating that to myself, and let the weight fall where it may.

Fit is a Feminist Issue, Link Round Up #22

This is where we share stuff we can’t share on Facebook page for fear of being kicked out! Read why here. Usually the posts are about body image, sometimes there’s nudity but we’re all adults here. Right?

By the way, Facebook recently clarified its stance on nudity, writing, “We remove photographs of people displaying genitals or focusing in on fully exposed buttocks. We also restrict some images of female breasts if they include the nipple, but we always allow photos of women actively engaged in breastfeeding or showing breasts with post-mastectomy scarring. We also allow photographs of paintings, sculptures and other art that depicts nude figures.” For the full story see here.

Why does a fitness blog even care about body image? You can read about that here.

 

If you’ve ever felt body conscious while on the beach then this woman’s story is guaranteed to make you feel better.

When Rachel Hollis posted a picture of herself on the beach, wearing a bikini, to her Facebook page, something amazing happened.

It racked up over 300,000 likes, which is a fair more than she was expecting.

The reason for the incredible response is because of the powerful caption she gave the image, which was an inspirational message to mothers.”I have stretch marks and I wear a bikini. I have a belly that’s permanently flabby from carrying three giant babies and I wear a bikini. My belly button is saggy. . . (which is something I didn’t even know was possible before!!) and I wear a bikini.

“I wear a bikini because I’m proud of this body and every mark on it. Those marks prove that I was blessed enough to carry my babies and that flabby tummy means I worked hard to lose what weight I could.

 

It’s easy to see why such pure photographs would be well-received. Women, the ones online commenters insist are dangerous sex pariahs en route to ruin, are shown here as harmless. They’re laying on couches, relax with each other, and stare at the camera or off in to space like no one is watching.

Photographer Anastasia Pottinger has a powerful photo series called Centenarians that reveals what the human body looks like at 100 years old. It’s a remarkable achievement to live so long and the marks of age are well worn on the oldest people on the planet.

The photos are taken of nude 100 year olds in black and white and they shine light on the universal truth of time. Deep wrinkles and sagging skin make the bodies look almost unrecognizable but they’re also beautiful in an emotional way.

Three years ago and unhappy with her body, Adelaide mother of three Taryn Brumfitt was preparing to undergo cosmetic surgery involving a breast augmentation and tummy tuck.

It was while observing her daughter playing prior to the surgery that Ms Brumfitt began to question her choice, not only for her own body but from the future perspective of her children.

“I had an epiphany. I thought ‘how am I going to teach Mikaela to have a positive relationship with her body if her mum can’t love her body as it is’,” she said.

Cancelling the surgery, Ms Brumfitt committed to a body building competition and routine aimed to sculpt her physique and led her closer to achieving “the perfect body”.

“I just think, how did I even come to that but I did,” she told 702 ABC Sydney.

“I guess it was a personal, social experiment for me to discover how it would feel to have the perfect body. I got that body. I shredded every ounce of fat and wore a bikini and strutted on a stage and nothing really changed.

What followed has seen Ms Brumfitt lead a global campaign for change, starting with a before and after image of herself posted on her social media account, seen today by more than 100 million people around the world.

Struggles and strategizing: back at the beginning, again

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I struggle with my weight. It’s been a lifelong drama, with many supporting players: relatives, doctors, well-meaning (and not-so-well-meaning) friends and boyfriends, teammates on the many sports teams I’ve played for, nutritionists, therapists, you name it. Sometimes there’s relative peace—when I’m active, social, well-rested, not too-too busy in my work life, and my relationships are on an even keel—life is calmer and I worry less about it.

Lately, as menopause has announced its presence in my life (I’m sorry, but who thought this was a good idea? evolution, you’ve got some ‘splaining to do) the struggle has resurfaced. My sleep is interrupted, and I have less energy (but more mood swings—yay) and my cravings for sugar and carbs are at an all-time high. Add to this a heavier-than-usual workload this semester and 108 inches of snow in Boston (and by the way, it’s snowing again now—argh) and it’s no surprise that my average baked good consumption is up, and I’ve gained weight.

Samantha, Tracy, Nat and the guest bloggers have written loads about the failures and perils of diets—they don’t work in the long-term and contribute to lowered self-esteem and increased weight. I know this, too—my research areas are obesity, eating, and health behavior change. And yet I keep flirting with the idea of dieting again. For me, diets are like bad ex-boyfriends—I’ve forgotten the pain and suffering they imposed, how the relationships failed or even backfired. I just remember how good-looking or charming they were, full of seductive promises that “this time, it’ll be different”.

So what am I to do about being back in a state of weight-panic THIS time? Here are three things I’ve done this week. I’ll report back later on to let you know what’s happening—what is working, what I’ve jettisoned, what other responses I’ve adopted, and how I’m feeling.

1. I bought a book.

For an academic, nothing is more reassuring than book purchases, especially when one is confused, frightened, stalled, or in need of comfort. Just the thought of reading books, especially in a comfy study or library, is reassuring.

library

The book I bought is Gretchen Rubin’s “Better than Before: Mastering the Habits of our Everyday Lives”. The New York Times Well Book Club is running an online discussion, which caught my eye this week. Partly out of academic curiosity, and partly out of need to do something, I got the book and checked out the online discussion.

There are loads of books with loads of theories about behavior change, and of course this blog has talked about many of them. When I actually get around to reading this book I will fill you in. For now, all I’ve done is taken the quiz to set the stage for where I fit in Rubin’s behavior-change taxonomy. From there she has lots of suggestions for tailored strategies to optimize effectiveness.

Now, I have no particular expectation that this book is better or more effective than others; I will report back on my experiences later on. But for now, just owning this book feels like it’s helping me regain a little more perspective, which is good.

2. I’ve stopped eating sugary foods (at least for now).

While talking with a therapist about my energy levels, cravings, menopausal moods and general dissatisfaction with life on planet Earth these days, she suggested that maybe stopping eating processed sugar for a while might result in improvement of my overall mood and well-being. Just to be clear, I’m not talking about stopping eating these:

apples

but rather, stopping eating these:

bakery

For now.

I’m on day 3 of the no-baked-goods-and-other-sugary-stuff plan, and will report back on what I’ve done and learned.

3. I’ve changed primary care doctors.

This was a very big move—I’d been with the same doctor since 1998, and value familiarity, loyalty, and the deep knowledge base she has. But I never felt comfortable talking about my weight with her, and dreaded what she had to say, which never felt supportive. We squabbled about calcium and vitamin D supplements, and frequency of mammograms (she disagreed with the USPSTF recommendations which I wanted to follow). I would delay physicals in order to avoid being weighed.  Again, even though I know how bad the effects of weight stigma are on women in healthcare settings, it still took me a long time to act.

The first meeting with my new provider was eye-opening: she spent an hour with me (unprecedented in my experience), and we talked about weight, activity, menopause, sex, etc. in ways that felt positive and centered on my goals and needs.  I told her that I was willing to be weighed for my yearly physical and also when there was a medical need for complete accuracy (say, if this was a surgery pre-op visit).  Otherwise, I said I really didn’t want to be weighed, that it was a deterrent to my seeing her  She agreed, and we moved on smoothly.

Here’s how I handled the scale issue with the nurse (who I saw before the provider came in). She introduced herself and said, “I need to get your weight and height”.  I responded right away with “I’m not going to get on the scale, but I’m happy to tell you my weight; I weighed myself this week.”  She said okay.  When we got to the scale, she said, “you’re not going to get on the scale?”  I said no, but then told her my weight.  Then she asked, “are you willing to have your height measured?”  We both laughed, and I said yes indeed.  It turns out I’m the same height as the last time I was measured.

The issue of primary care office visits and weighing of patients is controversial and far from settled.  For what it’s worth, in a US National Institutes of Health document about treating obese patients, one of its recommendations is to weigh them during visits only when it’s medically appropriate.  I’m not here to speak authoritatively about this issue, but I did want to include how I handled my experiences and fears of weight stigma in this environment.

I’m very lucky not to be on any prescription meds, so I don’t see healthcare providers often. But I’m hopeful about my prospects moving forward with this new practice.

I’ll report later on progress, shifts, and lessons learned. For now, thanks for reading.

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Back to walking to work

It’s still quite cold in London, Ontario but the sidewalks are dry and clear and the past two weeks I’ve been walking to work. I know from my time using a Fitbit that my walking commute is the best way to get daily exercise in. I’m lucky, driving takes 10 minutes, walking 30 so I really don’t need to change much to make those steps happen. My feet and hips are aching a bit, I look like an evil garden gnome AND I’m very glad to be getting back to walking to work. Yay spring! 

 

“No excuses” no more: Fitness instructing from a place of body positivity (Guest post)

loveLast week, Tracy posted about her transition from indoor to outdoor cycling. In her post, she mentioned some of the things she likes about indoor cycling (everyone stays together, none of the unpredictability of the road, to name a few). She also mentioned some of the things she doesn’t, namely, being stuck right next to me:

“I may have grumbled a little bit about my winter of basement biking on the trainer. I’m not a huge fan of loud music. And one of the reasons I avoid fitness classes is that I get irritated when instructors holler out commands and tell us to work hard.  It motivates some, but it’s not my cup of tea. The other day I had the dreaded spot right beside the instructor. Cheryl is great, but please don’t put me right beside her with the speaker two feet behind me ever again.”

That’s right, I’m the Cheryl that busted Tracy’s eardrums and probably flung sweat on her in our coach’s sweaty basement. I’m also one of her former students, a freelance writer, and a blogger myself at Happy is the New Healthy.

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