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.

About Cate Hundleby

I am an Associate Professor of Philosophy at the University of Windsor, Canada, where I am also cross-appointed to Women's and Gender Studies and Director of the Interdisciplinary PhD program in Argumentation Studies.