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Insomnia caused by awareness of a sleep disorder

April 29, 2011

Can’t sleep. Fourth night in a row. Seriously glazed during the day, and inconveniently at peak alertness after midnight. So here I am blogging at 2 a.m.

The cause of my sleeplessness? I became aware that I have a sleep disorder. Severe obstructive sleep apnea, to be precise.  Take it away, National Institutes of Health…

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. You often move out of deep sleep and into light sleep when your breathing pauses or becomes shallow. This results in poor sleep quality that makes you tired during the day. Sleep apnea is one of the leading causes of excessive daytime sleepiness.

… The most common type of sleep apnea is obstructive sleep apnea. This most often means that the airway has collapsed or is blocked during sleep. The blockage may cause shallow breathing or breathing pauses.

“Poor sleep quality” is the immediate effect of sleep apnea. If untreated, it can also raise the risk of high blood pressure, heart disease, stroke, weight gain, and diabetes, among other happy consequences.

I have all the major risk factors for sleep apnea: I’m male, in my 50s, and overweight. And for some time, my wife has been aware of nighttime interruptions in my breathing. Which is kind of a scary thing to witness, yes?

So my doctor sent me off for a sleep study, which was the subject of a previous whiny blogpost. And earlier this week, he gave me the bad news.

There are two primary treatments for OSA: surgery on the soft palate, and the wearing of a lovely item called a CPAP (pron. SEA-pap), short for “Continuous Positive Airway Pressure.” It keeps the airway open by gently pumping air into your nose. And I cannot imagine being able to sleep while wearing one of these contraptions. I had enough trouble with a simple cannula during the sleep study; how in the world will I sleep with a plastic mask affixed to my head?

Ahhh, so comfy.

Nonetheless, sometime soon I’m going back to the sleep clinic to be fitted for… my very own CPAP. (There’s a nice title for a children’s book. What with our epidemic levels of childhood obesity, there must be a potential market of youthful apneics out there.)  My doctor assured me that CPAPs make a huge difference, and that people get used to them fairly quickly. I stifled a bitter laugh.

That night, I found myself in the unusual position of being fully aware of a normally automatic bodily process — sleep. I worried about having to sleep with a CPAP. I hated myself for being overweight and, hence, being the moral agent of my own problems. And most disturbingly, I wondered exactly what would happen when I fell asleep.

In the comfortable, well-protected existence of an upper-middle-class American, it’s extremely rare that you have a chance to stare directly into the abyss. Not actually being in the abyss, mind you; just getting a creepy sense of what it would be like if the foundations of your life were suddenly absent. Well, on Monday night, I felt that way about sleep: it was a mystery, a fog, an unknown country. With the obvious consequence: I didn’t fall asleep, at least not until about four in the morning.

That sense of the abyss has not stayed with me, but a vague uneasiness returns whenever I try to sleep. And I’m foggy, cranky, and unproductive during the day.

And oh boy, am I not looking forward to what comes next. Maybe my very own CPAP will be a revelation: the absence of apnea will be such a blessed relief that I’ll scarcely be aware of the big plastic doohickey clamped to my skull. I’ll be rested, alert, productive, energetic, and generally free of the medical condition that has blocked me from realizing my potential.

On the other hand, maybe I’ll be so obsessed with the CPAP that I won’t sleep at all. And I’ll have to choose between letting the apnea go untreated, or letting a surgeon carve up the back of my throat.

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