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Monday, December 20, 2010

Some Health Issues

First of all, calm down. Whenever people read the phrase 'health issues' in the title of a blog post they always assume the worst.

No, I'm not dying. Well, actually I am dying... but I'm doing it at about the same rate as everyone else (tfu, tfu tfu).

Many of you may remember last year I finally woke up (pun intended) to the fact that our mattresses were [figuratively] killing us? For the record, 18 years is way too long to hold onto even the best mattresses. People, you spend a huge chunk of your life in bed. Be a sport... if you're waking up tired and sore, blame the bed and buy something better.

Anyhoo... we went from what had been some very high end Sealy 'Posture-Pedic' mattresses to some very high end Visco-Elastic foam (like Tempu-Pedic) mattresses from a company called Comfort Living (which has offices in Israel and in the US).

The quality of my (our) sleep improved dramatically once we had more comfortable beds. However, many of you left comments recommending that I should still consider getting my doctor to prescribe a sleep study in a hospital sleep laboratory (instead of the rather low-tech home experiment I had conducted).

At the time, agreed that having a formal sleep study done would be a good idea. And then did exactly nothing about it.

Over the past year I have noticed that, even though I'm not sore in the shoulders and hips the way I had been in our old bed, the quality of my sleep was going down the toilet again. I was exhausted during the day... was falling into bed nearly as soon as I got home from work... and yet I was waking up tired and fatigued every single morning.

Finally Zahava convinced me to see a doctor.

Well actually, she simply made an appointment for me (she knows what a sloth I am about following up on good advice).

Our family physician cut me off mid-sentence when I started telling him what I just told you. In less than a minute he had written me a referral to see an Ear Nose and Throat specialist.

Before any of you start accusing him of malpractice, calm down. He took my temperature, blood pressure and listened to all the gurgles and thumps my body makes while keeping me alive. But I could tell his heart wasn't in it. In his mind, I was already sitting in the waiting room of the ENT.

The appointment at the ENT was equally perfunctory. He looked at the referral from our family doc, looked in my mouth, nose and ears (Hey, that's his specialty, right? At least I knew I was safe from the dreaded rubber glove!), and asked me how my wife was sleeping.

I was puzzled by the question. "Don't you want to know how I'm sleeping?", I asked him. He responded that most people have no idea how they sleep (unless they are insomniacs), and spouses can give much more reliable information. I thought about it for a second and realized he was right. Zahava was always complaining about me waking her up at night with my snoring... and in fact, her sleep was suffering nearly as much as mine.

He told me that I needed to lose some weight (for that he needed to go to medical school?!), and told me that my uvula was a little on the long side (which could be taken care of with a small surgical procedure if necessary).

But he said said that his immediate worry was that my exhaustion might be caused by sleep apnea... a fairly dangerous cessation of breathing while asleep. The only thing keeping apnea from being fatal is that apparently when the body senses you've stopped breathing, the brain wakes you up so you can do something about it (like take a breath, idiot!).

Except when it doesn't. [yikes]

Within ten minutes I was back on the street with a referral to a Hospital Sleep Laboratory.

I immediately called up the sleep lab and was pleasantly surprised that they had an open spot in less than two weeks on a Saturday night. I grabbed it, and they sent me a faxed confirmation of the appointment telling me when to be there (10PM) and what to bring (pajamas, toothbrush,, etc.). I faxed this document to my health fund and they sent the financial commitment to cover the cost. I love socialized medicine!

[The actual sleep study is a blog post all by itself which I'll leave for another day. It's written... I just need to sit on it a little while longer. I've taken out all of the swear words and almost all the actionable insulting language... but it still needs a tad more fine tuning to be acceptable for a family blog.]

Let's flash forward to the report issued by the Sleep Laboratory.

When it arrived in the mail, I eagerly opened it up, read it cover to cover... and understood exactly nothing. It was page after page of data that had been gathered during the night via the roughly 150 wires and electrodes they had stuck to every exposed part of my body (and some to parts that weren't exposed).

Even if it hadn't been the obvious next step, I knew I would need the ENT to interpret the test results for me. So seeing as my lovely wife was going to be in the doctor's office for one of our children in a few days, I gave the report to her and asked her to drop it off.

Zahava called from the ENT's office. Apparently he'd been waiting for the results and had looked them over on the spot. Houston... we have a problem.

Without going into too much detail (yeah right), I have a serious sleep issue.

Apparently sleep is divided into two categories: REM (Rapid Eye Movement) and non-REM. If you're really interested you can go read this and find out more than any individual really needs to know on the subject. But here's the abbreviated version:

Non-REM sleep has three different levels. The scientists can measure all kinds of brain waves which tell them which level of non-REM sleep you are in. But aside from being able to identify the different levels, they don't really know much except that most people spend about 3/4 of their sleep time moving back and forth between the three non-REM stages of sleep.

That leaves approximately 1/4 ( maybe even a little more) of the typical human's sleep time which is spent in REM sleep.

REM is so called because one of the signs you are in it is that your eyes move around rapidly (duh!). REM sleep is when we do almost all of our dreaming. It is also the sleep stage where our muscles experience a sort of paralysis (maybe to keep us from acting out what we're dreaming about and possibly hurting ourselves). Some anecdotal evidence has shown that people who don't experience REM sleep (for whatever reason) can experience serious mental health issues, or even die. Cool, huh?

The funny thing is that the medical community doesn't really understand much about sleep. Like I said, they can identify all the stages and have a clear idea of what healthy sleep habits look like in a normal human. But amazingly, they still don't fully understand why we sleep or what it does for us. All they know is that sleep deprivation is fatal, and poor sleep can cause a host of health issues.

They also know that, while a person can experience a 'sleep debt' from continuously not getting enough of the various kinds of sleep... sleep is not something you can save up and bank like money for future use. The best you can do is slowly pay back the debt.

Even sleeping the correct number of hours isn't enough to stay healthy. You see, we humans (like most organisms) have something called a Circadian clock which tells our body what it should be doing during the 24 hour period of each day. So if you try to sleep when your body isn't ready for it, you will not get the full benefit from the rest.

Getting back to me, though... the ENT explained that I was waking up about 22 times per hour during the night due to my brain sensing that I was not breathing. Some of the longest cessation of breathing I'd experienced during the night at the sleep lab had been just under 90 seconds.

Let's take a moment while you absorb that information. Better yet, lets do a little experiment: Try to hold your breath. Take a big lung-full of air, look at your watch... and hold it (your breath, not the watch!) as long as you can. Go ahead, I'll wait.

How'd we do?

You can tell me your time in the comments, but let me add something at this point. Those long periods when I stopped breathing weren't preceded by taking a big lungful of air the way you just did. I exhaled normally... and simply didn't inhale for well over a minute (on many occasions)... until my brain panicked over the lack of oxygen in my bloodstream and applied the jumper cables to my muscles to wake me up.

More fun facts:

A healthy adult generally has more than 95% 'pulse ox' (oxygen saturation in his/her hemoglobin) as measured by a little instrument that clips onto a fingertip. Anything less than 90% is a condition called Hypoxemia (look it up... I can't link to everything!). When you drop below 90% on that particular stat, your body isn't getting enough oxygen, and you are in danger of a host of things, including... well, let's not talk about that right now.

My sleep study report indicated that my average pulse ox while I slept was 85%.

What does all this mean?

Because I wasn't getting enough oxygen, I was waking up. A lot. Because I was waking up so often to start breathing again, my body wasn't going through the various non-REM sleep stages in an orderly manner... and my REM sleep was almost non-existent (less than an hour, all told).

Like I said, people who don't get the proper amounts of each kind of sleep - and especially those who don't get enough REM sleep - are susceptible to a host of physical and mental health problems.

So yeah. There it is.

Again the ENT reminded me that I need to take off some weight. I'm working on that, but that isn't going to happen overnight. He also said that at some point we can talk about snipping off part of my uvula (an outpatient procedure with few risks but which nausiates me to even contemplate), to try reduce a potential cause of my apnea.

The good news is that apparently one of the side effects of my sleep issues is that the body gets so run down that it doesn't burn food efficiently... leading to weight gain (or at least making it very hard to loose weight). He said that once I start sleeping properly it will be much, much easier to lose weight.

But the immediate remedy to keep me from having a nervous or physical breakdown (or, G-d forbid, dying) is that I have to start using a C-PAP machine.

Glad you asked.

A C-PAP machine is basically a little electronic device about the size of a small clock radio that uses positive air pressure to force air into your (well, actually my) lungs during sleep.

I was worried about being able to sleep with a hose attached to my face... but it is actually fairly unobtrusive. A tiny soft plastic piece fits under my nose and is held in place by some straps. A hose runs from the nose piece to the bedside machine. The uber-quiet machine turns on automatically when you put it on... and turns off when you take it off.

So far I can report that in the week I have been using the C-PAP machine I have been waking up feeling incredibly well rested and refreshed. I still wake up occasionally during the night because of the odd feeling of the thing on my face. But it is far less frequently than before... and I am actually getting real sleep for a change.

The only real challenge is that to use the C-PAP, I need to sleep with my mouth closed all night. If not, all that air being pushed into my nose goes right out my mouth instead. Not to worry though... this has only happened a couple of times, and the sensation is so bizarre (like having a stranger exhaling air from my mouth) that it wakes me up immediately.

Well that's about it. I'm spending time on the treadmill and being more careful about what I'm eating. But most important; I am finally getting some quality sleep.

I'll keep you up to date as things (hopefully) continue to improve.

Posted by David Bogner on December 20, 2010 | Permalink

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This reminds me on a study showing that married men live longer and are more healthy than single men. You are just an example. Unfortunately the study also shows that women do not benefit from being married the same way. Hail to our wives!

טוב בלילה

Posted by: Kurt | Dec 20, 2010 1:56:41 PM

This is a family blog?

Posted by: Baila | Dec 20, 2010 3:31:51 PM

Glad you're taking care of this - a lot of us seem to have sleep apnea (without the CPAP I tend to wake about 73 times per hour). The difference is amazing. I actually use a mask that covers my nose, and I find the result is that my mouth stays closed automatically.

Posted by: Russell Gold | Dec 20, 2010 3:50:53 PM

What happens if you don't remember any dreams?

Posted by: Aharon | Dec 20, 2010 3:51:07 PM

Hi Trep.

Long time no talk.

I hope you don’t mind unsolicited advice. (You never did before.) And you can always run this past your own doctor or Psychotoddler for confirmation.

CPAP is the most proven treatment for sleep apnea (except weight loss which I take for granted you’re working on). The uvula surgery has much more mixed results, and unlike other treatments isn’t reversible. You can always stop using CPAP if it doesn’t work; you can’t have your uvula back.

The generally accepted algorithm for sleep apnea is:
1. keep working on weight loss
2. use CPAP
3. for those who can’t tolerate CPAP use a mandibular advancement device. That’s a custom made dental thing that you wear in your mouth that pulls your lower jaw forward, keeping your uvula off the back of your throat and thereby keeping your airway open. Again, it’s reversible; you can always stop using it.
4. Surgery is generally considered only for people who fail both CPAP and the dental device, and it doesn’t always work.

Whatever you end up using, you should have a sleep study with that modality (i.e. a sleep study with the CPAP or dental device) to show that it’s working and you’re breathing normally with it.

Stay well.

Posted by: Albert | Dec 20, 2010 4:46:42 PM

Many years ago, I worked with a woman who started using a C-PAP. She dragged herself out of bed in the mornings, insisted she wasn't a morning person, and was constantly tired. Once she started using the device, she was a different person. She had energy, was bright and cheery, told me she was waking - on her own - at 6am, feeling refreshed and energetic. I've never w- not once - woken up refreshed or energetic. Colour me jealous.

I'm sorry you're having to deal with this, but glad there's an answer to the problem. Good luck with the weight loss!

And. Um. Really looking forward to the actual sleep study post.

Posted by: Alissa | Dec 20, 2010 5:03:48 PM

I've been using a CPAP for several years now and it's been great. I adjusted to sleeping with a mask a lot quicker than I thought I would; in fact, now I find it easier to fall asleep with it on than without it. I know some people have had very dramatic results when they began CPAP therapy - almost like waking the dead - but for me it was a bit more subtle. I'm more alert during the day, don't get as fuzzy-headed in the afternoon, and my overall mood is significantly better.

I'm glad you've found the problem and have been able to take action to correct it.

Posted by: Chichikov | Dec 20, 2010 5:25:15 PM

Oy! Good luck with the weight loss and I hope this all gets resolved very soon!

Posted by: SaraK | Dec 20, 2010 5:54:22 PM

David, I have a very similar experience, only I'm about 12 years ahead of you! I used to want to fall asleep around 2-3 every afternoon. My wife wore earplugs and still couldn't get a good night's sleep because of my snoring. I guess the only 2 difference are that I was referred to the sleep clinic directly from my primary care physician (not ENT consult) and I had managed care, not socialized medicine (I won't go into that debate right now). Because I have very restricted air-flow in my nasal passage, I use the full mask which covers the mouth and nose. My wife says that, although I do still snore some, it's not nearly as bad and the mask itself muffles the noise. She doesn't even wear earplugs anymore!

One cautionary tale. I was given the CPAP and fitted for the mask by a medical supply company run by our local clinic/hospital. Within a year I had numerous cavities which eventually led to the removal of 2 teeth. In talking to my dentist he mentioned dry mouth being a cause of cavities and I, of course, mentioned that the CPAP dries out my mouth. He replied with "But you have a mister attached to the CPAP which puts moisture into the system, right?" "Umm, no" He was incredulous. The medical supply company hadn't included any sort of humidified device because the doctor hadn't specifically requested one. I didn't know that I needed one because I'd never used a CPAP before, and so on.

Anyway, I use the full mask and not only do I look like a fighter pilot (in my own mind, anyway), but I do sound like Darth Vader when I speak... too cool!

Good luck!

Posted by: ProphetJoe | Dec 20, 2010 6:57:59 PM

Oh, by the way, I simply love the real name for an ENT -- otorhinolaryngologist.
Oto=ear rhino=nose laryng=throat olgy=the study of

Trivia for the day!

Posted by: ProphetJoe | Dec 20, 2010 7:01:19 PM

David writes at one point: "I love socialized medicine!"

(Goodness! David! SHHHH! Not so loud for some of your American readers. If you had said that during one of the numerous "town hall" meetings held in the US last year, you would've been greeted with hoots of "Marxist Commie!! Socialist!! 'Death-panel' lover!!!")

But seriously, I have a couple questions for you here:

1). What percent of the Israeli budget is spent on health care? Is it considered a contributing factor to any spending deficit by the government?

2). When Netanyahu took office, did he or his appointees make any kind of push to make health care/insurance more "free market" oriented? Or, (related):

3). Is the Israeli health care system one "legacy" of Israel's Labour Party that even those who identify themselves as part of Israel's "economic right-wing" consider to be untouchable?

Good luck with the sleep issues, and, yes any study results will I'm sure be read with great interest...

All the best,

Mike Spengler

Posted by: Mike Spengler | Dec 20, 2010 7:30:32 PM

there is a laser procedure for the palate. a little less invasive than the surgery.

Posted by: dave | Dec 20, 2010 7:36:15 PM

Not all sleep studies are the same. I've had 3. The first, I walked out of. The next two were much more pleasant (not pleasant but much more so) than the original. I think that it's just that the staff became more experienced and the equipment more sophisticated. It is difficult to sleep with up to 29 thin leads attached. But if you're tired enough you can do it.

The CPAP machines have also come a long way. My original one was more complicated nosier and louder than the one I am currently using. I'm sure it will get better.

By the way my machine collects compliance statistics and monitors my sleep. At the end of the year I brought my card to the sleep specialist and he was able to give me a report on my sleep performance.

In the US it seems that sleep is a pulmonary subspecialty and not the provenance of the ENT specialist.

My recollection was that your Yonah also had an apnea problem and his adenoid procedure solved it for him. You'll be glad to know that I referred someone to your posts at that time and they were able to help their young child with a similar problem.

Yes, the CPAP did give me my life back. Yes, compliance is an issue with CPAP but it is well worth the effort to stick with it.

Good luck.

Posted by: Henry | Dec 20, 2010 8:18:27 PM

Interesting post!

Two comments:

Forget the uvula surgery. Results mediocre at best, primarily for those who fail weight loss and CPAP. Lose the weight as if your life depended on it--it does.

Do you read Andrew SUllivan's blog, the Daily Dish? He had a great thread on CPAP and apnea back in October. Worth a read.

Good luck.

Posted by: MD in the States | Dec 20, 2010 11:11:01 PM

1st: I'm sorry you have to deal with this.

2nd: I have a CPAP and so does my husband.

3rd: If a burglar walked in our bedroom I'm sure he'd think he had entered the mother ship.

4th: I stopped breathing 21 times an hour and couldn't get through a day without a sizeable nap.

5th: Welcome to the club. Glad you got checked. Points for Zahava!

Posted by: Maya | Dec 21, 2010 12:50:58 AM

A friend has been using the mask for years. It saved her life when her heating system went nuts spewing soot all over the house.

Added bonus is that your wife is sleeping better, because the snoring doesn't wake her up. Many spouses have to find tricks so as not to be awakened by snoring.

Posted by: Batya | Dec 21, 2010 8:15:29 AM

Kurt ... Reminds me of the joke: Q: Why do men usually die before their wives? A: Because they want to. :-)

Baila ... Compared with most of what's out there. Yes, I'd say it has a G rating. Maybe occasionally PG.

Russell Gold.. You're so competitive. :-)

Aharon ... I rarely do.

Albert ... Where you been?! I know, you've been practicing medicine. But you've been missed. Thanks... I always welcome advice from trusted sources.

Alissa ... The difference is striking. I hope that I can keep it up.

Chichikov... Nice to see you over here. I'm not quite 'there' yet in terms of preferring to sleep with it. It still feels odd. And it is really drying out my sinuses, so I am going to have to look into getting one of the humidifier attachments that can be added to the CPAP machine.

SaraK... Thanks. You and me both.

ProphetJoe... My kids say it makes me look like a scuba diver. BTW, I thought that was someone who studies birds. :-)

Mike Spengler... That is a huge discussion. However this should give you a lot of background. Everyone is covered here. And those with the means can opt for several tiers of additional 'private' insurance if they wish. We must be doing something right because the health care here is excellent and there is even a thriving medical tourism business. Long story short, it is not the third rail kind of topic here as it is in the US.

dave... In layman's terms, what exactly does the laser procedure do? Does it remove tissue? If so, from where?

Henry... You made my day by telling me that someone else benefited from what I shared. Thanks.

MD in the States... Thanks. I was steering clear of that in any event. the idea of it scares me. I'll look for the article you mentioned.

Maya... How is it that I didn't realize that half the world uses these things? I was feeling like such a failure and an oddity.

Batya... I wouldn't want to rely on this to save my life in a smoke or soot situation. The filter is tiny and the machine is drawing air from the same area you'd be breathing from.

Posted by: treppenwitz | Dec 21, 2010 8:42:23 AM

Both of my parents have used CPAPs for several years now- it has made a huge difference for them.

Posted by: Jack | Dec 21, 2010 11:09:50 AM

My Dad had similar problems, waking 18 times an hour with snores registered at 85-90 decibels.
He did the operation straight away - it wasn't fun but he soon recovered and now both he and my mother can get a decent night's sleep and feel much healthier as a result.

Posted by: Esther | Dec 23, 2010 6:28:05 PM

I'm curious to read all about your actual sleep-study....have you finished polishing??

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