Wednesday, July 27, 2016

Dealing with and Treating Sleep Apnea

ResMed CPAP Machine with full-face mask
More than a month ago I was diagnosed with moderate to severe sleep apnea. When it exactly started, I am not entirely sure, but I must have had this sleeping disorder for at least two years now.

At first, I noticed that I would often wake up the next day feeling not refreshed and tired throughout the day. After nights of stronger sleep deprivation, I would end up forgetting simple things; once I could not remember the PIN number of my credit card (good thing that I had enough cash on me that day to finalize the purchase).

What would happen to me was that I would occasionally stop breathing, which is the Greek meaning of apnea, with pnea standing for breath. This would result in strange suffocating dreams. I would see myself in tight places that I needed to crawl and climb through. This was basically my brain signalling me to wake up as it was not receiving sufficient oxygen.

In other cases, I would wake up coughing and even gasping for air. This would be sometimes so strong that I would have to get up and walk to an open window to let the fresh air calm me. I attributed this to asthma, as I often find myself slightly short of breath even during the day, although thank goodness I don’t have asthma attacks and, in my case, it is on the milder side and does not leave me out of breath.

But my wise wife had told me to get checked for sleep apnea. I discarded this – out of pride or foolishness, or both – until the month of June, where I had my worst sleeping episodes in my life. I would hardly get a wink, and if I did, I would wake up coughing. One night, I just could not get to sleep, no matter how hard I tried; all in all, I had perhaps one hour of sleep that night!

The next day was very difficult, not to say torture, but I am quite good at controlling my mood for the duration of my long workdays. However, I would get home, completely exhausted, and, at times, I felt even slightly depressed, which is generally quite an anomaly for me.

This continued for a while, with me forcing my way through days that should have been easy and enjoyable ... until one day I could not remember Tom Hanks! I could not remember the actor of Forrest Gump! I knew then that I had to go to our family doctor for a check-up.

As she heard about my symptoms and after asking me some more questions, she concluded that I had sleep apnea and sent me to a clinic for a sleeping test. The test was at-home with an oximeter attached to a finger to check the oxygen rate of my brain as well as another device on my chest to check my pulse and heartbeat, I suppose. It was a doubly uncomfortable night, but at least it took place in the comfort of the home instead of an overnight stay at the hospital.

The next day, I found out that I had had about 250+ episodes of apnea over that night, which broke down to slightly less than 30 an hour! This was definitely not good news, but it was at least something to work with.

The sleep specialist checked with me one by one all the symptoms of classic sleep apnea: Yes, my weight gain over the years did not help the issue, my BMI was too high, my neck circumference was not good either; I did snore; I had trouble breathing through my nose; I woke up to go to the bathroom more than a few times at night; I had night sweats and occasional migraines the next day; I felt like crap the next day.

Now before the diagnosis I had experimented with a new cervical pillow, breathing strips, a mouth guard, and they may have given me some slight relief, but nothing major nor of substance. So the chosen treatment, not cure, ended up the dreaded and feared CPAP therapy.

The CPAP machine, short for Continuous Positive Airway Pressure, is supposed to provide me with constant air pressure throughout the night. It detects episodes and provides the additional air to prevent them from becoming more serious.

The lack of oxygen, at some point in the quite dangerous territory of 70%, would cause damage not only to the brain but also to vital body organs and could lead to a number of ailments, including stroke, diabetes, and obesity. So in a way, it was a vicious cycle since part of my weight problems came from the disease itself, which ended up aggravating it!

As I cannot breathe through my nose, I was given a full-face mask. Now this looks worse than it is, but it is rather hard to get used to it. At first, the mask would feel too tight and not let me sleep. Then, once I somewhat got used to it, I had to worry about mask leaks. This means that the mask would not seal completely and air would escape making the treatment somewhat ineffective.

Then, after a while, I seemed to get the hang of it, but for some reason, my sleep specialist decided to increase the air pressure by 3 cmH2O. This was the worst part of the therapy as I would feel dizzy the next day, felt occasionally nauseous and slightly confused and would have headaches upon waking. I contacted him via email, but he did not respond until we met again on our then weekly appointments.

Now one thing needs to be mentioned here. You need a prescription to obtain a CPAP machine, and it is purportedly illegal to change the pressure settings. As I am wont to do, I asked for possible side effects, and my specialist told me that it would be bloating, sometimes rashes as well as mask discomfort. Nothing serious though.

I looked up information online and almost all of them claimed that it was safe. The creator of the machine supposedly had said that the only way it could cause serious harm was to hit somebody over the head with the machine itself. CPAP has been deemed the best therapy under current standards.

However, the fact that it had to be prescribed first and then supervised did ring an alarm bell with me, alongside the numbness in my fingers upon waking at night. I would not be able to feel my pinkies, in some cases half of my hand and that was a side effect I did not like and that worried me a little.

It seems that it was more tolerable after the air pressure was regulated and decreased. My numbness was partly due to the positioning at night (I am usually a stomach sleeper, but with the mask and the tube, that becomes impossible). Although I did respect the opinion of my specialist, the fact that he is young and that he is selling the equipment for profit made me suspicious of the whole thing. I had renamed it CRAP.

Yet, as they say, it takes time for one to adjust to this type of therapy. One really needs to be patient. After the specialist lowered the air pressure and found a suitable range (they have the ramp option, which increases air pressure slowly within certain given parameters), I ended up having a few relatively good nights of sleep. That means, for our intents of purposes here, I would sleep for the occasional three-hour block and briefly enter the deep sleep stage. That definitely made me feel better the next day.

I would still have the occasional dream of constricted space – for instance, last night I had a dream of two friends pulling my head underwater at an open-air swimming pool – but I would suddenly feel literally a fresh breath of air and would not awaken as a result.

I was given another test this time under the CPAP machine to check for any possible underlying issues, but the good news was that my oxygen levels were stable, and my incidents were low. On some nights I even reached the 0 threshold of incidents (my AHI was 0.0), which my sleep doctor had previously thought not to be really possible.

So there you have it! After some very difficult times and some additional difficult times to try to adjust to this machine, I have recently found better sleep! I am grateful for today’s technology and resources, and, in this particular case, there is an option (not app yet) to follow some general results of each night’s sleep. At ResMed, they even give you a (rather generous) user score to help you along and to keep you motivated.

I hope that my positive sleeping trend will continue, but in the meantime I know that I have to develop more healthy habits. Yet with better sleep, I should hopefully have a somewhat easier time shedding some extra weight without having to overly sacrifice good food or the occasional wine in the process.

Anyhow, I hope this is of help for some readers out there. Nowadays I feel stronger affinity for others who also suffer from sleep apnea and are undergoing CPAP therapy. I have been following the message boards for tips and advice and thought I would share some of it with you right here on my blog.

If you are suffering from it or know someone who is, please consider my sympathy and here's a cyber high-five. If you suspect that somebody has this condition, please encourage them to see a sleep clinic as it is essential to discard this uncomfortable and possibly fatal disease.

If you do not have any sleep issues and have read this post merely out of curiosity or because of the simple and wonderful habit of reading my blog ; ) I would like you to cherish the fact that you have good sleep as there are many in the world who do not or cannot sleep well at night, whether they are suffering from sleep apnea, insomnia or any other sleeping disorders out there. And most importantly, I would like to wish all of you sweet dreams!

Monday, July 18, 2016

Race issues and Police Killings in the United States

Black nurse standing up to police officers in gear and armor
The recent cases of police officers being ambushed and killed in the United States is very frightening and alarming, to say the least. The fact that officers who are there to serve and protect us and whose job it is to uphold the law are slaughtered in a brutal and cowardly manner is a dangerous portent of anarchy and is a reprehensible act. There is, as President Obama has put it, no justification in those acts.

Yet although I fully condemn such atrocious acts, I can see how and why they have come about. Within the American police force, there are officers some of whom have abused their power and authority and have killed innocent black people. Unprovoked or exaggerated reactions towards people of color is nothing new, but nowadays thanks to current technology, it has come to the forefront; these incidents are unacceptable and completely out of place in any time period, but more so in our day and age. 

Surely, I am not one to believe that acts of violence can ever have positive effects, but I understand the sense of frustration and impotence when facing these abuses of power. These officers are like school bullies, except that the school authorities seem to side with them in this case. As a result, the victims feel helpless and let down by the system as a whole. In a society where self-defense is accepted and in some cases encouraged, acts of retribution may fall within dangerous perimeters of possible tolerance.

Innocent people have been killed on both sides of the spectrum and for those who believe two wrongs make a right, there may be a sense of vindication here. In fact, the shock and uproar over dead police officers is much more palpable and disproportionate compared to the continuous slayings of black people (there have been a number of documented cases in which the so-called perpetrators have been unarmed and even innocent).

This is where the hypocrisy of the system can be felt and where it does seem that the state favors its own, the police force over the general black populace. This is why movements like Black Lives Matter need to occur since in everyday life, their voices are not given the weight and importance they should.

If the state is interested in upholding a sense of justice and not merely protecting its flock or (inadvertently) sanctioning wrongdoings against the black population, something must be done in this regard. 

Put differently, if those who are supposed to protect the people (and that means all people not a select few of them), are not doing their job, then they ought to be punished under the full force of the law. If it ignores or justifies illegal proceedings and killings against a group of its citizens, then the state, as a whole, cannot be trusted or respected.

To reiterate my point, all of this is careless and dangerous. It can lead to utter chaos and unnecessary racial conflicts. This is all happening under the eyes of the first black president, and it is undermining progress that has been made over the past decades. 

This is not to say that the civil rights movement has reached or fulfilled its goals; many of those promises have fallen short as we are still far from true equality, but both groups, white and black need to step up and find a way to deescalate the tensions and to ensure that things do not get worse before they get any better. 

There are three broad suggestions I would like to make for the state and the police force. I believe that first and foremost, we need to cleanse the force from its rotten apples. This needs to be done in a clear and impartial manner. 

Those who have committed crimes need to be brought to justice; some have, but many others have not. Merely wearing a uniform does not give people the right to break the law. The police union needs to stop supporting them, or else the shame and blame could fall upon each and very member of the law enforcement.

This means that all those good cops, and they are the silent majority here, ought to distance themselves from their evil brothers and even condemn and denounce any possible wrongdoings. I understand the feelings of solidarity and brotherhood among members of law enforcement, but in this situation they would be fully misplaced. Worse, this type of support for evildoers would endanger fellow police officers who are indeed doing a great job to secure peace and order in these chaotic and troubling times.

The second point is about the screening process itself. Police officers should not only be physically but also psychologically fit for the job. Any person who demonstrates bigotry or racist ideology should be immediately discarded from the position. They cannot be entrusted with protecting all citizens if they have their own inherent prejudices especially if those would interfere with their actions and could lead to cases of injustice.

Thirdly, the state must ensure that the police officers earn the salary they deserve and, more importantly, that they are not overworked. Police officers deal with human lives on a daily basis and they need to have sufficient rest as their job is stressful enough as it is. They fall in the same category as surgeons and pilots; if they are overworked, their lack of concentration and errors can cost human lives.

Also, they should have constant support and access to health services. Counselors have to be at hand for any traumas or stressful situations. Let’s face it, police officers have to deal with the worst types of people often on a daily basis. As a result, they can turn bitter, cynical, and even paranoid.

Police officers witness horrible and devastating scenes of pain and violence, and it is important that they can deal with all of these issues and that these experiences do not have a negative impact on their psychological and emotional well-being. A police officer needs to be constantly responsive. 

That includes being well-tuned to the respective situation and even have (if not show) empathy and compassion whenever necessary. A police officer who lacks those qualities cannot be fully effective and may make matters worse.

A final observation is also aimed at veterans. They are the ones who at the bidding of the state get their hands and fingers stained with blood; they kill in the name of their country and they risk being maimed and psychologically damaged as well as killed in the line of duty. 

The Dallas shooter had served in Afghanistan, while the Baton Rouge shooter had served as a marine in Iraq and their military service must have had traumatic impacts on their psyche. Veterans need to be treated well; they must be taken care of and the state owes them at least as much for all that they have done for the sake of the nation.

To sum up, the United States has reached an important breaking point, all of which is taking place in an election year. With all of this trauma, there is the chance to heal and forge ahead in unity against the ugly faces of hatred, bigotry, and racism. Killings need to come to an end, be it police officers or black people; at the same time, respect needs to ensue, a respect that involves both sides and that can hopefully lead to trust and peace among the diverse faces of the American nation.