How Are We Sleeping?
We all know sleep is essential, whether or not we always admit it in the face of work, talk, or all-night parties. What I didn’t know is that it is possible to spend hours in bed, thinking you are sleeping, while not really getting proper rest. And the results are dramatic, though gradual. What begins as simple fatigue gradually progresses to include daytime narcolepsy, difficulty with concentration and memory, emotional irritability, depression and/or paranoia, zero sex drive, as well as a higher risk for hypertension, car crashes, heart attacks, and strokes, making it a life-threatening condition. Relationships suffer, work suffers, mental and physical stability suffer — all from a little-understood disorder called sleep apnea.
Recently my father underwent a “sleep study” to address his snoring and periods of not breathing during sleep. He was put in a small hospital lab room and told to sleep, surrounded by machines humming, light shining, tubes and wires all over his body and air blowing in his face. “Of course you wouldn’t get a good night’s sleep with all that fuss and racket!” he said.
Ideal or not, the sleep study determined that Dad was experiencing enough “apneas” (periods of not breathing) in his sleep to warrant a diagnosis of “Sleep Apnea Syndrome.” His doctor recommended a CPAP (Continuous Positive Airway Pressure) machine, which is an air blower with a plastic mask that you attach to your face while you sleep. It keeps your throat open, your breathing regular, and your sleep healthy.
But all this made me feel queasy, especially the image of Dad, face-masked, lying still on his back in bed, like people in movies about comas lie. What was worse, I soon discovered that he wasn’t the only one with this problem. Nearly all his siblings wondered if they should have a sleep study considering how well they’re sleeping. And out of the blue a woman from my church told me about her husband’s CPAP machine. He hadn’t liked it at first, but now he felt much better and wouldn’t do without it.
I was skeptical. Suddenly people aren’t able to sleep without machines to help them? Is this new-fangled medical hogwash, a method destined for anachronism, like leeching and ice-pick lobotomies?
The sources I found (a book entitled Phantom of the Night; Google, god of answers; and assorted medical articles) proved enlightening. Sleep apnea, though recently identified and poorly understood, is a major concern in the health of millions of Americans, and CPAP, however new-fangled, can be a godsend.
How does sleep apnea occur? For my dad and for most apnea patients, it all begins in the back of the throat. During sleep the muscles of the upper airway (such as the tongue and throat tissues) relax and become floppy. In some people these tissues hang close to the back of the esophagus and vibrate rapidly when air passes. The sleeper’s spouse, roommate, and sometimes neighbors, hear this as snoring.
Obstructive sleep apnea happens when the tissues and muscles aren’t simply vibrated by the suction of breathing in, but actually sucked closed. For ten seconds or more, the lungs simply pull harder, trying to get air through, but eventually the brain sends messages to pull up the tongue, tighten the throat muscles, and let the air come in - Gasp! Snort! And the sleeper goes back to breathing.
You’ve probably heard this happen while lying awake cursing a nearby snorer—he’s sawing away, when suddenly he goes silent. You know this is only a temporary ruse, and sure enough, a few seconds later he snorts loudly, mutters, and turn over.
While also annoying, this is neither natural nor healthy. Though the sleeper doesn’t consciously notice the apneas, the brain has to wake up a little to breathe, and these many “micro-arousals” break up the natural flow of sleep, and the natural restoration of the body and mind, which, when prolonged, traps the apnea sufferer in what Phantom of the Night calls a “half-asleep, half-alive underworld.”
Although sleep doctors are usually able to recognize symptoms of apnea, it is not so obvious to those who suffer the disease, most of whom are middle-aged or elderly. These symptoms can be attributed to other conditions, or they can be seen as simply part of getting older. As Daniel Pinkwater, NPR commentator, says on the back of Phantom, “I woke up gray in color, got exhausted taking a shower, and fell asleep during breakfast. I didn’t think anything was wrong with me. ‘This must be middle age,’ I thought. No wonder my father had been so grouchy.”
I was surprised to learn that snoring itself, though it does not always indicate sleep apnea, is associated with similar symptoms and elevated risks. This means that sleep concerns are no isolated problem, but one affecting a wide swath of the population. The American Sleep Apnea Association (www.sleepapnea.org) says that “more than twelve million Americans suffer from sleep apnea, and it is estimated conservatively that ten million remain undiagnosed.” Phantom estimates that 4 percent of men and 2 percent of women suffer sleep apnea, but that snoring affects 40-50 percent of men over age 40, 20 percent of middle-aged women, and 40 percent of elderly women. It can also affect young adults and children.
As a twenty-something, I’m unsettled by the probability that I will suffer sleep problems twenty years down the road. But beyond that, what I learned about “good sleep” versus “unhealthy sleep” turned my attention to my current sleeping habits. When Phantom asks, “Do you wake up feeling rested and alert?” I ask in return, “Who does?” From high school through college, the norm became to wake up feeling groggy, drag myself through the preparations for the day, and spend the first few hours of work or class waking up. At night, I stayed up right to the brink of bedtime doing homework or entertaining myself. And I slept as late as I could on the weekends, forcing myself to sullenly readjust to an early rising on Monday. When was the last sustained period of time when I got eight plus hours a night, woke up at the same time every day, or any of the other “sleep hygiene” advice I’ve read? And as for the advice to lose weight, exercise more, and avoid caffeine and alcohol—I’m not optimistic about decent sleep for most Americans.
Isn’t sleep sort of a given? Aren’t we born knowing how to sleep properly? How can something so fundamental become so widely ignored, even to the point of taking on a self-destructive nature in sleep apnea patients?
For questions like these, my favorite culprit is “American Culture,” and Phantom backs me up on this. “Our culture praises the worker who succeeds on four hours of sleep; it judges harshly a tired person, who is seen as lazy, immoral, and unproductive.” One of the symptoms of sleep apnea is “automatic behavior” - doing complex tasks, such as driving, in a half-awake daze. How many of us have cultivated, as a survival skill, the ability to get through the day, follow schedules and routines, and maintain appearances, regardless of our energy level? Perhaps it’s not surprising that many people suffer sleep apnea for decades before realizing something is seriously wrong.
How depressing. But perhaps, in my favorite sleep tidbit, there is a ray of hope. Dolphins can keep one half of their brains awake while the other half sleeps. If dolphins can do it, why can’t we? We don’t need to change our 24-hour-a-day, espresso-powered sleeping habits—we just need to evolve.
Jonathan Wichmann ((jonathanwichmann@gmail.com) ) is headed for a book in the bath before bed.
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