I jerk awake, mouth open, gasping for air. It is the sixth or seventh time that I have come awake this night with my heart pounding, my brain stem having punched the alarm when the oxygen in my blood got too low. I was dreaming, not of nameless terrors or falling—causes of childhood nightmares—but of a verdant garden party crowded with people of my past and present, a warm gathering did not wish to leave.
In recent years, my dreams have rarely played out uninterrupted. I need only relax on my back to experience breathing problems. The muscles of my throat loosen, the flesh of my airway becomes flaccid and gently closes off my supply of air. Last year I was diagnosed with mild to moderate sleep apnea, a condition characterized by long pauses between breaths while sleeping. It is caused by an obstruction in the airway—an excess of flesh in the airway or a passage that collapses when the throat is relaxed. Research indicates that overweight people may have an increased risk of sleep apnea and that losing weight may reduce the problem, but thin people are affected too. Fifty percent of people with sleep apnea are not obese.
Listening to a person with sleep apnea is both aggravating and terrifying. We are conditioned from the womb to take comfort in the sound of steady breathing. The snoring and snorting that accompanies a sleep apnea sufferer’s attempts to breathe may keep a partner awake, simultaneously irritated by the noise and waiting with increasing dismay during each pause for the sleeper to draw air.
The treatments for moderate to severe sleep apnea are crude. Some people are helped by wearing a face mask that repositions the jaw or retains the tongue. Others use a CPAP device—a breathing machine that uses positive air pressure to inflate the airway. I imagine my throat expanding like the long thin balloon a clown twists into an animal. The CPAP unit is loud in the stillness of the night. The user must wear a face mask and breathe in sync with the air pressure from the machine. By all accounts, the device is effective, even life saving for severe cases, but most people dislike using it. Surgery is an option for some. The doctor removes tonsils, adenoids, or excess flesh from the throat. But all surgery carries risk, and the procedure for sleep apnea is bloody, painful, and has a poor success rate.
My sleep specialist is an energetic Chinese woman inclined to chatter about her fiancé’s nightly breathing problems. She informs me there is a fifty percent chance that surgery will not work and a significant chance that it will result in the formation of scar tissue that will make matters worse. I ask about gentler remedies. She recites the list: lose weight, sleep on your side, raise the head of your bed, or use a nasal dilator, breathe right strips, or saline nasal spray to open your nasal passages. It may also help to stop using alcohol, tobacco, and sedatives, because they relax the muscles of the throat and encourage snoring.
I have slept on my back all my life, but I learn to sleep on my side and find some relief. Unfortunately, I have reached the age of osteoarthritis. When my shoulders hurt, I flop from side to side like a fish in a pail. Naproxen sodium helps to a degree, but I am reluctant to take it too often for fear that it, like aspirin and ibuprofen, will irritate my stomach. Finally, I discover Cyclobenzaprine, a muscle relaxant that consistently helps me sleep. I start visiting the gym regularly. The regular exercise helps most of all, even though I lose only a few pounds.
My diagnosis of sleep apnea required a sleep study, a cross between an FBI sting and a visit to a mad scientist’s laboratory. The university sleep center rents a floor in a local hotel. One room is converted into a waiting area. Couches face a coffee table littered with brochures about sleeping disorders. Another room is packed with monitoring equipment: humming computers, thick bundles of colored cable, and rows of video monitors.
At 9:00 PM, a humorless technician shows me into a hotel room like any other, except that it is equipped with a video camera mounted on the wall facing the bed. The room could be a porno set or the site of an illicit meeting—minus the picture frame to conceal the camera. She instructs me to relax, to read, to watch TV, and to get ready for bed. After an hour, a vivacious young woman comes in, her arms full of colored cables. She asks me to remove my shirt and proceeds to glue colored leads all over my head, face, and chest. The wires pick up brain activity. She fits me with a nasal cannula to feed an oxygen sensor. She supplements this macabre headdress with a band around my chest to record the expansion and contraction of my diaphragm. The bundle of sensors come together in a thick cable she plugs into an extra-large serial jack hanging from a hole in the wall. Should I need to get up in the night, she tells me, I must press the call button attached to the side of the bed. She will come and detach me from the serial jack so that I can carry the bundle of cables into the bathroom with me. Now, she instructs me cheerfully, I can sleep.
In the long hours of the night, I wonder how anyone can endure such an experience without appearing to have a sleeping disorder. As dawn seeps under the window shades, I am exhausted: Gulliver tethered by Lilliputians. At 6:00 AM, the attendant returns to detach and send me on my way. I wander into the pale light seeking breakfast, but nothing is open, so I catch an early train home. It is there, bolt upright in my armchair, that I sleep and dream of a lush green yard, the gentle swell of conversation, and the smell of barbecue.
Book II 