#nojoke

Sleeping for the first time in my life.

The doctor cut me off mid-sentence with an uncharacteristic, soft chuckle that made her face mask billow, “Oh, I assure you, Mr. Storey,” she said, her tone turned more serious, “you have never had a good night’s sleep.” I tried to process this information by thinking back to when people asked, “How did you sleep?” All this time, I thought I knew. Now, I wasn’t sure how to respond to that question. I thought I knew what sleep was. I had a reputation of sleeping on command. If that wasn’t sleep, then what is?

I returned to the conversation as she continued, “Based on the data and looking at your anatomy, you have been dealing with this problem your whole life. It is just that when you were younger, your body worked to compensate for lack of restorative rest.” Furthermore, the doctor shared that my problems with sleep have very likely contributed to weight gain (which I’ve always struggled with) and memory loss (I don’t remember if I’ve had issues with memories), and a loss of brain cells (Probably linked to the memory thing but I think I’m okay as I have a few billion or so left).

I was on my second visit to the somnologist, the formal name for a sleep doctor. During the first consultation, I had to answer a simple survey with questions like, “Do you often feel tired?” or “When you sit at a desk, do you start to drift asleep?” Options for answers were on a scale from “never” to “often.” After I finished, the receptionist tabulated the answers heuristically (as in not to be mistaken for medical advice) to indicate a level of sleep disorder. My survey results came close to 100%, which didn’t feel great, but I was finally glad to be in the care of people who could help.

For as long as I can remember, I have always been some form of tired. In high school, I’d often drift asleep for a minute or two during an afternoon class, especially on a warm day. I didn’t have to sleep for very long, just a bit to close my eyes, and I’d wake up feeling great for the rest of the day. I chalked it up to always being busy with school, work, and extracurricular activities like student government, student newspaper, and yearbook committee. As I got into college, my need for a two-minute power nap started to creep into morning classes, but not all of them, just the boring ones. I was still busy going to work and attending class full-time, but I added the additional data point of my level of interest in the subject divided by how engaging the professor was.

Back in the doctor’s office, she continued to share her thoughts on my condition. Newly educated on this problem, I thought back to other times when I had trouble staying awake. Like when I was in a dark room during a lecture or a movie—out for a few minutes. Every time I got on a plane—right before we pulled away from the gate through take off—boom, lights out until the chime that indicated we had climbed to ten thousand feet.

Years later, much to the chagrin of a good friend, I nodded off during a Wilco concert he took me to. I recall seeing the first five minutes of the opening act of Hamilton. Hell, I even fell asleep right before I got married. Thirty minutes out from go time, I decided to grab a quick nap. My mother woke me up to tell me it was time to get married.

All this time, I thought sleeping-at-will was a superpower. People around me frequently joked about how they envied my “ability” to fall asleep anytime, anywhere. Nodding off here and there seemed perfectly normal until it got worse. Much worse.

As I got older, I found myself conversing with people who shared their problems with sleep apnea. They told me about the CPAP machine, and inevitably, I’d make some form of a dad joke. Laughs ensued, and we’d move on to other topics. It’s about this time when I started to think that I might have a problem. Not only with sleeping but admitting that I might have an issue I can’t control on my own. And I didn’t like the idea of being hooked up to a machine, especially at night.

Most sleep tests are conducted in special centers that require an overnight stay. From what I gathered from others, you typically go in around 7pm, get hooked up to all kinds of wires and probes, and then tuck-in to fall asleep. I remember when a friend told me about this visit. He was only asleep for 30 minutes when the technician came in, woke him up, and told him he could go home because his apnea was so severe they didn’t need more data.

Thankfully I did not have to sleep in a lab. Instead, I was cleared to do a home-based version because COVID had disrupted so many tests that the labs were fully booked four months out.

I still had to go to a sleep center to get training on the “home test,” which resembled a giant, G-SHOCK watch. It took two minutes for the technician to explain how to turn the device on and attach it to my wrist properly. It took eighteen minutes to review the insurance disclaimers, legalization, and details on returning the device. I had to agree to conditions about the test and return the device promptly, or I would have to pay $5000 to the insurance company. I made it a point to return the device promptly the next morning as soon as they opened.

The “home test” aka Fancy Sleep Watch, doesn’t provide any data to the user. That information is pulled from the device by a technician who forwards it to the doctor. That’s all to say, I knew I had a problem but taking the test at home didn’t mean I knew any more than I did the day before. Weeks later, I found myself back in an examination room at the sleep doctor’s office for the results.

The Apnea Hypopnea Index is “the number of apneas or hypopneas recorded during the study per hour of sleep. The number is generally expressed as the “number of events per hour.” The number of times a person has apnea (loss of breath) or hypopnea (partial loss of breath) is divided by the hours of sleep. A normal level is considered fewer than five events on average, whereas a severe result is 30 or more events.

The doctor explained all of this to me and then revealed the results of my test. When she said that my AHI score was 70, tears began to roll down my face. I knew I had an issue, but I never expected a result so bad. How in the hell was I still alive? My mind raced to how my life could have been different if I had received treatment as a kid. I thought back to the nights of waking up several times attributing it to getting older or the food I ate or the beverages consumed. I had a hunch my quality of life was decreasing but not this bad. No way. If I had placed a Vegas-style bet, I would have lost my home. Thankfully those thoughts passed as we began to discuss treatment.

Ten days later, I had an appointment to pick up a device that provides “continuous positive airway pressure” or more commonly called CPAP. According to the Cleveland Clinic website, the machine “keeps your airways open while you sleep so you can receive the oxygen you need for optimal function. CPAP machines can significantly improve sleep quality and reduce your risk for a number of health issues, including heart disease and stroke,” which is great because I’m a big fan of never having to suffer either.

I expected to sit through a 10-minute presentation on how to plug the CPAP in, which buttons to press, how to make adjustments—routine instructions. Instead, I got the full one-hour workshop that included everything but the history of CPAP development. I walked into an incredibly bland, beige room, the walls sparsely covered with a few posters from device manufacturers. Half of them featured super healthy people smiling from ear to ear because they were now capable of deep, restorative sleep. The other half of the posters depicted the same type of people with a face mask strapped to their head connected by a hose to the CPAP machine placed on a nightstand with a dimly lit lamp shining down on a book with a pair of glasses resting on top.

I thought this was a big miss on the part of the CPAP company’s marketing departments. You walk into this place knowing that your life is about to change forever—hopefully for the better—but from here on out, each night, you’ll have to strap scuba gear to your face before counting sheep. You go in a Skywalker and come out a Sith Lord. This whole situation screams for the need for positive mask positioning. The walls of this place should be adorned with images of the most badass characters to don a mask: Darth Vader, Bain, Captain Dallas, Maverick, Immortan Joe. Where are the motivational posters with words phrases like BREATHE FREELY, DREAM AGAIN, or STAY IN BED BECAUSE YOU WON’T HAVE TO PEE SIX TIMES A NIGHT!

Why not make wearing masks cool, again, right?

Larry—I honestly don’t recall his name, but the middle age, balding, white (I’m not drinking fucking merlot!) male managing a medical devices sales company…yeah, he’s a Larry—ran me through all of the ins and outs of the ResMed Air Sense 11. His presentation finished with a bit of punditry on how much better the model 11 is from the 10. When Larry finished his monologue I replied, “So you’re telling me this is the Cadillac of CPAP machines?” He snorted, “Oh yeah! That’s certainly a creative way of putting it.” Up until that exchange I always presumed the most boring job in the world was selling life insurance. Not anymore.

I was told several times during the presentation that the CPAP collects data that goes to both my sleep doctor and the health insurance company. Larry told me that to avoid paying thousands of dollars for the device, I have to use it 20 days every month for ten months. I didn’t understand why he kept repeating this warning. If I had my way, I would have been on my third month because that’s how long it took to get through all of the steps. Was I unknowingly casting negative non-verbal communication? So, I interrupted and asked why.

Larry replied that many people go through everything, including this one-hour session, then take the device home and never plug it in. And some of these folks never take the device out of the box!

This process required three visits to a doctor’s office, a visit to a sleep study center in the middle of nowhere to pick up a “sleep watch” and drive back and drop it off the next day, and then sit through this session with Larry at Larry’s CPAP Barn. I estimate at this point, I had roughly ten hours invested in getting to this point. Why in the hell would anyone go through all of this just to go home and do nothing? That’s stupidity on another level, on the stupidity spectrum that I can’t see, not even with a NASA telescope.

As he zipped the carry-all bag closed, I thanked Larry for all of his instructions, grabbed my CPAP Cadillac, and headed home hoping my life was about to get a big upgrade.

I was tempted to try it out immediately, but I waited until the evening to get everything set up. I filled the “AirSense 11 Water Chamber” with distilled water, strapped the mask to my head, hooked up the hose between the mask and the device, and hit the “On” button. The machine came to life with a sound similar to a baby Vader drawing a breath. Air shot into the mask, sealing it to my face as the pressure built up. Larry said to expect a big surprise and that it might take me weeks to get used to the whole sensation. Maybe that happens to others, but I found it comforting. I rolled over to a side, my wife lovingly tucked me in, and fell asleep almost instantly.

While I slept like a log, my wife could not. She had grown so used to my not-breathing properly (aka snoring) for decades that the silence was unnerving. The following day she shared that she checked on me at 2 AM, found me sleeping soundly for the first time ever, and cried.

As part of Larry’s instructions, he gave me some anecdotal advice about what to do when nature calls in the middle of the night. “My advice,” he advised, “is that you leave your mask strapped on but pull the hose, leave the device still running, go do your “thing,” and reinsert the hose when you’re back.” I didn’t think much about his advised process because Larry’s the expert. So when nature called, I got up, and pulled the hose from the mask, and left the machine running. As I did this, the peaceful ebb and flow sound of breathing pressurized air was replaced with the sound of a roaring jet engine-powered vacuum. When I got back, I found the hose, plugged it back in, and fell asleep quickly.

So, in addition to what my wife previously shared with me about her version of the evening, she said that when I pulled the hose, our cats, previously sleeping peacefully, went into immediate DEFCON 1 mode. Manicotti, the cat who is constantly on high alert, shot up three feet into the air, landed on my wife’s head, hissed at everything around her, and bolted, full-tilt, for dear life.

Thinking back on this, I’m going to assume that Larry doesn’t have cats at home.

On January 7, 2022, I slept for 9 hours and 31 minutes. My face mask seal was rated “good” at 20.4L per minute. Events per hour—in other words, the number of times my rest was interrupted averaged 3, down from 70 during my sleep test in December. All in all, I received a score of 98 out of 100. In other words, I slept relatively normally for the first time in my life.

Seven months in my life has improved radically. I rarely wake up in the middle of the night, not even for “calls of nature.” On average, I went from sleeping 9-ish hours a night down to six. During the months leading up to the solstice, I had to make an effort to sleep five. It’s not uncommon for me to be up around 4-5 AM, feeling energized and ready to go.

I’m no longer tired during the day. The quick power naps are gone. It takes effort and meditation to get to sleep at night, a very new experience. My doctor said it would take a while for my body to respond fully to the treatment and I’m just now starting to really feel it. A few months later, I made more improvements to my life with changes in diet and exercising daily (this morning, I got a notification that I have closed all of my Apple Fitness rings for 170 consecutive days). Not only do I feel awake and increasingly optimistic, but I’ve also lost fifty pounds. And thankfully, Spaghetti and Manicotti don’t fear the machine anymore.

I think back on my life in the last couple of decades. All the things I have built, created, and led–Achievements that my younger self would never have dreamed were possible. And I did those things despite this handicap. Now I think about what I am capable of now. I’m not 100% yet, but today I get glimpses of positivity and confidence levels that never existed before. Give me a few more months, and I’ll be ready to Hawaiian Punch everything that comes at me.

I share all of this with you to raise awareness and hope that it helps someone who, like me, never realized they had a severe problem. It wasn’t until my body could no longer compensate for the lack of sleep that it quickly became a bigger and bigger problem. Sleep apnea had a real, increasingly negative impact on my quality of life in the last couple of years. This whole process of getting diagnosed and the lifestyle changes may sound like a bit of a fuss (it’s actually been the opposite), but there’s no way in H-E-double-hockey-sticks-hell I’d go back to my life before January 7th.