Book Preview – Breathless Sleep…no more. A Compelling Case Study.
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Foreword to 1st edition
Foreword to 2nd edition
Introduction : Why I am compelled to write this book. p1
Chapter 1: The many tentacles of the “apnoea octopus”. p5
Chapter 2: Facing and conquering my worst fears. p13
Chapter 3: A now and Zen experience – bodily changes and the benefits of quality sleep. p35
Chapter 4: Liberation at last! – Freedom from the machine. p43
Chapter 5: To be in control or to be controlled – that is the question. p53
Chapter 6: Speaking in Tongues. p63
Chapter 7: What does it all mean? Or “less” means “more”. p77
Chapter 1 – The many tentacles of the “apnoea octopus”
Sleep apnoea is a pause in breathing during one’s sleep pattern. The word apnoea (US apnea) medically means a temporary cessation of breathing. The word comes from the Greek word apnoia which, in turn, comes from apnous meaning breathless. It can last several seconds or several minutes. In extreme cases it deprives the brain, heart and other essential organs of oxygenated air necessary for the proper functioning of our body. As we all know, our body and mind need the restorative effects of a good night’s sleep.
I can recall, when I was in my thirties, being roused to partial consciousness by my wife because I wasn’t breathing. “Paul – breathe!” she would exhort from some far distant valley. After processing my scrambled thoughts, I rolled over and wondered what she was carrying on about. Invariably, I would later discover, I had been snoring whilst lying on my back … until I stopped breathing. This abrupt halt to my breathing caused my wife some alarm. However, I was largely oblivious to what was happening – let alone why it was happening.
In later years I would learn that snoring is the body’s attempt to slow down the rate of breathing. If we over-breathe or hyperventilate, we deplete our lungs of the amount of carbon dioxide (CO2) necessary to regulate our breathing and maintain the pH (or proper acid/alkaline balance) of our blood. The maintaining of the correct pH levels is essential for all living organisms.
I would also learn that the sudden and abrupt interruption to my breathing was a signal from my body that its lungs needed to replenish the amount of CO2 necessary for efficient breathing.
During my thirties I was overweight. I was married with two young children. My wife worked irregular hours and I was a self-employed lawyer. The recession in 1991 forced me into sole practice. Life was challenging enough without the debilitation caused by sleep apnoea.
Unconsciously I continuously breathed through my mouth both day and night – like an animated goldfish. But just as a goldfish cannot be sustained by breathing through its mouth, neither could I be adequately sustained. Yet I had done so all throughout my childhood and teenage years and right through until my late forties. The only time I can recall it ever bringing itself into focus was when I was a teenager and a friend of mine punched my arm when I ridiculed him for breathing noisily through his nose. We were at a funeral and the noise made by his whistling nose jarred with the otherwise funereal silence expected on the day. Also, his nose breathing annoyed me. It struck me as an unnatural aberration. Didn’t everyone breathe through their mouth?
Yet now I would no sooner breathe through my mouth than put my hand in a frypan of hot oil. In the space of nine months – a mere pregnant pause – I managed to overturn a lifetime habit of mouth breathing and convert to exclusively breathing through my nose.
With the benefit of hindsight, I can now reflect on how sleep apnoea impacted on my quality of life. As a young man in my thirties I would often fall asleep in front of the television in the evening. I also experienced, on more than one occasion, episodes where my heavy eyelids would stay closed for many seconds whilst night driving. At times my car would swerve off the road forcing me to quickly correct the steering wheel. I would wind down the window and drive with a wall of cold air reviving my sleepy brain. The worrying aspect was that these episodes sometimes occurred when my children were in the car.
In fact, studies have attributed more than 20% of road accidents to driver sleepiness. Sleep apnoea, affecting about 25% of middle-aged men, has been identified as an important cause of driver fatigue. Drivers with sleep apnoea have shown to be at 2–7 times increased risk of motor vehicle accidents compared with drivers who do not have sleep apnoea.
It has been my experience, whilst driving, to momentarily fall asleep without warning. Even though I was consciously aware of being relaxed and tired I had no warning whatsoever of the possibility that my eyes would actually close and that I would succumb to a microsleep.10 Even after experiencing such an alarming and frightening episode I recall treating it as a total aberration and being utterly convinced that it would not happen again.
In an article in the 2003 Medical Journal of Australia on fatal fall-asleep road accidents it is observed that studies have shown that healthy people do not fall asleep without a significant awareness of sleepiness for some time before a “fall-asleep episode”. However, it is important to note that this research on awareness of sleepiness was conducted on healthy volunteers, not patients with sleep disorders. Patients with sleep disorders, the article states, may not be aware of impending sleep. It further states that patients with sleep apnoea are often only aware of the severity of their sleepiness after treatment of their sleep apnoea.
I can confirm this ignorance. For many years my sleep apnoea was undiagnosed, and I struggled on blissfully unaware of how serious a threat my condition posed to me, my passengers and other drivers and their passengers.
There is another less obvious and little-known consequence of sleep apnoea insofar as the male’s libido and sexual performance is concerned. To my great dismay, horror and shame I suffered from frequent bouts of impotence during my first marriage. I was under 40 years of age! I was completely ignorant of any connection between my sleeping patterns and my impotence. I had blamed it on other elements of the relationship. The psychologist, from whom I sought assistance for my ailing marriage, was also ignorant of any connection between impotence and sleep deprivation.
For sexual arousal and erectile function to be maintained it is essential for your nervous system to be relaxed. The consequence of a breathing disorder such as sleep apnoea is that it is associated with stress responses, including increased heart rate, blood pressure and blood supply to vital organs like the brain and lungs and away from low priority tissues, which include the reproductive organs.
In the context of a Korean study on the link between depression and erectile dysfunction in men with sleep apnoea it was posed that sleep apnoea might impact what is known as the parasympathetic nervous system, which is responsible for many bodily functions including sexual arousal.
During the day I would often yawn or sigh heavily without being aware I was doing it unless someone mentioned it to me. Sometimes I would put my head down at the office during my lunch break and succumb to a 15, 20 or 30-minute sleep. I would not feel refreshed afterwards but would regain some semblance of normal functioning. Often my thoughts would become fuzzy or scrambled. I would put this down to a lack of concentration or just the effects of a bad night’s sleep. Having a bad night’s sleep would eventually become a normal phenomenon for me, particularly as I struggled to cope with depression following the deaths of my parents over a 16-month period during my mid-40s.
I often suffered headaches and tried to alleviate them by resorting to “sugar fixes” or “popping a pill”. I was self-medicating without understanding why my body was behaving in the way it did. For years my skin, particularly on the soles of my feet and my scalp, was dry and flaky. Skin deposits formed on my legs. I had accepted this as “part of my lot” or just the way I was.
With hindsight I was amazed at how I battled on unquestioningly, enduring my pains and discomfort – almost like a dumb animal. I have known others, including family and friends, who also struggle on and tough it out. Perhaps we do so because we are creatures of habit? In doing so we live by the maxim “ignorance is bliss” and, at the same time, become beasts of burden.
My lack of sleep did not inspire me to exercise as my energy levels were low. So instead of shedding weight I actually gained weight. However, my 15-year-old son was keen on going to the gym. So I dragged my weary body and accompanied him by going through the motions on the various exercise machines. I would much rather have slept. But I was also torn between wanting and not wanting to sleep. I was not enjoying good quality sleep and I felt that I might jeopardise my prospects of sleeping later that night.
So I was caught on a vicious merry-go-round which made me feel dizzy and light-headed. These sensations also made me short-tempered and irritable. I was often subjected to panic or anxiety attacks.
On other occasions, without warning, I would feel a chill of fear from within my soul. It sometimes took hold of me and catapulted me into absolute despair. The depression didn’t fix itself on anything in particular, but latched on to everything that was going on in my life. Whilst I was feeling this way I would paint black any aspect of my life which I focussed on.
A study of 18,000 Europeans conducted in 2003 and appearing in the Journal of Clinical Psychiatry is the first study to show a link between depression and sleep apnoea. People with depression are five times more likely to have a breathing-related sleep disorder than non-depressed people.
Lack of regular quality sleep had the effect of exacerbating everyday stresses of my life. It magnified the losses I had experienced. Those losses began with the fragmentation of my family following the breakdown of my marriage in 1999. I found it very difficult to cope with being apart from my two young children (then aged 3 years and 6 years). I would often refer to them as “my left and right hands”.
For the next eight years or so I struggled with tending to the needs of sick parents, especially my mother. They would eventually leave this world less than 16 months apart from one another during 2006–2007. Their absence left a huge hole in my life both separately and jointly. I was fortunate to be in a loving relationship at the time each of my parents passed on. Those relationships, at the time, provided significant support for me.
My life was full. I was both managing and conducting my legal practice, bringing up children, maintaining a relationship and looking after sick parents. Consequently, it was easy to push aside those health issues which didn’t immediately confront me or prevent me from functioning at all. Sleep apnoea can be surreptitious as, depending on its severity, it may only slightly or moderately retard your functionality. I could largely ignore its deleterious effects as I was still able to function or “cope” even though, with hindsight, not to my optimum level.
I believe that during the three years from 2005 to 2008 sleep apnoea began to assert itself more prominently. During a time of emotional and physical stress bad breathing habits began to exact a toll. At one point the combination of antidepressants and sleeping pills with sleep apnoea meant that I was only having two to four hours of sleep each night. It was a rollercoaster of nightmares which I can barely recall thanks to the passage of time and the cloudiness of an unclear memory.
Surprisingly, it wasn’t until 17 July 2008 when my treating doctor first diagnosed the possibility of a breathing disorder, in particular sleep apnoea. I had attended a Council of Adult Education (CAE) seminar on breathing habits a few weeks earlier. Consequently, I realised that I needed to undertake a sleep study.
It also led me to make further enquiries which would ultimately prove to be life-changing.