The indignities of aging. . . where to begin?
“Old age is no place for sissies.” (Bette Davis, award-winning actress)
“Inside every old person is a young person wondering what happened.” (Sir Terry Pratchett, author, humorist, satirist)
“We all are going to die.” (Joni Ernst, Iowa senator, cerebral orator bar none)
I expected – even welcomed to some extent – the wrinkles and gray hair. All part of the process, I figure. And I’ve lost an inch – an entire inch!!! – from my already shorter than average frame, but these things happen. Every day is a gift, right?
The latest: Now I use a CPAP and, you’ve been warned, felt like sharing.
Since bonking at the Tokyo Marathon last year, I’ve seen tons of doctors. None could find any reason for my symptoms of dizziness, fatigue, general malaise. Some blamed the blood pressure meds I was on at the time. Others shrugged and said maybe I was dehydrated. But a few months ago, the pulmonologist I was sent to by the cardiologist who found nothing wrong with my heart, thank goodness, added another piece to the puzzle: severe sleep apnea.
No idea how long I’ve had it. Seems like I’ve been tired forever. Yes, sleep has been hard to come by in recent years. Working full-time while caring for ill parents then coping with their deaths took a huge toll on me, physically and mentally.
And then there was the overlapping exhaustion from running all those marathons. Yes, that pursuit of endurance excellence helped me cope. In many ways, I was and am super strong. But also, that physical stress, along with the stress of all that travel, added to all the other stress? In retrospect, the last decade or so was a non-stop roller coaster ride featuring every emotion on the spectrum, and what little downtime wasn’t really downtime. It was mostly staring into space from sheer exhaustion time.
And lately, add to that the ever- present mushroom cloud overhead. Like many other Americans I haven’t slept well since the presidential election. How I know the present political insanity is weighing on me: A few months back, saw a post that the loser had kicked the bucket. Those immediate feelings of lightness, goodwill, and joy? Indescribable. Equally as hard to put into words -- that awful weightiness that descended when I learned that the news was false and the creep was still of this earth.
Given all this, when the pulmonologist ordered the sleep study referral back in January, I did exactly what I thought was right. I ignored the referral because though I have no medical degree, I had a running tally in my head that gave me all sorts of valid reasons why I was tired so why should I listen to a doctor? Idiot.
Finally in May, exhausted beyond exhausted, constantly falling asleep while trying to read, write, exist, it hit me that doing a sleep study might be worth my while.
Here’s what the sleep study involved: next to nothing. I called the sleep study office. They sent me a package. I didn’t need to go anywhere overnight. Didn’t need to travel out of state or visit strange offices. Didn’t need to arrange for someone to feed the cats or check on the house.
All I had to do before I went to bed that night the package arrived was open it, and follow some basic instructions involving a cannula and a pulse oximeter, that contraption doctors stick on your finger to measure oxygen. It sort of looks like a clothespin. I remember waking up the next morning, eight hours of sleep later – or so I thought, feeling unusually refreshed because I’d just had the best sleep ever, and thinking of the cannula and company, “Well that was a huge waste of time.”
But dutifully, I sent the package back through the mail. A week later, I got the results and my mind was blown.
Based on what I thought at the time was a decent night’s sleep, I have severe sleep apnea. Turns out, that night I slept a total of five hours and 44 minutes, during which I stopped breathing an average 45 times per hour and my oxygen at one point dropped to just 80 percent. And for me, that was a GOOD night’s rest. Guess that goes to show just how far gone I was.
Here’s what happens when you stop breathing 45 times in an hour: oxygen levels plummet, adrenaline spikes, blood pressure goes nuts. Restorative REM and deep sleep? Forget about it. There’s no such thing when you are waking up once every minute or so. Multiply that by days, weeks, months, years. Your risk of dizzy symptoms, arrythmia, stroke, heart attack, diabetes, depression, anxiety, go through the roof.
Every symptom I’ve experienced the last few years, what I put down to normal aging, coping with loss, overtraining, adapting to new meds, all of it, can likely be traced to severe sleep apnea. How crazy is that?
I truly thought the doctor was nuts, ordering that exam for healthy-as-a-marathoner me. Boy was I wrong.
Within days of getting my results, I was in the pulmonologist’s office. Within a week after that, I was getting fitted for a CPAP, which was super easy.
At that appointment, which lasted 45 minutes, I learned how to care for my machine, which is roughly the size and weight of one of those AM-FM digital clock radios every college kid had back in the 80s. I was measured for and given a mask, a bit of plastic about three inches long, that attaches to my nostrils and straps onto the back of my head, where a tube runs from the strap to the machine. I was given an app so I could track my usage and measure my progress.
I would love to tell you that the CPAP was a dream and so easy to get used to. That was not the case. It’s no accident that up to 30 percent of users abandon their CPAP within the first few weeks. It’s not natural to sleep with a bit of plastic attached to your face. The first night, I was up every hour or so, tugging on the tube, adjusting the mask. Even woke up panicking a few times because I thought I was suffocating.
Exhausted the next morning, I was so discouraged, convinced that this was all a very stupid idea and that nothing was ever going to change and I was doomed to a life of fatigue.
Then I checked the app. Turns out I slept 8 hours, a whopping amount. My breathing stopped an average 12 times an hour, not fantastic but a huge improvement over the 45 times/ hour of my initial test.
But why was I so worn out? Shouldn’t I have felt refreshed, finally? I remembered that the nurse told me that I might not start feeling better for weeks. I needed to be patient. One step at a time, I remember thinking. Marathoning is good training when it comes to remembering the big picture.
I’m one of the 70 percent of CPAP users who kept at it, spurred on by two things. First, my insurance would make me pay for the machine if I didn’t use it 21 out of 30 days for a minimum of four hours a day. Second, I was desperate for something to change. I truly was not myself at all, almost literally sleepwalking through life.
Weeks, the nurse had said. I’d need to wait weeks to see results, she insisted. The nurse was wrong. By the afternoon of day two, I was feeling better than I’d felt in ages. Proof: I hit the gym and stayed a phenomenal ninety minutes on the cardio equipment, then managed 45 minutes of weights. I swear I even got a tiny endorphin high.
Things continued to improve. By week two, I was averaging under ten events per hour. Week three that amount was hovering close to five, which is considered within the normal range. Now seven weeks in, if I have more than four events per hour it’s unusual. This week, I averaged 3.4 events a night. The app gives you a numeric score that considers hourly usage, events, mask removal times. I started in the low 90s, and this week averaged 100 percent, which is an excellent description of how I feel; I have more energy now than I’ve had in ages; think more clearly; blood pressure is improved. I’m craving healthier foods, and I look forward to going to bed.
That’s an unexpected gift – looking forward to sleep. Because I struggled with falling asleep these last few years, I got in the habit of spending hours most evenings dozing upright in front of the television. A form of self-medication, I guess.
The CPAP isn’t something I care to use in the kitchen or living room. It needs to be plugged in and must rest on a flat surface. For me to use it comfortably, I need to be in bed. So, I’m going to bed earlier, forgoing all the junk TV I once watched and fell asleep in front of.
And the CPAP IS comfortable now. I’m used to it. It took about two weeks or so, but my body adapted.
I could sing my CPAP’s praises all day, but that doesn’t change the fact that I really, truly hate the thing. Yes, I’m glad I can finally sleep at night and that I have much more energy during the day. But the CPAP is a stark reminder that, despite my best efforts to stave off the signs of aging, I’m getting older.
While the doctor can’t say specifically why I need to use this machine, it likely comes down to the harsh fact that I’ve got six decades of living under my belt. I’ve got strong legs and a heart that won’t quit anytime soon, fingers crossed. But the muscles that support my breathing don’t have the tone they once did, and that’s hard to accept.
Right now, I’m exploring ways to change that, because I’m not quite ready to go gentle into that CPAP-supported night. But I know the truth, that this CPAP stuff is most likely permanent.
And then there’s the fact that you can’t always outrun genetics. Thankfully, at present I don’t have the cardiac issues one parent had, or the lung issues of the other. But despite my exercise regimes, and (mostly) healthy habits, I have nonetheless been duly blessed with the same two hernias as my mother, who never marathoned a day in her life, and have been equally graced with my father’s and grandmother’s acid reflux issues. There IS a family history when it comes to sleep apnea too.
Ultimately, this machine, while giving me new life, is a reminder of my own mortality. That’s sobering but also a gift in a way, I guess.
That greatest of great philosophers, Ferris Bueller, got it right when he said, “Life moves pretty fast.” I’m glad I’m not sleepwalking through it anymore. But geez, if time could slow down just a little, that would be great.
Oh well. Onward and upward. Damn the torpedoes. Full speed ahead.
Forward, ho.
