Monday, December 24, 2007

Sleep, part four

Well, I have my CPAP machine. This consists of a pump and a small mask: the pump sends pressurised air through a tube, into the mask and down into my throat. The pressure has to be high enough to raise the soft tissues which settle on top of the trachea and prevent air entering the lungs.

After another brief consultation with the sleep doctor, I was ushered into another room with a man who I naively assumed was a technician, but was in fact a salesman for one type of CPAP machine. Obviously I don't have enough experience (make that no experience) to know which make of machine is suitable for me, nor which type. He fitted me out with an automatic model, which measures the air resistance coming from my lungs; after a week, they'll download the stored data and decide whether a fixed pressure machine is better (and establish what that pressure is) or whether the automatic model is better. I imagine it will be the latter. Not only is it more flexible, but it's also 25% more expensive. Fortunately I only have to bear between 25-35% of the cost; my health insurance will pay the rest.

Try to imagine what it's like going to bed with a pump chugging away by one's side, blowing air into a tight fitting nose mask pinching one's face. While this is imaginable, try imagining falling asleep with this! As the pump takes in air from the room (and the pump is near an open window), the air is somewhat cold. Basically, the first night was a disaster and I got almost no sleep, until about 2am when I decided to remove the apparatus and sleep "normally", apnea and all.

In the morning, I slunk round to the kibbutz clinic and asked whether the doctor (who was not there) could prescribe me some relaxants in order that I might fall asleep. In the mean time, the nurse gave me some OTC natural relaxant pills based on the herb valerian. The first night (Friday) that I took these pills, I did fall asleep reasonably quickly, only to awake a few hours later boiling with heat (I had left the electric blanket on and my wife had yet to come to bed). Somehow I managed to fall asleep again for another few hours, and then decided to remove the mask. The past few days have followed the same principle: take one or two valerian pills, sleep for four hours, wake up, struggle to sleep again for two hours and then remove the mask and get another two hours sleep.

Last night I was looking at various web sites which said "yes, it's frightening to wear the CPAP mask, and yes, it's difficult to sleep with it" - reassurances which I didn't hear in the sleep clinic. According to work done in Greece, there are definite benefits to be gained from using the CPAP for more than four hours a night, although of course more is better. At the moment I'm using it for four-five hours each night, and I must admit that it's getting slightly easier each night.

The internet articles suggested that there are some machines which are capable of heating the air before it enters the mask. Normally there would be no need for this here, except for during this cold month, and unfortunately that month is my introductory experience.

I do think that I'm less tired during the day, although the road to recovery is going to be slow. My back also hurts, which could be a combination of several factors, including the cold and possible bodily contortions which enable me to sleep "comfortably" with the mask.

Saturday, December 15, 2007

Sleep, part three

I got the results of my polysomnogram back the other day. From a scientific point of view, this is very interesting: there are several graphs each showing differing states on the timeline (sleep state, body state, oxygen saturation and snore volume). From this, I can see that there were times that I thought that I was awake when in fact I was asleep, although the sleep was of low quality.

I'm not too sure how much can be read into the fact that only 25% of my sleep was rem-sleep. I don't know what the usual fraction is, and also one has to bear in mind the unusual circumstances of the test. What is much more important is the number of breathing "events" - these were on average one a minute! Which means that I have severe sleep apnea: no surprise that I am always tired during the day, and often nod off for a few seconds if I'm not doing anything.

I have a return appointment with the sleep doctor on Thursday, during which he will no doubt recommend treatment with "CPAP, or continuous positive airway pressure, in which a controlled air compressor generates an airstream at a constant pressure".

One subject which I intend to bring up is the fact that I often suffer from headaches upon rising on a Saturday. This is particularly annoying as these can often ruin my one day off from work. I remember mentioning the subject to my family doctor, and naturally he asked what was different on a Friday. Now I that mention this, I recall that I blogged on this subject earlier this year. Anyway now I have a different hypothesis. It's obviously not due to caffeine withdrawal, as I don't drink caffeinated drinks (I had to give up drinking tea as it prevents iron absorption). No, I think that the cause of the headache is that I sleep two to three hours longer on Friday night, and in that time, the apnea causes less oxygen to be absorbed. The extra hours of sleep mean that the body has more hours of oxygen deprivation, and that's what is causing the Saturday headaches.

Migraines are a separate subject, and they generally start in the early afternoon. So even if my hypothesis is correct, it won't explain the migraines.

Uncle no longer

As of last night, I am an uncle no longer. Premmie lived for one week and died of complications.

I don't have any details and I'm not too sure that I want to know. Whilst in Victorian times, a lifespan of one week was not uncommon, it's unusual a century plus later. On the other hand, a 600 gram baby would have been left for dead immediately on birth, and it's doubtful whether the mother would have survived either.

To use a modern word, I am gutted - and I'm not even a blood relative. I hate to think what pain my brother in law and girlfriend must be suffering. It was I who advised them not to abort a few weeks earlier, and instead let nature take its course. Little did I know. As the girlfriend (soon to be wife, I hope) is approaching 40, her chances of a safe birth are decreasing daily, although she points out that their troubles began after the amniotic water test was performed.

Sunday, December 09, 2007


I have become an uncle for the first, and probably last time.

My wife's brother's girlfriend (WBG) gave birth to a baby boy early on Friday morning, Dec 7. The baby weighed only 600 grams and was born 3 months premature. Of course, at the moment he is in intensive care and will probably stay there for about a month, before moving into the regular premature babies ward.

The WBG announced that she was pregnant a few months ago, which got us wondering when their wedding was going to take place. As I understand it, this pregnancy was not planned, but as she is nearly 40 years old, one takes what one is given. A few weeks ago they called to say that WBG had been hospitalised as she had been leaking blood and amniotic fluid. As the pregnancy was not very far advanced (20-21 weeks), she was placed in an ordinary women's ward, and it was touch and go whether the pregnancy would be terminated. At that age, the foetus is not considered to be viable and so an abortion for medical reasons (in this case, mother's health) is definitely possible.

Our advice was to hang on and let nature take its course. One week went by, and she was sent home. Another few days found her back in another hospital, again a women's ward. The clock was slowly ticking by, and eventually the pregnancy advanced to the 24th week, at which time she was moved into the prenatal wards.

My wife was in such a ward for nearly two months, and our son was born two months premature, weighing 1.2 kg, so we do have some experience regarding these matters. Only this time, the pregnancy was about a month behind my wife's when she was hospitalised.

On Wednesday night, labour pains started, which continued through Thursday, and the birth itself was in the early hours of Friday morning. The foetus had been monitored all through the birth process and was ok, but after he was born, his heart stopped beating. He was quickly resuscitated and placed in an incubator.

I could have written about this on Friday morning, but I wasn't sure that he would survive the weekend. We were in the hospital last night and saw the relieved mother and father. Only parents are allowed into the premature babies ward, so of course we didn't see the baby (yet to be named), although we understand that he is doing as well as he can under the circumstances. A full "systems scan" will be done today to see exactly how well he is doing.

Wednesday, December 05, 2007

Sleep, part two

These are the pictures which I saw on the Internet of someone being sleep tested:

My apparatus was completely different.

I told my family doctor about the experience, and as I imagined, he was not aware of the fact that the test could be done at home.

I phoned the sleep clinic today to discover that they were able to extract enough data from the test, even though I felt that I barely slept at all. This means that I won't have to do the test again, although I have a feeling that the data which was extracted was not particularly representative.

The results are supposed to arrive after about ten days; I'm not going to hold my breath waiting.

Saturday, December 01, 2007


This column was supposed to be about spending a night in a sleep laboratory, something that I imagine most readers will not have experienced. Unfortunately, the reality is somewhat different from the dream.

I had an appointment for the sleep clinic in downtown Jerusalem. I arrived about an hour before my appointment, as I had expected traffic jams and there were none, so I saw the doctor well before the appointed time. Upon registration, I had to fill in two questionnaires about my sleeping habits (especially how they affected me during the day), and both showed that I have some form of sleep problem.

It seemed that the doctor didn't look at the questionnaires at all and neither at my referrals. He did not examine me, and only asked a few standard questions (do I feel sleepy during the day? Yes! Are you healthy? At the moment I have anaemia) before asking the surprising question "Do you want to spend a night here doing the sleep test or would you rather do it at home?".

As I (and apparently everyone else in my position) has remarked on the seeming impossibility of sleeping well in a sleep laboratory, I instantly opted to do the test at home. So I was shown to a technician who showed me the portable machine. Unlike the one which I saw on the Internet (I can't find the same picture again, as I'm writing this on a different machine) which had maybe eleven leads connected to the patient, my portable machine had only the following:
  1. a contact mike just below the throat which records snoring
  2. a position monitor, below the mike, which records in which position the patient is lying
  3. a detector on the third finger which measures oxygen saturation of the blood
  4. a big detector on the index finger which measures pulse, sleep status etc
  5. the brains, a small box, which was taped to the left forearm
I stayed up late (11:20pm) on Thursday, which in retrospect may not have been a good idea. I watched Maccabi basketball luckily eke out an away win, during which I had often felt tired, but not tense regarding the outcome. Once I had connected the machine, I lay in bed waiting to fall asleep. Normally this happens within 20 minutes, but this time I just laid and laid, conscious of the weight on my forearm and the pinching of my index finger, waiting for the kiss of sleep.

I looked at the clock and saw that it was about 01:30am. I imagine that I must have slept an hour but it didn't feel like that. I got up, went to the toilet then came back to bed ... laid there for another fruitless hour ... finally fell asleep until 05:00am. This time I realised that there was no point in trying to fall asleep again, so after about half an hour I removed all the detectors.

I have to return the machine on Sunday morning, upon which the technicians will remove the recording in order to diagnose my problems. There was another questionnaire to be completed after the test, which included such key questions as "how many hours do you think you slept?" and "how well did you sleep compared to normal? (much better, better, the same, worse, much worse). I ticked "much worse" and have a suspicion that I will have to do the test again, maybe this time in the clinic itself (I saw the "bedrooms" there), as I don't think that the amount of sleep which I achieved will be sufficient for diagnosis.

A better idea would have been to have worn the equipment for one night without turning it on so that I would have got used to the weight and feeling, and then operate it on a second night. I will suggest this.

As a result of my poor sleep, Friday was exceedingly difficult, being very tired. I had to do some detailed programming and found myself making small mistakes all the time so forced myself to stop.

And now for something completely different ...

I have written here that I help a clinical psychologist. It turns out that I misunderstood the meaning of the term; she is not a clinical psychologist but rather an occupational therapist, someone who helps people find the correct job, or helps communal settlements weed their applicants, choosing only the people whose profile matches the ones desired by the settlements. I try not to interfere with the application of the results obtained from the various tests in order to keep a certain amount of distance. Obviously I do see people's test results, but they don't mean anything to me; I only look at them in order to make sure that my programs do what they're supposed to do, and to suggest better ways of displaying the results.