Home again, home again, jiggeddy jig. Just in time for the last throes of the strongest El Nino in recent history. It spares the west of much storminess at the beginning of March and saves the best til the end, in typical going-out-like-a-lion fashion, To wit, we have had snow day and night since our return. With killer exceptions, navigation through all of this has not been bad since at this time of the year what falls usually melts pretty quickly. But we're talking goodly amounts here--6 inches a time. So we are snow white outside, but the roads are clear. The farmers must be happy for the irrigation supplies; and we fishermen are happy too for the pond water. And yet, by the weekend it is supposed to be 70 degrees!
Doc Drachler was worried about my return to elevation--we live at the 5,100 foot level--and he was correct. It has taken some re-adjustment. Primary symptom: shortness of breath. The breathing difficulties have, in turn, led to an upset in the sleep cycle. (I am typing this at 5 a.m. MDT.) Being aware of the importance of maintaining appropriate stimulus control of the bedroom as sleep related, I tend to get up and get out of there if I am awake, rather than struggling to return to sleep. (However, the dam was long ago breached with the advent of a TV in the room and an easy chair.)
The oximeter has shown occasional forays into the less than 90% diffusion level I should be at. However, Drachler has also said that occasional is okay, sustained lengths of time below 90% is deleterious. And by sustained, he apparently means 20-30 min or more.
Here is what has been happening of late: I put on the CPAP machine and it pumps air through my nostrils at about 13 psi. This is to control chronic, obstructive, sleep apnea, where one ceases breathing throughout the night for periods of 10 sec or longer. You know, these are the breaks you hear in the performance of a snorer. Periods of non-breathing less than but close to 10 sec are called hypopneas. Without treatment I exhibit about 25 an hour of both of these combined. With the CPAP machine, my rate, ideally, is down to about 4 per hour. This is good because sleep apnea is related to an increased likelihood of stroke. With the machine I began to get the best sleep of my life, a full eight hours per night. And I was more alert driving.That has been the status quo ante.
Lately, however, I put on the machine and relax into sleep--which can involve an apnea. Usually the machine controls this and one drifts off blissfully unaware. With shortness of breath, however, that first apnea now signals an absence of O2 and one jerks awake in an attempt to get more O2. Upon this occasion, the mask also begins to feel suffocating and the beginnings of panic can be felt. This cycle repeats itself, ad nauseam, until I say, fuck it, and get up. Even if I am successful in the beginnings of the night and get through the first sleep cycle (about 4 hrs) the scenario can and does present itself again for the second cycle. One then is really ready to get up and to say the hell with it. (This latter scenario is partly why I am up now blogging.)
This cycle began in earnest with the advent of the pneumonia episodes. In the search for O2 one next reverts to sleeping in the chair next to the bed (the CPAP machine can reach that far.) Sleeping vertically seems to provide more O2. I have done a lot of vertical sleeping of late.
So there is the background. Next I wonder what is happening during these episodes and I put the oximeter on my finger. It also includes an HR monitor. I find that as I go into the first stage of sleep, I usually drop below 90% diffusion into the mid-80s or below. And I note that my pulse oftens drops too--down into the 40s! Now the 40s are okay as a resting pulse rate if you are a world class long distance runner, which I am not. In ordinary sleep the CPAP machine keeps my O2 levels high--in the mid 90s.
So Tuesday afternoon when I began to put all of this together It was at the end of a frustrating period of time when I was exhausted from lack of sleep, trying for an afternoon nap, which was not forthcoming (see above cycle), and noting the repeated return of my O2 levels into the 80% range and my pulse diving to 40 bpm that I began to wonder if I needed some professional help. My own doc's advice was to try some melatonin (more about which below). So we went to the ER. And they did the usual and tubed me and observed, etc. and sent me home with a Holter monitor on to get a look at heart function over a longer period.
In the ER with all its literal bells and whistles, I could hear the dong, dong, dong, of the diffusion monitor each time I relaxed and slipped below 90% and each time, of course, it would snap me back up again. But it really was confirmatory of the reality: when I goes to sleep, I goes into bad territory, without my mask on. All of this is very frustrating. I need the mask to sleep well. But I am now fighting with it, And one learns to defeat it, by dropping one's jaw and letting the pressurized air out through the mouth. Full masks stifle this by strapping the jaw in place. I cannot tolerate them. When I have O2 I don't need them.
So the Holter comes off today at 6:30 pm and in a few days we'll see what the heart is doing in all of this. I am on the upside of this episode now, probably for a couple reasons. One, we have been back in Utah for over a week and I am probably adjusting to the thinner air, Two, the melatonin, taken at bed time, appears to have a calming effect and gets me beyond that first apnea into sleep where all is well. If I can get one good cycle of 4-6 hours, then a good nap during the day fills up the sleep bank.
More as I know more...
