So the good news is that the doctor found something wrong with me. The bad news is that the treatment is lifelong.
According to the polysomnogram I got last week, I apparently stop breathing when I sleep. Not all through the night, mind you, but only during REM sleep. As soon as REM is over, I’m back to mostly normal. “REM-dependent sleep apnea“, the doctor called it, which means I just don’t sleep very well. How awesome is that?
See, when you’re in REM sleep, your brain is firing most of your neurons in a random fashion; this is necessary for memory, cognition, and sanity. Any interruption of this has negative consequences. During REM, you’re dreaming, and what you experience in your dreams is nothing more than an interpretation of this randomness. We act out in our dreams, but are prevented from actually acting on them. For instance, if the neurons responsible for remembering a childhood fear are triggered, the neurons that enable you to feel fear are triggered in response, and you may get the strong motivation to run away from the imagined threat. So you start running, firing the neurons that tell your legs to pump back and forth. What happens instead is that the nerves at the top of your spinal cord block these running signals and redirect some of them to the muscles in your eyes, effectively paralysing you and preventing you from accidentally killing yourself in your sleep by knocking yourself out of the tree or running off a cliff.
With the exception of your autonomic nervous system (which controls heartrate, breathing, digestion, etc.), every part of you is shut down during REM sleep. Even if your brain wanted to, you would be unable to move until this paralysis wore off. That’s why some people report suddenly waking up and being frozen stiff, unable to move. Stories like this are sometimes accompanied by a vision of a ghost or some other paranormal activity present in the room — an expected after-effect of the suggestibility of dreaming, but propped up by the dreamer as a convenient, though incorrect, explanation. The person is awake, but their nerves from the neck down haven’t caught on.
This paralysis varies with each individual. Some people are able to talk in their sleep, some walk in their sleep, others eat or have sex in their sleep. At this end of the pool, the paralysis isn’t deep enough. On the other end, you have people like me, whose paralysis is so deep that breathing stops frequently throughout the night. There are two sets of muscles that control breathing: the main set is the diaphragm underneath your ribcage for “belly breathing”, and the second is around the ribcage, used for “chest breathing”. During REM, the chest muscles are shut off, since they’re not part of the autonomic nervous system, so your only way to breathe is your automatic diaphragm motions.
With me, the diaphragm isn’t enough, so it either struggles to pull in air or just doesn’t move at all. The extra weight I carry on my belly is a contributing factor, as is my sleeping position (worse when I’m on my back). And so what happens if I’m not breathing? My blood-oxygen level drops. According to my sleep study, during these REM episodes it drops to as low as 60% O2 saturation. And so my adrenal system goes into panic mode, makes my heart pump more to keep O2 levels up, and my dream gets really intense and panicked, causing me to wake up just enough to start breathing again. The immediate result is disruption of necessary REM sleep. The intermediate result is a really bad night of sleep. The long-term result ranges from loss of concentration, bad memory, weight gain, all the way up to increased risk of diabetes and early-onset heart disease. All the stuff that comes from lack of sleep and a high-stress lifestyle.
No wonder I feel crappy in the morning, can’t focus, and can’t remember important stuff ever. FML.
So what’s the treatment? Sleeping with a CPAP machine. How cool is that? I get to sleep with an air hose jockstrapped to my face for the rest of my life. Fucking awesome.
The doc is having me come in next week to do another sleep study to determine just how much air pressure I actually need. “Titration”, it’s called. Then I’ll come back again to get set up with a machine of my very own (joy joy), and then a final checkup a month later to gauge my improvement. I feel my youth slipping away as I type.
So, it feels like my days of going to the submarine races are drawing to an end. I’ll be snorkeling in the shallows for the rest of my life.