Treat your sleep apnea, yo, for your health and my sanity

I made a joking post on Facebook a while back about sleep apnea:

Ah yes, larps. Where you learn how many people you know probably have untreated sleep apnea.

The context was that I was larping in the woods, awake at 3am, listening to someone in the next cabin gasping for breath in between thunderous snoring. This is not a new phenomenon at larps; indeed, in the bathroom the next morning, I heard several people complaining about the snoring of their cabin mates. (We even came up for an in-character term for it: “nose thunder”).

I may have been joking there, but ultimately sleep apnea is no joke. And I wanted to elaborate a little more on this, since I realized many of you don’t know me well enough to know that I too, have sleep apnea. It has made me a bit of an evangelist about the condition. I hate to see people suffering when there is a solution out there.

My history with sleep apnea

In 2009 I got diagnosed with moderate sleep apnea. I had spent the three previous years — maybe more — never feeling rested. I had serious problems staying awake at the wheel; on my commute to work, I would continually punch myself in the leg just to stay conscious. I could sleep anywhere — unfortunately, that included boring client meetings at my job. (I eventually lost that job, and that was partially why). On my rare free days, it was hard to motivate myself to do anything, and I would inevitably need a three-hour nap in the middle of the day.

I got a CPAP machine fairly quickly after my diagnosis. A CPAP applies “continuous positive airway pressure,” i.e. it fits over your nose and delivers constant air flow to keep your airway from collapsing when you sleep. It’s basically the gold standard for sleep apnea treatment; there are also surgeries, but none of them are very effective. If this sounds really annoying, well, at first, yes, it can be. But I adapted to it very quickly, perhaps because at that point I could sleep through anything 😉

After two or three nights, I wasn’t exactly convinced it was doing anything. My daytime sleepiness lingered for a while. It wasn’t until I was at a larp event a month later — and I wasn’t falling asleep on any horizontal surface — that I realized it was working.

If you snore — especially if people tell you you stop breathing — please, please, please get a sleep study. If you have unexplained daytime sleepiness, even if no one tells you you snore, please get checked.

Some of the objections and questions I hear about sleep apnea and CPAP therapy, and my answers (keeping in mind that I am not a doctor):

“But I don’t fit the profile for sleep apnea.”

Neither did I, according to the PCP who wrote my referral for a sleep study. While I was overweight at the time, I wasn’t significantly so, and heck, I didn’t even think I snored. I got checked anyway, and so should you. Even if you don’t have obstructive sleep apnea, there’s also central apnea — where your brain just stops telling your body to breathe in your sleep — which can also be treated.

“I’ve just started using a CPAP/I use it intermittently, and I don’t notice any difference.”

The thing about sleep apnea is it’s insidious. You won’t notice 1, 2, or even 3 nights of low-level sleep deprivation. But you sure as hell notice months and years of it.

And your health will, too. Spending a third of your life gasping for breath takes its toll on the body: it raises blood pressure, increases risk of stroke, and probably other stuff we haven’t even discovered yet.

“How the heck am I supposed to get used to having air shoved down my throat all night?”

It’s amazing what the human body can get used to, really. If it helps, most CPAP machines have a “ramp” function, where they start at low pressure and gradually ramp up to their full pressure over a time you set.

Additionally, durable medical equipment companies (DMEs) have really been working on the problem of making these things comfortable. There are masks that touch as little skin as possible, humidifiers, preheat functionality, leak testing, and all kinds of conveniences.

It’s all small and portable too, so you can take it with you while larping, assuming the site has power. Heck, you can even by cozies for your CPAP hose so that they look less medical. (Or, in my case, so that my cats would stop chewing on the delectable plastic).

All I have to say about this is: if my mother — in her 60s, with chronic health problems, and sensitive to anything touching her skin while she sleeps — can get used to a CPAP machine, then you can too.

“Isn’t the sound of the machine just as annoying to my bedmate as snoring?”

Not even a little. Modern CPAPs are almost silent when the mask is fitted to the face. (If the mask slips loose, you will hear a “whooshing” noise, though). It’s white noise at worst.

“But what do you do when you have no power?”

That is a problem. Depends for how long, I suppose. I can go without for a couple of nights, but my sleep apnea, as I said, is only moderate, and mostly harmful in the long term. Luckily most larp sites these days DO have power, and CPAP machines are actually a very low draw, which is a concern at some sites I’m at.

There are also DC power solutions for CPAP, to allow you to hook up to some kind of battery, though I admit I haven’t experimented with them. (They look super pricey!)

“It’s expensive!”

Without insurance, oh, definitely. Most insurances, however, will cover this stuff pretty extensively, because it’s cheaper to treat sleep apnea than it is to treat the respiratory and circulatory issues this will eventually cause.

Again, I use the example of my mother — as a self-employed person with chronic conditions, she is still able to get her paltry insurance to cover her CPAP equipment and supplies.

That said, I realize that CPAP therapy is still not accessible to all. If you can’t manage the expense of the diagnosis or treatment, one of the best self-treatments is sleeping on your side. There’s even the “tennis ball technique” to prevent back-sleeping.

“All these people getting diagnosed with sleep apnea is just a scam by doctors/medical equipment companies/insurance to sell people equipment they don’t need!”

Yes, I have really heard this. What I will say is that given the expense of doing a sleep study — which is basically an EEG plus a bunch of other monitoring while you sleep — I guarantee you no one is making a fortune on selling you CPAP units afterward.

If anyone is making any real money off this, it’s the insurance companies, and they aren’t keen on sharing it with the doctors and the DME.

But hey, that’s the fucked up American healthcare system! Either way, your suffering isn’t going to stick it to The Man.

“Speaking of sleep studies… I can’t sleep in hospitals. Especially when there’s a bunch of stuff glued to my head.”

Sleep studies aren’t exactly super fun times, but they’re still way better than most medical procedures. I found the worst part to be trying to sleep on the schedule it enforces, which has you going to bed at 9pm, and then being kicked out of the hospital (not literally) at like 5am.

But the staff will do everything to make you comfortable — I remember mine bringing me ginger ale and asking me if there was a TV show I wanted to put on. And yeah, it took me a long time to fall asleep, but once I did they got the data they needed, which is what mattered.

(Generally they’ll do half the night just observing, and then if they see apneas they will hook you up to a CPAP to get your titration numbers, i.e. how much pressure you need. This is so you don’t have to come back for a second sleep study).

My mother told me horror stories about a sleep study where it took an hour to hook her up to the equipment. It… did not take me that long. They had it all hooked up in about fifteen minutes.

You do have to wash conductive goo out of your hair afterwards. No big deal.

Oh hey, and I’m told that in some places, you can do a sleep study at home. Like the hospital gives you a kit to hook yourself up, and then you send the data back to them the next day. That’s pretty neat, if that’s an option for you!

“I don’t want another medical condition to manage.”

If this applies to you, you probably already have a medical condition. You’re just not managing it.

Management, incidentally, is super low intensity. I have an appointment with a pulmonologist once a year (every six months for the first year), and every few months my DME calls me and says “hey do you want new supplies?” The biggest challenge I ever had was when I tried to get an auto-titrating machine two years after getting my first machine, and that was quickly resolved when they saw my compliance data. (Which lives on an SD card that you stick in the back of your machine. Some machines can send it directly to the DME/doctors, too).

In conclusion

Take care of your health, and the sanity of your fellow larpers. Please get checked ASAP if you think any of this applies to you.

If you have any questions about my experience with sleep apnea — especially as a larper with sleep apnea! — please feel free to drop a comment!

Photo credit: Jordan Whitt on Unsplash.

The sleeper must awaken: meditations on climbing and new experiences

Taking a break from climbing

My friend Jess — she of the occasional book club — long ago invited me to go climbing with her, and I finally did.

… that sentence is much simpler than the actual event warrants. This was in fact the third date we’d set, reaching back almost a year. One of those times was canceled because she injured herself falling off her bike, but at least one other time I canceled because I was too anxious to follow through.

I wasn’t scared of injury. Indoor climbing is pretty safe, as some cursory research told me. There are injuries related to strain or overuse, like any sport, and various scrapes and bumps, but almost no one is hurt from falling. There’s always a soft pad (in bouldering), or a harness (in other types), to catch you.

But I have regrettably reached the point where new experiences — even something as simple as learning a new board game — are anxiety-provoking. I wasn’t afraid of falling, but I was afraid at looking or feeling like an idiot.

… no, not even that, precisely. It’s more like a foundless sort of anticipatory anxiety. It’s believing that whatever the change is, it’s going to be more uncomfortable than the status quo. It’s similar to what I feel before I go to any larp event, or when I decide to listen to more mindless radio rather than an audiobook.

It’s a kind of comfortable inertia.

I mean, let’s face it. Most days, I get up, I go to work, I come home and do something time-wasting. Coming out of work, taking a right turn to go east on the Mass Pike — towards Boston, towards civilization — feels so wrong that I have countless times accidentally gone west, towards home, instead.

You might have bet I’d chicken out again on the Wednesday in question. The odds certainly looked against me that morning. Matt was still recovering from a larp weekend, so he wasn’t awake to make breakfast and put the trash together, like he usually does. On top of that, there were 3-4 inches of snow on the ground when I woke up. I had to bag up the trash myself, get out the door, clean off the car, and deposit the trash at the end of the long driveway — all without caffeine or food in me. I got as far as the center of town before I realized I’d forgotten to leave the trash, and had to double back. Work wasn’t especially troublesome that day, but I was crabby, and so every little frustration seemed doubled.

But, I was determined: no matter how shitty I felt, I was going to climb.

At the appointed time, I left work, turned right to go towards Boston, and found myself in Cambridge with Jess. A short walk — and an explanation of the different types of climbing — later, I walked into Brooklyn Boulders Somerville (BKBS).

The first thing I noticed: there was a line out the door.

I dunno about you, but I’ve never been to a gym or athletic club where there was a line to get in.

Jess assured me it was busy every night, though it was a little bit busier tonight, as they were running their Out to Climb event, a night aimed at bringing in LGBT climbers. (And how awesome is that??)

Anyway, I signed a waiver, rented shoes and a harness, and Jess got me in as a guest on her membership. I got a very brief tour of the facilities (co-working spaces! yoga classes! a full weight room!), and didn’t have the heart to tell the very kind gentleman that I didn’t live anywhere near Somerville and was unlikely to ever buy a membership, even if I did fall in love with climbing. I then got a quick “how to fall” lesson, and then Jess and I were ready to climb.

A thing to know about Jess: she loves to climb, but she loves to teach even more. Teaching me to climb really made her super happy, and that made me happy, too. In particular, she said, she loves to teach women to climb, as it’s a very male-dominated sport. Also, even well-intentioned male teachers don’t necessarily know how to relate to someone with a different body than theirs. And things like center of gravity, height, and the size of hands and feet make a big, big difference in climbing.

(Climbing in general may be a male-dominated sport, but you wouldn’t know it to look around BKBS!)

The type of climbing I tried is called top rope climbing, which means that your harness attaches to a rope which is double-looped over an anchor at the top of the wall. The rope then comes back down into a belay device held by a partner on the ground. As you climb, some combination of your partner and the belay device take in the slack. The friction from the double wrapping at the top, plus the belaying, mean that if you lose your grip on the wall — which you will — you never descend more than a few inches. Pendulum physics woohoo!

The disadvantage of top rope is that it means your partner can’t climb at the same time as you. From what I saw, top rope climbers usually work in pairs, taking turns belaying each other, but since I’m not belay-certified, Jess had to belay me for the whole session. She told me not to feel bad about that. She’d climbed already that week, and in this case, her pleasure with teaching eclipsed having to stay on the ground.

So we picked out the only easy route that was available, a 5.5, which is the lowest they have at BKBS. Jess tied the rope into the harness, showing me how to safety-check it, and going over some of the common signals I’d need to communicate with my belayer. I got about halfway up the wall — maybe about 10-15 feet up? — before my shaking arms and legs told me I had to stop. From what Jess told me, that’s not half bad! (But maybe she says that to all the people she teaches).

While I took a break, we walked around the gym watching other people climb. We watched an especially brave woman lead climbing the Tongue — a ~60-foot wall which angles outward at the top, so that you are climbing nearly horizontally for the last ~15 feet. (I think this is a picture of it? All I have to say is, wow. I get sweaty palms just thinking about that).

Jess also showed me different types of handholds, and made suggestions about how to position my weight on slanted handholds. We talked too about “reading the route,” i.e. placing your hands and feet in the way the designers of the route intended, making it easier on yourself.

When there was another 5.5 route free, we tried it… and was less successful. I didn’t get more than a few feet off the ground, and scraped some skin off my hand in the process. Interesting that the same rating of route was so much more difficult. It was just really hard to perform the movements necessary to get where I needed to go — I had to raise my legs too far above my center of gravity, and reach beyond my height.

I had another shot at route #1, and didn’t get as far as my first try, but by that time I was pooped. (And desperately in need of dinner).

I was also exhilarated — this new climbing culture was so fascinating to me. Here I was surrounded by the fanatically fit, who seemed to be having a great time. We ran into a pair of women who were top-roping while wearing party hats, and that pretty much embodied the whole spirit of the place.

On the way out the door, we noticed a sandwich board with this quote chalked on it:

“A person needs new experiences. They jar something deep inside, allowing him to grow. Without change something sleeps inside us, and seldom awakens. The sleeper must awaken.”

Obligatory nerd pedantry: It was attributed to Frank Herbert in the book Dune, but I think it’s actually from the movie version. Some version of it was in the book, I seem to recall, but not precisely in that formulation.

Seeing that quote was like a jolt of lightning. It perfectly expressed the sentiment I had felt prior to coming — that comfortable inertia — and how the experience had awakened and refreshed me.

I connected it immediately with another quote — the “soft animal of your body” that Mary Oliver speaks of. That creature to whom comforts are often attributed. There’s nothing wrong with that sleeping creature — Mary Oliver exhorts us to let it “love what it loves” — but there is no potential for change there, either.

Anyway. All of this is to remind myself how important it is to branch out, to put out new leaves, to not let myself fossilize.

Also to say: I can’t stop thinking about climbing and I’m already making plans to go again.