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George's Story: Overcoming sleep apnea, my 40-year journey

I am a 52-year-old male, married, and the father of a four-year old child. I am currently a manager for a government agency and supervise nine employees, thanks to successful treatment of my sleep apnea. Life before treatment was not as good.

I was finally diagnosed with sleep apnea in 1993, the result of my spouse's complaints about my snoring, but it was not appropriately treated until four years later. Symptoms of my apnea included daytime sleep attacks and intense fatigue, depression, weight gain, memory problems, inability to concentrate, and more. Needless to say, untreated sleep apnea affected every aspect of my life.

As far back as high school and college, I remember I was always tired. Photos of me even as a young child reveal dark circles under my eyes. No matter how much sleep I got, I was still tired. I suffered from a deviated septum and engorged turbinates, the nasal airways. (The latter condition remains.) These problems together nearly closed my right nasal passage and, I think, contributed to my breathing difficulties.

The problem of sleep apnea began in earnest late in 1972, in my second year of teaching public school. I have painful memories of repeated episodes at my desk struggling to stay awake. Yet, despite the undiagnosed apnea, I then still managed to be very successful in my endeavors. I was asked to head a district-wide program on creative and performing arts and was appointed as one of four lead teachers to start a special school for gifted students. I even engaged in free-lance services. My career prospects were bright.

Yet by 1975, my last year in teaching, I was constantly so tired and sleepy that I simply could not cope with the demands of the 450 students I saw weekly. Until this point I had been able to hide the problem from others, a problem I believed was of my own creation. Moreover, I thought no one else had this problem, no one could understand it--oreven believe I had a problem, if I were to explain it. As my ability to cope diminished, personal setbacks mounted.

I resigned my teaching position in December 1975. Not only did that obviously not resolve the sleep apnea, it created financial problems. Fortunately, family and friends helped out here. However, they could not help me with diminished self-esteem, depression, weight gain, lethargy, limited social interaction, poor decision-making on many levels, suicidal thoughts, and feelings of helplessness and failure. I was spiritually shutting down. The future looked bleak, to say the least.

After leaving the teaching profession, I opened my own business, a franchise hundreds of miles from home, at that point my only option for employment. I struggled with the vagaries of the new enterprise. I was so tired, I literally had to drag myself out of bed to get myself to work each day. Photographs taken of me during this time painfully and clearly reveal the impact of my predicament.

As the problem grew in all its guises, I realized I had to concentrate on somehow healing myself. I embarked on a long course of ultimately unsuccessful therapy, and, sadly, in the process of focusing on my own survival, I became unnecessarily estranged from family members who thought I no longer loved or needed them.

Pressures mounted and, in the early 1980s, I closed my business after three years. Perhaps six months later I was able to land a decent job in the field that I should have been in all along. It was a major relief, and money was no longer an issue. I continued to persevere with my career and was even able to buy my first home.

Nonetheless, the apnea symptoms continued to worsen. I constantly fought sleep at the office, suffered from memory problems and a growing inability to concentrate, and endured more frequent bouts of depression. My relationships with peers and supervisors were poor. For the next 11 years, however, through more successively responsible positions, I somehow managed to hide the problem of chronic fatigue and severe daytime somnolence.

My marriage did not fare as well. Married in 1985, we were divorced three years later.

Fortunately luck of a special sort was with me, and in 1989 I met my second wife, a trained social worker with supportive sensibilities and sensitivities to match. We married in 1992, and not too long after that, she began to complain about my snoring. My spouse also noted that I twitched and jerked a lot while sleeping, and that I seemed to stop breathing periodically (typical symptoms of sleep apnea).

Somewhere along the way, my constant complaints of sleepiness became attributed to the snoring. This was the beginning of the end of my sleep apnea. The first of four sleep studies was conducted in 1993, and my wife's observations of my twitching and jerking were corroborated. The doctor then prescribed medication for--of all things--Parkinson's disease. The medications didn't do anything for me, so I did not take them for very long.

Soon after, I had a second and third sleep study, at my wife's insistence. They did not result in a prescription of any use, although I was finally diagnosed with sleep apnea. I suffered from more than 800 arousals (or momentary awakenings) in a single night.

During both of these sleep studies, the same well-meaning technician attempted to apply the CPAP mask. Unfortunately, because of my breathing problems and fear of suffocation, I was claustrophobic and could not tolerate the CPAP device at all.

Or so I thought.

After refusing CPAP, in hopes of finding another solution to sleep apnea, I made visits to pulmonary specialists and ear, nose, and throat physicians, had a third and fourth operation on my nose, and underwent the UPPP surgical procedure (to remove my adenoids and tonsils and to shorten the uvula). None diminished the fatigue, improved my breathing, or even ended the snoring! The daytime sleepiness continued to worsen. My sleepiness from untreated sleep apnea was further complicated by my sleep deprivation after becoming the father of a newborn baby. In 1996, what appeared to be the job of a lifetime presented itself. It turned out to be a very high-stress position that required much energy, far exceeding my diminished physical capacity. I managed a budget of $5 million and supervised a staff of 18. At this point, unfortunately, my sleep apnea was at its most severe. My eating habits changed and my weight began to climb. I would fight sleep at my desk constantly. My employer was clearly dissatisfied with my performance (as was I).

I lasted nine months. It was a bitter disappointment.

I again went to my primary care physician about my problem with sleep apnea. He then recommended that I see another doctor at a different sleep center, which I did in mid-1996. Another sleep study ensued and I was again faced with the issue of tolerating the CPAP. Here I would like to make a very important point.

The manner in which the technician helped me gradually become accustomed to wearing the CPAP mask was crucial to overcoming my resistance to it. Ultimately he set me on the road to recovery.

The technician did not give up when I said I could not tolerate the mask and air pressure. He employed a technique to address my complaint: he did not have me strap on the entire contraption with the air flowing full-blast in the beginning. Instead, with the machine on, the air pressure set at the lowest level, and me seated upright, he had me hold the mask loosely against my face for just a couple of seconds. After several tries, I was able to increase the length of time until I was able to hold it in place for a minute or more. Next, while still sitting up, I strapped on the mask and continued to breath with the CPAP device using the "ramping" feature. (This lets the air pressure start low before it gradually builds up to the prescribed setting.) I then lay down, turned off the lights for the rest of the night and went to sleep. While I did not awaken feeling rested (I think my sleep debt was too great), at my doctor's urging, I did purchase a CPAP machine for home use.

A month later I started a new job. Within 11months, I was promoted to supervisor. Over the course of the first 18 months, I received four cash awards, a certificate of recognition for outstanding service, and an outstanding performance evaluation. Above all though, the best reward I've received since conquering sleep apnea was hearing what my supervisor said upon informing me of my promotion, "I wish I had three of you!"

I think I might further improve my current condition by moving to the use of a bilevel machine; I will soon explore this with my doctor. For the time being, I continue to use the CPAP; I even bring it with me when I travel for business or pleasure. I've tried to go without it, but now I cannot fall asleep without it. The sound and rush of cool air usually lulls me to sleep in five minutes.

The successful application of the CPAP is supported and reinforced by the use of prescription nasal sprays (to overcome the engorged turbinates) and a chin strap which prevents me from breathing through my mouth (this was a critical addition for me). It's taken a while to overcome the discomfort of the triangular mask and to learn to adjust the tautness of the mask straps to create an airtight seal without leaving ugly marks and bruises on the bridge or under the tip of my nose. (Another, simpler device called nasal pillows did not work because I found it did not provide as much air as the mask.) However, the purple bags under my eyes are almost gone; I've joined a health club and now exercise more; and my spouse no longer complains about my snoring.

For those out there who suffer chronic fatigue, snoring, and daytime somnolence no matter how much sleep they get, do not give up hope. See a sleep specialist. Undergo a sleep study. Persist in finding your solution. Do not give up. And if you have sleep apnea, by all means, give yourself every chance to get used to breathing and sleeping with a CPAP. It is truly life-changing.