Interesting Week Ahead & Stertorous Sleep

6 Month Check-up Week

Honey, You Snore!

How's About Some Polysomnography?

Wired! I Can't Sleep!

You Need Help!

CPAP It works!

Big Week Ahead. Prayers Requested

Monday is bone marrow biopsy day for JoJo, followed by an early morning PETscan on Tuesday. Neither are much fun. The PET takes a couple hours of lying completely still which can be difficult, especially if one's tookus is sore from a biopsy. The results will be reviewed by the BMT staff, and we will meet again next Monday to review the 6 month results. We can't decide if its gone fast or not. In a perfect world, there will be complete acceptance of the donor cells, and no evidence of cancer cells in the marrow. It may be that we are impatient and all of that can take longer in some patients, but let's shoot for it anyway. Prayers people. A little extra this week if you can find it within you.  We appreciate it more than can be expressed in this forum.

JoJo has been struggling with a sinus cold for several days. At least that is what we think it is. She visited the clinic twice last week and there doesn't seem to be any other underlying causes. It could also be nothing more than a side effect of one of her medicines. She continues to take a broad spectrum of antibiotics and gets along ok, so we will just ride it out for a few days. She is slow to overcome colds anyway. I picked up her sinus infection which is encouraging in a weird sort of way. When it comes to infectious bugs, JoJo has mostly been taking it, and now she is healthy enough to dish it out for a change.

Now that JoJo is back to life on level ground, she indicated that my nocturnal concertos were no longer soothing to her. It wasn't so much the sound as the extended periods of time when I appeared to stop breathing. She would lie there listening, just get to a point where she felt compelled to give me an elbow that would wake me when I would all of a sudden loudly take a gulp of air and start the process again.

Each summer I get together with a group of grade/high school buddies for a weekend of decadent behavior. In the setting of a shared cabin, one becomes overly familiar with one's cabin mate's sleep behaviors. Over the years, one of the gents became notorious for snoring. Friends and family encouraged him to do a sleep study, but he was hesitant for whatever reasons. It took several years of coaxing, but he finally went in for the study. He had obstructive sleep apnea and was set up with a CPAP device that instantly changed his quality of life. Knowing his story, I was very comfortable enrolling for the study.

Over the course of JoAnne's illness, I have gradually gotten to a point where it is impossible to go through a day without a nap. I could sleep anytime, anywhere and that is not typical for me. Under the circumstances, it is hard to know if it was the stress, old age creeping in, some weight gain, a little depression or what.  JoAnne's observation that my breathing was erratic highlighted a classic symptom of sleep apnea.

My family practitioner set me up for a sleep study within less than a week. I went in on Sunday evening after making certain that I took no naps that day. It is nothing more than staying in a nice but small hotel room with a discrete camera and some monitoring equipment.  40+ electrodes are attached to the head, face, chest, stomach and legs. There is no pain or discomfort while they monitor breathing, heart, motion, facial activity and eye movement. 

The first objective is to fall asleep while being watched on a monitor with all of the equipment attached to you. Plus, my sleep tech Ryan refused to read me a bed time story like JoJo usually does. Alone with my thoughts, I wonder, "What if I am an insomniac?! All this effort and I can't fall asleep." But I finally do. In about 45 minutes. Which I find out later while reviewing the sleep report. 15 minutes is normal, but during a sleep study, they cut you some slack.

The protocol allows the subject two hours to exhibit signs of sleep apnea. It took me far less than that to provide indisputable evidence which prompts them to wake you up so they can put a CPAP device on your head. Monitoring continued and at 6:30 AM, they woke me up and sent me home. I was scheduled to report back on November 28th for review of the test results. The day after the test, the clinic called requesting that I come in as soon as convenient. During a visit on Friday, we reviewed my test results.

As explained to me, sleep apnea occurs when some bulk in the neck and tongue combine with relaxed muscle tone. When one falls asleep the airway relaxes further. The tissues and structures collapse and block the airway effectively shutting off oxygen to the lungs and body. After several to many seconds, the brain detects the absence of oxygen and tells the body, "Wake up and take a breath!" The body responds, takes a breath and goes back to sleep, never realizing that it woke up. Then the process begins anew. In my case, I would wake up on average, 40 times per hour or once every 90 seconds. That falls into the severe category, yet some extreme cases experience 150 episodes per hour.

So much for restful sleep. There are 4 increasingly deeper stages of sleep, plus REM (rapid eye movement) sleep when dreaming takes place. Through the night, we normally cycle up and down through the 4 and REM. In my case, I rarely get beyond Stage 1.

The solution is straight forward......a CPAP (continuous positive airway pressure) machine. It pumps humidified air through a flexible tube that is connected to a nose piece. The nose piece is held in place by a head dress of sorts. I put this gizmo on when I go to bed and it pumps air up my nose all night. The pressure keeps my airway open and I sleep soundly.

After two nights, I can report that the results are immediate even though I've got a sinus thing going on right now. I sleep silently and soundly for the first time in memory, and JoJo is highly appreciative. She is almost as excited as I am.  Sleeping with the head gear usually takes some adjustment, and the sleep tech tells me to give it 3-4 weeks. As I look at the symptoms of sleep apnea, I am curious to see what changes will occur over the next few weeks. Maybe I'm not as old as I have been feeling.

Not everybody who snores has sleep apnea nor does everyone who has sleep apnea snore loudly. But holy smokes, if there is any question, you might want to check it out. There are other ways to deal with it including mouthpieces, sleep positioning, etc. Weight loss can help, but the sleep nurse was kind enough to tell me that in my case, I could weigh 140 pounds and I would probably still have problems. Alright! That calls for a cheeseburger and a beer!

In typical fashion, tonight's blog features a few paragraphs on JoJo and the rest about your's truly. Characteristic of a first born, no doubt. If you've been with us for the length of JoJo's stem cell transplant, this is a big week for you too. We will be praying for swift and comfortable testing for JoJo and good results come next week. We welcome all who join us and thank you for thoughtfulness. Keep the faith.

Cancer Sucks