I gave the following speech to Toastmasters on March 5th, 2003, as Speech
#3, "Organize Your Speech".
My wife is a cyborg.
That's not to say that she's the Terminator. Nor even that she's the
six-million dollar woman, although I do value her greatly. She calls
herself a cyborg because she sleeps with a breathing machine. At night,
she wears a mask over her nose to force air into her lungs.
When I first met her, she complained of being tired all the time, of
not getting a good night's sleep, of feeling stupid. When she drove for
any length of time, she'd have to pull over for a short nap every hour.
It was that or fall asleep at the wheel.
Once we started spending the night together, I quickly learned that she
snores. Loudly. But it was a different kind of snoring than I was used
to. In my experience, most people snore steadily, in a seesaw pattern
like this: <snore in> <whistle out> <pause> <snore in> <whistle out>
Not so Emma. She would be very quiet for a minute or so, hardly
breathing at all. Then she'd breathe in very loudly, almost gasping for
air: <SNNNNORKKK!!> She'd go quiet for a minute or so, then snore
loudly again. And so the cycle would repeat. All night long.
Naturally, I didn't enjoy this much. Sometimes, it would keep me awake
for hours, and I'd have to move to the spare room just to get some
After one such episode, when I snarled "I can't take this anymore!" at
her, she decided to see her doctor about it.
Emma's doctor thought that her symptoms sounded like sleep apnea, even
though she didn't fit the stereotype of being an overweight,
Apnea is Greek for "without breath". Sleep apnea is a breathing
disorder, where the sufferer repeatedly stops breathing during sleep.
After a minute or two without breathing, which leads to a reduction in
blood-oxygen saturation, the brain forces the upper airway muscles to
open the airway. Breathing resumes, usually with a loud snoring sound
or gasp. These frequent arousals means that the sufferer doesn't get
much deep, restorative sleep: the REM sleep that you need to be
The effects of this lack of deep sleep build up over time. The
sufferers often feel very sleepy during the day. Their concentration
suffers. They lack energy. They become irritable and they have
difficulty learning things. They may fall asleep while driving and they
are significantly more likely to have accidents. Occasionally, they may
even die in their sleep.
Sleep apnea occurs in all age groups and both sexes. It's estimated
that four percent of middle-aged men have sleep apnea, and two percent
of middle-aged women, with perhaps twelve to eighteen million Americans
suffering from it. Most cases go undiagnosed.
The primary kind of sleep apnea is due to an obstruction in breathing.
This can be due to a physical abnormality in the nose, throat, or upper
airway. Many, but not all, sufferers are overweight and have an excess
of soft flesh in the airway. When they sleep, the muscles in the soft
palate, at the back of the roof of the mouth, relax, closing the
airway. This can make breathing difficult, or it can stop it
One analogy is that it's like putting your hand over the nozzle of a
vacuum cleaner. Your hand blocks all air getting in, like the upper
airway collapses, even though the vacuum cleaner is still applying
suction, just as the body continues to try to breathe. The vacuum
cleaner is straining and so is the human body.
Under managed care, Emma's doctor couldn't send her for a sleep study
directly. Instead, she was referred to an ear-, nose-, and
throat-specialist. He also joked that she didn't fit the stereotype of
being fat, fifty, and male. He looked at her small mouth and nose and
her undershot jaw, and he agreed that it probably was sleep apnea. He
referred her to a sleep specialist. The sleep specialist also trotted
out the line about her not fitting the stereotype, but he did schedule
her for a sleep study.
She spent a night at the sleep clinic in Swedish Hospital in Ballard.
They attached electrodes all over her head and torso, as well as other
instruments that made her look like the Bride of Frankenstein. The
instruments were hooked up to a plotter that graphed all kinds of body
functions continuously. When I came back in the morning to collect her,
the plotter had produced a pile of fanfold paper that was a foot thick.
When Emma went back to the sleep specialist for her follow appointment,
he told her that she had stopped breathing about twenty-six times an
hour. It was no wonder that she had such difficulty in getting a good
He told her that she could either have surgery or learn to sleep with
the help of a breathing machine. The surgery would have involved
removing excess tissue at the back of the throat and moving her jaw
further forward. Emma was not keen on that, especially as the success
rate of surgery is only about fifty to sixty percent.
She opted for a CPAP sleep machine instead. She straps a nose-mask
around her head. This nose-mask is connected by a hose to a continuous
positive air-pressure machine. This forces air through her nose and
into her lungs.
She had to have a second sleep study to calibrate her CPAP machine for
her breathing. It starts out at a low pressure and ramps up to the
right pressure over a twenty-minute interval.
It took her a few weeks to get accustomed to the CPAP machine. It's not
a very natural feeling to have air forced into your nose continuously.
She now sleeps far better with it than she did before. Sometimes, she
doesn't bother to put on her mask before taking a nap, and she usually
regrets it, because she wakes up feeling less rested.
It took me a while to get used to the CPAP machine too, because it
makes white noise all night long, as it's huffing away. It's a little
like sleeping beside Darth Vader, and it's not very romantic, but it
certainly beats her snoring.
When we travel, we bring the CPAP machine in an overnight case, along
with an extension cord and a selection of adapters for foreign
electrical outlets. The CPAP machine means that we can't go camping for
more than a night or so, or Emma doesn't get enough rest.
In retrospect, Emma probably had sleep apnea for many years before it
Now, not everyone who snores has sleep apnea. Only if they also have
difficulty in breathing and chronically can't get a good night's rest,
are they likely to have sleep apnea. Most undiagnosed sleep apnea
sufferers are unaware that they repeatedly stop breathing because they
don't wake up far enough to realize it.
If you know someone who may have the symptoms of sleep apnea, please,
urge them to see their doctor. You could save their life.