My boyfriend Ereck and I live in an arrangement substantially similar to marriage. We share a home and a pickup truck. We shop together for furniture and gardening supplies. And we sleep in the same bed, a pretty old four-poster we inherited from my Great Aunt Edie.
Lately, though, it is not just us in the bedroom, because joining us these nights is a CPAP device. What's a CPAP device, you ask, correctly pronouncing it 'see-pap'? CPAP is the unlovely acronym for the even more unlovely phrase 'continuous positive airway pressure,' which describes the function of the machine, no bigger than a breadbox, that sits on a table beside our bed.
Each night Ereck checks that there is plenty of water in the CPAP (it's a REMstar Plus, from the manufacturer Respironics). Then he dons a piece of headgear -- called, soothingly, a 'nasal pillow' -- that keeps some rubber tubing pressed to his nostrils. He attaches the tubing to the CPAP, turns the whole shebang on, and warm, moist air is gently blown into his nose. He sleeps.
And so, blessedly, do I.
He used to snore, because he has a condition called obstructive sleep apnea. Obstructive sleep apnea can cause all sorts of dire health problems. In his case, it also caused snoring.
When he wears the CPAP, he does not snore.
I'm a very light sleeper. My boyfriend's snoring was keeping me awake. That made me unhappy. Which in turn made him unhappy.
We were unhappy.
Let it be said: I'm not the easiest guy to sleep with.
I often do not sleep well, and to deal with that fact I have developed some sleeping habits that are, I'll be the first to admit, odd. In light of them, I am lucky that Ereck has not banished me from our boudoir altogether.
First of all, I can only fall asleep if I am reading a book. This means I must have a light on. And it needs to be on all night, because I always awake at least twice in the night, and I have to read to get back to sleep. The light does not thrill Ereck, but I use a lamp with a dim red bulb -- at night our bedroom looks like a darkroom -- and he wears a sleep mask. When we travel, I bring a red krama, a Cambodian scarf I picked up in Phnom Penh. To re-create the effect of the red light bulb, I drape the krama over hotel lamps. This works, well, okay.
Second, I need four pillows to sleep. I snuggle up with three of these, and I prop the book on the fourth. Ereck calls this arrangement the fortress. Also: To sleep, I need to have the sheet tucked tightly over my head. This he calls the bonnet.
And last but not least, even the quietest sound wakes me up. So every night before bed I activate the white-noise machine on my nightstand, and I put in earplugs. These I started wearing in my college dorm, where a neighbor with whom I shared a wall was given, late at night, to loudly playing his favorite Little River Band CD. Having picked up the earplug habit, I can't stop. I have tried. I worry about what, over time, all this earplug-wearing is doing to my ears.
But I still wear earplugs. Unfortunately, they don't block out all noise. They don't block out snoring.
Needless to say, my boyfriend's snoring woke me up, and kept me awake. At first, about six years ago, I thought the problem was cute, a little domestic dilemma that proved we were really in love. I tried putting a pillow over my head.
But I couldn't sleep.
I thought something was wrong with me. After all, my grandfather snored loudly enough to shake the house, and I never heard my grandmother complain. It only struck me recently that this probably was because, at least when I knew her, she couldn't hear much at all.
At my urging, my boyfriend tried nasal strips, those small bits of fabric you sometimes see football players wearing on their schnozzes. Their manufacturer claims they can stop snoring. They didn't work on my boyfriend.
Then I began to gently nudge him when he snored. Once I gently nudged him with my foot, and he objected to my kicking him. I explained that I was gently nudging with my foot, not kicking. He said I should just wake him when he snored.
I studied him at night. Perhaps, I thought, he snores only when he is lying on his back -- or is it his side? After time, I realized he snored either way.
Sometimes I would wake him five or six times a night. 'You're snoring,' I would say, pleadingly. He would moan and turn over. In the morning, we would both be exhausted.
Finally, I installed an air mattress in our living room. I began sleeping on it more and more. I was sleeping better, and so was he.
But we wanted to sleep together! Isn't that what normal couples do?
We were unhappy.
So he spoke to his primary care provider, a nurse practitioner. She arranged for him to see a sleep specialist at the UW Hospital, and the medical intervention was under way.
First the doctor sent my boyfriend home with an Embletta. This is an electronic device, about the size and shape of a Game Boy, that monitored his breathing as he slept. The results of the monitoring were inconclusive, we learned, but they suggested that he needed a full-blown sleep study.
And so came the evening when I dropped him off at the UW Hospital, where he spent the night at the sleep laboratory, wired up like a science project.
He slept only fitfully. That was partly because electrodes were glued to his head, and partly because at one point a technician awoke him and had him put on a CPAP device. But his sleep also was disturbed by -- I find this odd -- the sound of the hospital's Med Flight helicopter landing on the roof, not far from the lab. (A hospital spokeswoman says the sleep lab is slated to be moved away from the helipad in late summer or early fall.)
The next morning he was tired, and he had glue in his hair.
Soon, based on the results of the overnight study, he had his diagnosis: obstructive sleep apnea -- a disorder that, according to the American Sleep Apnea Association, affects more than 12 million Americans.
What is it? In a nutshell, when he slept, the muscles in his airway were relaxing to such a degree that they made him stop breathing, in episodes called apneas. He was having as many as 20 apneas an hour.
People with obstructive sleep apnea may not be getting enough oxygen at night, which is alarming to contemplate. Untreated, sleep apnea can lead to various ills, including hypertension, heart failure and stroke. More immediately, people with sleep apnea commonly feel tired, and they may not even know something is wrong.
'It's not unusual for people to have the symptoms for 10 to 20 years before they present to a health practitioner,' says Dr. Steven Barczi, a sleep specialist at the VA hospital, and an assistant professor at UW Medical School. (He is not my boyfriend's doctor.)
People with the condition usually seek help because their partners feel their snoring is getting out of hand, says Barczi -- 'or, more distressing, they're seeing the person stop breathing.'
The most common treatment for obstructive sleep apnea is the CPAP, which delivers air at a pressure high enough -- it varies from person to person -- to keep the muscles from blocking the airway. The pauses in breathing no longer occur, and the snoring stops, too. CPAPs don't work for everyone, though. Other treatments for obstructive sleep apnea include dental appliances and surgical procedures of varying invasiveness.
Obstructive sleep apnea seems to be related in some cases to obesity and in others to overbites, says Barczi. In my boyfriend's case, his doctor suggested an 'unusually large uvula' might be implicated.
Still, the precise cause remains a mystery. 'If I knew, I probably would be a Nobel laureate,' says Barczi.
Meanwhile, back in our bedroom, Ereck and I are together again and sleeping much better. Our bed is beginning to seem smaller and smaller, though, what with the pillow fortress and the bonnet and the sleep mask and, now, the CPAP device. Perhaps it is time to look into a bigger bed. Sorry, Aunt Edie.
If you -- or your bedmate -- worry that you have sleep apnea, consult your primary care provider, who may refer you to one of the area's sleep centers. These include:
Meriter Hospital Sleep Disorders Center
202 S. Park St., Madison, WI 53715; 267-5938; www.meriter.com
St. Mary's Sleep Center
2844 Index Rd., Madison, WI 53713; 258-5266; www.stmarysmadison.com
Comprehensive Sleep Disorders Center
University of Wisconsin Hospital & Clinics
600 Highland Ave., Madison, WI 53792; 263-7200; www.uwhealth.org
For sleep apnea, an overnight evaluation at UW's sleep center usually costs $3,000-$4,000. On cpap.com, CPAP devices cost $247.50-$695, plus $42-$250 for headgear; CPAP devices require a doctor's prescription. Medical insurance generally covers some or all of these costs.