Continuing Saga of the Sleepless Man

I woke up around 1:00 am this morning and had to go to the bathroom. That's not a good sign. On the positive side, I don't recall waking up after that, so perhaps the rest of my sleep until 6:00 am went relatively well. Still, I didn't want to get up when the alarm went off this morning (at six), so I dozed in bed to the news for half an hour. That's not a good sign either as it indicates that I didn't get enough good sleep to feel rested and ready to go.

So, do I call the Sleep Clinic today and make an appointment or do I not? The only reason not to call is if I think (a) that the past two nights have been aberrations or (b) I believe my wife who thinks that I was awakened by her letting the dogs out or in some other external way.

I'll grant those arguments and say that I've been down this road often enough to know when some sort of adjustment needs to be made. So I'll call and see what comes of a quick visit in to the sleep doctor.

Meanwhile, I'm starting to give serious consideration to a tracheostomy. What research I've done indicates that it is the simplest and most effective surgical option. It just leaves me with a hole in my throat so I can breath with my mouth closed. Fair trade, it seems to me. We'll see what else I uncover in the near future.

Now that I've spent a few minutes writing this out, I have to say that I'm feeling tired. I'd like nothing more than to close my eyes and "rest" for a few minutes. It doesn't help that my eyes have been bothering me for a week now. The new lenses are an improvement, but they highlight to me the fact that we couldn't resolve my right eye to 20/20. I will be very interested in what the eye doctor has to say after next Tuesday's appointment. He's going to recheck the pressures and take another look at the blood vessels in the eye and probably give me a more definitive diagnosis.

Well, that's enough for the moment.

Not Sleeping

I didn't sleep particularly well last night. I find with the bi-PAP I can't sleep on my back at all. I didn't sleep on my back, but I used that time to drift off when I used CPAP. But with the bi-PAP I find myself being jerked awake to take a breath, which tells me that I must be stopping.

Last night I rolled on my side and did go to sleep, but I woke up around 3:00 am when the dogs had to go out. My wife did the honors, but I had trouble, even laying on my side, getting back to sleep. Same problem of having my breathing stop and waking me up to get a breath.

This is not good. If it happens again tonight, I'm calling the Sleep Clinic tomorrow. I'm beginning to think I need to consider the surgical options. Hell, we've tried everything else, and nothing seems to work for very long, though this is the shortest failure I've been through.

Among the problems sleep apnea causes, there is depression, which I take medication for. And I'm feeling that the medication may be losing its effectiveness. My wife says I'm depressed, which is a good indicator. My writing in this space sure would seem to support that notion. Whatever the cause is the effect is that I'm tired, irritable, sullen, and withdrawn. I'm doing my best not to inflict myself on others while I'm in this state, and yet it still spills over.

I guess there's no cure for what ails me. There's nothing to do but hold it together as best I can.

---

It's later in the morning than when I wrote the above. I definitely feel the effects of a lack of good sleep and the pressure on my eyes from incipient glaucoma (or whatever it is). My eyes are raw and red, even with the eye drops the Ophthalmologist recommended. My concentration is not at its best, and I have a general feeling that I just don't care about much at the moment.

Everything requires effort, and the effort just seems like more than I can give. It takes all of my mental energy to write this. The only saving grace of writing in this blog is that it makes me 'look' busy to anyone who passes by. (Though if they look at the screen they won't recognize what I'm doing as anything work-related, I'm sure.) I have trouble even caring about that. All that is going on inside me combines to make me just not care about much. I just want to go home, climb into bed, and sleep it all away.

I'm scheduled to see my psychologist next week. Should I wait or should I schedule something for this week, if he has an opening? The easy thing to do, the thing I prefer to do, is wait. Doing nothing is easier than doing anything.

---

It's now afternoon, and I've actually done a small amount of the work they pay me to do. I have a roadblock in getting with someone who has information I need. Nothing unusual, just a nuisance.

I feel less foggy than I did, but I'm still not motivated to do much. I've been doing additional research on surgical options for treating sleep apnea. Frankly, it looks like the simplest option is a tracheostomy (sp?). Yeah, the old hole in the throat. Apparently, you can cover it over during the day and open it at night for sleeping. That sounds promising. Their are two side-effects. One is that it requires careful daily cleaning to avoid infection. The other is that it is cosmetically unattractive. But since I'm no beauty to start with, and I'm not likely to get better with age, It still sounds like an attractive option. If I go back to see the sleep doctor this week, surgery is definitely going to come up. (If last night was an aberration, then I'll start feeling better and surgery becomes a moot point.)

I want to recommend a new web site I found on the topic of sleep apnea, http://sleepapnea.org. It is very concise and useful. WebMD, http://www.webmd.com is very thorough, but it's also very dense in places, and it's not always easy to find exactly what you're looking for.

Living with Weimaraners

I need to wash the taste of that previous journal entry out of my mind. With that, I want to tell you a bit about my dogs.

We should have known as soon as we brought Sebastian into the car that we were in trouble. Sebastian was six weeks old, the last of the litter of pups from a breeder. We had bought Cora, our three and a half year old Weimarauner, from the same breeder. Cora was a wonderful dog. She loved my wife, and she looked to me as her playmate and walker. My wife had gotten into the backseat of the car to hold the new puppy so that Cora could gradually get to know her new companion.

Cora was not amused. She took one sniff of this male puppy and haughtily turned away. I started the car and started for home. Within a mile, realizing that Susie was not sitting in her accustomed seat up from but continued to hold that 'thing' in her lap and invite Cora to check it out, Cora climbed up into the front passenger seat and sat looking stonily out at the passing countryside, ignoring everyone in the car. She was miffed.

Why do we need a dog? she seemed to be asking.

When we had gotten Cora, she had been quite standoffish for the first few weeks. She didn't seem to dislike us, but she didn't climb all over us for affection or attention either. Initially, we put her in a large rectangular basket, perhaps two feet by four feet by three feet. For a few weeks, it would keep her from getting out. Each night when I put her in there for bed, leaving the top open, she would just stare up at me blankly. I would scratch her and pet her, and she would tolerate it, but I got no wags of returned affection, just a blank stare.

Gradually, she warmed to Susie. When my wife, who has several health conditions that have forced her to be totally disabled for work, would take an afternoon nap she would put Cora on the bed with her. In the first few weeks, Cora would not snuggle up for warmth. She would stay on the bed--she was still small and the height was too great for her to jump down--but she would stay as far from Susie as she could on our king sized bed. But over time, she warmed to Susie and moved closer and closer until one day, finally, she would sleep touching Susie. At last, she had accepted Susie as her primary caregiver.

Cora warmed to me in much the same way, though I was more good for playing with and running with. Susie was her feeder and her full time companion. Cora would follow Susie wherever she went and always curl up in some comfortable spot where she could keep an eye on Susie.

Cora was the first dog we got a crate for, and Cora took to it like a second home. It was her favorite place, and her place of greatest safety. We always had a blanket in the cage with her. If the blanket wasn't to her liking, she would crawl out of the cage and sit there, perhaps emitting a polite whine from time to time until we got the idea that she needed her blanket straightened and smoothed. If we were so preoccupied that we didn't pay attention to this, she would pull the blanket out of the cage completely so we would have to do something with it.

When we fixed her blanket for her, it had to be perfectly smooth. If she saw a wrinkle or worse, laid down on one, we had to immediately correct the problem. Otherwise, she just could not get comfortable. Still, she loved that cage. Whenever we left for a few hours, she would go into her cage before we told her to, and all we had to do was latch the door, and she would sleep contentedly until we returned.

Sebastian hated to cage. He hated--he still hates--being separated from 'the action', whatever it is. We used the cage with him for perhaps 18 months, but he hated every day of it. Yet, there were times when he would do the most amazing thing in the cage. He could smooth a blanket out perfectly flat in the cage floor, even as a small puppy. There would be not a wrinkle or a crease! Cora still insists that her servants (my wife and I) fix her blanket each night. For the past few years, she has designated me as the one person who does it most to her satisfaction. My wife can do it as well or better than I, but I must go through the motions before Cora is satisfied.

(I'll write more about these dogs. We have a ton of stories that, we think, rival Marley.)

Facing Mortality

I may be wrong--nothing is ever certain in life except death--but I believe I now know how I will die. It will be a stroke. All of my symptoms point to eventual and fatal stroke.

When I realized this I am ashamed to admit that I panicked. Of course I do not want to die. As much as I complain about aspects of it, I like my life. I might wish some aspects were different, but that wish is not enough to give me incentive to change it, for it is a good life taken all in all. That is perhaps a hallmark of a kernel of wisdom: to take things in their entirety rather than focusing on one piece or another to the exclusion of the big picture.

My panic, which is really my fear, was in wanting this cup of death by stroke to pass from me. I want a quick, painless death with no lingering. I recognize my father's dislike of process in that. He just wanted to be dead once the inevitability was upon him. I too prefer reaching the end result to the process of getting there. But whatever it is, I will undergo the process. I have no choice. Each of our death's is ours alone, just as each of our lives are ours alone.

I have long held that death is not only inevitable, it is unavoidable. We can take treatments, have preventative surgery, eat healthier, exercise more, avoid those vices that shorten life all without changing a whit the date of our deaths. This not how our culture sees things. My culture tells me that I can stave off death by eating right, exercising, avoiding smoking and excessive drinking, and having regular medical checkups. I do all these things (okay well maybe not smoking) and yet my weight continues to climb slowly, my blood pressure requires medication to regulate it, and I have other conditions besides. I'm able to maintain myself comfortably, but I'm not able to reverse the effects of sleep apnea. That will lead eventually to a stroke, and that will kill me. I can do all the good things I do, and yet I cannot arrest the decline that continues to occur.

I am sad to realize this. I am sad to realize that I probably won't enjoy those ten years of happy, active retirement I have looked forward to. I remain determined to enjoy today as if it is the last day of my life because it may well be. It is not given to a mere mortal to know the hour of his death.

And now I'll go walk my dogs.

Conflict Resolution

I've been privately wrestling with this question for some time: "Is it possible to resolve conflicts peacefully?" Put another way, "Are war, insurrection, civil strife, whatever you want to call it, necessary?" Is it possible to resolve antithetical points of view fairly for all and without violence?

Well, of course it is, I think to myself. All we have to do is agree to sit down and talk through our differences. All we have to do is be willing to listen to others and work with them to resolve the conflict peacefully. That sounds good and right, and it seems like it ought to be doable. In practical terms, though, it doesn't seem to be possible to get to the stage where (a) we sit down to talk with our enemies, and (b) we are willing to listen to our enemies. In practical terms, neither of these activities happen very often.

Take the Israelis and Palestinians. The late Yitzhak Rabin and the late Yasser Arafat had to overcome a lot of distrust even to sit down in Olso, Norway and negotiate a peace framework. They did it in secret over many months, and when word of it was made public there was a great hue and cry on both sides. Eventually, Rabin was murdered by an Israeli citizen who couldn't bear the thought of a cowardly peace with the enemy.

If he wanted to, I don't think President GW Bush could negotiate with Osama bin Laden to end terrorism. The politics would overwhelm him or anybody who tried to make peace with the architect of the 9/11 attacks. It's very clear that bin Laden wants something from the US. It's equally clear that we Americans can't get past the fact of the coldly calculated murder of 3,000 people. We want, not without some justice, punishment for those responsible.

What does bin Laden want? He has said a lot of things, some of which are contradictory. Perhaps he wants nothing less than to remake the world into his vision of what it should be. Without some discussion where we hear what he really wants can we know.

Then, of course, there is the question of whether we would want him to have what he wants. I'm not sure I want to live in a world that is the vision of an Islamic radical. On the other hand, I don't want to live in any of the worlds envisioned by Christian radicals, either.

And here I arrive at the crux of the problem as I understand it. We can't always sit down with our enemies. We can't always engage them in dialog, either because we won't or they won't. The differences we see, or they see, are insurmountable. President Bush would be impeached if he even attempted a dialog with bin Laden.

We need our enemies. They validate our values by their opposition to them. We value freedom, for instance, and we see in bin Laden's apparent call for pure Islamic governance more examples than we really need that what he wants is antithetical to how we defined freedom. And he sees in our definition of freedom much that is antithetical to his vision of an ideal world. We believe, and he seems to have demonstrated, that he will kill to achieve his vision. That behavior is hardly dialogue inducing. We believe we must kill him to prevent him from killing others, killing us. And most especially we believe we must kill him to kill is vision before his vision overwhelms ours and kills our values.

Once a conflict reaches this point, it cannot be resolved peacefully. So the trick must be to keep conflicts from rising to this level. But to do this, we must recognize when a conflict is coming into existence and resolve it before it becomes a clash of world views that cannot be compromised. So, when could we have done that with bin Laden? I'm not sure we know. I'm not sure anybody knows.

I think back to the American Civil War. I've read a lot about that conflict and about the events that led to it. The seeds of the Revolution were planted in the Declaration of Independence. To win its approval, the non-slave colonies had to compromise on the language to achieve the unanimity that was needed to get the Declaration approved by all of the colonies in attendance. That compromise carried over into the creation of the US Constitution, and that compromise was tested and retested in the decades that led up to the split in the republic in 1861.

Eventually, there was no more room for compromise. The two competing world views refused to coexist together. For the abolitionist, slavery could no longer be tolerated anywhere. It was an affront to human dignity everywhere. To those in the slave states, abolitionist sentiments could no longer be tolerated because they threatened an individual's and a state's right of self-determination. Once it reached that point, war was inevitable, and the seeds were there from the beginning.

Everything is not amenable to compromise and peaceful resolution. That is the lesson of history.

Health minutiae

So, I've been on the Bi-PAP for over a week now. I feel like I'm sleeping reasonably well. Some nights are better than others, but overall, I feel better.

Went to the eye doctor for a check-up and to get my prescriptions strengthened. It has only been a year since my last check-up, and I was a little disappointed to need a prescription update so soon. Turns out they couldn't get my right eye to resolve any better than 20/30, though they were able to get 20/20 for the left eye. It also turns out that my inter-ocular pressures were higher than the doctor liked. If memory serves, he likes them under 20, and mine were nearly 30.

It's an early sign of glaucoma, but the doctor suggested I not worry. He also didn't like the color of the blood in my eyes. So I get to go back in two weeks for a recheck. Even though he says not to worry, I'm betting that I am in the early stages of glaucoma. It looks like there are some good treatments available. I'll see what is needed and take appropriate action.

And I'm reminded that I need to call the proctologist in about eight weeks to schedule my next colonoscopy. I've had polyps in my previous two. What I hate is not the procedure--they use very good drugs for that--it's the preparation that stinks. I get to drink a gallon of a strong laxative. That is no fun, either on the intake or the inevitable outflow.

I think I'm beginning to break down at an accelerated rate. So it's true; when you get over the hill, you pick up speed.

The "Grouch"

In the past four years, it has not been unusual for me to be a flaming grouch online. I'll read something that is sent to me in an email, and I'll go off like the wrath of an angry God on the sender. Several of the angrier essays on my web site, http://trmurrell.netfirms.com/, were written in that very angry state. I can't say I'm really ashamed of what I wrote, though I do wish I had not put quite so much of that anger into what I wrote. I abhor prejudice, and some people are idiots and ought to be told that, even if they won't believe it. Still, when I write from my anger I don't exactly foster communications, you know.

Now, I have a different sense of what all is going into that anger. The part that is new to me is a realization that my grouchiness or touchiness or whatever it should be called is fueled by my sleep apnea. Apparently irritableness, especially irrational irritableness, comes from sleep deprivation caused by the apnea. For those who don't know, in sleep apnea the sufferer stops breathing in the night. In order for the body/brain to rouse itself and resume breathing, it awakens itself. This awakening pulls the sleeper out of REM sleep, which is vital for getting true rest and for mental stability. Even on my CPAP, I was being roused in some fashion six or so times an hour. As I experienced it, I might simply be rolling over, or I would blame it on someone in the house or area going to the bathroom or otherwise wandering the building.

This bi-PAP is expected to correct the problem. Apparently, with CPAP I can't exhale against a pressure higher than 16, and the other data from the sleep study showed that I needed 18 to keep my airway open and keep breathing.

Maybe I won't be so grouchy anymore. As I said in the earlier post, it will take some time to see how well it works.

New Sleep Machine

For those of you interested in the continuing saga of my sleep apnea, I got a new machine to help me breathe at night. The old one was over 4 years old; it was time to upgrade.

When they did the most recent baseline study at the sleep clinic, they told me that I stopped breathing 121 times in an hour and my pulse-oxygen dropped to 83. On CPAP at 16, I believe, I was still stopping 6-7 times an hour. So now they have me on bi-PAP, that is bi-directional positive air pressure. My settings are 18/14; that mean inhalation is at 18 PSI and exhalations at 14 PSI.

Last night was the first night. It seemed like a good night. I think I need to wait a week at least before I can really see if there's a difference. Sleep deficits build up over time; so it's only natural that they are corrected over time, too. (That's my theory, and I'm sticking to it.)

Much Ado

Well, the Vice President of the United States, a politician I do not love, was involved in a hunting accident. He accidentally shot one of his hunting companions. That's sad, and I'm sure that at the time it was scary for all concerned. News reports indicate that the victim is recovering nicely. End of story, right?

Not for the White House Press Corp. They are incensed--INCENSED, I tell you!--that they were not notified immediately. They have launched a two day (so far) crusade to find out why they weren't told immediately, and why they found out 24 hours after the fact when the story was published in a local Corpus Christi, Texas newspaper. The Vice President is being flogged from pillar to post for not stepping up and informing the world, through the White House Press Corp, himself, so that they would have the privilege of grilling him.

Okay, it's news when a high government official shoots someone, even by accident. But is it bigger news than, say, the budget or health care or even the snow storm in that part of the country? No, it's not, but it feels to me like the WHPC doesn't feel there is anything more important to cover than a hunting accident in which everyone involved was shaken up or injured but is recovering fine.