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ANNE RAWLEY SALDICH, Ph.D.
Anne Rawley Saldich, Ph.D., MFT
For the past two years I've had a siege of sleeplessness, not in Seattle but in several states and two foreign countries. There's no pattern. I might get eight hours of sleep, two the next night, then zero, followed by four, until I end up with 25-35 hours for the week. Not a lot when you divide by seven. With six hours of zzzzzs I'm running on all cylinders. Under five and things get marginal.
Sleep deprivation is a timeless, favored means of torture. You just keep someone awake long enough and their mind muddles. Their body weakens. They become an emotional mess. They can't concentrate.
My case is not extreme. When Duty summons I can still function. But it is sufficiently disturbing that I went to a world famous sleep center last year for an overnight assessment. What follows is my cautionary tale.
As required, I arrived early in the morning and was greeted by a grumpy receptionist who doesn't seem to understand that my money pays her salary. After the usual forms were signed, including paragraphs which I crossed out requiring me to give up rights that were not even relevant to my situation, I was escorted to a simple, nondescript room.
A cheerful technician, whose beauty transcended her hideous, bilious green outfit, asked me to get into my night gown. She left but returned shortly thereafter to wire me with little black disks, about the size of a quarter. They were glued to my scalp, forehead, arms, chest, legs. Their wires ran from the center of each and somehow they all connected somewhat like a skein of wires inside a telephone box. A little red light was taped to my right forefinger and for some reason it reminded me of "Rudolph the Red-Nosed Reindeer". Immediately the song stuck in my head and I couldn't get rid of it.
Kelly was chatty, kindly and reassuring:
"If you want anything here is the two-way microphone. It is not monitoring you unless we tell you that it is on. There is a camera up near the ceiling, in the corner, but it is on only at night."
"Oh really?" I thought. I remembered the London hotel with a two-way intercom between the rooms and the front desk. I was there for a conference and the first morning there were several indignant guests at the front desk who learned that the intercom had been left on "accidentally" all night, to the amusement of the front desk personnel. I made a mental note not to say anything I didn't want Posterity to hear.
Before Kelly left I was settled in bed. Though I never admit to watching them I was looking forward to a good old fashioned soap opera. She was barely out the door when I switched on the TV. It didn't work. "Serves me right," I thought. So much for secret lusts.
I had strict instructions to stay awake until bed time. "How will they know if I take a nap?" I asked myself, looking with new interest at the camera. We eyed each other and each of us knew exactly how they would know. I got out a photo project and set to it. In jig time a diminutive woman arrived and proffered a brown bag. Ah, yes, lunch. I finished the turkey sandwich and drained the cold, fresh orange juice from its styrofoam cup in less then fifteen minutes. At $2500 a day one would think a world class sleep center could provide a tray and a real glass. But, amenities were not their strong suit.
And, now? A nap would be nice. I looked at the camera. It looked at me. I took a book and started to read, and read, and read. As the sun was beginning to set, yet another staff member dressed in hideama (where were those nice crisp white uniforms from days of yore?) arrived to announce that I had to move my car or I would get a ticket. He had a chart in his hand, his chin was high like a snooty waiter and he looked down a short bulbous nose.
"Me, move the car? I can't do that. Look at me."
"Why not? All the other patients do."
"But, someone could have told me when I came in that I was parked in the wrong place. Surely you don't expect me to go out in public looking like this?"
"No one will notice," he said, wagging his chin at me.
I thought about that. He must be blind. Just 40 minutes ago I had a look at myself in the bathroom mirror and wondered who was looking back at me. I nearly fainted from fright. My hair was akimbo, parted in squares to make room for the little black disks whose wires sagged around me like a carelessly spun spider's web. Without makeup, and having had minimal sleep for many nights, I looked like last week's lunch.
"Robert, (I read his name tag) I am not going to move the car."
"You'll get a fifty dollar ticket." He sang out that information as if he had a solo in a glee club.
"Robert, ask someone else to move the car." I gave that directive in my most calm, deep, wise, reasonable voice which only I knew was a prelude to anger. "I am not going to walk through a labyrinth of corridors, get on an elevator, flip flop across the parking lot, wrangle myself and all these wires into the front seat and find a new parking space. I will not do that!" My voice was not loud, but louder.
He smiled a teensy-weensy victory smile, gave a little shrug and turned on his heel: "Your choice!" he sang, and he was gone. I could feel myself fussing and fuming inside. Then I remembered Big Brother, took several deep breaths, uttered a silent litany of Damn! Damn! Damn! and felt much better.
About an hour later Robert reappeared, as if we had never met. "If you want me to I'll move your car." He was just as supercilious and condescending but I gave him the keys and did us both a favor by not asking about his change of heart.
Dinner arrived. An exact duplicate of lunch, but a different porter. I didn't mind. "It's just one night." Oh, was I tired! I looked at the camera and decided to play by the rules. More reading and a bit of writing. The hours limped toward bed time. Finally I had permission to sleep.
I snuggled down among my wires and tried to get comfortable, right hand just under my chin. Rudolph's red glow was there, despite closed eyes. I rolled over gingerly, not wanting to disturb the wire they put in my nose and taped across my face so they could track my breathing at night. Rudolph disappeared completely when I shoved him under the pillow, my pillow, the one I brought from home. Theirs were hard as stone.
Given the lumpy bed (would you believe it, in a sleep center?), the disks, the wires, their black tendrils, the soft glow of infrared lights so the camera could see, it's not surprising that it took over two hours to fall asleep. It was a restless night. It felt as if I had slept just a few minutes when Kelly arrived in rumpled togs, wishing me good morning. It was seven o'clock.
I stayed through the rest of that day so they could chart my naps. Yes, on the second day I was told to sleep at various intervals, and each time I fell asleep like a champ. By five I was back in my civvies, en route to my car and who should I meet but Robert. With great restraint I smiled and didn't trip him.
A few days later my doctor and I met to discuss the data. His diagnosis was sleep apnea. In brief, that means I stop breathing at night and struggle for air, which wakes me up. Hence, interrupted sleep, fatigue, possible death if I don't succeed in my nocturnal struggle for air.
My options were medication that might upset the central nervous system. I ruled that out. My brain is already addled. Or, an apparatus that I could wear across my face every night for the rest of my life. Need I say more? Or, surgery. A bit more conversation with the genial doctor revealed that recovery is painful. The word "pain" had an off-putting effect.
I told the Dr. Great-and-Famous that I would sleep on the possibilities and get back to him about my choice. It is six months later. I was still "sleeping on it" until a surgeon, whose specialty is sleep apnea, told me I do not have sleep apnea.
Only by accident did we meet.
A few weeks ago I had an infected ear and decided to see an ENT (ear-nose-throat specialist). On the jungle drums, I heard of a man who was a respected ENT and an apnea surgeon. After he examined my ear I handed him the printout from the world famous sleep center, which I requested in preparation for my ear exam. He deciphered the statistics and explained that a number seven was normal for a 64 year old woman; that he would have generated a number five if they wired him, and there is no reason for concern about apnea until the number is 20 or above. He is half my age. He also noted that apnea is characterized by falling asleep immediately but my data showed a delay of 147 minutes to reach the Land of Nod.
His diagnosis is insomnia. I think he showed immense moral courage to contradict Dr. Great-and-Famous from a world class sleep clinic. But, bless his heart, he did it. He has referred me to a neurologist.
Am I relieved? You bet! Suppose I had been taking meds that messed up my brain for the past six months? Or had an operation for a problem that isn't mine? I now know that my first response to the apnea diagnosis should have been to get a second opinion, if only from my cat.
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