The Sleep of the Lambs

It has been another tough week. My dearest T has needed to see two different specialists: an Endocrinologist and a Respiratory specialist. The good news is that she got a diagnosis and began a course of treatment; the less good news is that she will probably need this treatment for life.

Around a year ago I was at a clinic waiting for an asthma review when I saw a poster on the wall: ‘Does Someone you Love Snore?’ The poster explained that bad snoring can be a symptom of a dangerous respiratory disease called sleep apnoea, and said that there was a simple test for this. I went home and spoke to T about it.

She snores very loudly. I often found it difficult to sleep in the same room as her, even wearing earplugs. Not only was her snoring loud, it was disturbing in other ways because she sometimes sounded like she was choking. We looked up sleep apnoea; it was dangerous because your airway would become blocked whilst sleeping. Usually your nervous system would kick start your body and wake you from deep sleep to reopen the airway. But when you subsided into deep sleep, the airway would often block again and you would need another kick start. Over time this process would put a lot of strain on your heart and could lead to high blood pressure, a stroke or a heart attack. 

I asked T to go for the test. At first she was reluctant but I persisted. Then she began to suffer other symptoms: extreme tiredness, bad headaches, shaking, occasional blurred vision, pins and needles. She went to her GP who gave her some blood tests. The results showed that her hormone levels were abnormal. After some discussion he referred her to see the two specialists. Then, through an acquaintance of T’s, we learnt that sleep apnoea with disturbed hormone levels can be a symptom of a problem with the pituitary gland. Her husband had a tumour on his pituitary gland which had caused the sleep apnoea. We began to worry a good bit more.

The sleep apnoea test is quite odd. T was fitted with a heart (mini ECG) monitor and finger (blood/oxygen) monitor. A small microphone was also taped to her forehead. She wore this for one night, and returned the kit to the hospital the next morning. Then we waited. Strangely enough both of the appointments came in the same week.

The Endocrinologist was first. He spent the best part of an hour talking through T’s symptoms. His view was that the core problem was sleep apnoea because the majority of her symptoms were intermittent. He felt that if there was a problem with the pituitary gland these symptoms would be continuous. But to double-check he sent her for a suite of blood tests.

The Respiratory specialist told her that she had mild to moderate sleep apnoea. The test showed that she had woken up 15 times an hour for ten seconds or more. She was shocked, that meant she was waking up from deep sleep over 100 times a night. But this had been happening automatically, she was hardly ever aware of it. When your sleep is this disturbed it disrupts your body’s maintenance systems and can cause a whole host of distressing symptoms. No wonder she was feeling so tired and debilitated.

The treatment is a small breathing machine which keeps her airway open at night. The machine pumps in air to her nose and mouth through a close fitting mask. It makes her look like a cross between a Second World War pilot and Hannibal Lecter. We both laugh at it. But, given the dangers, it is a small inconvenience. The first night with the mask on her snoring stopped and, despite suffering from a bad cold, T began to feel a little better the next morning.