Friday, June 3, 2011

The Benefits of Getting Your Throat Ripped Out

I'm writing this because I've always wanted to put it down on paper but frankly I never had the self-awareness before to really describe it.

Fig. 1. Anthony Hopkins as John Talbot. Go get 'em, Tony!
When you are an insomniac, nighttime is, to steal a phrase from the character John Talbot in the recent remake of The Wolfman, "a wilderness of horrors" [Fig. 1]. You never know what kind of a journey you're going to have, but you know it won't be nice. You dread bedtime. You avoid it, you pace around it like a wolf in a cage. A good night is when you lie awake thinking of all the things you've done wrong, ever. Something hunts you. Your brain runs grainy, poorly-produced films of your failures. You spend your time staring at that frozen clock blinking 3:20 am knowing that now, no matter what happens, tomorrow is going to suck. Maybe you get up and watch tv, but you can't really work because you're tired and raw and scattered. On a good night, if you're me, you prowl the house, the internet, the refrigerator, and get whatever sleep you can on the couch. If you do sleep, it's an abyss, full of nightmares, or a gray, timeless blank that seems to do nothing to assuage the fatigue toxins accumulated in the previous day. Coffee would help clear your head, but then you can forget about sleeping at all. I've gone the other way a lot - brew up some joe, do some jumping jacks, and then you can work or play coherently through the night. But that's not a good idea - you can get away with a day, maybe, but the second day is much worse, and by nighttime you want to crawl out of your skin. After three days, you're in a perpetual fog. Little creatures flash at the peripheries. After five days of not sleeping, you have conversations with people who aren't there, and this is in the daytime. You take little side trips to alternate dimensions, which sounds fun, doesn't it? Whee. The thing that hunts you gets closer [Fig. 2].

Fig. 2. Insomnia - an insider's perspective.
Sleep to me is something that has for the past twenty years come in sporadic, short bursts - little oases in a big desert that slake just enough to make the aridity worse. If you're an insomiac, you know this - you fall asleep for fifteen minutes, then you're awake for two hours, sleep for fifteen minutes, and awaken again disoriented, frustrated, heart pounding, brain yoked in steel wool. The thing hunting you all night manifests in the room, staring from the edge of the bed. After a century, it gives up that soulless stare and gradually resolves itself into a shirt hanging from a hook, or something, which is small comfort. You feel like you're losing your mind. Or, you choke down some zolpidem tartrate (the down-market ambien), and then you feel like the poisoned corpse of Alexander VI, so bloated that the Swiss Guard have to jump on you to stuff you into your coffin. Sleep comes then under pressure, like a big hand holding you down until the alarm goes off. You come out of that groggy and bleary and on edge, and it takes a steady suction of caffeine to get through the waking day.

This experience is not uncommon, I know. But in my case, things continued to get worse over the years. For years, the second I fell asleep, I stopped breathing, so my brain mainlined the adrenaline cascade, and I caromed out of a dreamless sleep bolt upright, scared, angry, ready to fight or run, sometimes thrashing. The air pressure unit I had made things better for a while. If you have a CPAP you know it's no picnic - it's uncomfortable, noisy, it constantly blasts you with random spurts of air in your face, when it's up to speed you have to really work your lungs to exhale, and it perpetually farts and squeaks. Mine was set at 18 psi, out of 20 maximum - I hear that's pretty extreme - everyone else I know has theirs set at 4 or 6. But for me it improved my ability to stay asleep by about 50%, and so it was worth putting up with.

Fig. 3. This won't hurt a bit.
How you live with this, and try to eat right and exercise, and have a career and raise a family? Well you can plow forward with your wind machine telling yourself nothing's seriously wrong and yet complaining about it to anyone who has the misfortune of being stuck in an elevator with you until sooner or later it gets the better of you and some doctor says "it's time to rip out your throat" [Fig. 3]. Which, if you have a sense of humor about it (which I did NOT) is kind of like letting that thing that was hunting you catch up and kill you, and in the process discovering that you actually were the thing that was hunting you. Very Zen.

So the good news is, like most of the things that Zen promises if only you can resolve the ridiculous paradoxes, it worked. Haven't used the CPAP since. I admit it has been hard to fall asleep, because I am pretty uncomfortable from the surgery still, but once I fall asleep I more or less stay asleep -at least, I do not choke or stop breathing, and when I wake up I FEEL like I've slept! I used to drink about six cups of coffee before 1 o'clock - now I drink one or two.  I used to drink four diet cokes in in the afternoon and at dinner, now I drink one. I'm settling into a sleep pattern I can describe as "regular." The effects of the surgery were immediate but, as the scars in my throat solidify and tighten, it's getting even better.

I'm not fully recovered yet from the surgery, but it's kind of a new world. And best of all I'm not going to have to buy those silver bullets - which is a relief, because, have you priced those things lately?


  1. I'm very glad to hear the surgery helped.
    I found out 4 years ago (after I graduated and moved to NY) why I have trouble sleeping - GERD.
    But it's caused by haital hernia - which I don't fit the standard cause-effect paradigm for and they keep telling me I'm not a "candidate" for the corrective surgery. So for now I just randomly doze off at work.

    ~Sam L.

  2. Sam -

    That sounds really awful. I urge you strongly to keep asking different doctors until you find someone who will help you. There is a surgical procedure called fundoplication which repairs the hiatial hernia and then changes the geography of your stomach to stop the GERD. You probably know all about this already, but the sorry truth is that not every doctor is as concerned about your health as you are. I've learned from this that you really have to be your own advocate in health care. Good luck - I hope there is relief for you soon.