“Snoring Through Midnight”: Nights at the Sleep Clinic -The Toast

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die-homer-simpson-sleep-text-the-simpsons-Favim.com-142214Marissa Maciel’s previous work for The Toast can be found here.

After I graduated from college, a newly minted, twenty-year-old psychology major, I worked at a sleep disorder clinic. The job put me in bedrooms with strangers, people who couldn’t sleep and wanted answers, and I was there to help figure out what was going on.

Mostly, these people were here because they snored. When some people snore, their breathing can also slow down (hypopnea) or they might stop breathing altogether (apnea). Sleep apnea can cause daytime drowsiness, and can cause dangerously low blood-oxygen levels. The stopping of breath wakes you up, robs you of the deeper brain waves that restore you during sleep. But I saw more than just snorers and exhausted 9-to-5’ers in the clinic.

One time a client passed out and showed me just what apnea looked like, and it freaked me out.

I had gone into her room to wake her up; she had gone through the sleep study and was looking forward to going home. She sat up too quickly, swung her feet off the bed too fast, and in the middle of a laugh about how she was glad to be done, she slumped forward and hit the wall – literally, with her head.

I followed her body as it came to rest on the floor, her unconscious weight was as heavy as anything I’d ever tried to lift in my life, and the best I could do was to guide her down. Together we went, finally her body ended up on the floor on her back, kind of breathing – kind of not. This is what apnea looks like, what she was here to be examined for. Gasping like a goldfish out of water, soft clicking noises coming from her trachea.

So there she was, a red mark on her forehead from where she made contact with the wall, laying unconscious on the floor, and I’m going through my CPR checklist while my coworker is saying “Fuck! Fuck! What do we do!” He was about ten years my senior, and this was maybe my third month on the job. I told him to call her home, try to reach her husband.

He called, and called, and called again, and her husband didn’t answer. I pictured that man in their large bed, sleeping peacefully this one night – The Snorer wasn’t there. His tired body enjoying the quiet and comfort of solitude. He wasn’t going to wake up for anything.

Finally, in what seemed like ages, she woke up. We asked her questions: What day is it? What’s your name? Where are you? She answered accurately, laughed about the whole thing, and begrudgingly took a soda pop to help her blood sugar. I watched her walk out in the darkness, at barely 5am, and enter a code on the car’s door handle to get inside. Only later, when we retold the story to my boss, did we find out she had a concussion.

The only other time someone hit the wall at work was when my boss was angrily moving furniture, and his ass crashed into the wall and left a round crack in the sheetrock. I suspected the man did cocaine; he had bloodshot eyes and a permanent runny nose, coupled with egomaniacal stories of a not-so-exciting sounding nightlife (“I did this one dance move and this chick couldn’t even keep up with me, so she just stood there!”) When he worked nights, he liked to step out at 2am to chain-smoke three cigarettes at work, in the freezing cold air that swirled around our building. But mostly he stayed away from the night shifts; that was the main perk of being the boss.

The rest of us staff members were young, barely into our twenties. We were called medical technicians, but only a couple of us actually read our training materials and could tell the difference between a normal heartbeat and brainwave. There were different reasons why people worked at the sleep center. There were people who wanted to help people; people who wanted independence at work; and people who worked two jobs to try and earn more money. Some of us could handle the hours – starting at 7pm, leaving by 6, four days a week. You drank coffee through the night, microwaved dinners in the kitchen, or scooted off to a drive-thru while your coworker covered for you (you had to bring back a small french fry order for them) – trying to nudge your circadian rhythm into alignment. Of course some of us couldn’t handle it, dozing off to sleep in the middle of a shift.

On my first night at the center, my coworker was supposed to show me the ropes. “Here’s how we prep the electrode box. Here’s how hard you scrub their scalps to get a good connection with the nodes. This is how you put the belts on their chest and stomach.” He told me his tips for staying awake – “Listen to talk radio! It’s interesting, keeps me going.” He fell asleep two minutes after his clients did, in the most ungracious manner. Elbows propped on the desk, head propped on his hands – slowly bowing down with it’s weight – faux-watching the monitors. Occasionally his head would drop with a slump, only to be jerked violently back with a groan. I was wagering with myself about when he would actually hit the desk with his forehead – it took about 30 minutes and was not as satisfying as I had hoped. After the thud, he sort of shook it off, and went back to propping his head up.

Working at night can make you tired, sure. But it also makes you feel uncomfortable in the dark. We had no bathroom in our center, which was a renovated office suite, so we had to go outside to a separate restroom with a locked door. When you’re camping, leaving your tent and stepping out into the darkest of night to go to pee in the woods is creepy; What about animals? What if I step on a slug and bring it back into my sleeping bag? Spiders hiding in the bushes! Leaving an office to go to the bathroom in the middle of the night should have been easy, but it wasn’t. You’ve created a simulated “work day” atmosphere inside the office, with computers humming and music playing, fluorescent lights blaring. Then you step outside of your work zone into the dark, where it’s quiet and still. You think, “I’m probably the only person out here, at this hour.” And then, you worry that you’re not.

Maybe it’s from years of conditioning, being told not to be out alone in the dark, use the buddy-system. I felt exposed and vulnerable, but also determined to show no fear. I walked with a quick, determined pace to the bathroom, key out and ready to open the door. My head constantly moving, scanning left-right-left, like I was going to spot that killer before he spotted me. I would tell my coworkers, “If I’m not back in two minutes, come and find me.” That wasn’t really instilling confidence, I suppose.

“If I’m not back in two minutes it’s because they’ve already got me. Come and find me and distract them so I can escape.

I felt bad for the clients who had to go to the bathroom during their sleep study. They’d wake up, turn over a few times, then reach for their room’s intercom in the dark. A scratchy voice would say, “I have to go to the bathroom,” with more than a hint of disappointment as if it was a failure to interrupt the study for such a stupid thing as peeing. We’d come in with a flashlight to unplug them and help them outside, unlocking the door and waiting for them like they were prisoners.

If it took a while, my sympathies would start to weaken. I would sometimes ask, “OK in there?” trying not to sound annoyed, and with practice I learned to say it in a way that didn’t sound like your mom, waiting impatiently outside of a dressing room at the mall, “What’s going on? Are you OK? Do you want me to help you?”  Didn’t they realize how vulnerable a position we were in, in the dark, exposed by this stupid outside bathroom? This didn’t count as a buddy-system situation because these people were hampered by being in their pajamas and connected to 12 wires, which were connected to a box. They probably felt safe because I was there as a guardian. I looked at them as dead-weight. I wouldn’t think twice about running away if shit went down (shit never went down).

Except for these momentary pangs of survivalism, I had empathy for the clients. I think I developed my empathy and professionalism from seeing the different kinds of people come in feeling vulnerable, or embarrassed, or maybe angry about having to relent themselves to having their sleeping habits studied. If I felt they were open to conversation, I would try to break down their armor by making little jokes, giving them a compliment, or making them feel like they were getting some special information none of the other clients had.

“You know,” I would say, in a quieter tone of voice, “people don’t realize that metabolism can be hampered by sleep apnea. The loss of sleep makes your body less efficient, and you end up in a loop of being tired, gaining weight, snoring more and having problems staying asleep, and on and on.”

“Oh!” they would say, looking at me as if I’d cleared up some long-unanswered question, and they’d open up to me about whatever hardship their tired bodies had been going through.

But some people were happy to talk, and they would give me their history while we got ready for the study to start, and my heart would grow another inch or two for them. There was one woman, a nurse, who had chemical burns on her arms from working with industrial cleaning solvents. She talked about how she couldn’t complain about it at work or they would give her the crappy shifts (ha ha). I looked up some advocacy groups and a legislator’s contact information during her study, and gave her the numbers when she left.

One time a young girl came in with her parents. They had planned it so that mom would share the bed with her, and dad would sleep on the floor. At first I thought they were just a tight-knit family, and wondered why dad didn’t just sit this one out. Then I noticed how the daughter was very nervous, and mom and dad seemed like they had coordinated this arrangement one or two times before. We didn’t talk about her history, or why she was here exactly; I strove to be professional and affable, but let her parents take the lead. Maybe this was one in a long line of nights they’d spent with their daughter, three to a room in some clinical setting. I asked her mother to help me get the electrodes and straps on her daughter, to help make them both feel more comfortable. I made sure not to step on her dad when I had to come in for the second phase of the study.

That second-phase, usually after they’ve been sleeping enough to demonstrate that their breathing drops (or stops) enough to wake them out of deep sleep, was when we came in to put on a CPAP mask. Continuous Positive Airway Pressure, ideally, would push air through their noses, down their airway and keep the soft palate from closing when the sleeper inhaled. This would prevent apneas, hypopneas, and snoring. We’d strap the mask over the client’s nose, turn on the machine (which sounded like a quiet vacuum, which is an oxymoron), and they’d fall to sleep again…we hoped.

Most people really would fall asleep quickly, only to wake up after 20 minutes feeling like they were suffocating. Or swallowing air. Or choking on their dried up tracheas, dessicated from the forced air of the machine. Even though we’d see positive results from the treatment – reaching deeper phases of sleep faster, without any apneas – nearly everyone would swear to never put that mask on again. One woman told me she dreamt she was drowning while scuba diving. “Well,” I offered, positively, “at least you had a dream, right?”

My empathy did have its limits. One patient came in with a begrudging attitude – which was normal. He was in his 60’s, with a bald head, a thick, a grey mustache, and a pot-belly. He sat through the preparation almost sternly quiet, not asking questions or complaining but also not replying to me without more than a grunt or a nod. I figured he was just nervous.

When we went into his room, he immediately flipped open the doors to the armoire.

“Where is it?” he asked, in a panic.

“What?!” I asked, feeling like I had forgotten some crucial thing about armoires.

“The television! I can’t go to sleep without watching t.v.!”

I felt for him, I really did. How could I not, with his eyes wide and fixated on my like I had ruined his life. I explained that he had to sleep here, we didn’t have time for him to watch t.v. and besides, we didn’t get cable, ha ha.

“Oh, alright,” he said with a sigh, and he slumped down on the mattress. I felt relieved that he didn’t protest more, maybe demand that I let him fall asleep in his car listening to the radio.

After a few seconds, he shot up to his feet again. “Wait, I forgot something!”

He shuffled out to the parking lot with his box of wires in one hand, and came back with another box. A big box.

“What’s that?” I asked.

“I need to have this to sleep, too.”

It was a case of beer. 24 cans of beer.

“How much do you drink of that?” I said, pointing at the box.

“All of it.” he said. Like, duh.

This was my line in the sand. I could feel the back of my neck getting hot, imagining how badly this could go, and I resolved that if he left I wouldn’t care because this wasn’t going to happen on my shift. There was no way my boss would allow me to run a sleep study on a man with 288 ounces of beer in his system.

“I can’t let you do this. You can’t have that much to drink before a study,” I started digging deep for a good, logical reason. “Your doctor won’t consider the results valid if you’re on alcohol, and you’ll have to come back, again.”

“Well,” he said, his hands gripped tightly on the cardboard handle, mentally calculating the discomfort between missing his beer versus coming back to go through this rigmarole again. “What if I drank half?”

I imagined countering his offer, saying, “Six, only six!”, and then imagined him dying from the DT’s on my shift. My coworkers would tell the story, long after I’d been fired; “Then, the old man curled up, let out one last snore, and died.

My empathy kicked in again, and I decided I could live with twelve cans of beer in him and make his case with my boss later. He sat up in bed, drank those beers as fast as possible, and was snoring before the hour was over. When I came back to put his mask on for the second part of the study, I complimented his fortitude. I told him I was impressed that he fell asleep without watching t.v.

“Yeah,” he said, a little hint of sarcasm peeking out from his more than half-asleep face. “Me too.”

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