Counting sheep, losing sleep, and chasing time.
By Mazel Ceniza
“75 years old,” he reminisced.
During a time management workshop in the Philippines, Gener felt that his ‘departure age,’ or the age he was content with passing away, would be 75 years old. At the time, Gener was 35 years old and planned to spend half of his remaining years earning and saving and the other half enjoying his retirement.
Once a philosophy professor at a university in the Philippines, Gener was highly regarded and loved by his students and co-workers. After finally defending his thesis for his masters, his plans abruptly shifted to immigrating to the United States. When he couldn’t find a teaching job, he decided to study nursing, a field he was completely unfamiliar with. Still, he was determined. Growing up in a province where opportunities were slim, working hours and hours a day, perseverance was nothing new. He knew that he could adapt to the external circumstances. However, he did not realize that what would slow him down was something internal.
At 51, Gener was diagnosed with a sleep disorder known as Obstructive Sleep Apnea (OSA). Typically, when we sleep, the brain commands the muscles to hold open the threat so oxygen can travel through the windpipe to the lungs. Sleep Apnea relaxes the muscles in the throat, blocking this essential airway, preventing air from getting to the lungs. To address the drop in oxygen levels, the brain partially wakes up to jolt the airway open. These tiny wake-up calls are very brief, so the next morning, those with OSA are completely unaware they woke up hundreds of times through the night. Still, they feel the physical toll of sleep deprivation, as if they pulled all-night, according to the Nature of Science and Sleep medical journal.
“You’re tired even before working. How about that?” He laughed almost in disbelief.
However, Gener had not considered that the cause of his fatigue and his dwindling focus was due to a sleep disorder. Between working night shifts in his first licensed vocational nurse job to accommodate for his daughter’s school schedule and staying up studying for his registered nurse degree, sleep was the least of his priorities.
Moreover, the symptoms of sleep apnea are generally normalized. A common belief, for instance, is that snoring occurs when an individual is merely in a deep, deep sleep. However, the reality is quite the opposite. Snoring is a result of when the body is unable to sleep deeply. According to The Journal of Clinical Sleep Medicine, when air is forced through the space constricted from the relaxed muscles, the surrounding tissues vibrate, hence the loud snoring.
It was only when his wife, Queenie, who is also a nurse, commented on his symptoms that he considered me have sleep apnea. When he looked into it, he recognized how much he resonated with the symptoms online, especially the cognitive symptoms of brain fog.
Gener describes the sensation as if he’s floating, where his brain is working against him rather than alongside him.
With the fast paced environment of nursing shifts and the expectation to understand all symptoms and history of every patient, Gener describes the sensation as if he’s floating, where his brain is working against him rather than alongside him. In every work shift, rather than going based on memory like every other nurse, he uses a clipboard and paper to track all his patient reports, including their medications. Otherwise, he’s certain he’ll forget when speaking to the doctors. While writing rapidly, he aims to keep smiling and remain approachable.
“I’m so excited to learn about nursing and getting advanced,” He sighed in frustration, “My brain is just not cooperating like it should. I should know this."
Gener’s Speech in his Registered Nurse Graduation Ceremony. Photo by Mazel Ceniza.
Gener highlighted, however, that it wasn’t just his limited physical capability that frustrated him, but the confirmation of growing old that taunted him. Knowing you’re getting older is one thing, but actually witnessing your body slowing down is another.
“I’m not afraid to die. I’m afraid to get old,” he said.
Immigrating to America only further exacerbated this feeling of racing against time. Between completely starting a new job, having to learn all the basics, and adjusting to the culture and lifestyle of a different country, he feels as though he’s rushing through the remaining years of his life before he’s even starting it.
Sleep apnea deepened his fear of having to get to this stage early, knowing that he is very much capable. He aims to advance his career, become a charged nurse or a leader in the hospital, but with the limitations of fatigue and brain fog, he lower his expectations.
The good news is the condition is treatable, he reminded himself. Still, the journey to get treatment was complicated. Between his perception of the CPAP machine being suffocating, his guilt in his wife’s inability to to fall asleep because of his snoring, and recognizing the difficulty in navigating his work, the risk of developing bradycardia, common in patients with sleep apnea ultimately led him to seek treatment.
Bradycardia means a low resting heart rate, which can be dangerous when the heart rate is too slow to met the body’s oxygen demands to the brain and other organs. Evaluating a group of six sleep apnea patients, researches in the Journal of Clinical Investigation found that bradycardia occurred during 95% of all apnea, regardless of type.
Gener went through three sleep tests. The first two times, he wore a small monitor overnight at his home to track his breathing effort, airflow, snoring, and blood oxygen levels, both which did not give enough information for a diagnosis. After the third test in-person, the polysomnographist confirmed Gener had OSA.
It is now Gener’s third week using the CPAP machine and he’s feeling hopeful. A CPAP (or a continuous positive airway pressure) machine treats OSA by preventing the tongue and soft tissues in your threat from relaxing and closing off the airway by delivering a steady, gentle stream of pressurized air into the throat through a mask, according to the Dove Medical Press.
For Gener, the masks grips the sides of his nose so tightly that it leaves mini bruises, which he shamefully notes are painful and physical reminders of his condition, like battle scars that he hopes aren’t noticeable.
He doesn’t want anyone to know. The CPAP machine remains among the main reasons people hesitate to begin treatment, which is attributed to the stigma associated with it. A recent skit on Saturday Night Live, pokes fun at how unflattering the CPAP machine is and markets the ‘CoolPap machine,” a more creative, playful twist to the design of the machine. Although SNL is satirical, the skit reveals the underlying perception of many that this treatment is “unattractive” or out-right “weird. Nonetheless, Gener declares the he’s still grateful for starting this treatment.
“I’m very positive that things will workout,” He peered out a slight smile.
Gener Ceniza and his family celebrating his 51st Birthday. Photo by Mazel Ceniza.
Since he began using the CPAP machine, he has felt the difference in his productivity in working and his sleep. Gener is starting a new position as a supervisor at a hospital and is excited to start new hobbies like pickleball with his wife. He looks forward to spending these remaining years, until 75 years old or later, with energy for his family, confidence in his career, and giving himself grace.
As a nurse and a previous professor, Gener spent most of his life taking care of other people’s education and health. And as his daughter, he spent most of life taking care of me.
For the first time, he’s taking care of himself.
References:
Chou, Michael S., Natasha C. Ting, Nicole El-Turk, Zinta Harrington, and Claudia C. Dobler. “Treatment Burden Experienced by Patients with Obstructive Sleep Apnoea Using Continuous Positive Airway Pressure Therapy.” PLOS ONE 16, no. 6 (June 7, 2021). https://doi.org/10.1371/journal.pone.0252915.
Hooper, Robert G. “CPAP Therapeutic Options for Obstructive Sleep Apnea<p></P>.” Pragmatic and Observational Research Volume 11 (July 2020): 67–76. https://doi.org/10.2147/por.s258632.
Maimon, Nimrod, and Patrick J. Hanly. “Does Snoring Intensity Correlate with the Severity of Obstructive Sleep Apnea?” Journal of Clinical Sleep Medicine 6, no. 5 (October 15, 2010): 475–78. https://doi.org/10.5664/jcsm.27938.
Osman, Amal M, Sophie G Carter, Jayne C Carberry, and Danny J Eckert. “Obstructive Sleep Apnea: Current Perspectives.” Nature and Science of Sleep Volume 10 (January 2018): 21–34. https://doi.org/10.2147/nss.s124657.