Health

What’s it like to have sleep apnea? – Joshua Davis

Prologue: Facts are not the same as understanding

I purchased Something Deeply Hidden by Sean Carroll and I came across these interesting passages:

In one of Aesop’s fables, a fox sees a juicy bunch of grapes and leaps to reach it, but can’t quite jump high enough. In frustration he declares that the grapes were probably sour, and he never really wanted them anyway. The fox represents “physicists,” and the grapes are “understanding quantum mechanics.” Many researchers have decided that understanding how nature really works was never really important; all that matters is the ability to make particular predictions.

Scientists are trained to value tangible results … The idea of working to understand a theory we already have … can be a tough sell. … In a world where all the incentives push us toward concrete, quantifiable outcomes, less pressing big-picture concerns can be pushed aside as we race toward the next immediate goal.

In a later chapter he goes on further to say:

The fact that the (theory) provides us with probabilities rather than certainties might be annoying, but we could learn to live with it. What bugs us, or should, is our lack of understanding about what is actually happening.

He then gives an example of a computer program, capable of answering any question physicists might ask it about the real world. It then makes accurate predictions which physicists can use without understanding how the world actually works:

Such a program would obviously be of great use to scientists and engineers. But having access to (the program) wouldn’t qualify as understanding the laws of physics. We would have an oracle that was in the business of providing answers to specific questions, but we ourselves would be completely lacking in any intuitive idea of the underlying rules of the game.

He concludes that, rather than being satisfied with merely having the right answers the scientists should:

work to figure out what the laws of nature actually are.

Why my memories and previous personality seem foreign to me

We all have a poor sort of memory, its the kind that only works backwards (L.C.)

In this case, the mysterious and perplexing nature of quantum physics seems to describe my everyday life.

Imagine if just like the physicists in the example above, your memories were like that computer program capable of providing you answers. You could get the answer perfectly fine, but it would be completely absent any intuitive idea as to why those answers are true. Someone can ask you a question about yourself and although you know the answer, disconcertingly you can’t quite provide a reason as to why “past you” made that choice. If you think really hard you can even remember what the reason was, but you cannot construct a narrative as to why the choice you made was actually the right choice or the wrong choice.

Can you imagine someone asking you, “why are you still single” or “why did you get married” and as soon as you try to explain the answer, it doesn’t feel convincing to either you or the person with whom you are speaking to? If your best guess is, “wow, that seems like it would be a very not fun experience,” you’d be right. Not only would it be not fun for you, but just imagine how awkward it would feel for the other person. Such is where I’m at right now at this stage in life.

Given such a condition I can see why someone might become a pathological liar. This is because I could use my imagination to come up with a narrative that would feel convincing to both myself and the person with whom I am speaking. I could assign persuasive reasons to past made up choices. I could create a compelling narrative that was far more fun than having to admit, “I kind of remember but I kind of don’t remember.”

I can already hear the response, “How can you not remember something so important? Did you have a traumatic brain injury or something?” This seems like a reasonable question to ask, my answer however does not.

“Not exactly, I have sleep apnea. Unfortunately it makes my past memories dull somehow and by extension my personality also when I talk about the past.”

The conversation becomes awkwardly silent. “But” I interject cheerfully, “look on the bright side, I‘m spared from feeling bad when I see high school pictures of me acting in the drama club on Facebook.” The good news is that my personality which is based on my more recent choices (previous 5 years or so) seems intact (at least for now).

You’re not a doctor. How do you know it’s caused by sleep apnea?

To be clear, the experience of loosing your memories and having your personality change is likely a small minority of people who struggle with sleep apnea. I think the honest answer is, “I don’t.” I have a bunch of circumstantial evidence which indicates that the two are linked but no conclusive evidence. I do attempt to explain the mechanism of how this might work below. Given how little we know about how memory and consciousness function, I doubt that even the best doctors would be able to speak conclusively about my condition.

This is from the Wikipedia entry:

It has been revealed that people with obstructive sleep apnea (OSA) show tissue loss in brain regions that help store memory, thus linking OSA with memory loss. Using magnetic resonance imaging, scientists discovered that people with sleep apnea have mammillary bodies that are about 20 percent smaller, particularly on the left side. One of the key investigators hypothesized that repeated drops in oxygen lead to the brain injury.

Additionally patients with sleep apnea have been shown to exhibit signs of irritability, mood-swings and depression. Not fun.

Those memories were probably sour anyways

This type of attitude is a two edged sword. On the positive side I’ve been allowed to change and become a totally different person. On the negative side I’ve lost who I was in the past. To be clear, I haven’t lost the facts about who I was or what happened, I’ve merely lost the narrative reasoning as to why I made the choices I did. Often times I know some of the reasons or beliefs I held in the past when I made certain choices, I just can’t logically understand why I believed what I did. I can’t justify the past and connect it to the person I am now. It’s like having to tell someone else’s story which seems strange being that the “someone else” is yourself.

The odd thing is that certain memories are perfectly fine but others are almost completely gone. When we remember something we don’t merely read the memory stored somewhere in our neurons, the act of remembering something requires that we recreate the memory each time we remember it. PTSD patients have been given MDMA and then were asked to relive some of their most traumatic memories. The result was that those memories had less power to obstruct their everyday life. In some sense this is because those memories were altered simply by the act of remembering them again.

But how can the facts of a memory remain when the emotional reasoning that was embedded in the memory is now absent? In trying to understand this phenomena I realized that there is some relational similarities in how we treat substance abuse. If you’ve never heard of the Sinclair Method of using naltrexone to treat alcohol or opioid dependence then I would recommend this helpful video which discusses the treatment.

It seems like it wasn’t the facts recorded in my memory which where changed, but rather my ability to enjoy remembering that event. This is similar to how pharmacological extinction works. Some very positive memories seem to have lost all their charm and some negative ones their bite. The more I try to reevaluate those memories the more foreign they seem to me. Eventually I almost have a type of autoimmune response to those memories as if my mind is saying, “that’s NOT me.” Once that happens in relation to a remembered event, that event is more or less gone. So the more I try to remember some things the more those memories are destroyed in the process.

Why don’t you just treat your sleep apnea?

How my oral appliance works (minus the industrial strength twist ties)

Oh I’ve tried, believe me I’ve tried. I can’t use a CPAP or APAP because I just rip the mask off at night. I had a good solution which involved hacking an oral appliance with the help of a drill and some industrial grade twist ties. I also lost 14 lbs, yet the issue still persists. With the help of the appliance, I was cured for about a year or so and then it came back recently. That’s a bit of a mystery because the appliance didn’t change, so I suppose somehow my anatomy changed, not sure. The only thing I’ve yet to try is surgery which is not covered by my insurance and it’s expensive.

You don’t seem concerned


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