Sleep, Inc. Part I

By the time I first learned about sleep apnea, CPAPs had actually been on the market for almost six years. My best friend in high school, church, college, and the time thereafter was a year older than me and transferred to The University of Texas when I was starting my sophomore year. I'm not and was not as enamored with Austin as many people seem to be, but most of my friends were all attending UT around the same time as me, and when Jim decided to transfer, I couldn't have been more excited.

We rented an apartment in West Campus with another friend from our church in Houston. He had his own room, and Jim and I were content to share a bedroom. We were like brothers. Our humor aligned with one another. We both enjoyed mountain biking. We both enjoyed just getting away from the cluttered campus and the traffic around it to explore central Texas.

But having Jim as a roommate, let alone one who shared a room with me, came with a major downside I had never encountered before. Snoring.

I was a light sleeper. So light in fact that I used to get very irritated if something woke me up. Yes, I was that guy in high school and college that would call the police on your party, or even pound on your door if it whirled up again after a police visit. I feel so ashamed of this, really, because now I wouldn't call the police on anything short of finding a dead body, but I also wasn't self-aware enough about LGBTQ+ or Black history to have formed a negative opinion of the police I hold now.

I got so irritated about being woken up in the night that during my sophomore year in high school, when I was staying at a friend's house for a D&D-themed sleepover, someone pressed a still-closed and very cold can of Coke against my face, and my first instinct was to launch the can across the room where it broke the nose of another friend.

So Jim's snoring was a pretty big deal. I discovered earplugs then, but he was so loud that they were of little help. I'd bury my face under my pillow hoping it would work. I even slept with a CD boombox at the head of my bed and listened to the same album continuously through the night to try and escape the sound. Nothing helped.

I took up reading instead, and I would listen to the snoring, and it soon dawned on me that Jim wasn't just snoring. He would stop, and when he stopped, it was very clear he was struggling to breathe. I told him he should have this looked at after talking with someone who informed me it was most likely sleep apnea. But Jim didn't ever think about seeing anyone about it.

He wasn't the type you associate with sleep apnea today. He wasn't a big guy. In fact he was rail thin. I imagine he still is. Neither of us were drinkers, and while our diet wasn't healthy, we both still had the metabolism of the young. But dear god, his snoring was loud. When I would sit up reading and listening to this hellish scraping coming from his mouth, I wondered how such a nice young man could make a noise that sounded like a choir of devils. And when he stopped breathing, forgive me for this, I sometimes hoped he wouldn't start again. Not really, but the thought floated through my mind on more than one dark occasion. Don't worry, Jim knew I felt this way.

There was just no way to escape it, and it's not like I was doing research on sleep apnea like a character from an occult horror film scouring their local library for books on demonic possession to figure out how he could be saved.

When we graduated, we moved to Dallas to start a Christian band. We were entirely unsuccessful, but it was a pipe dream that we both had because we loved church and wanted to be like Rich Mullins.

During that year we rented one side of a duplex, and we each had our own rooms. His snoring would still keep me awake.

This was 1995, and my burgeoning need to come out and be free to openly explore relationships with men outweighed the dream of being in a cool Christian rock band. During a very stressful conversation, I came out to Jim. It was a good conversation, though, because he admitted to me he was ready to move on too. He had been eyeing the Southern Baptist Convention's Journeyman program that sent youthful devotees to far-flung corners of the globe to do mission work.

My secret boyfriend's daughter was a Journeyman in Burkina Faso, and consequently, I know way more about Burkina Faso than most people.

Jim ended up in the spectacularly exotic Eugene, Oregon. It was there that he met the woman who would become his wife. I couldn't afford to attend their wedding because I was buying my first home back in the olden days when such things were possible. But I met her later and asked how she dealt with the snoring.

"He doesn't snore anymore."

WHAT? Jim had a surgery called (deep breath) uvulopalatopharyngoplasty, or UPPP for short. Sleep apnea, in case you don't know, is when someone's airway is obstructed or partially obstructed during sleep. The muscles in the throat relax, the tongue falls back, and soft tissue collapses against the airway. It's a perfect storm of suffocation. Air from both your nose and mouth can't get in or out. You won't suffocate. When your body needs to breathe, it will jolt you awake in what the medical world calls a micro-arousal. Sleep apnea won't kill you, but it can lead to further complications that can kill you. Little things like a stroke, sudden cardiac arrest, and even a form of diabetes.

But the UPPP procedure reshapes those areas at the back of your throat. It removes tissue to allow the airways to remain open during sleep.

I was actually rather irritated that it took a wife and not a best friend for him to get the procedure done, but it changed his life for the better. The UPPP procedure has about a 50% success rate, which means it may not work for everyone. But it worked for Jim. I just wish it had worked for Jim going into the year 1992.

I brought up CPAPs at the start of this because they are the mechanism now used to treat sleep apnea, and the reason Jim's surgery has all but disappeared from the conversation. Jim's surgery, when he had it, was around $1,000 if I remember correctly. Today, the same procedure costs around $8,000. But the simple UPPP procedure isn't common anymore.

CPAP stands for continuous positive airway pressure. It's a device that forces air down your throat to keep your airways open. Just enough pressure to allow you to breathe without blowing you up like a balloon. CPAP has a fancy high falutin' relative called BiPAP, or bilevel positive airway pressure machine. Where a CPAP delivers one constant pressure, a BiPAP delivers two: a higher pressure when you inhale and a lower pressure when you exhale. This makes it more comfortable for patients who need stronger intervention.

If you are not familiar with sleep apnea or CPAPs, you might remember when Galaxy Brain Genius Elon Musk claimed to have purchased ventilators for hospitals during the COVID pandemic. What he actually purchased were BiPAP machines. Ventilators can take over breathing entirely for a patient in respiratory failure, operating within a closed system. BiPAPs and CPAPs cannot do that. They are open systems that push air into the airway but also blow air back outward, which meant that using them on COVID patients carried a real risk of spreading the airborne the virus into the room. So not only were they not ventilators, they were potentially dangerous for medical personnel, caregivers, and the world at large.

CPAPs began as a technology at the University of California, San Francisco, where a doctor named George Gregory spearheaded a device to help babies suffering from infant idiopathic respiratory-distress syndrome. They were born too small and needed help breathing, and Gregory's work revolutionized neonatal intensive care. Building on that concept, an Australian physician named Colin Sullivan developed the first CPAP designed for adults with sleep apnea in 1981. By 1985, the first commercial CPAP was put on the market by Respironics, a division of Philips. It would take some time, but the capitalization of the sleep apnea industry had begun.

Now, over 40 years later, CPAPs are more common than UPPP surgeries, and the CPAP business has grown into a $26 billion industry. I doubt the procedure Jim had, which again at the time cost around $1,000, ever created a $26 billion cottage industry that would hook sufferers of sleep apnea into a never-ending spend cycle to control their nighttime breathing.

But I will share more about that in the next part of this story.