(I'm asking because you've given this a lot of thought.)
Are you still a trauma nurse by the way? You are my hero.
I'm still working ER in a lovely part of Silicon Valley. I stopped doing trauma several years ago. With any luck, I'll be able to stop boot strapping in the next 6 months, and leave nursing behind for good.
re: sleep apnea
The problem with Sleep Apnea, is that you adjust to how you feel. I thought that one of my biggest problems was the shift work that I was doing. I would have jags, where I would sleep 4 hours, and then be up for 12 to 16 hours. Turned out, after a couple of sleep studies I was waking myself up after 4 hours because I was suffocating repeatedly while I slept. When I woke up after 4 hours it was because my body had jolted itself awake with a surge of adrenalin, because I had desperately needed oxygen.
Sleep apnea is correlated quite highly with nasty long term diseases like pulmonary hypertension, heart attacks, strokes, diabetes, and obesity. Your whole cardio vascular system is over worked because it struggles with oxygen deprivation for 1/3 of each day. It also messes with your endocrine system (stress hormones, insulin production, adrenalin production, etc...) because your body isn't able to get a full 8 hours of rest and recharging. Instead, it's is constantly stressed ( releasing adrenalin and cortisol) throughout the night, and it leads to things like constant hunger throughout the day.
Since getting treatment, I've lost about 30 lbs, my blood pressure has dropped 20 points. A bigger personal benefit, was that I found that I was able to get into programming flow a lot easier (not as fuzzy), and I was able to program for several hours at a stretch longer than I was able to 2 years ago.
And, I find that I don't need to have a cup of coffee to get myself through the day. I don't drink caffeine at all, now.
Were you regularly tired? What finally pushed you over the edge to look into sleep medicine? I'm wondering if there's something symptomy I should be looking for.
Note that 51% of Wikipedians believe that "The hallmark symptom of obstructive sleep apnea syndrome in adults is excessive daytime sleepiness. Typically, an adult or adolescent with severe long-standing obstructive sleep apnea will fall asleep for very brief periods in the course of usual daytime activities if given any opportunity to sit or rest. This behavior may be quite dramatic, sometimes occurring during conversations with others at social gatherings".
It's not "let's diagnose Thomas" day on HN or anything, but: nobody who spends any time with me during the day thinks I'm epsilon from falling asleep.
How did you end up as an ER nurse? How did the state transition from ER nurse to startup developer start happening? I've known about your profession for ages but never thought to ask about it.
Sleep studies are a bit of a pain in the ass, but the time I've invested in getting my sleep problems figured has been one of the highest ROI of most anything medical I've put myself through, including my cleft lip repair. I love my sleep doctor. They are crazy smart. They do a 5 to 7 year residency after med school. 3 - 4 years medicine. 1-2 years critical care/pulmonary fellowship. 1-2 year sleep medicine fellowship. They are generally happy doctors, because they have a pretty good lifestyle (High billing rate, 9 to 5 work week without call.) as opposed to other high end specialties like Cardiology, Intensivists, etc..
So, the sleep study is the unpleasant bit. Just be sure that you go to a sleep clinic in the richest neighborhood around. You'll get the best trained doctors and the happiest staff working for them. (Most of their patients have good health insurance).
re: Symptoms of Obstructive Sleep Apnea:
What you are describing is narcolepsy, which can indeed be a byproduct of sever obstructive sleep apnea. If you go to a sleep doctor, they will give you a battery of tests like "sleepiness scales", basic tests for depression, questions about your sleep patterns, etc... People with Severe sleep apnea (and concomitant narcolepsy) will fall asleep at very inopportune times. My wife's grandfather was notorious for falling asleep mid sentence. He died of Congestive heart failure.
I never fell asleep during conversations, but the likelihood of falling asleep on a long car ride when my wife was driving was extremely high. I'd also struggle to stay awake while watching TV with my wife in a dark room, and I'd occasionally fall asleep in a movie theater. I had always chalked my sleepiness to working the night shift for years.
The best symptom: Your wife tells you that you stop breathing when you sleep. :)
You're not going to notice much, because you are the proverbial frog in the kettle. You have been slowly adjusting to decreased oxygen levels, and increasing periods of hypopnea (under breathing) or apea (stop breathing) for years. As I said, I had chalked it up to working nights for years. It wasn't until my sleep disturbances really became severe, and my sleep pattern started interfering with work that I went to the doctor.
That being said, I was completely stunned with the results of my first sleep study. As a critical care nurse, I routinely intubate people (put them on a ventilator/life support) when their oxygen saturation (percentage of hemoglobin saturated with oxygen) goes down to 80%. Normal is 95 to 100%, and there's an exponential decay (read patients get much sicker much quicker ) after O2 Sats drop below 90 - 92%. [1]
I almost crapped my pants, when my doctor told me that my Oxygen Saturation routinely dropped into the mid 80's and the lowest it got was 82%. Meaning, that if I were a patient in my ER, and having symptoms of difficulty breathing, I would want to put myself on life support if those numbers sustained themselves.
Needless to say, I got busy and started to take care of things. What's amazed me most, is how much better I can focus on programming now. I'm also a lot "sharper" now, even though I never would have thought I was fuzzy before treatment.
re: nursing.
send me an email, and I'll be glad to tell you the story. This thread is getting a little too off topic. :)
Besides, I gotta run out the door and catch a plane.
ref:
[1] http://upload.wikimedia.org/wikipedia/commons/8/8a/Oxyhaemog...
There's a big difference between steady snoring and interrupted breathing, even if you're not noisily gasping for breath. I'd say my quality of sleep is only about 15% better since I started using CPAP, a meaningful difference if by no means night and day, but I'm also less likely to die of a heart attack in my fifties or sixties.
When the brain notices it's starting to suffocate and jolts one into waking up enough to recover from an apnea event, it releases a small amount of cortisol, dozens or hundreds of times per night. That's the source of the long-term cardio risk, as I understand it.
I was already getting straight A's in school and was captain of sports teams in high school, but the first night I slept with a CPAP machine after that study, I woke up and felt BRAND NEW. It was insane. My whole body from head to toe felt more rested and restored. My life has since gotten a lot better and I've felt more outgoing and healthy.
If you have any shred of a doubt I would get tested. Heart attacks have run in my family and I think it has a lot to do with sleep apnea.