SLEEP

Wheelchair

LIFE

Chances are, if you use a wheelchair you may have to sleep on your back at night. See the section on House & Home for considerations about Beds. I get cold or hot a little more easily when I'm sleeping. So I pay close attention to the thermostat's temperature setting, in order to find a balance between comfortable for me, and comfortable for those in my home. I use a heater or a fan at night sometimes, when temperatures fluctuate to the extremes.

Along with sleeping on one's back comes the increased likelihood of sleep apnea. Sleep apnea has become more well known recently. In layman's terms, sleep apnea is a condition in which the windpipe relaxes, or the tissues around it, relax and closes off the air passage when one falls asleep. Thus causing the body to wake up momentarily to reopen the airway, without consciously knowing about it. The result is less oxygen and far less restful sleep, because the person literally stops breathing and does not reach the deeper levels of sleep. Additionally, the erratic intake of oxygen significantly increases the likelihood of heart attacks, strokes, and other health issues. People with sleep apnea also tend to gain weight, and feel generally more lethargic. Apnea (or as they called it on Seinfeld, "the apnea") also affects memory and attention span. If untreated, it can be fatal.

There are various sleep apnea treatments, some of which result in cures. One way to reduce or maybe even eliminate the negative effects of sleep apnea is to lose weight (made more difficult because sleep apnea can actually cause weight gain). Doctors say that the tissue that falls to block the airway when people fall asleep is primarily fat. Apparently, there are reported cases of people dieting and/or exercising to lose enough weight that the tissue no longer occludes oxygen flow during sleep. Surgical intervention may also be attempted to remove or reduce the tissue, but that is obviously more invasive, and there are no guarantees it will work. There are also mouth appliances which are designed to hold the bottom jaw forward and prevent the tissue from relaxing into the airway. The troubling part is none of the treatments or attempted cures are guaranteed. So it makes sense to attempt the least invasive first. Besides, for most people, losing weight can be a good idea, notwithstanding any sleep apnea concerns (okay, for some people ... anorexics ... losing weight is not a good idea. Which reminds me of one of my favorite lines ever: "If Mama Cass and Karen Carpenter would have shared that sandwich they'd both be alive today.").

A sleep study will help to determine if you have sleep apnea. Medical and health insurance very often will pay for a sleep study. I was able to have mine done in my home, because of the obvious obstacles to a quadriplegic getting in and out of bed in a laboratory. The study determined that I had sleep apnea and stopped breathing an average of 78 times an hour, as a result, my oxygen absorption was very poor.

The treatment I eventually settled on is a CPAP (Continuous Positive Airway Pressure) machine & mask which pressurizes room air and pumps it through a tube into a mask on my nose. It creates pressure that keeps the airway open. Almost immediately I was a changed man. I felt better, my general health was better, I was told I looked better, and my attention span and memory were better. I did not even realize the level to which I had deteriorated. My CPAP is not very convenient or sexy, but the benefits far outweigh the hassle and the 'nerd' factor. I make fun of myself when I wear the mask, and refer to it as my Pigs In Space mask (after the old Muppets skits). When I first got it, my friend Jason quipped, "That’s a good look for you." (Notice I’m not posting a picture of me with my CPAP mask on). But, despite it not being "cool," it is great. When I travel, I don’t leave home without it.

Ingress/Egress

One of the tricks I learned about getting in and out of bed is the use of satin, fitted-sheets and "draw" sheets (or "turn" sheets). They allow me to slide much easier, thereby making it easier on my nurses getting me out of bed, and my roommates (or whoever) when they put me in to bed. I still like the smell and feel of clean cotton sheets, though. So that's my top sheet. I also found that while sleeping on my back, I sleep better without a pillow. I'm not exactly sure why. It may be that laying flat helps the airflow, I don't know. I also don't wake up with a cramped neck.

When I get situated in bed at night, my routine involves aligning me, so that I can sleep through the night with less chance for spasms that may cause my legs to pull up and cross or apply pressure on bony prominences (heels, ankles, knees, hips). It helps to have my legs swung back and forth a few times, smoothly (feet about 18 inches apart) until they find "the sweet spot"... that is, where they "want" to be (and that's not always aligned straight with my upper body). I then get pulled toward the end of the bed by my ankles, so the back of my heels are barely off the edge of the mattress (topper). If the heels remain on the bed they can get pressure sores, or they can spasm out of place. If they hang too far off the bed it can cause a medical condition called "drop foot." That is a condition in which the feet are pointed and remain that way. Drop foot can cause problems with pressure sores, keeping shoes on, and keeping feet on the wheelchair. I don't but some people even sleep in heel protectors [various types pictured] to prevent skin ulcers and drop foot. The best bed -- for me -- is a regular king-size mattress with about a two-inch built-in pillow-top. It's configured so the top is even with the top of my wheelchair cushion, for easy in and out!

Good sleep is so important to good physical and mental well-being. We need to take care to ensure we get quality sleep. One trick I've learned is that when I don't get enough good sleep, and need to take a nap, I sometimes sleep better leaning my head forward and resting it on a pillow of some type. That's because it is rarely, if ever, practical for me to get back in bed for a nap, and then out again.

Sleep tight.

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