Sleep Apnea, Vegetable-based Ramen and the Milan Diet

Today I want to share some thoughts and reflections about my health. Weight has been an issue for me dating all the way back to high school - I yearn to be as skinny as I was then, even as I recall feeling fat compared to my peers at the time. But the major weight gain happened in a couple of waves.

My first year in college, I had a meal pass to school buffet, which meant I could eat multiple slices of pizza every day - and that is exactly what I did! Freshman 15? More like the freshman 40. I put on a lot of weight quickly while indulging. I'm sure weekend drinking didn't help, and the food I ate when I was hungover was just as bad. My period cramps got really bad, and so while I wasn't sexually active, I decided to go on birth control. The problem was that I couldn't swallow pills - even the tiniest birth control pill. So I did the 12-week injection instead. I was fine with the shot and the soreness that came with it, and it solved my period problems. Wonderful, right? Well, not exactly. The drug was known to cause depression and even suicidal thoughts, as well as significant weight gain. I do think I may have been a little depressed, which naturally turned into eating my emotions. I gained a lot of weight in a very short period of time.

During that time, I had another issue and had to swallow a pill for it. After years of getting advice from others and trying to practice swallowing pills, I figured out a method that worked for me. While the advice I got was usually, "Just don't think about it," what I learned was that I actually had to consciously think about it. My gag reflex would react to the foreign object if I pretended I was just drinking water, so I had to convince myself that I know what I'm doing and I needed to swallow this thing. But that wasn't all. I had to shove the pill into the back of my throat, almost choking on it, and then I threw back about a gallon of water, almost drowning myself until the pill went down. Dramatic, right? And it made a mess; I'd throw back so much water at once, basically flooding myself, that I'd spill a lot of water. But, the pill went down.

Learning that I could kind of swallow pills, I decided to switch my birth control method to the pill. Practice makes perfect, and over time I got better at swallowing without having to choke and drown myself. Although from time to time I still gag or a pill won't go down, and I definitely cannot swallow pills without water. Regardless, problem solved, right? Getting off the thing that caused weight gain (and maybe depressing leading to emotional eating) would allow me to lose weight, right?

Of course it wasn't that easy. Eating like I normally did, I still gained weight. I got into kenpo, started dancing again, started running again, but still gaining or at best staying flat. I tried various diets, Atkins and the like. As so many others, I'd see an initial drop and then it would lose its effectivity, and I'd gain the weight back and then some. And so the yo-yo dieting continued for years and years. I eventually became convinced that my metabolism was broken from all the dieting, and did the metabolism reset diet. I lost 12 pounds which is great, and I do think it "reset' my metabolism to an extent, but without constant maintenance it feels like it slipped back to being broken. I could eat well all week and have two slices of pizza and gain 5 pounds overnight. And that wasn't temporary, that became my new normal and I had to slowly work that off. I'd lose 2 of those pounds and then have another cheat meat and gain another 5. It was maddening. All that hard work to lose a couple pounds and one indulgence caused me to gain double.

In health, all things are connected. When I started running again, I also started coughing at night. It got so bad I finally went to the doctor three days before a race. I did a breathing test and was informed that I was using 25% of my lung capacity. I had asthma. I got an inhaler and was warned that the inhaler's positive effects would take many days to totally work, but I took it when I needed it. I ran my race but it was terrible because I felt personally defeated by having labeled my condition. The diagnosis of asthma seemed to change my identity as a runner to a sick person. I finished the race and had class afterwards, and I'll never forget that class because I sat in the back and hacked through it. But the damage was done. How could I lose weight running if I'm an asthmatic?

I gave it up for a while and sought out other activities. But walking, for one, was never as satisfying or beneficial. I have never been a speed walker, and in fact, I walk slower than anyone I know who isn't slowed by old age. I can tell myself to speed up, and I will a little, but not for long and not that much faster. I would joke that I have two speeds, running and ambling. So I'd get back into running for a time, and then stop, yo-yoing my running as I was my diets.

Then I read a book, "Rest," which really stuck with me. It talked about how active, rigorous exercise was actually good for being productive and creative in our work, among other things. I decided my half-ass running a half mile was insufficient, and I aimed to run a 5k, or 3.1, miles multiple times a week. I knew I had to work myself up to that, but to my surprise, my progress went faster than I expected, and I was regularly running 3.1 to 3.7 miles every day. This was when I was living in San Diego during the pandemic, so I got to run through Balboa Park and breathe in the ocean air from the nearby beach. My "wall" was around 1.5 to 2 miles, but once I pushed through that, I'd get a runner's high and didn't want to stop running most days. The only reason I stopped was because I knew I had to get to work. It felt great! I was losing weight and felt like I was getting stronger. One morning, just before leaving for a weekend in Yosemite, I went for my morning run. But within .4 miles, my hip started hurting. I had disciplined myself to push through the various aches and pains I sometimes felt while running. But this pain was different and persistent. I got to the point of tears and decided I had to take it seriously and stop running. I stretched and walked for a bit, trying to shake it off, but the moment I tried running again, there it was. I did a total of about 2 miles, mostly walking, before calling it quits. Later, I researched the issue and it seemed like it was related to being overweight and putting too much pressure and overuse on the joint. Once again, I felt defeated. Here I was trying to lose weight and really pushing myself, and my body just wouldn't have it.

With Ozempic and related treatments being all the rage, I looked into them on my own. Everything I've read indicates that they work by suppressing appetites. I had gotten to the point in recent years where I feel like I can control my portions and my appetite. I'm not a late-night snacker (usually, anyways), I don't obsess over sweets, and I've learned to cut my carbs. I can eat healthy, but I can't lose weight. It doesn't appear to me to be an appetite problem. In fact, I worry that I eat so little on a regular basis, if I suppressed my appetite, my body would go into starvation mode. The problem, I continued to feel, is still my metabolism. But I HATED the metabolism reset diet and couldn't get myself to do that again. I'd been considering buying a Lumen for a long time, which is supposed to tell you what your metabolism is doing and when to eat what. 

After a lot of consideration, I decided to pull the trigger on it, and it was interesting but didn't inform me very much. Virtually every day it told me it was a low carb day, with a handful of medium carb days sprinkled in, based on the fact that my body wasn't burning fat. Well no crap! I also found it super challenging to even do the breathing the Lumen wanted. It has you breathe in for 10 seconds, which was fine, then hold your breath, which was fine, then exhale for 10 seconds while it counted down. I struggled to make it to 2 seconds remaining, and often would run out of air by 3 or 4 seconds remaining. This meant that my reading was incomplete and I'd have to do it again, which was exhausting.

Separately, I had seen a couple documentaries and am convinced that the production of food how we're doing it now is unsustainable and bad for us. While our ancestors and people living in Blue Zones might consume meat once a week, we were largely using meat as the center of every meal. Raising enough livestock to keep feeding the world in this way meant more and more forests were chopped down to grow the grains and foods needed just to feed our meat animals. And the idea that protein only comes from meat and can't be found in plants somehow is accepted but untrue. Where do the animals get the protein, anyways? One of my long-time-ago ex's was really into sustainability and explained to me that he tried to eat more chicken than beef since the amount of water and food needed to raise one pound of chicken meat was substantially less than one pound of beef, which made sense to me. So I tried to keep that in mind to craft my intake towards poultry instead of beef.

Sam has a philosophical aversion to eating anything that comes from a pig, which has been a difficult consideration in practice for me. He has never asked me not to eat pig in front of him or anything like that, but knowing he doesn't like it means I'm not going to order it for us. It turns out, I eat a lot of pig! Bacon and sausage for luxurious breakfasts, pepperoni on my pizza, salami in my sandwiches, barbecue pulled pork for a Texas dinner. In addition to never eating pig meat, Sam also tried to minimize how much other meat and poultry he ate. His influence paired with my understanding of the sustainability of our food chain has made me again reconsider my preference for meat. An ad on facebook about a plant-based instant ramen that was high in protein intrigued me, and I ordered a sampler on Amazon. For the most part, it was somewhere between good and bland. But adding a heap of garlic chili sauce made it addicting! I started eating it once (and sometimes twice) a day, and suddenly, I started losing weight with minimal exercise and no other change to my habits. The warm broth and feeling of satiation, paired with the weight loss results, made me an addict to something completely plant-based.(Not that I'm selling anything, but the brand is Immi if you're interested.)

Another fun dieting "trick" I had picked up from a long-ago-ex was "the pickle diet." The premise being that pickles are tasty, filling and relatively low in calories. Snacking on pickles instead of, say, chips, or eating a pickle before a meal, would help get that full, satiated feeling with fewer calories. While unproven, there is also a notion that pickles and pickle juice help athletic recovery from sore and stiff muscles - something I feel I can attest to. Often when I go out dancing, I drink some water but clearly not enough, because despite not having an ounce of alcohol, I wake up the next morning feeling depleted and hung over. Pickle juice, I've found, has helped that, as well as just chugging water for the entire following day.

Somewhere along the line I developed a snoring problem. My family pointed it out to me but it always felt like a judgey, lecturing way. I didn't want to hear it. The connection to not getting good sleep and not being able to lose weight was not yet apparent to me and I dismissed it as nonsense. I knew I was overweight - I ate too much and moved too little. Calories in, calories out, right? It got so bad on our family Christmas vacation in Hawaii that nobody would sleep in the same room as me and everyone was going to extraordinary lengths to get away from me. I was annoyed at my family - how bad could it be, really? I had slept with a snoring boyfriend and eventually just got used to it. They could do the same.

It was Sam who really reframed my thinking on this. He wasn't judgmental or condescending, but curious. The problem wasn't just that I snored, but that I wasn't getting sufficient rest. So, I'd fall asleep during the day. He caught me sleeping in the car in Scotland while he was driving. He noticed me nodding off during the Taylor Swift concert at Wembly Stadium. I was apparently quite the spectacle when I was snoring on the bus coming back from Stonehenge. He got a kick out of me sleeping in the rowdy crowd at a soccer match near Richmond. And most shocking to me was when I passed out on the boat part of the London tour, because I love boats!

I was also sleepy at home. It wasn't frequent but I would fall asleep in front of the TV. The most disturbing though was that I'd start nodding off in the car on my morning commute. Just a couple hours after waking, the 15 minute commute would lull me to sleep and I had to fight with myself to keep my eyes open. It was worst at red lights, and once I got honked at for not being alert when the light changed. Often, I'd be so groggy and exhausted by the time I reached my office parking lot that I'd park and allow myself a power nap that would last 20 or 30 minutes.

I knew the jig was up. I had to see a doctor and get my diagnosis which I knew from what people told me would likely be sleep apnea and I'd have to get a CPAP and that would suck. I was not looking forward to it. My Mom had had a CPAP and she ended up stopping her usage because it was too annoying to her and my Dad. I was determined that if that's what I had to do, I would get it my all. I first had to get a referral from a general doctor. So I went in to see her.

Besides daytime sleepiness and nighttime snoring, not being able to lose weight, being asthmatic and having year-round allergies, there was still another issue I had. My ability to regulate my emotions, or more correctly, my physiological responses that looked like emotions, aka crying, seemed to have greatly diminished. I'm not saying I never cried when I was younger, many boyfriends had been frustrated with me when we'd fight and I'd cry. I think it started with anger issues when I was a child and I learned that I could not unleash my fury so I bottled it up inside and that became tears. When I was mad, I didn't get violent or yell, I'd cry. Even when other people were mad, I'd cry. That was true for years. But it had gotten so bad that the littlest thing could set me off - good or bad. I'd get a compliment from my boss and I'd cry. Sam would pinch me a little too hard and I'd cry. I'd see stranger propose at the Taylor Swift concert and I'd cry.

So when I talked to my doctor, she connected a lot of the dots for me. My symptoms sounded like I had sleep apnea. Of course I wasn't losing weight: I had no energy to work out, no willpower to eat the right things, and my body wasn't metabolizing like it should in deep sleep at night. Having felt heard and relieved it wasn't "my fault", I started to cry. And she asked what was wrong and I said, well, this sucks too. I can't control my tears. And she told me, interestingly, that assuming I had sleep apnea, that meant my body was in a constant fight or flight state and never recovered from that. So little triggers could cause crazy emotional responses. That made sense to me. I asked her if I'd have to get a CPAP and she said likely yes, but reassured me that people who use it regularly say it's life changing.

It's actually a little crazy how all these conditions are connected. My asthma, allergies and presumed sleep apnea are all conditions caused by, or contributed to, and made more likely by being overweight. But losing the weight is made difficult (to impossible) by having asthma and sleep apnea. A death spiral that started with overeating and weight-inducing medications that cannot seem to be reversed. I had to get to the root of it. If better quality sleep will help me to have more energy and better emotions and potentially improve my metabolism, then I had to address the sleep problem.

Completely full of conviction now, I went to my sleep doctor and told him my symptoms. He agreed it was likely sleep apnea and checked the size of my throat hole or whatever. He showed me a chart with 6 shapes of throat holes and said mine was the tightest of them all, which made me physically prone to sleep apnea. He'd have to do a sleep study to confirm, but he was pretty confident. I had the option of doing an at-home study or in-clinic study. The at-home study was lighter, had fewer diagnostics, and sometimes could be inconclusive which would result in the need to do the in-clinic study anyways. I wanted the full gambit. I wanted to be as close to 100% sure as we could be. I wanted to give my doctor all the information possible so he could get this right. If it was sleep apnea or something else, I wanted to know and get the treatment I needed.

I found the sleep study a little hilarious. To be fair, it was quite comfortable, I had my own room with an attached bathroom, which I was grateful for because I tended to have to use the bathroom multiple times at night - another symptom apparently of sleep apnea - the body doesn't turn off the mechanism causing you to have to pee. But being connected to a million sensors meant that when I had to use the bathroom, I'd have to signal my nurse to disconnect me. Instead of disconnecting all the individual things, they plugged into a master machine and she would disconnect that and hang it around my neck while I did my thing, and then reconnect me when I was done. The goop in my hair and the suction marks on my body were funny to me, as was the way I looked when I was all connected up. When I was up for another bathroom break early in the morning, my nurse informed me that it was close enough time to the end of the sleep study anyways, so after using the bathroom, we could take the things off and I could get dressed to go home. As she was disconnecting me, I was concerned that my discomfort had prevented me from sleeping enough and asked her if they had gotten sufficient data. "Oooooh yeaaaah," she said, snorting a little, "we got LOTS of good readings on you." I thought that was a little funny even though I wasn't quite sure what it meant.

When I got my results back, they were absolutely stunning. Most notably, I had 98 "events" per hour. PER HOUR! That meant that 98 times per hour, I would choke or stop breathing. Fight or flight indeed. When I talked to my doctor about the results, he was concerned that the CPAP wouldn't be enough, and I might have to move to a bi-PAP which is more intense. But he said we should start with the CPAP and he assured me that even if it wasn't enough, it would still help greatly. But it would take a couple weeks, and I was nearing my trip to Milan for two weeks. So the CPAP would have to wait.

Knowing that it was very easy to gain weight on a business trip, I had bought a travel scale with me to monitor my weight for the two weeks in Italy. I knew I'd be tempted with all the pasta and pizza to overindulge in carbs, and so much as looking at pizza caused me to gain weight, so I wanted to give myself real-time feedback. To my surprise, however, while I gorged on the hotel breakfast buffet, polished whole individual pizzas at lunch, and ate a full meal of pasta or similar for dinner, I lost weight every day. I missed my plant-based ramen a little bit, but I was eating so good and so well in Italy, and losing weight, so I didn't mind too much.

My asthma, however,  was aggravated by the smog of Milan, the second hand smoke on campus at my work site, and probably the cold weather to an extent. I was using my inhaler multiple times per day but it got worse and worse. I knew from recent experience with something similar, and having been seen by a doctor back then, that as long as I didn't have a fever, I could rest assured I wasn't sick. But my asthma would need to be treated with something more intense than an inhaler.

I picked up my CPAP when I was back home, and didn't have time between returning and leaving for Tucson and then to Australia to see a doctor about a more intense treatment for my asthma. So I hacked through my holiday in Tucson with my family and in the ICU where my sister was beating the odds in her own medical issues. When I got to Tasmania, Sam told me what I could already sense, that the ocean air on our beach in Howrah was some of the cleanest air in the world. He
walked me through a breathing exercise which I felt was unnecessary, but I liked that he cared so much. I gulped in all the fresh ocean air I could while I was there, and I could tell my aggravated asthma was subsiding a little every day. We went north for a two day mini trip, and the mountain air up there was equally refreshing. Even in Sydney, walking out to Darling Harbor, I felt like my breathing was improving day over day.

I have been religious about using and maintaining my CPAP. I got the distilled water needed and changed it daily, I sanitized the tubes with apple vinegar, I got baby wipes and wiped down my mask every day. I had to use it for a minimum of 4 hours every night. The average didn't matter, so even if I used it 6 hours one night, I still had to use it for at least 4 hours the next. So I tracked my usage and made sure I got my 4 hours. The app had instant feedback and the results were telling and felt very accurate to what I could remember. That is, when I was struggling with my mask fit, the app would say I needed to correct it, and when I felt like my mask was good, the app would confirm.

But the most shocking result was that the events were now in the single digits per hour, around 5 typically. From 98 events per hour down to 5 is a 1960% improvement! Almost instantaneously, too, I had stopped dozing off during the day. It was no longer a struggle to stay awake in the car. And, I was still losing weight even after returning from Milan. I also feel less stuffed up from allergies, which could be seasonal but I suspect the humidifier effect on the CPAP is contributing at least.

Over the course of a several weeks, I felt healthier and healthier. I still puff on my asthma inhaler before dancing, but I no longer felt as winded or in need of another inhaler puff after dances. One night, I was waiting for my inhaler refill to come in but went dancing anyways. I was sure my current inhaler was completely out of dosage, but I sucked on whatever fumes I could grasp. And I didn't cough at all that night, despite not having a real dosage of inhaler. I am feeling healthier now than I have in a long time. I feel happier, too, and have emoted less. I've felt more in control of my tears and my ability to get things done. It has been quite a change. I'm not sure I'm ready to call it "life changing," but I can see how all these things are connected and relieved that I am working on the root of the issue, or at least one major contributor.

Recently, however, my weight has started to tick up again even though I'm doing the same things - eating my plant-based ramen, dancing, eating salads or lean meals when I'm not eating my ramen, drinking my water, etc. As such, I renewed my subscription for Lumen and am trying to use it more to figure out what's going on and what I need. To my surprise, I have been finding it easier to make it through the breath recording - I can now exhale all the way to 10 where I wasn't able to do that before. Something has improved, even if my weight is waffling.

I recently listened to "The Dorito Effect" which confirmed what I kind of suspected - the processed food wasn't as good for us as the food in, say, Milan, which wasn't packed with preservatives and artificial flavoring. I really do think there is something to that. The book also talks about how the "good" food has been "dumbed down" and made to taste worse and carry less nutrients - chicken, tomatoes, lettuce, for example. Chicken used to taste good on its own apparently, but the way commercial farms feed them to get fatter quicker is causing a loss of the taste and nutritional value, leading to use not only getting less out of the chicken itself but also having to smother it in sauces to make it taste good. It makes me just want to get a piece of land, raise my own chickens, grow my own crops and make my own sourdough at home. That sounds like a lot of work, but my goodness, this feels like a bad situation, doesn't it? What else are we to do?

Well for now, I'm looking forward to a full month in Milan, knowing that I was losing weight while gorging my appetite there. In the meantime and after that trip, I will have to focus back on eating pickles and plant-based ramen and other good things and drinking more water, getting the sleep I need, dancing and exercising, and so on and so forth…. and the health journey continues.

Oh yeah, and here's a vid of my dance group performing last night!