Apnea

Laura Adamczyk

They are all of them adults, but even so they will bring stuffed animals, pillows shaped like hearts, and scraps of blanket with satin borders hanging on by threads. The technician will, one at a time, hook them up, turn out the lights, and through a Plexiglas window watch them sleep. It is dark but for the blue from a streetlamp outside, the tiny lights of the polysomnograph beside the bed, electrodes running out like arteries from their chests and forearms. A different man or woman each night but the same restless sleep; they thrash and shift over the machine wires. He makes sure they stay connected.

Diagnosis

They are inevitably all diagnosed with the same condition. Simply, that while asleep, they stop breathing. In doing so, their bodies wake them. It happens dozens of times per night, though they do not remember most awakenings, if any. 

Their bed partners tell them they snore. How the snoring churns, churns louder, and then seems to catch. A popping, struggling motor. A piece of string pulled smoothly from a knot, then stopping, knotting again. The catching is the awakening and the awakening is the apnea and this is the diagnosis.

The Technician

He wakes the woman in the morning. Turns on the lights gradually, one at a time. How did you sleep? he asks. Are you tired? Drowsy? More or less than usual? Do you remember waking up in the night? The woman is middle-aged and overweight. They are nearly all middle-aged and overweight. She’s sitting herself up in bed, sighing, cracking her neck. She pinches in her brows and rubs the space between them, as though this were all an imposition. As though this were her bedroom and he an unwanted man entering.

He knows the woman’s twisted, crumpled face, like that of so many others. Their adult lives have become a phantom tiredness, as though a spirit entered their bedrooms at night and stole their breath from them, leaving only red morning eyes. They go to bed earlier than their friends, wake up limp and heavy. All this without the romanticism of insomnia, the mysterious hours spent awake in the dark.

He takes her temperature in her ear. She crosses her arms, asks when he’ll be done. The skin of her face is washed out and pocked like dough. Her wrinkles bare, not trying to hide anything behind makeup. He thinks of his mother. Any woman brought to impatience or anger reminds him.

Without looking at her, he points to the bathroom, tells her she can get changed. He ejects the clear plastic tip of the thermometer into the garbage beside the bed. 

When she emerges in a dark sweatshirt and jeans, exhaling sickly sweet toothpaste, he tells her that she will get her results in a few weeks. Although he already knows, he is not allowed to say (the physician will glance later at his report and sign her name and degree on a line). While the woman slept, the technician had watched the polysomnograph’s spider-leg etchings unfold across the scroll, counted more than fifty times in the night that her breathing stopped and woke her.

It is like having a dream of a person who does not know you’ve dreamt of her, he thinks. What he knows, but they do not, about themselves. He thinks of this as he leaves the hospital in the mornings: birds screaming at each other, buses heaving themselves down the street, people hustling to work carrying paper cups of coffee, hair still wet from their showers.

Back at his apartment, black plastic over the bedroom windows, daylight pulsing in at the edges, he will get into his bed and try to sleep.

Falling

The ones who do remember will describe it this way: like something breaking or a tear. I will be dreaming and then I will fall from a great height or miss a step one step from the ground. I will fall and fall but before I hit I will wake up, pulling in air, gasping, a waterless drowning.

Temperature

Or like just before his mother hit him. The air around him heating, seeming to change density. The same way her face changed with her drinking, both clenching and loosening, tightening into focus yet sinking farther away from him. How, from her place in the corner, she would home in on something in the room she seemed to wish was no longer there.

And today, just as he is waking. Never knowing what time it is anymore, never quite sure what it is that has woken him. But then the familiar scratch of her voice on his phone, muffled yet alive, as though she were calling from some bright, foreign country: I’ve stopped drinking.

Really.

Really. My therapist wants you to come in for a joint session.

Your therapist wants me to. 

Yes, that’s what I said.

The air conditioner is churning in the window; behind it, a halo of summer light. It could be ten-thirty in the morning, it could be four in the afternoon. An oppressive heat, either way. He feels it soak into his blood like a drug even before he enters it. He’ll eat cold cereal again for breakfast, put ice in his coffee.

I sleep during the day, Holly. As he says it, he recognizes the lie of it. His insomnia, tiredness, worse than his patients’. Had he really been sleeping when the phone rang? His mattress on his bedroom floor, his phone on the floor next to it. His glass of water has bled its moisture in a ring into the wood. Even over the air conditioner’s motor he can hear his cats outside his room, pawing, trying to get in. He throws a shoe at the door. He says “Maybe” and then jots down the address and time. 

When he started calling his mother Holly, he cannot say. When he left home after high school. When he started selling pot to pay for college. It was the same to him, she was Holly. He knows no one else with her name, just as some will only ever call one woman mother. It has been years since he’s seen her face to face, despite their proximity to the other. All the same, he says only maybe.

Dreaming

That same feeling of a fall. It would bring him to the pizza parlor where he worked in high school. To one afternoon. Sitting on the concrete step outside the kitchen doors, smoking a cigarette, throwing the butt in the white-gravel alley. Hands on his knees, about to stand up and the girl who would be his girl coming up behind him, placing her hands on his shoulders, he jumping, turning, she saying with that warm smile, Hey, why so skittish?

Or the falling would bring him to a dream. Or a dream he wished he was having. Her hair as fair as his was dark. As his mother’s was dark.

Those two teenage years they were together. Making out like crazy in her car, staying out as late as, later than, they could get away with. He felt himself getting lost in her, felt like he was going insane with joy.

She was a listener. She watched him. Her eyes so steady, he looked away when he spoke to her. His head drifting down, he’d stare at a hamburger wrapper on her car floor, imagine folding it out flat, then crumpling it up again, flat then round, open then tight. In this way, he told her everything.

Breathing

The airway is a release during sleep. A muscle, a balled hand, opening. Because there is too much tissue and not enough muscle. Flesh like a blanket puffed out then falling, settling on a bed, finding and filling in empty spaces. The airway is a collapse during sleep. The most natural of chokings. Someone putting a hand over their mouths, saying, Stop, do not tell this secret. Wake and do not remember.

Treatment

Because she was quiet. A shy, though sarcastic girl around others. Keeping herself apart, crossing her arms over her small chest. Walking the halls of their massive high school, looking down in front of her, as though the tiled floor were not flat, as though something might rise from it and trip her.

Because he was quieter still, her eyes were only bold with him. When they were alone: laughing and brighter, her face so open it looked pulled apart, nearly unrecognizable. Teasing him, tickling and pinching. She would nudge his hand out of his pocket, spread his palm out flat to read what was there.

Bedtime

The men and women develop arrhythmia without treatment, an irregular heartbeat, the muscled fists of their hearts mimicking their syncopated breathing. Their bodies become hiccups, interruptions. 

He knows before they’re diagnosed. He knows hooking them up—when he leads them into sleep, when he leaves them to watch from his separate room. Like members of the same gang recognizing the other from across a street. From his dark distance he sees their chests rising like floodwater to a levee.

One treatment: A clear plastic mask worn over their noses and mouths. A cool stream of air—a mouth over their mouths. A flow of air, a breath whispering, Shh, go back to sleep. It’s all right. I am here. 

The Technician

From his place standing on the sidewalk, he looks down a set of shady concrete steps: a garden office. Wrought iron railings and window boxes filled with red and white geraniums. He looks up and down the street. A bright day, the sunlight he’s missed this past year.

The small window gives nothing away from this distance, but he can imagine the light on the other side of it—muted and gentle. Yellow light perfect to read or nap by. They’ve been through this—joint, group, individual sessions. He has forgiven her before. Many times over, but always took it back later, alone with his thoughts. Kept his anger like a tightly knotted piece of rope in his pocket.

Trees shade the sidewalk—a nicer neighborhood than his own. He’s up; it is beautiful. He should go to a park and enjoy the day. Talk to a person. Have a different kind of conversation. He thinks of the girl from high school, wonders whether or not she is happy. There are people who have no trouble sleeping, he thinks.

Placing his hands in his pockets, he steps down onto the shaded steps. He imagines his mother’s hands, her short, chubby fingers clasped over her round middle. He imagines his mother’s face as happy, fat with the pinkness of sobriety. Or tight and curled into itself, stiffening into a defense. He’s seen both, but cannot decide which is worse. This time can be like every other time, he thinks. He can be polite and distant, or loosen the ball of his fists into something flat and open. Because she is on the other side of the door—her same loose, round face and dark hair, the same hands she had when he was a kid, a teenager even—he misses the last step down. His hands caught in his pockets, nowhere to go, he falls, catches his breath, sucking in air, like he is being ripped from this world.