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June, 2018:

65 and Then Some

Jun 29th, 2018
by Jeff Duntemann.
15 comments

66 today. By Bismarck’s reckoning, I was supposed to die last year, so any days lived going forward are gravy. My guess? I’d better get used to gravy. I foresee a lot of it. (Gravy, after all, is penance offered for cooking the turkey a little too much.)

I blew past the traditional boundary of old-guy-hood pretty satisfied with the general state of the old guy:

• I’m healthy. This is a matter of good luck more than clean livin’, though I do what I can.
• I know who I am and what I’m good at.
• I am a free man, in an era when an appalling number of my friends have sold themselves into tribal slavery for, well, nothing.
• I am not alone. I walk upwind in life with my soulmate beside me.
• I understand my limitations and have come to terms with them.
• I have arranged my daily life so as to be no at one’s mercy but my own.

This is a pretty good place to be. I could write several books about how I got here, but probably won’t. Such things are highly domain-specific, and your mileage will vary. I’ll postulate a few explanations:

• Luck is real. I recognized good luck and capitalized on it. I recognized bad luck and minimized its consequences.
• Anger is a trap. It killed my grandfather. I will not allow it to kill me.
• I was careful. Whether this interferes with good luck is an interesting question. I’m pretty sure it interferes with bad luck, which is most of what being careful is about. And being careful in turn requires knowledge of things like gravity, kinetic energy, integrity of materials, coefficient of friction, the hiding places of banana peels, and consequences of decisions.
• I learned fast, especially from my mistakes, and doubly especially mistakes due to not being careful.
• I tempered rational thought with emotional thought, and calibrated emotional thought with rational thought. Overall, this amounts to rendering unto the left brain the things that are the left brain’s, and to the right brain the things that are the right brain’s.
• With all my strength I resisted the siren call of tribal slavery and the transparent bullshit of political ideology.
• I can get along with anybody until they go on the attack. When people attack me, I giggle a little and write them off. I don’t tell them I’ve written them off. I just don’t take them seriously anymore.
• I learned fairly early (if not quite early enough) that nothing is simple, and nothing is certain.

My great-grandmother, Martha Winkelmann Duntemann, lived to be 96. That’s my target, and barring some peculiar and unlikely advance in anti-aging technology, it’s a reasonable expectation in the 21st Century. It means I have thirty years to go. That’s a long time and a short time; thirty years ago I was editing Turbo Technix, which seems like yesterday. My plan file for those thirty years is fairly simple:

• I will love my wife;
• I will tell my tales;
• I will exercise my mind;
• I will enjoy the company of my friends;
• And I will revel in a life lived at what I consider the best time in human history to be alive, in our beautiful and extravagant creation.

I invite all of you to join me, chill out a little, and (as my grade school friend Rich Maas says) enjoy the ride!

Odd Lots

Jun 23rd, 2018
by Jeff Duntemann.
7 comments
  • Lazarus 1.8.4 has been released. Bug-fix release but still worth having. Go get it!
  • From the Questions-I-Never-Thought-to-Ask Department: How was sheet music written after quill pens but before computers? With a music typewriter, of course.
  • How to become a morning person. Yes, there are benefits. The larger question of whether circadian orientation is born or made remains unanswered. Carol and I both lived at home during college. We’re both morning people. My sister and I had the same parents, grew up in the same house and obeyed the same rules (bedtimes were set from above and were not negotiable) and she went away to school. She is a night person. Proves nothing, but I find the correlation intriguing. (Thanks to Charlie Martin for the link.)
  • Here’s a long-form, highly technical paper on why human exposure to low-level radiation is more complex than we thought (hey, what isn’t?) and that some data suggests a little radiation experienced over a long timeframe actually acts against mortality. I’d never heard of the Taiwan cobalt-60 incident, but yikes!
  • Sleep, exercise, and a little wine may help the brain’s glymphatic system clean out unwanted amyloid waste products within the brain, preventing or staving off Alzheimer’s. This process may be the reason that anything with a brain sleeps, and why humans (who have more brain matter per pound than anything else I’m aware of) should get as much sleep as we can.
  • An enormous study on the benefits of the Mediterranean diet was found to be profoundly flawed, and has been retracted. The data was supposedly re-analyzed and the original results obtained again, but if the researchers made the mistakes they did originally (assuming that they were in fact mistakes and not deliberate faking) I see no reason to trust any of their data, their people, or their methods ever again.
  • How faddism, computerization, national bookstore ordering, a court case, and New York City cultural dominance destroyed (and continues to destroy) traditional publishing of genre fiction. The good news is that with indie publishing it matters far less than it otherwise would.
  • If you’ve followed the nuclear energy industry for any significant amount of time, you know that fusion power is always 30 years in the future. Now, I’ve also been hearing about thorium reactors for almost 30 years, and I got to wondering why we don’t have them yet either. Here’s a good discussion on the problems with thorium power, which intersect heavily with the problems plaguing ordinary uranium reactors.
  • Long-held myths die hard, especially when governments beat the drum for the myth. Eggs are good food. I eat at least two every day, sometimes more. The American Journal of Clinical Nutrition published a study indicating that people on a lots-of-eggs diet lost weight and suffered no cardiac consequences of any kind. Good short summary here.
  • I don’t see a lot of movies, but I’m in for this one, crazy though the concept is. After all, spectacle is what the big screen and CGI are for. Mad Max meets Cities in Flight? Sold.
  • The contrarian in me has long wondered how much of what I put out on the street every week in the recycle can is actually recycled. The answer is very little, especially since single-stream recycling became fashionable. Almost all of it goes into landfills. The reasons are complex (there’s not a lot you can do with scrap plastic, for example) but apart from aluminum cans, the cost of sorting it far exceeds the value of the reclaimed materials.
  • The antivax movement has always boggled me for its indomitably willful stupidity. Having stumbled upon a research paper on who the antivaxers are I boggle further: They are almost all members of the educated elite in our urban cores. This was always a suspicion of mine, and now we have proof.
  • Here’s a fascinating piece on the effects of water vapor and continental drift on global temperatures. The topic is complex, and the piece is long and rich, with plenty of graphs. The comments are worth reading too. The primary truth I’ve learned in researching climate for the last ten or fifteen years is that it’s fiendishly complex.
  • Brilliantly put: “But anger isn’t a strategy. Sometimes it’s a trap. When you find yourself spewing four-letter words, you’ve fallen into it. You’ve chosen cheap theatrics over the long game, catharsis over cunning.” –Frank Bruni, NYT.
  • A few days back I got Leonard Bernstein’s quirky, half-classical, half-klezmer “Overture to Candide” stuck in my head all afternoon. One listen to this was all it took.
  • I got there by recovering an old memory, of a chap who came to SF cons in the 70s with a strange keyboard instrument that he blew on through a hose, which as you might expect sounded like a piano accordion without a bellows. He was a filker and played interesting things, and I always assumed that he had somehow built the device himself. (It was much-used and taped up in several places.) But no, the chap is Irwin S. “Filthy Pierre” Strauss, and the instrument is a melodica.
  • Finally, one of the creepiest articles I’ve seen in a couple of years. I considered and set aside a plotline in my upcoming nanotech novel The Molten Flesh that involved sexbots, real, fully mobile AI sexbots enlivened (if that’s the word) by the Protea device. Maybe I should bring it back. The original 1959 Twilight Zone episode “The Lonely” has always haunted me. Maybe sex is a sideshow. Maybe it’s about having something to care about that cares back, and therefore gives your life meaning. I could work with that.

Hose Wars, Part 3: I Love It…But I Hate It

Jun 22nd, 2018
by Jeff Duntemann.
6 comments

This is a series. Start here if you haven’t already.

Yes, I’m back. I didn’t pause the series because I was tired or busy. I was waiting because I wanted more data to analyze. So as of this morning I had four weeks in with the S10, and I decided to see what the trends were, and talk a little more about the experience itself.

In terms of what it was designed to do, the ResMed S10 Autoset is a complete win. If you recall from Part 1, my headband sleep study indicated an AHI of 36, meaning that over the time I was tested, I experienced and average of 36 events an hour. The events are of various species, some of which I still understand poorly. The biggie is obstructive apnea (basically, your soft tissues close your airway temporarily) which encompassed most of the events reported by Sleepyhead, assuming you include “Clear Airway” events with OAs. (I’m still trying to determine the precise difference between the two categories.) I’ve logged relatively little hypopnea (abnormally slow or shallow breathing) and almost no Cheyne-Stokes respiration. The machine is not capable of identifying central apnea events (which are basically an EEG issue) so I have no data on those.

And leaks. Lordy, do I have leaks. Still working on that. Fortunately, the S10 can tell what’s a leak and what’s some sort of breathing irregularity. It reports the leaks so I can try different things to minimize them. Useful, and some engineering is in process. Much of leak management is actually hose management, and the engineering lies in keeping the hose from pulling on the mask. I’ll describe what I end up with after I end up with it.

Now, results. For the first three nights, I tried the full-face mask I bought. It kept me awake, even with a Belsomra pill in me. I took a leftover clonazepam pill to knock me out a little more, and I managed to sleep. However, I have no intention of becoming dependent on a benzo just to sleep with a bigger mask. The USP of Belsomra is that it doesn’t disturb sleep architecture to the degree that benzos and the Z-drugs do. If I can’t do a mask on Belsomra, it’s unclear that I can do APAP at all.

So everything hinges on the “nasal pillow” mask I bought. It’s not exactly comfortable, but I’m able to sleep with it strapped to my face. It’s a ResMed AirFit P10, and has a very good reputation. I may try others as time allows.

Now, I can fall asleep with it…and sleep for about six hours. After six hours, the Belsomra is leaving my system, and there’s no longer enough to keep my orexin receptors neutralized. So come about 3:30 or 4, I can no longer fall back asleep. (I’ve been getting up twice a night for bathroom breaks for 25+ years, usually at 1:30 and 4.) Keeping the mask on if I’m not sleeping does nobody any good, so after my second bathroom break, I take the mask off and shut the machine down. This gives me 6-7 hours of treated sleep, plus another hour or two of untreated sleep. It’s not a perfect solution, but it may be the only solution I can manage. Even bad sleep is better than no sleep, and I’ll take whatever benefit from those last two hours that I can.

The improvement in my AHI has been spectacular. From a sleep study AHI of 36 I’ve gone down to an AHI of less than six on all 28 nights. And on only two nights did it go over 5. Most nights it’s less than 3. Last night, I had only four events across 5.53 hours with the mask on, for an AHI of 0.72. That’s not shabby. In fact, an AHI of less than one is considered no apnea at all. I don’t know why I have more events on some nights than others. That’s a subject of ongoing research.

There have been some weirdnesses. My prescription called for a pressure of 6-18 cm. (The S10 supposedly adjusts pressure to what it needs to clear an event.) What I found is that at least once a night, the pressure was up above 17, and I felt like I was being blown up like a balloon. I would wake up completely, and become so annoyed that I had a hard time falling asleep again. Not useful. So I set the machine to vary only between 6 and 13 cm. Now there are no excursions above 13, and from the graphs I can tell that I can sleep when it’s pumping in the vicinity of 12 cm. Median pressure is 7.7 cm. Given the reported AHIs, nothing of value was lost in the adjustment.

Now the bad news: APAP has taken all the pleasure out of sleeping. It’s a hard thing to describe. I’m aware of the mask as I try to fall asleep. It’s a constant irritation, and without the Belsomra I don’t think I would sleep at all. Relaxing completely is difficult. Maybe it’ll get better with more practice, but after 28 nights I’m thinking that whatever I’m experiencing now is what I’ll be experiencing for the rest of my life, which is nothing if not depressing. I’ve begun looking forward to the final two hours of the night as my reward for suffering through the first six hours.

I’m not sure what, if anything, can be done about this.

Now, one can’t argue with results. I don’t feel like a 10-year-old again, and I’m good with that. I wouldn’t mind feeling like a 20-year-old, but I’m not getting that either. The improvements are incremental but real: I’m getting more ideas, spending more time reading, and more time at the keyboard. I don’t feel a great deal more energetic, but something is getting the work done, and I can only credit that to better sleep.

I’m not sure there will be a Part 4 to this series, but when insights become available I’ll report here. So far…

…so good.

Hose Wars, Part 2: To Breathe, Perchance to Leak

Jun 2nd, 2018
by Jeff Duntemann.
5 comments

This is a series. Start here if you haven’t already.

I’m not a good sleeper, and never have been. When my publishing company (now mostly forgotten) collapsed back in 2002, I developed severe insomnia. I was getting as little as three hours of sleep per night, often less, and sometimes none at all. After a couple of weeks of this, I started to hallucinate cute little cartoon devils doing calisthenics at the foot of my bed, along with other things I’m not sure I can describe. Sleep isn’t optional. I sometimes think we sleep in order to dream undisturbed, and that dreams are somehow where our humanity comes from. If we can’t sleep, eventually we start to dream while we’re awake.

My big fear in starting APAP therapy was that I couldn’t sleep with a mask on my face. Had I been a better sleeper, I’d probably have begun thereapy years earlier. I was given two masks: One covered my nose and mouth. This is called a “full-face” mask, even though it doesn’t cover your eyes. The other is harder to describe: It’s a little plastic thing on an elastic strap that inserts a couple of cushioned tubes into your nostrils. These are called “nasal pillow” masks, and they’re a great deal less intrusive than full-face masks.

The whole point of CPAP/APAP therapy is to push enough air into your nose to keep your airway open, and to open it if by some chance it closes. For this to work, you either need a full-face mask so that if your mouth opens it won’t matter, or with a nasal pillow mask you need some way to keep your mouth closed. There are chin straps of various sorts and other things lumped into a category called “headgear.” Yet more stuff to tie myself up in; no thanks. I did the obvious: I used that blue surgical tape you buy at Walgreen’s to tape my mouth shut.

It worked. It worked, at least, until the machine upped the pressure for some reason. The higher pressure blew the tape off one corner of my mouth, which became a massive air leak, one noisy enough to wake me up.

This is my problem in a nutshell: APAP is noisy and uncomfortable, and keeps me awake. The noise I’m getting used to, at least the fairly modest noise from the machine itself. Leaks are a separate issue. I sleep on my side, which means that both kinds of mask eventually contact my pillow. I can position myself carefully when going to sleep, and that generally works. But if I squirm around even a little while I’m asleep, my pillow nudges the mask to one side, making noise, or (with the full-face mask) spraying air into my eyes. That wakes me up in a hurry.

To keep me asleep despite masks and leaks and hoses flapping around, the doc gave me a prescrption for a sleeping pill called Belsomra (suvorexant.) It’s the first of a new class of insomnia treatments that target the orexin receptors in the brain, rather than the GABA receptors. Pills like Ambien (zolpidem) target GABA, and force you to sleep. If you take one and don’t hit the sack, you’ll start dreaming anyway, and say or do dumb things. The orexin receptors keep you awake. Interfere with their operation using an orexin antagonist like Belsomra, and the signals to stay awake go away. You drift off. I’ve taken Ambien, and it always felt like a whack to the back of my head. Boom! I’m out. Belsomra has a gentler touch, and from what I’ve read, it doesn’t affect sleep architecture (i.e., the different stages of sleep like REM) nearly as much as more preemptive pills like Ambien.

It’s expensive, but very fortunately, Medicare covers it. And so far, it’s done a pretty fair job keeping me asleep in spite of mask issues. As for mask issues, there’s a third sort of mask that I’m going to buy and try: A nose mask. This is like a smaller full-face mask that only covers your nose. It may not be any better than nasal pillows, but it’s cheap enough to do the experiment and be sure.

I’ve found that there’s a downside to blowing air up your nose. A couple downsides, actually, but there’s one big one, and that’s where I’ll start next time.

Hose Wars, Part 1: Overview

Jun 1st, 2018
by Jeff Duntemann.
9 comments

ResMed S10 AirSense 500 Wide.jpg

About a year or so ago, the bottom began to fall out of my supply of personal energy. At the time I assumed it was due to my age, or to all the effort I was pouring into our move down here from Colorado Springs, selling the Springs house, fixing up our Scottsdale house, and so on.

Now, virtually all of that stuff is done with…and my energy hasn’t come back.

I started a decent new novel at the end of 2016, and while I got off to a pretty brisk start, I’m now 42,000 words in and making little progress. I have other projects that I’ve done some work on, however, writing is the most difficult thing I do. It’s also the most important to me personally. If something starts getting in the way of my writing, I have to get to the bottom of it.

So it was that in February of this year I did a sleep study. I’d had one done at a Colorado Springs sleep clinic in 2010, but the wires and electrodes and everything kept me awake so much of the night that the pulmonologist declared the study inconclusive. To have a sleep study, well, it helps to be able to sleep.

Sleep study tech has gotten way better in the last eight years. I went down to the sleep lab and picked up a gadget that was something like a stiff but adjustable plastic headband. The part that contacted my forehead had a tacky, silicone-y feel to it, and embedded in the silicone were several electrodes and an LED oximeter. There were no wires and no separate electrodes to get tangled up in, like I had in 2010. The electrodes provided some EEG functionality, and the oximeter continuously monitored my blood oxygen, which is an issue I’ve had for some years. (It was one reason we no longer live at 6700 feet.)

The headband gadget was remarkably comfortable, at least compared to the ratsnest they trussed me up in back in 2010. I was able to sleep on my side, which I’ve done now for probably forty years. (When I sleep on my back I tend to compress the ulnar nerves in my arms, which makes them go numb and then prickly when I wake up.) I took a new-model sleeping pill (I’ll come back to that) and managed to sleep for almost the entire night while the headband gathered data.

The good news ended there. I returned the headband device to the sleep lab, where they downloaded the data and sent the reports to my pulmonologist. I had an AHI of 36, which means I stopped breathing an average of 36 times an hour across the seven hours that I slept with the thing on my head. Basically, I stopped breathing every…two…minutes.

No wonder my blood oxygen was excursing down into the low 80s.

Breathing is good, and tech steps in where nature fails. I was given a prescription for a ResMed AirSense 10 Autoset APAP device (above) and was fitted with a couple of face masks. Laying hands on the actual machine involved a surreal struggle with insurance paperwork, but I finally got it, and about ten days ago I started using it. For the first week, my average AHI was…3.67. That’s literally an order of magnitude better than what the headband reported. Last night was my best night yet, with an AHI of only 2.44.

The AirSense 10 records data on a standard SD card. There’s a clever open-source reporting utility called Sleepyhead that you can install under Windows, Mac, or Linux. There’s a Linux binary for Ubuntu 14.04, or you can rebuild from source. Here’s the wiki for the software, with a link to the user guide. (The software is written in C++, alas, or I’d be tempted to tinker it.)

Sleepyhead aggregates your data by day, week, or month (or just “always”) and presents a number of graphs for the stats gathered by the machine. There’s also a feature to report oximetry data, but I don’t have a recording oximeter yet and haven’t tried that feature, which is described as “cranky.”

I’ve read a number of people report that starting in on CPAP made them feel like ten-year-olds again. This has never been a longing I’ve had (what, go through puberty twice? I think not!) and in truth the improvement I’ve felt so far has been, speaking charitably, incremental. The road has been rocky, and I’m going to have to divide the full story into several entries. Stay tuned.