Daniel - Interview 28

Age at interview: 78

Brief Outline: Daniel is a retired social worker, having spent a large part of his working life with children and teenagers. He was diagnosed with sleep apnoea when his snoring at night was making him feel very drowsy during the day. His sleep is quite broken at night, and he often finds he dozes off during the day.

Background: Married, two children, retired Social Worker

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A typical night’s sleep for Daniel is one where he wakes up a lot, then finally wakes at about 5 am. After that, he may doze until he gets up, usually at about 8 am.

 

Daniel was diagnosed with sleep apnoea in 1991 and was given a CPAP machine [continuous positive airway pressure] which he found hard to adjust to because he felt he wasn’t in control of his own breathing.

 

Daniel also knows that if he has things to worry about he will wake up a lot in the night. Sometimes, if a problem is keeping him awake he might get up, have a cup of tea, and try and solve the problem. In the past Daniel has had bad, recurring nightmares and occasionally has these now. From time to time Daniel wakes up having trouble breathing and this can keep him awake for some time until he can control it again. Daniel was prescribed sleeping medication by his doctor but he will only take these if he has a period of bad sleep.

 

A perfect night’s sleep for Daniel would be one that is undisturbed and that lasts about seven and a half hours. In particular he would be happy to sleep until 6 am. Daniel believes the quality of sleep is more important than the length of sleep.

Daniel typically wakes up at about 5 am now he is older, but will doze in bed until about 8 am.

What I usually do is start by saying to somebody can you just describe for me what a typical night’s sleep is for you, so starting say from when you plan to go to bed to when you get up?

 

Okay, so when you say a typical night, it does vary. I am glad to say at the moment most nights are quite reasonable. I go to bed at say half past ten to eleven o’clock and I find I can go to sleep fairly easily just at the moment. And a typical night’s sleep is I am conscious that I wake up in the night a number of times but then I must go asleep again, so I can’t actually say when, but I am conscious that I don’t sleep right through. I virtually, every morning wake up at 5 a.m. These days I never seem to sleep after 5 o’clock, but I don’t get up. And I sort of lie in bed dozing till say 8 o’clock when we do get up. So that’s normal, but there are other times that are not so normal.

Daniel and his wife always sleep badly when they go away, and now take a sleeping tablet on the first night to help them.

What about when you go away how do you sleep if you go away anywhere?

 

Well whenever we go away its always been the same hasn’t it. That for both of us the first night, however comfortable the bed is we can’t sleep. I won’t say can’t sleep of course we must sleep but it’s not something we look forward to and we always take a sleeping tablet to counteract that so that is something that we do. But it’s only then that we do that on a general basis.

 

And then after that you sleep as you would do normally?

 

Not always. Not always.

 

Oh okay.

 

It’s hard to generalise. I can think of friends of ours where we go and there is two single beds that I suppose are quite comfortable but I don’t think either of us sleep much do we. 

Daniel has been prescribed sleeping tablets, but will only rarely take them in case he becomes addicted to them.

Okay what about going to the chemist. Have you thought about getting anything over the counter or seeing a pharmacist to say I’m having real difficulty sleeping can you recommend something or bought anything at a chemist?

 

I wouldn’t because I’m on a certain level of medication, but I’ve been told once or twice by the GP that for instance there are certain painkillers I mustn’t take because I’m on Warfarin and also I’m on other tablets as well for my heart and that. And therefore I’ve been told I have to be very careful with that. So no, I’d have to go to my GP.

 

Now you have said that, it’s reminded me I do have some sleeping tablets prescribed by the GP and that would be the route I would take. Having said that I don’t take those sleeping tablets too often because I don’t want to get well addicted is the word that comes to mind. I don’t want to get reliant on any sort of medication, although I am on these regular tablets, anyway that’s…

 

So when did you get the sleeping tablets from your doctor?

 

How long ago do you mean.

 

Yes. I mean what prompted you to get those. Was it you going to the doctor about your sleep or was it him telling…?

 

Yes. You are right. I did say to her, it’s a while ago now, a long time ago now.

 

Was it before the sleep apnoea or after?

 

Oh no. I am talk about like say about two years ago.

 

Oh okay.

 

Or even a year ago. More like two years ago and it's not on my repeat prescription actually, interestingly. But I can write it on and the doctor accepts it.

 

Okay. And so you have got those but you only take them occasionally?

 

Yes. If I think I am not going to sleep very well or even in desperation once or twice, I have been lying awake and thought oh well it will take about half an hour to take effect, I’ll go and take a tablet. 

Daniel sleeps badly at night, possibly because of sleep apnoea, so he often dozes off during the day.

Well I do, but as I mentioned to you earlier, probably off camera, about being diagnosed 1991 sleep apnoea. I do think it is related to that. I do doze during the day, and so I am tired, I feel tired during the day. I don’t mean the whole time during the day but there are just times, periods, so I don’t know whether it’s the sleep apnoea type of thing or whether it is that I have not had proper sleep for some reason. 

Daniel, who is trying to lose weight, believed it would stop him sleeping well if he ate later at night, but his practice nurse has told him it doesn't matter if he eats in the evening.

This is the thing as I said to you before about sleep, I take it as just something you do, you get, and so therefore I must admit I don’t avoid things. No I don’t think so.

 

And you wouldn’t worry about eating late at night, that wouldn’t worry you?

 

It’s an interesting point because I don't, I wouldn’t eat really late at night, now that is something I wouldn’t do, so you can say that is one thing, but it was interesting when I was talking to our practice nurse. I don’t know how it came out in conversation but she was saying it doesn’t matter if you eat in the evening. She was talking about if you had your meal later than we do that sort of thing.

 

You eat about five is that right?

 

Pardon?

 

Do you have your meal 5 ish your main meal?

 

Yes, well six say, before six. But she was saying it didn’t matter if we ate later and things like eating fruit or something I don’t eat those in the evening, 'oh yes you can'. I always thought, no, it doesn’t digest and that would keep you awake. But she said no, so I take her word. 

 

Daniel, who had lots of recurring nightmares when he was younger, remembers a hissing sound in his ear which he identified as a trigger for his nightmare.

When I was a young boy one of my very real memories is of me lying awake and hearing on the landing my Mum and Dad arguing and my Dad saying, ‘you’re too soft with him’. Words like that. ‘He shouldn’t have a light on’. My Mum had left the light on in the bedroom because I was scared going to sleep. And he was saying no. And I remember every night it was like a compulsion lying on the left side, I still do lie on my left side and my ear on the pillow and I could hear, and you do probably get an audio sensation in your ear, it was like a hissing, and I knew when that started that I was going to have a nightmare.

 

Oh really?

 

It could be auto suggestion or whatever but it can happen to me.

 

So you had lots of nightmares when you were a youngster as well?

 

Yes, and there were two types of nightmare. One was that I got out of bed and I looked downstairs and there’s the front door and the letter box and that letter box would open and there would be two green eyes. That doesn’t sound that bad in the light of day but for me it was terrifying. And the other one, and this recured into my married life/adult life was blackness and of me walking along the road coming to this big old house and going looking through rooms knowing that there was some being or other somewhere in that house and why did I do that. And I was terrified and I would wake up in a cold sweat.

 

So that was a recurrent nightmare as well?

 

And that one actually carried on, there were probably periods when it didn’t happen but I can remember that it carried on into our marriage didn’t it. 

Daniel remembers having very bad nightmares at a time when he was under a lot of stress during his employment as a social worker.

The dreams, yes, bad dreams. Well they are not so bad as what I used to have. I used to have really bad nightmares. Really bad nightmares. And I don’t know what would happen but for the fact that I have my wife with me. She would actually wake me up. I would be in a nightmare and she would wake me up and say 'you are all right. It’s okay I’m here'. And really you know, I was awake. I wasn’t there in my mind.

 

At what stage of your life was that. Were you working then as a social worker?

 

Yes.

 

Do you think there might be a link between what you did, and I am not sure that you want to go into what you actually did?

 

No. I don’t mind saying generally speaking that I was in – when I started in [city] as a social worker, we did what we called generic social work and our case load, the number of cases we had were all of different groups of people that there are, you know, mental health, elderly, families, children in care, all sorts of stuff. And then it was changed, in quite a revolutionary way in [city] and I ended up doing what I really wanted to do and that was working with children and young people and doing what we called long term child care cases. And yes, there were, I wasn’t the only one but there were a number of us from time to time who went off with stress, high blood pressure related to the stress of the job. And we would be off for a month at a time, that sort of thing. And there were a number of us like that, and yes, I had some of the heaviest cases. So, that must related to my sleep a lot at that time.

 

Was that the time when you had the nightmares as well?

 

Yes.

 

And were you worried a lot at night and wide awake at night?

 

Yes, yes.

 

So it obviously did have an impact on you?

 

It was very hard to switch off. I mean… to be the perfect social worker you switch off but I certainly found it hard to switch off. As time went on I got to tell myself something to get into that mode, but it wasn’t easy. 

Daniel did go to the doctor about his snoring and he was diagnosed with sleep apnoea. He was given a CPAP machine, but didn't get on with it.

Can you take me back to, you mentioned about this diagnosis of sleep apnoea, could you take me back to that and tell me how that came about, what sort of led up to you seeking help for it and how that happened?

 

A good question. Very difficult now in 2008 to remember. All I can think of was the snoring that I must have gone to my GP and the GP referred me to the unit in the local hospital, because they did this research into sleep apnoea, and therefore I was taken on board there and I spent two separate nights, they did one sleep study and then because of the results of that whatever they were, they said we want you to come back and do another one, which I did and that was difficult because I had a camera like this focused on me like that and I found it was hard to get to sleep. I was too aware of it, but whatever, they said I had sleep apnoea and gave me this sleep apnoea machine and as I say it was too much to cope with.

 

How long did you have it for?

 

Well I only coped with it for a few weeks really.

 

Did you have anybody sort of advise you mid-term what they do now, is they go back to you and say how are you getting on, they try and help you get through?

 

The thing that spoilt it if you like, was when that was diagnosed, because I was on their books as it were, by this time you see we had moved south, so that it split, it cut me off from them, because you know, once they’d made this diagnosis and I’d had this machine and I couldn’t cope with it, I suppose really it was my fault, I could have gone back and said look I’m not coping and can you help me. But I didn’t do that. So there is no responsibility on the hospital.

 

Right, okay.

 

You know, for the fact that it just didn’t work for me.

Daniel would not go to the chemist for help with his sleeping as he is concerned that anything from over the counter might interact with his existing medication.

Have you thought about getting anything over the counter or seeing a pharmacist to say I’m having real difficulty sleeping can you recommend something, or bought anything at a chemist?

 

I wouldn’t because I’m on a certain level of medication, but I’ve been told once or twice by the GP that for instance there are certain painkillers I mustn’t take because I’m on Warfarin and also I’m on other tablets as well for my heart and that. And therefore I’ve been told I have to be very careful with that. So no, I’d have to go to my GP.

Daniel has been diagnosed with sleep apnoea but hasn't followed up with this treatment because he has moved away from his local hospital.

Can you take me back to, you mentioned about this diagnosis of sleep apnoea, could you take me back to that and tell me how that came about, what sort of led up to you seeking help for it and how that happened?

 

A good question. Very difficult now in 2008 to remember. All I can think of was the snoring that I must have gone to my GP and the GP referred me to the unit in the local hospital. Because they did this research into sleep apnoea, and therefore I was taken on board there and I spent two separate nights, they did one sleep study and then because of the results of that whatever they were, they said we want you to come back and do another one, which I did and that was difficult because I had a camera like this focused on me like that and I found it was hard to get to sleep. I was too aware of it, but whatever, they said I had sleep apnoea and gave me this CPAP machine and as I say it was too much to cope with.

 

How long did you have it for?

 

Well I only coped with it for a few weeks really.

 

Did you have anybody sort of advice you mid-term what they do now, is they go back to you and say how are you getting on, they try and help you get through?

 

The thing that spoilt it if you like, was when that was diagnosed, because I was on their books as it were, by this time you see we had moved south, so that it split, it cut me off from them, because you know, once they’d done this diagnosis and I’d had this machine and I couldn’t cope with it, I suppose really it was my fault, I could have gone back and said look I’m not coping and can you help me. But I didn’t do that. So there is no responsibility on the hospital. 

Daniel may wake up in the night with trouble breathing, which can lead to a panic attack.

I can’t really remember in detail but you see there are a lot of other times, I can’t remember if it was then, but there were times, when I have woken, this is the problem that I think I have had for years, and that is, occasionally I wake up with problems with my breathing. Breathless and for people who don’t have that problem they probably don’t appreciate what it is, but when you are breathless it can lead to a panic attack and I have had them. And it's pretty nasty. You feel you are not going to breathe again and it’s a horrible feeling. So it's your mind as well as the physical side.

                                   

How often does that happen?

 

Thankfully now not so often, but it used to be more frequent. It used to be a big problem, because I can remember I would wake up, and [my wife] would be very helpful to me, you know, reassuring me that everything was okay and that. And of course I had probably woken her up. But it would gets so bad sometimes I would have to say, I’m sorry but I’m going to have to get out of bed and I did and I would get up and go in the kitchen and make a drink of tea and sit down here for sometimes an hour, two hours before I went back, and even when I went back to sleep then it wasn’t good sleep you know. 

Daniel's sleep was badly affected by his job as a social worker, and even led to him having nightmares.

Do you think there might be a link between what you did, and I am not sure you want to go into what you actually did?

 

No. I don’t mind saying generally speaking that I was in – when I started in [town] as a social worker, we did what we called generic social work and our case load, the number of cases we had were all of different groups of people that there are, you know, mental health, elderly, families, children in care, all sorts of stuff. And then it was changed, in quite a revolutionary way in [town] and I ended up doing what I really wanted to do and that was working with children and young people and doing what we called long term child care cases. And yes, there were, I wasn’t the only one but there were a number of us from time to time who went off with stress, high blood pressure related to the stress of the job. And we would be off for a month at a time, that sort of thing. And there were a number of us like that, and yes, I had some of the heaviest cases. So, that was related to my sleep at that time.

 

Was that the time when you had the nightmares as well?

 

Yes.

 

Okay and were you worried a lot at night and wide awake at night?

 

Yes, yes.

 

So it obviously did have an impact on you?

 

It was very hard to switch off. I mean to be the perfect social worker you switch off but I certainly found it hard to switch off. As time went on I got to tell myself something to get into that mode, but it wasn’t easy.