Sleeping sickness two

Photo of the week: Lucy's cub gives a hyena a not so warm welcome

Highlight of the week: Our last weekend Sunday in the park with Perry - our top friend and guide who last week passed his level 1 guiding exams - and came top in the country. Nothing but the best for us.

Lowlight of the week: It dawns on us that we are leaving here next week. A house to pack up. Bags to pack. Goodbyes to be said. 

Maximum temperature: 43 degrees Celsius

Rainfall: Looking forward to saying yes next week as we return to a wet cool October

Let’s swap beds for a night! The space next to Keith can easily accommodate any morphology. We have a king sized bed. We use a light sheet and keep the aircon on. All night. And the fan to boot. And yet somehow sleeping in the oppressive Zambian summer is problematic. A sleeping sickness, of a sort, is afflicting me. And so you are welcome to swap beds with me. For a trial run only.

I tick a few boxes for the possibility of all sort of maladies and hormonal misfires. At the age of 59, I’m well past my natural menopause and my hormones come nicely packaged up in a box. Strike one. My night sweats are not peri-menopausal. Perhaps we should consider TB? Keith has been coughing for an age. He reckons he’s allergic to Zambia. The sneezes are quite a thing. Not quite typical of TB. Strike two. The fatigue that accompanies sleep deprivation, combined with doubly sapping daytime conditions, even has me mooting cancer. But that is easily scrubbed out. Strike three.

The honest truth. On reflection. Is that 24/7 responsibility, in itself, almost has us on our knees. Tired. Burnt out. Call it what you will. A 3 month stint here is quite enough. How did we ever do 6 months in 2021? We really deserved a medal, Muttley-style. For services, above and beyond the call of duty. We left with nothing, but scabies.

I crave a day off. Proper down time. The opportunity to light a fire, on an autumn evening, in Yorkshire. To snuggle under a 13 tog duvet and to need it. To listen to the night sounds, without the constant hum and drone of dual aircon and fan. Even chortling hippos, roaring lions and barking baboons stay masked here. I crave the hoot of my Yorkshire owls and the peace of still cold nights.

Sleeping sickness is affecting our Valley in more ways than one. Tryp is a fussy little fellow. Rare and very niche. But other sleeping ailments also exist. My drenching night sweats might not be particularly pathological, but they mess with my crystals and chakras nonetheless. Perhaps I should move on? This blog is not meant to be all about me.

Let’s talk about William. He is this week’s case study. His need for attention is greater than mine. He is currently out of work and unemployable. All because he has a sleeping sickness. Not tryp you understand. His story doesn’t fit with tryp. William would have you believe that his problem started about a year ago. The rot started well before that. But more of that later. The bottom line is that tryp can’t be the cause of William’s woes. If it had been, William would have been dead and buried at the end of last year.

William is a 42 year old guide. By all accounts, he is the bees knees. Skilled. Knowledgeable. Amenable. A favourite with his guests. But only when he is awake. And here is the crux. William has a tendency to fall asleep. At the drop of a hat. And that hat seems to drop all the time. While sitting down chatting. While at the bar getting a drink. But more importantly, while at the wheel of his safari Landcruiser. A big issue when he is driving guests in the park. Picture this if you will. Narrow dusty tracks. Steep drop-offs, next to a crocodile infested river. Trees. Elephants. Hippos. Too many obstacles for his now autonomous vehicle to navigate driverless. Guests have had to grab his steering wheel. Give William a sharp nudge in the ribs. Relaxing game drives in the park have become white knuckle. Not surprisingly, William has been sacked. Again.

We find William serendipitously. A chance encounter with William’s boss. Keith’s ears prick up at the story. As part of our stroke prevention programme, we screen for obstructive sleep apnoea. A condition linked to hypertension, type 2 diabetes and strokes. Mainly caused by obesity. As a person drifts off to sleep, the muscles in their neck relax. The fatty tissue in the neck becomes unsupported. It compresses the upper airway. Typically, a person snores loudly. And then has a pause in their breathing. Which lasts for 10 to 30 seconds. Followed by a gasping intake of breath. The person has been suffocated by their own body. This happens repeatedly overnight. Leading to a poor night’s sleep. And then daytime sleepiness. A tendency to fall asleep easily. In meetings. Whilst being driven. And occasionally whilst driving. A plan is hatched. Keith will see William. Diagnose his problem. Enrol him in our stroke prevention programme. And help William to help himself.

It's Monday morning. Par for the course, there is already a line of patients to see Keith, as we arrive in clinic. WhatsApp sounds off. Morning Doctor Keith. William here. I am waiting for you. I am wearing a red checked shirt. We scan the waiting crowd. And do a double take. There is just one person in a red checked shirt. A smart, smiling man. But he is the wrong shape for us. He has defied our expectations. Tall and slim. His waistline is just plain wrong. Sleep apnoea seems only an outside bet now.

Keith works his way through his morning queue. William is patient number three. A quiet space is found. William is able to tell his story. He describes some sleepiness. A poor sleep pattern at night. He recollects it starting just about a year ago. After a short illness. Keith asks some directed questions and works out his Epworth Score. Epworth Hospital is a sleepy place in Australia that has 2,000 beds. Their scoring system just tells Keith that William tends to fall asleep a lot during the day. William scores 18 out of a possible 24. But William is keeping schtum about what happens when he drives a car. A common white lie. As Keith documents the tale, William drops off and has 40 winks. And Pinocchio’s nose gets a little longer.

William’s slightly sugar coated tale of woe also involves a poor sleep pattern. Night time comes and he barely sleeps at all. Two hours on. 2 hours off. Perhaps repeat. Never refreshed. Schrödinger’s cat is either asleep, or not asleep, in this particular box. But the cat needs a firm diagnosis to fix this sleep disorder conundrum. For now, Keith parks the conundrum with some melatonin and some sleep hygiene advice.

Keith is a bit of a whizz with sleep apnoea. He has a tool kit of remedies for that all too common affliction. But his gut instinct is that William has something altogether different going on. He decides to phone a friend.

Meanwhile, we happen upon William’s ex-boss. We tell him that at least William is playing ball. Engaging in the medical process. But his boss is still worried. The story from William does not add up. This problem has been recurring for years. William has lost a good few jobs from falling asleep at the wheel. He has gone to other parts of the country to work. But his sleepiness has travelled with him. This bad penny keeps cropping up. Perennially out of work.

Everyone needs friends. And many of you know that we aren’t always the best of correspondents whilst we are in Zambia. Except, that is, when we really need you as a friend. And so our friendship is rekindled. Shamelessly. Our first friend Simon recommends that Paul might be a better friend to us than he. Paul happily, is a sleep specialist. A friend indeed. We set up to rejuvenate our friendship.

We hate to admit that Mr Musk has any virtues whatsoever. But his starry connections guarantee a decent chat online. For social intercourse and even for work. Paul is a mine of useful information. William likely has narcolepsy. In effect William gets a tertiary specialist opinion, In Africa. Within a week.

Paul shares that the proof of the pudding is in the eating, as far as narcolepsy is concerned. There are some tells. Vivid dreams, especially during the day. Poor night-time sleep. Positive emotions triggering sleep or blank episodes. But Paul advises that tests are rarely important. My ears prick up at this. This is right up our street. Well down our sandy track at the very least. We specialise in not doing tests. What have you got to lose by trying him on the right medicine for this? says Paul

Baclofen, an underused drug, is available here, at a pinch. It helps people with narcolepsy get some restorative sleep. And modafinil. Basically an on switch, to combat William’s perpetual tendency to be switched off. William will need to be paced, to get the balance right between the ons and the offs. After being on for 4 hours during the day, he will need to nap for 30 minutes. Off. That could be just right for a guide who’s drives last for about 4 hours.

The ink is barely dry on the first page of William’s notes. As a guide, he gets to be part of a private medical programme, that should pay for his drugs. There is light at the end of the tunnel for him. A bright light during the day, to keep him awake, and a soothing dull night light to cushion him, as he takes restorative sleep. Medications and good sleep hygiene. Hope for William. To allow him to take the wheel again. To allow him to share his passion for nature with his guests. His Landcruiser currently off limits.

William and I are in a not so exclusive club. Sleep disorders are a motley collection of some common or garden varieties and some rare and fascinating maladies. But more people have occasional sleep issues than not. And more than one in ten of us is chronically afflicted. Sleep apnoea for example, affects 10% of our camp staff. William’s problem on the other hand is almost esoteric. He is special. Perhaps only 1 in 5,000 people are affected. But it’s not esoteric to William. William needs to know. He needs to know about his sleeping sickness. And so do Paul and Keith.

Remote cam picture of the week: another busy day at the water hole

Doing what lions do best - eating and sleeping

Studiously ignoring each other in the early morning light

The heat gets to us all out here

Sitting on our patio

A close up at sunset