Cut From Steel

He sold nostalgia better than anyone and could not sleep through a night

Don Draper is not a real man, and he is the most accurate portrait of a certain kind of American executive ever put on television. In the first-season finale of Mad Men, an episode called The Wheel, he pitches Kodak on a slide projector. He does not sell the mechanism. What he sells is the ache of looking at pictures of your own family, and he renames the thing the Carousel so the client can feel it.

Draper is not even Draper. He was born Dick Whitman in 1926 to a prostitute and an abusive farmer, and in Korea a gasoline explosion killed his commanding officer, a Lieutenant Donald Draper. Whitman swapped the dog tags with the unidentifiable body and walked out of the war with a new name.

Draper then spent fifteen years being brilliant at nine in the morning and hollow at nine at night. By 1968 the drinking and the unravelling had cost him a forced leave of absence from his own firm. Two years later he walked out of a meeting and drifted around the country working as a mechanic.

You are not carrying a stolen identity into work today. Draper belongs here because the man had everything the century was selling and still could not get one honest hour of rest, and rest was the thing that might have held the rest of it together. A man who never sleeps properly is running the whole operation on borrowed money.

Eight hours in bed and three hours of recovery

You go to bed at eleven and get up at seven, and the afternoon still flattens you. Your wife has mentioned the snoring more than once, in the tone people use when they have stopped expecting anything to change. You put the tiredness down to fifty-six years of living.

I want to hand you the mechanism, because it is mechanical. Mayo Clinic describes obstructive sleep apnea as the throat muscles relaxing until the airway narrows or closes. An apnea is a stop of ten seconds or longer. A hypopnea is a drop of thirty percent in airflow for ten seconds or more. Your brain notices the oxygen falling and wakes you just enough to open the airway, and you will remember none of it over breakfast.

Three facts about the snoring

So how common is this in a man your age? I have three numbers, and the second one is the scandal.

01 / Nearly Half of Men Aged 50 to 70

You are in the likeliest group there is. The Wisconsin Sleep Cohort analysis by Peppard and colleagues estimated that 43.2 percent of men aged 50 to 70 have an apnea-hypopnea index of five or more, and that 17.4 percent sit at fifteen or more, which counts as moderate or worse. Around 17.6 percent of men in that band have the breathing events together with daytime sleepiness.

02 / Most of Them Never Find Out

You would expect something this common to get caught. The American Academy of Sleep Medicine's 2016 analysis set 29.4 million American adults with obstructive sleep apnea against about 5.9 million diagnosed, which leaves roughly eighty percent of cases undiagnosed. Earlier Wisconsin work found that 82 percent of men with moderate-to-severe disease had never been diagnosed clinically.

03 / Left Alone, It Charges Interest

You are not simply tired. Four years of follow-up published in the New England Journal of Medicine found the odds of developing high blood pressure rose with the index, at 2.03 for five to fifteen events an hour and 2.89 above fifteen, adjusted for weight and age. A separate cohort linked untreated apnea to stroke or death from any cause with an adjusted hazard ratio of 1.97. Crash risk pooled across ten studies came out around two and a half times.

Get it measured this month

You can start with a home sleep apnea test. The American Academy of Sleep Medicine's guideline allows a home test or a lab study for uncomplicated adults with signs of moderate-to-severe disease, and requires the full lab study if a home test comes back negative or inconclusive. Ask for the lab study first if you have heart or lung disease, a prior stroke, or you take opioids.

You should pull the levers that need no prescription while you wait. Peppard's analysis found a ten percent weight loss predicted a 26 percent fall in the index, while a ten percent gain predicted a 32 percent rise and six times the odds of moderate-to-severe disease. Positional devices cut supine sleeping from forty percent of the night to about six percent and dropped the index from 21.8 to 9.9. Alcohol before bed relaxes the same throat muscles and raises the threshold at which you wake. Measure your neck too, because seventeen inches or more sits on the risk list.

One last thing. Your wife has been running a sleep study on you for four years. Believe her report.

— Travis

Insider Member's Corner

6 free habits that decide what your night is actually worth:

You didn't put in 45 years to settle for beige.

01 / Watch · IWC Pilot’s Watch Mark XX

IWC built the Mark 11 in 1948 under contract to the British Ministry of Defence, and it went to Royal Air Force navigators as a working instrument, with a soft-iron inner case shielding the movement from magnetism. The current Mark XX keeps that inner case in a 40mm steel watch and runs the in-house calibre 32111 with a five-day reserve. It sits around $5,800 on a strap and $6,150 on the bracelet. The Mark XVIII it replaced is a secondhand proposition now, and a good one.

02 / Recovery · Therabody Theragun PRO

Therabody lists the fifth-generation PRO at $529.99 with six attachments, and it is discounted often. I will be straight about the evidence: a review of thirteen studies covering 255 people, rated fair for quality, found acute improvements in pain and range of motion, no advantage over plain static stretching for flexibility, and no data at all on long-term effects. Buy it because ten unhurried minutes with it before bed feels good. Do not buy it as a recovery programme.

03 / Book · The Old Man and the Sea

Hemingway wrote this in about two months at the turn of 1951 and published it in Life on 1 September 1952, where it sold 5.3 million copies in two days. It took the Pulitzer in 1953, and the Nobel committee named it in his 1954 citation, the only book of his they mentioned. The book runs 160 pages and lists at $17. Read it in one sitting on a Sunday and see what it does to your week.