Scott wrote a comment on my post a couple of days ago that makes a good opening as I shift gears a bit:

Chuq, do you think the weight gain triggered the sleep apnea or did you have apnea first, which led to weight gain? Sleep apnea shows itself as a lot of different symptoms — it’s great that you decided to get to the core problem.

And the answer to that is complicated, and the experts are still figuring all of this out.

But first, a few notes before I dive in:

• I am not a trained medical professional. I am an interested layman who’s been trying to learn as much about this as I can because it interests and affects me. Do not use me as your medical doctor replacement.
• Be careful who you believe on the internet. Including me. There’s a lot of bullshit out there, some of it spouted by loonies, some of is published by people who want to sell you crap, and some of it published by people funded by large companies who want to sell you crap. Be wary of who you believe.
• If they use the words “easy” or “foolproof” run away fast. Or toddle. Or waddle. Or whatever it is you do, as fast as you do.
• If you are offended by someone making fat jokes, well, sorry. It’s okay. I’m fat. I can do this….

There does seem to be interesting research (also here) coming out that indicates that sleep apnea, and that inadequate sleep can both be a trigger for obesity. There are now some studies showing particularly strong links to inadequate sleep prior to the age of 5 being linked to obesity later in life. If you burn your candle at both ends, it seems to affect your metabolism, and your body is more likely to go into a defensive mode where it tries to collect fat.

Weight gain and apnea is a particular conundrum, because it looks like the apnea leaves you in a state of chronic exhaustion, and that exhaustion mucks with your metabolism and slows it down, which encourages fat storage. And as your weight goes up, it can enhance the apnea, creating a nasty feedback cycle. Apnea does a lot of other things — if you’re always exhausted, you’re rarely functioning at your best. Your mental processes slow down, you don’t think as clearly, your reaction times slow down — you know that feeling you get after an 18 hour day or pulling that end of project all-nighter? When you hit that point where no amount of Red Bull brings the edge back, and you have to think twice about how to tie a shoelace? Apnea takes you to that point and leaves you there is it strengthens. It saps your energy, meaning you’re less likely to exercise, also encouraging weight gain and muscle loss. You end up stressed; when you’re exhausted, you’re more likely to feel negative and unhappy and the stress and anxiety pile up.

Ultimately this all turns into a negative feedback cycle. And let’s not forget that there are strong correlations between apnea and insulin resistance, which leads to diabetes. And it all tends to happen slowly, over time, so you don’t really see the results until you’re far into the process.

I’ve always been hefty. I’m 5’8″ but with a seriously heavy bone structure. As a sophomore in high school, I wrestled at 142, and in good shape it was a struggle to meet weight. If you look at a recommended weight chart, a 25 year old at that heigh with a large frame is suggested to sit in the range of about 145-170. A 15 year old still developing and in good physical shape hitting that range is sort of off the chart, so one word never used to describe me is svelte. or petite. I exited high school about 175 in decent shape, and then got lazy. I was 280 on my 30th birthday. My doctor and I have done some work reconstructing my weight profile, and I started gaining about 7-10 pounds a year out of high school, and just kept it up, until close to the end at Apple when I hit that point where it spiralled and I put on about 60 pounds.

When I left Apple, I weighed 380. Today, four years (and a month) later, I weigh — 385. That in itself is a victory of sorts, but not a complete on. In those four years, I gained at least 20 pounds (maybe more; I stopped weighing) and joined the 400 club, and then lost it again. And then in 2008, I took of 35 pounds, only I wasn’t trying to, and that was one of the things that caused me to go get tested and we caught the diabetes fairly early on; I know I wasn’t diabetic in early 2007 when I got tested. I seem to have flipped this particular switch in late 2007. Since I and my doctor both know I’m was a good candidate for diabetes (as well as having a family history of seriously high cholesterol) we’ve kept a fairly close watch over time while I tried to figure out how to get the weight loss. Unfortunately, in 2008, my dad got sick and I spent much of 2008 helping mom deal with that, and then deal with the funeral, and then deal with the estate, and I never got around to the tests until fairly late in the year, when in all honesty I already knew. I emailed my doctor and suggested we should do some tests, he agreed, and the numbers came back seriously sideways. We retested and added in some other checks, the urine test came back “HEY! YOU CAN MAKE POPSICLES FROM THIS!”, and that was that.

Diabetes, according to a friend of mine, is nothing much at all to worry about, but you have to keep a very close watch on it. What he means by that is that as long as you take it seriously and pay attention and manage it — it really isn’t a big deal. he’s right. That’s a whole set of discussions for down the road, but suffice it to say, the best control I can put on the diabetes is to get the weight off and keep it off. Right now I’m controlling it by managing my diet and with some drugs, but the goal state here is to manage it by diet alone, and that means getting in better physical shape, getting the weight off, and eating a diet that keeps the body in balance. I’ve made good progress on that third part; I’m still struggling with the first two.

it’s complicated.

In talking with my doctor about all of this over the years, and with my therapist when I was in therapy, and with nutritionists, I’ve learned a lot about what makes me tick and where my struggles come from. Bad lifestyle habits don’t get fixed overnight; if you try to fix everything all at once, I can pretty much guarantee you’ll fail. One of the best pieces of advice my doctor gave me was to grab one thing I felt I could fix, and fix it, and keep working at it until the habit was relearned, which takes weeks. Try to do too many things at once, and as soon as you muff one, or you hit a patch of stress, or something comes up — you fall back into the old habits and lose it.

Try to pick up a mountain, and you’ll fail. Pick it up one rock at a time, and it’ll take a while, but if you keep at it, you’ll find you moved it. Slow and steady. My last year at Apple, I was on the burger and fries diet — five, six times a week (at least). Whatever was fast and didn’t require thought, since I only allowed myself 15 minutes for lunch, including acquiring it.

Today, there’s very little to complain about in my diet. One of the most effective tools in fixing a diet is the food diary, where you track everything you eat. Since i decided I needed to get serious about this, I spent a week tracking what I ate and did an analysis of it. The good news: I was right, I was eating to maintenance (no gain, no loss), and the food ratios where just about where I expected them to be. The bad news: the total calorie count AND what I thought an appropriate was an appropriate calorie range for maintenance were off by about 20% — I was eating more calories than I tallied mentally, but I also had the goal number off — so in practice, the result was accurate but the scale was off. That’s easy to recalibrate. The food ratios were just about where I expected them to be, more or less 30% fat, 35-50% carb, the rest protein. That’d be a great diet — unless you’re diabetic. As a diabetic, that’s too many carbs, and one of the diabetes drugs I take works by encouraging the liver to sequester blood glucose (i.e., stuff it into fat cells); hence losing weight with that going on is even more complicated. So I have to change that ratio to something more like 30% fat, 30% carb, 40% protein. Thank god I like deli sliced turkey…

There is, in our culture, this weird aspect that can best be described by the words “Just say no”. it drives me crazy sometimes, because it’s incredibly naive — and it doesn’t work. It doesn’t work with kids and drugs or alcohol, it doesn’t work with kids and sex (or priests and sex, or married adults and sex, or…). And it’s embodied with weight with things like “just put less on your plate” or “you just need to walk 15 minutes a day”.

Here’s the hint: if it was THAT SIMPLE, all of us would be thin and healthy, okay? Notwithstanding that I take full responsibility for some bad choices I made, if you look around, there’s a huge obesity epidemic. there are more things driving that than being lazy and eating badly. Wherever the western diet gets introduced, obesity and diabetes follow. Here in the states, the combination of the western diet (heavily processed foods, carb heavy foods, fast food places everywhere, sweetened soft drinks, etc, etc) AND a culture of “don’t walk, get in the car” the obesity issue is magnfied. In places like Canada and New Zealand where there’s still a culture of “go outside and play”, it’s a lot less prominent. Just saw a study the other week where the average New Zealander takes twice as many steps per day as the average US person. And it shows in the average waistline.

I’m convinced that we’re going to find that there’s a direct link between the growth in usage of high yield corn syrup and many of our societal issues here. I would non be surprised if we end up coming to realize that this is our generation’s tobacco, and if you’re old enough you remember when the tobacco companies spent megabucks telling us it really was healthy. Where my mother’s generation in many ways died of lung cancer and deal with emphysema, our generation and the kids growing up today are as likely to die of heart attacks and strokes and suffer from diabetes. The evidence is still being built — but I expect it’ll happen, with the mega-food companies fighting it the entire way. At least until they can find a graceful exit strategy to convert their processed foods back to sugar.

In my case, there are a couple of things that have complicated this further. One is that I’m wired to eat under stress. When I stress out, I eat. That’s not something that “put less on your plate” remotely deals with. You deal with it by learning how to not be stressed. Which, if you’re stressing out about your weight, is an interesting challenge.

The other thing is a piece of biology. There are two hormonal signals tied to eating. One is the hunger signal, which tells you to eat. The other is a second signal called satiety, which is actually the trigger that tells you you’re full and you to stop eating. You start eating when you’re hungry. You stop eating when you’re full. In my case, the satiety trigger is sluggish. I don’t get the signal as quickly as the average person. That means that you eat longer, which means you tend to eat more, before you stop. Which means more calories.

All of which, I guess, is a long-winded rant on the stupidity of our culture that goes after simplistic answers to things that clearly are complicated and difficult. We set ourselves up for failure — and then beat ourselves up when we fail. And then go eat a donut to make ourselves feel better, which is okay because we suck and we deserve to be fat and everyone hates us. And so the cycle starts again.

I’ve spent a lot of time trying to understand it in the context of myself. I’m now ready to make a serious stab at the core problem — my weight — because I believe I’ve finally dealt with all of the OTHER things that tie into it and complicate it and get in the way of dealing with it or trigger it, whether it’s a crappy diet because I was so tied to my job I didn’t allow myself enough life to eat properly, or stressing myself out over things that honestly didn’t deserve to control my life that much, or any of a dozen other things that all pile on and get in the way, like, oh, if you’re a stress eater and your dad is dying, losing weight just doesn’t hit the top of the priority list…

The reality is — this stuff’s all incredibly complicated. It’s a different path for everyone. Maybe I’m finally on mine. Maybe not, but I know I’m closer to it if I’m not there. And that’s why I’ve started writing about this — not because it makes my situation any easier, but because maybe it’ll help you find your path a little faster and easier. And even if not, it never hurts to know that you’re not alone in the struggle, right?

(the last few days have been heavy and deep. thanks for sticking with me. we’ll switch gears and go lighter for a while, but we’re not done here, not remotely. And if you have thoughts or questions, drop me a note….)

Sherman, set the wayback machine to February, 2004.

It’s the standard weekly team meeting, only this time, it was a bit different. My management recognized me for finishing (surviving?) 15 years at Apple, and I got my pin, my plaque, and cake. the team we’d put together congratulated me. It’s something not a lot of people can claim.

Afterwards, I went back to my office and sat down to check email, and started crying. And couldn’t stop.

I was emotionally and physically exhausted. I blamed work and stress — I know better now. It wasn’t the first warning. Even six months prior I was noticing changes. I was honored to be invited to Tim O’Reilly’s Foo Camp 1 and found myself spending the time feeling isolated and distant from everything. I came home from Foo inspired to do a number of things — and instead dug a hole and crawled into it and pulled the sides down on top. It slowly got worse, too. Laurie and I took a long-planned trip up to Victoria and Vancouver to spend christmas. That was the year of the great freeze, with snow in Victoria, sub-zero (F) temperatures, and a mad dash out of Portland to the 101 on the coast to try to get home before the entire state of Oregon got snowed in. We made it, and those who weren’t smart enough to do the same waited about 5 days for I-5 to re-open at the california border.

That was the first time my body sat me down and said “DUDE! Stop! Listen to me. THIS ISN’T WORKING”. It was also the first time I ran into something I couldn’t just out-stubborn. Here’s a lesson learned that I wish I’d known then: if you’re blaming work and stress for how badly you feel and you take ten days off and go on vacation and you rest and relax and don’t think about work — AND IT DOESN’T GET BETTER — then hey, dude — it’s not work. And you probably ought to look into it.

I know that now. Learning that lesson saved me a lot of fun later down the road. When something’s going south, it rarely does so without some early warning signs. It gives you a chance to intervene and deal with it before it turns into a crisis.

If you’re paying attention. If you don’t think you can simply out-stubborn it.

In my case, I ignored it until the crisis hit. Then I tried to ignore it for another couple of weeks until I realized it was winning. That was a tough time for Laurie, one I regret to this day. I was seriously manic. By the time she told me to get help or else, I’d already made the phone call.

The words “nervous breakdown” cause interesting reactions in people. I was amazed at how many people I ran into that when I admitted it to them said “dude, yeah. Me, too”. And how many also said “whatever you do, don’t blog about this.” Maybe they’re right. We’ll find out. Mostly, my view today is any potential employer who reads this and won’t hire me because of it isn’t someone who deserves to have me work for them. Their loss, not mine. Better to find out those things before you commit.

My therapist was awesome. One of the first things he said in our first meeting was “You wouldn’t believe how many people in your industry end up in my office”. Later, as I talked to people about it, I found he was right. it’s one of the dirty secrets of high tech in Silicon Valley, how people commit themselves to work themselves until they fall apart, and how companies take advantage of that and create project demands that encourage it. The “sleep under your desk” mentality isn’t healthy, and it catches up with you eventually. When it does — the company rarely makes it up to you. In my case, I was lucky. My management was extremely supportive and did what they could. My team was even more supportive, and for a while, simply worked around the problem and took care of things until I got my act together enough to be a functional part of the operation again. For a while, I was pretty literally a basket case. In a lot of companies, they toss you to the curb and put another body in your cube. That’s something you ought to remember before you commit to chronic 60 hour death march schedules. The company benefits when you do. You probably won’t get a cookie. Just sayin’

I spent a couple of months in therapy, understanding my situation and learning what it meant and how to manage it. Some people need pharmaceutical help, I just needed some perspective and some ideas on how to cope.  It took me a couple of years, but I finally learned how to like myself, something that’s always been a struggle, and how to not let the stress and angst pile up until the container is full and it all spills out in a badly timed mess. For me, it came down to getting an outside perspective and some trained advice on how to change things I was doing to cope with life challenges (and failing at coping). Everyone’s a bit different, but the big lesson is — don’t be afraid to ask for help.  I always believed I could do anything, that I could make it happen by working longer and harder. Look where that got me. Maybe the hardest lesson I had to beat into my thick skull was that I have limitations, and sometimes I need help — and not to be afraid to ask.

What we didn’t do, what we didn’t realize was hanging out there, was look for the root cause. I thought it was work and stress, and my therapist saw no reason to think it might be something else, since dealing with mewling blobs of protoplasm caused by work stress was his stock in trade. And if you look at the dates involved, it’d be another three years before I did get far enough into this to get the root cause identified and treated.

The root cause here was the apnea. And while I don’t have many regrets in life, I do wonder at times how things might have been different had I made the connection and gotten it treated earlier. Would I still be at Apple? Perhaps. What I do know is that a number of people I know and love got caught as collateral damage along the way, and whether I was able to avoid any of this personally, I wish I’d been able to keep them from having to come along for the ride.

The lessons to take out of this?

• Listen to your body. If something’s wrong, don’t out-stubborn it, and don’t wait until your body pulls out the sledge hammer to get your attention. Things you catch when they’re small are a lot easier to fix.
• Make sure you’re finding the cause, not just treating the symptom.
• There are large chunks of silicon valley whose business plans are based on working you into the ground, and then replacing you with someone fresh and ready to go back into the grind. What are you getting out of this relationship? Deathmarches are a fact of life, and deadlines happen; but if every day is a deathmarch and the deadlines are never rational, do you really want to be there? And will they really make it worth what you go through to ship that product? Really?
• Too many companies demand loyalty but offer none. I know way too many people who did way too many 70 hour weeks to get a project done, only to find out their job moved to india (but thanks for making our quarterly numbers. oh, and we stripped the package. sorry). Find the companies that see you as an asset, not a cog, and make the relationships work both ways.

The reason I stuck at Apple for two years beyond my breakdown was simple: my management and my team kicked serious butt for me when I needed it, and I wanted to do everything I could in return for them. So let me close tonight with this final thought. To Axel and Dean and Michelle and Jason — the more time passes and the better perspective I have, the more I understand just what I put you all through, and the more I appreciate how you all helped me through it. It’s a debt I can’t repay, but it’s one I am happy to recognize and honor. Thanks.

That goes doubly so to my wife Laurie. I’m convinced I wouldn’t have made it without her.

Hey, can someone push the big green button on the Wayback machine? the one labeled “return?” thanks.

How time flies when you’re having fun. It was four years ago that I left Apple after 17 years to go do something else.  I announced my decision in July, and spent eight weeks transitioning, and in September 2006 walked out of Apple for the last time and into — well, at the time, I had no idea what I was going to do. Something different. I redid my blog into Chuqui 3.0, and four years later, again for my birthday, redid it again into its current form.

I tried my damndest to get hired by Yahoo! at the time. It’s still a company that looks to me to have huge potential — but right now, it’s just not clicking, and it looks like AOL is seriously gearing up to make a run at doing what Yahoo ought to be doing and isn’t (and some really interesting yahoo! talent keeps sneaking off to AOL land) . Not really sure why a Yahoo job never happened, there was plenty of interest in both directions, just never quite the right match (and in one case, an internal transfer that tooks a slot I was waiting for an offer from). Having lived through all of the bad years at Apple, not being hired by Yahoo turned out to be a blessing in disguise, and the best things are the things that don’t happen.

I wrote  a series of blog entries about all of this, the Apple Post-Mortem series:

• Part 1: Why I left: and more on this in a bit..
• Part 2: Jobs I Wish I could Have Taken: most of which are jobs I STILL wish I could have taken, and ones that I still think a company like Apple (or most companies) should create for some one…
• Part 3: no longer online (and I don’t even remember what it was, or why it’s offline. Doesn’t really matter)
• Part 4: Why Apple doesn’t have a blogging policy (and it ain’t what you think); by far, the piece that created the biggest kerfluffle, way back when.  And of course, there was great hue and cry about how Apple had to blog, or it was going to fail and the universe was going to shun and scorn it. We see just how badly faltered by failing to understand this basic requirement of the universe… This is the one where folks called bullshit on me without in some cases seeming to notice I’d actually left Apple.
• Leaving Apple after 17+ years was both an easy and tough decision. Part of me really wanted to stay, wanted to, as I put it a few times, get carried out on my XServe.  Not exactly, looking back on it from today, a ringing endorsement. Most of me understood that I needed to make some fundamental changes to my life or they would in fact carry me out on my XServe, and that would have been bad.  I was physically exhausted, I was emotionally exhausted, I’d gained close to 60 pounds in the previous year. I worked myself into pneumonia,  and then hid from my doctor and bosses that I worked through treatment for it.

I was a wreck. I’d spent a good part of a year trying to find ways to fix the job situation with the help of my bosses — and failed. In many ways I blamed Apple for this; in reality, there was nothing that happened that I didn’t volunteer for and jump into with both feet and great enthusiasm. I was physically and emotionally bankrupt, and I had no idea how to resolve the problem; I honestly wondered if I was simply too old to keep up with silicon valley. I didn’t know. What I did know was that the current situation was pretty literally killing me, and I was doing myself no good, my project no good, Apple no good and the people around me no good.

So I jumped, deciding that some time off would help me recharge and give me some time to reflect and decide on what to do next and how to fix my life. At the time, I was somewhat bitter that Apple didn’t do more to convince me to stay. In reality, it did me a great favor by not trying, and in reality, I didn’t work too hard to find a place to land, either. That was just exhaustion speaking, and now, I see that and I feel that Apple — and my bosses all those years — worked their butts off to try to make things happen. It was just a situation where nothing Apple could do could fix it.

Because what I didn’t know at the time, wouldn’t find out for another six months, was that I was really sick.

When I did finally haul myself off to my doctor and talked, he sent me off to the sleep clinic to be tested. They wired me up — and the results were stunning.

I had sleep apnea. I didn’t just have sleep apnea, I was seeing an average of 50 “incidents” an hour. An incident, by the way, is when your breathing passage blocks and you start to suffocate, at which point your body has to react (i.e “wake up”) and do something to allow you to breathe again.  I was — pretty literally — snoring myself to death.

I started wearing a CPAP that night, something I’ve been wearing every night since. it’s basically the inspiration for the Darth Vader mask. I’ve talked about this a couple of times in the past, but now that some time has passed, I have a better perspective on all of this.  it’s now clear, for instance, that I was suffering from Apnea for at least a decade prior to my diagnosis. The more I look at that time of my life, the more I realize how much it was impacted by this.

In the year prior to deciding to leave Apple, I gained about 60 pounds. At the time, I blamed work and the stress of the project I was on. I strained friendships (and lost a couple I still regret). I had no energy, I was always worn out and exhausted. I was starting to suffer from high blood pressure. I was not a lot of fun to be around, and I didn’t particularly want to be around anyone.

In the two weeks after putting on the CPAP, my blood pressure dropped 20 points and I went off blood pressure medicine. I slept well for the first time in years — and so did Laurie, because she wasn’t having to deal with sleeping with a fog horn. She stopped wearing earplugs to bed, and her sleeping improved, too. After about six weeks, my energy levels started coming back, and so did my attitude.

At that time I realized I had to get serious about lifestyle changes. I decided to try to adopt a new attitude. The easy way to sum it up is:

I’ve given up denial for Lent.

And that’s been the foundation for what turned into a major effort to rethink every aspect of my life, how I lived it, and how I needed to live it moving forward if I wanted to be around for a while and actually have a quality of life that made being around worth it.  I feel for the first time in decades comfortable in my own skin and satisified with how I’m living. For the first time in decades — warts and all — I like myself.

And here’s why I’ve decided it’s finally time to talk about this.

Your health is like a credit card; you keep putting purchases on it and making minimum payments against the balance, eventually it’s going to hit the credit limit, and if you go over, bad things happen. Lifestyle choices I made in my 20′s and 30′s came back to bite me in the ass in my 40′s when the bill came due, and here I am now in my 50′s, “restructuring the debt” and realizing that there are things I’m going to have to live with the rest of my life.

Things that were completely avoidable if I’d made different choices and taken a different path.

I can’t go back and do that, but I’ve decided this is my time machine, and hopefully I can help someone else who is just starting to move down a path to understand the options and maybe make a better choice than I did.

It’s probably not as much fun as geeking out over HTML5 transforms or complaining about the ref’s call in last night’s hockey game — but it might save someone’s life. I promise not to lecture and not to whine or play “poor me” games. I have no intention of telling you how to live your life. But if I can help some people better understand the implications of some of the decisions they need to make, then this will be worth doing.

We’ll try it and see what happens.