I have a plausible explanation for Pres. Biden's recent trouble and obvious return to vigor.

[Maru Kitteh]

This has been gnawing at me like a post-apocalyptic dog on the last bone at the edge of the Sonoran desert. How on Earth could Joe have been that muted, in every way, on that debate stage? No - he wasn't gone ala Mitch McConnell, but he was undeniably muted. Slightly softer, slower.

I don't buy the notion that George Clooney is some evil elitist oligarch. I think he's scared, like many people have been and remain even now. Clooney saw something on the eve of that fundraiser, and he was reminded of it on debate night. He then acted in fear. Clooney has a lot of company in many people I still believe to be good persons like Adam Schiff. I will not call for the collective heads of natural allies for expressing their thoughts and fears - because we are not a personality cult. We shouldn't be in the business of asking people not to think, not to be afraid, not to worry, and not to speak their minds. Let the Trump party do cults with their hands over their eyes and ears. That should never be our way.

I'm not a neurologist. I'm not a medical doctor. I am a BSN RN with advanced education and years of experience in geriatrics. I'm also the wife of a man diagnosed with sleep apnea, as Joe Biden was almost exactly one year ago.

I think much of what has been happening with the President may be explained by his diagnosed struggles with sleep apnea and the effects thereof. If I'm right, I think this is potentially very good news because I think the same theory explains his steady but now readily apparent return towards vigor.

When a person has sleep apnea, it's so much more serious than the often comically depicted problems with a partner's snoring. The body of a person with sleep apnea may enter a waking state 200 times or more every night. When this happens, every cell in your body is starved of the oxygen needed to live. The damage done on both a micro and macro level is cumulative as the lack of oxygen injures the cells of vital organs and other tissues which must then expend more energy and need more time to heal and recover. Those with untreated apnea may have increased fatigue causing daytime sleepiness and confusion that can lead to problems like increased trouble with word finding and mental slowness. It can also lead to problems with concentration, irritability/agitation, decreased muscular coordination, poor reflexes, and decreased response times.

The very good news? Appropriate therapy can reverse many of the effects and with consistency, over time, restore function and vigor. This usually involves CPAP (continuous positive airway pressure) therapy with or without supplemental oxygen.

CPAP, though, has a notorious failure/non-compliance rate. People find it difficult to strap a big mask and tube to their face and go to sleep every night. It's often noisy, feels awkward and unnatural, kills spontaneous intimacy, and it can cause gastric upset, flatulence, sore throats and bad breath. It's pretty easy to understand why even people who need the therapy very badly and have the best of intentions to do what their doctor orders, still find reasons not to use their CPAP and eventually stop therapy.

As I said, Joe Biden was diagnosed with sleep apnea just over a year ago according to media reports. My theory is that insidious symptoms before diagnosis contributed to increased difficulty with the old nemesis of stuttering, physical upsets like stumbles, and decreased vitality.

It seems reasonable to speculate that like most people, Joe Biden has had some compliance issues with using his CPAP. I also think you throw in a mild illness, a crazy schedule, some international travel and the crushing demands of the most important job in the world and you could easily get the debate performance that fed this firestorm.

If I'm on the President's medical team and he comes to me and asks about ways to improve his endurance and sharpness one of the first things I pull up to look at is his sleep data. When it comes to everyday recovery, healing and maintaining health and life, NOTHING is more important than sleep. You die without it. It's a thing. Look up Fatal Familial Insomnia sometime, it's awful. I suspect he's back on his CPAP and maybe with his covid history they've thrown a little oxygen on him at night as well. I would. I don't know how many of you saw him yesterday at that rally, but that guy got his sleep. That guy got his sleep and ate his Wheaties and that guy can take it to Trump. Keep it going Mr. President.

I don't pretend to know what the future holds but I know it was never going to be easy, either way. If it was sleep apnea, I hope they share that openly, because CPAP is something 33 million Americans struggle with and relate to. Joe looked and sounded amazing yesterday. He was the robust, fierce fighter we need to hold fascism at bay. He's still fighting for me, so I will fight for him. I'm still ridin' with Biden.

[dmr]

1. Kick

[Metaphorical]

2. I have Sleep Apnia

I have had a couple of myocardial infarctions over the years, and suffer from COPD - Chronic Obstructive Pulmonary Disease - that eventually put me into the hospital for a week. Until it was treated, I was getting about 85-90% of the oxygen that I needed during the day, was constantly tired, and was reaching the point where even crossing the room became a struggle. I started on a CPAP machine, a large, coupled with an oxygen pump (the latter of which is VERY noisy and weighs enough to be difficult to move around).

The CPAP machine + oxygen + a boatload of drugs has helped dramatically, but it comes with its own problems:
* Dizziness
* Frequent laryngitis and hoarseness
* The need to urinate frequently during the night (primarily due to Furocimide)
* A soft voice (my voice is naturally quiet, but this exacerbates it)
* I wake up energized, but by early evening I'm struggling to stay alert, and definitely need my oxygen.
* I tire more easily than I used to
* Colds can prove difficult, because CPAP typically uses a nose clip that requires clear nasal passageways.

I'm relatively young (early 60s). I had not heard that Biden had sleep apnea, but once that was raised it made a great deal of sense. Especially if he had been doing a lot of air travel and was sick, all of the symptoms could be explained this way. Note that it has not changed my own mental acuity once it was treated, but the COPD had a major negative impact as a writer and programmer, and it took me almost two months to recover even after being in the hospital.

[ms liberty]

3. And when you have a stuffy nose, cold, allergies or flu it is so much worse

I have what they staged as "moderate" sleep apnea, I stop breathing about 17 times per hour. To me that seems pretty freakin' severe, lol. I have the sleep apnea that comes with the classic crescendo kind of snoring, where it increases in volume to a peak where I then stop breathing, start breathing again, then the cycle recurs. My mother had it as well (and died before cpap machines), and I grew up lying awake listening for her to start breathing again when she'd snore. I also have a very deviated septum, so I have to wear a full face mask, which makes the cpap more difficult too, because it's so hard to get comfortable and if you turn over, you have to wake up enough to move your hose or adjust the mask. Imagine how it feels when your head's stopped up. 0/10, would not recommend.
When I read on his medical report and saw that he'd been diagnosed with sleep apnea and used a cpap, I saw it as an aha moment too. They reported he had a cold or something and that was obvious, but it is another level when you have something like that with sleep apnea and a cpap.
All this is to say that I agree with you. Thanks for posting this, because I hadn't really spoken about it yet!