Over the past few years, I gradually came to realize that I have obstructive sleep apnea. I hadn't had a really good night of sleep in years; I often woke up several times a night; Sam complained that I snored like a sawmill, and would sometimes actually hear my breathing stop entirely for a while. My symptoms generally resembled those of a whole bunch of people I know here and elsewhere who have sleep apnea, and got some relief from using a CPAP, a machine that blows air into you all night through a face mask. The idea is that the positive pressure can help keep the airway open, and the machine can even detect an apnea event and force the airway open by increasing the pressure.
So I wasn't surprised when, at my last physical, the NP quizzed me and recommended that I do a sleep study. This turned out to be, not a visit to a sleep lab, but a much cheaper at-home thing I did by borrowing a sleep monitor from Lawrence General, and sleeping with its pulse oximeter stuck on my finger and a cannula up my nose. That turned out to be kind of difficult, but I guess I got enough hours of fitful sleep that way for them to tell that there was something going on. (They also figured out that I had some pretty terrible acid reflux that needed treatment, and that's helped my sleep too, among other things.)
What followed was a month of fighting with my insurance company, who apparently thought I wasn't sick enough for them to pay out, but the sleep specialist my doctor referred me to eventually successfully badgered them into playing. So a couple of weeks ago a nice person from the CPAP dealer actually made a home visit and gave me my shiny new machine.
This is a ResMed model that has a cellular modem in it, the main purpose of which seems to be for the insurance company to spy on my sleeping habits so they can stop paying out if I'm not using it. There was a scary article about this going around recently; it's absolutely true, but the dealer did tell me the parameters up front: I have to use it at least 4 hours a night for 21 nights a month, which is not exactly onerous and would occur naturally if I'm making any effort at all to actually use it. It's a rent-to-own deal where the machine is eventually going to be mine, but it needs regular replacement masks and such.
The CPAP itself is a surprisingly quiet machine (I'd worried there was going to be some loud fan, but it's not really audible). It's about the size of a large bedside clock radio, but heavier, with a built-in humidifier that needs to be filled with distilled water every day or two. There's a start/stop button on top, a phone-sized display screen on the front, and a dial that clicks in that's used to manipulate the menu system. I'm not allowed to mess with the air-pressure settings (these are prescription-specified), but I can adjust the temperature and humidity of the air that comes out. It turns out that these controls are worth fiddling with: I seem to do best with warmer and slightly drier air than the defaults they left me with.
The base unit is connected by a long hose to the mask, a clever Philips model made of clear silicone rubber, where the hose connects at a swiveling joint on the top of my head, the better to lie down with. The head harness consists of flattened hoses going down both sides of my face to connect at a piece that fits under my nose (all held on with a Velcro/foam rubber strap in back). I like that there isn't a big cup over my nose and/or mouth, which many CPAP masks have, but the bottom of my nose does sometimes get a bit sore and pimply from this thing pressing up on it.
I was a bit apprehensive initially about the mechanics of this: how do you breathe out? What if the machine stops working? The mask isn't completely airtight, though: aside from the hole that goes under the nostrils, the nose-piece has another little port in front for venting air, and there's also a bunch of vent holes on the hose connector. Breathing through your nose with a non-working mask on is entirely possible, though it becomes much easier when the machine is on. The machine seems to sense when you're inhaling and dials up the pressure then, at least if you take a deep breath.
Getting used to it
So... how is it to sleep with this thing? Does it work? Well... it's a process. The mask was weird and uncomfortable at first. They suggest that it might take weeks to fully acclimate to wearing the mask at night. I've had plenty of bad nights when I woke up at least as many times as before the CPAP, and didn't actually get much sleep. These aren't completely over yet. But I've noticed that on the nights when I do sleep (last night was a good one), I wake up in the morning feeling distinctly better, less kicked-in-the-head than I used to. I think the first noticeable benefit was just that I'm breathing filtered air, so whatever allergens are about at night don't bother me any more. This aspect will probably help a lot in the spring.
The strangest thing about wearing a nose-only mask is that you still can't really talk with it running: if you open your mouth for any reason, there's a bizarre sensation of air blowing out of your mouth when you try to inhale. Coughing is unpleasant unless you're sure to breathe in through your nose first.
There's an app/website where I can look at a summary of the data the machine uploads via its modem. Probably the most practical thing it does is show how badly the mask is leaking. While there are vent holes in the mask, in order to work it relies on there being a fairly good seal around the nostrils, and for the first week or so I didn't entirely have the fit worked out and could see big leaks in the numbers there. Eventually I got the hang of it.
It also shows the frequency of apnea events you're having through the night; these numbers are all over the place for me, and I don't really see a consistent trend, but presumably the machine is helping me start breathing again when I do have an event. There's a silly overall "score" it gives you, which mostly depends on whether you actually used the machine all night, but this other stuff figures into it too.
Probably the biggest issue is that my nose often gets progressively more congested over the course of the night, just from lying down, and if it's really bad the CPAP only incompletely powers past that. I may have had a mild cold when I started, which didn't help. I think I'm actually not a mouth-breather most nights (that would show up as a mask leak in the uploaded data), but I was wondering for a while if I needed to switch to a nose-and-mouth mask. Eventually I figured out that the temperature and humidity settings can help with this. But it's tricky. Some humidity helps clear out my nose; too much gives me this unpleasant situation I can only describe as "swampy nose", in which I get a powerful sensation that my nose is running like a hydrant and is going to fill the mask up with snot. When I take the mask off, this turns out to be an illusion. (I sometimes tell myself that even if it did, it wouldn't block the airflow, because of the redundant side hoses.) I suspect that with time I'll learn to discount it, but keeping the humidity right in the sweet spot helps.
A couple of nights I experimented with using Breathe Right strips to improve airflow inside my nose. I'd used those before getting a CPAP, and it actually is possible to use them with this mask, but they tend to degrade the fit, so it's a last resort.
As stated, it sometimes makes my nose kind of sore. Keeping the mask clean and using a lot of lotion there seems to help. It also takes a little fiddling to deal with my mustache, but I suspect it would actually be harder on my upper lip if I didn't have a mustache. I may end up experimenting with different kinds of masks, though I'll probably give this one some more time first.