A Medical Equipment Upgrade

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As many longtime readers of this blog will already know, I use a CPAP machine when I sleep. It’s a very nice, quiet machine that we can’t even hear over the fan that we have blowing in the bedroom at night. The mask is a version called a nasal pillow mask. The plastic and silicone part of the mask goes under my nose to create a seal against my nostrils, the hose comes out from the center of the mask, and the wings stretch up along my cheekbones to connect with a foam-back fabric and neoprene series of straps, one going across the top of my head, and one – the neoprene part – going across the lower back of my head, just above my neck. This piece of headgear is attached to the wings of the mask using something of a hook-and-loop attachment, like Velcro, only there’s not much of a loop system there. The hooks simply connect to the fabric and stay there. Unfortunately, this means that over time the fabric deteriorates to the point that the hooks don’t want to stay fastened to the fabric without some considerable effort to secure the connection between the two.

Insurance will cover a new headgear every six months, but it seems that the fabric is going to be lucky to make it that far. Last night, at some point in the evening, one of the connections came loose, which in turn broke the seal of the mask against my nostrils, resulting in the CPAP machine blowing air useless across my nose and face. I don’t know how long it was like that, but I’m gathering that it was a fairly long time. I slept off and on – mostly on – until nearly 2 pm today. That tells me that I didn’t sleep well last night and that the mask was off for the majority of the time that I was sleeping.

There’s a new mask called the Dreamwear (pictured above) that’s now available where the wings of the mask themselves act as part of the hose system, which feeds down from the hose attachment at the top of the head into soft silicone chambers that feed the nasal pillows. There’s a minimal strap holding the contraption in place and it looks to be a significant improvement over the mask I currently use.

Fortunately, I can switch masks later this month, I believe, and I’m looking forward to using the new mask, especially since it appears that failures of the headgear won’t be as likely with this mask.

I’m always nervous using a new mask that I’ve never tried before, but I hope that my experience with this new mask will be beneficial. It’ll take some getting used to having the hose at the top of my head instead of on my face, but I’m sure that won’t take long to adjust to.

My biggest worry is that I’m remembering my timeline correctly. I’m not sure now much longer my current headgear is going to hold up, and I really need my CPAP machine to sleep well. If I’m right, it won’t be many more days before I can order the new mask, and I can put this problem – excuse the pun – to bed.

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The Effects of CPAP Machine Usage on Middle-Aged Males Suffering From Sleep Apnea: A Brief Analysis and an Overly Long Title

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So, I’ve had the CPAP machine for nearly two weeks now, and there are some trends beginning to emerge.

In the beginning, there were instances of both waking late and taking naps, but from the first night my body’s overwhelming, undeniable, irresistible urge to lie back down wasn’t there. I attributed the naps to being bored rather than notably tired.

The second night of using the machine was a difficult one, as my body registered the addition of air pressure into my nostrils as me choking, and it took forever for that sensation to calm down to the point that I could drift off to sleep. This sensation was greatly diminished on the third night and has since completely faded away. It now feels a little weird when the air begins to gently blow, but it’s a feeling I’ve become accustomed to, and I no longer feel anything resembling a choking sensation when I use the mask.

As my usage has progresses, I have noticed that I need less and less sleep during the day. Sunday I woke at shortly after 7:00 am and stayed awake the entire day, not sleeping once. Yesterday I awake at around 7:30 am and did not go lie down for a nap all day, although I did take a short, 15 minute long catnap sitting on the couch. Today I slept in, awaking at 9:30 am, and have not returned to bed since, and as of this writing have no urge whatsoever to do so.

The most apparent benefit is an increase in energy. I seem to be more alert during the day, though I’m still waking up very groggy for a time, and I also seem to be accomplishing more with my day more efficiently.

I’ve been keeping a close eye on my blood pressure and haven’t noticed that there’s been much of a change there, although it seems more often that my blood pressure is slightly below 120/80. Blood pressure fluctuates wildly throughout the day, however, and it’s difficult to see any sort of definite trend. I’m going to continue to keep a closer eye on that to see if a notable change develops in the weeks and months that I continue to use my machine.

My compliance has been near perfect. I’m sleeping with the mask on every night, and have only had a few examples of napping without the mask, though that was largely situational, as I had already broken down the machine for its daily cleaning and its parts were drying at the time. I’ve been perfect with my cleaning regimen with the single exception of failing to wash the headgear during the one weekly cleaning that I’ve done (that will resolve itself in a couple of days, however, on the next weekly cleaning cycle).

The only downside that I’ve noticed is that for a while after I remove the mask in the morning, my nostrils are dry and sore. After an application of saline nasal spray, that fades fairly quickly, so it’s not much of a downside.

Overall, I’m already starting to see some improvements in my life thanks to the CPAP machine, and I’m hoping for in the not-too-distant future.

 

Tonight’s the Night

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I’ve picked up the new CPAP machine and mask. All the parts of the machine and mask that require daily cleaning have been cleaned and are drying at this time. The machine itself has been programmed and is set up, awaiting use tonight. The tracking software that automatically tracks my compliance (which is a bigger deal than it would normally be because of Medicare regulations) has been installed on my laptop and is ready to start accumulating data. I have alarms set on my phone to remind me to do both daily and weekly cleaning cycles. I couldn’t be more ready – or excited – if I tried.
 
If things go as expected, I will be sleeping very well this evening and will likely notice an immediate difference tomorrow in the lack of need to nap during the day. More long-term benefits will hopefully follow over time, like lower blood pressure, for instance.
 
I’m really excited about tonight and I can’t wait to see how things go.

Hope on the Horizon

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Friday night was the follow-up sleep study.

They gave me the same intake form, describing my day, gave me the same technician (Carl) to wire me up, gave me mostly the same wiring configuration – everything but the nasal cannulas – and then fitted me with a mask.

It was a nose pillows type of mask, with a small piece of silicone forming the seal between the mask and my nose. The silicone part had two holes in it to correspond with my nostrils, and with the help of a few straps around and over my head secured the mask tightly to my nose. We’d also tried a nasal mask, which is similar in design to the full face mask that covers the nose and mouth, only this one covers the nose only. It had a fatal flaw once air pressure was activated: the shape of my face prevented a tight seal from happening, and the mask was leaking in such a way that the air was blowing straight into my right eye. So we switched to the pillows.

I’ve used a CPAP machine twice before, for not a long time before setting it aside due to comfort issues with the full face mask I’d used both times. The nose pillows mask is by far the most comfortable mask that I’ve ever worn. It felt natural in every way except when trying to speak – the air pressure that’s coming through the nose tends to interfere with the lungs’ ability to get enough air out to speak, and so it’s like fighting uphill to talk with the mask on. However, it’s nowhere near as bad as trying to talk with a full face mask on, where air pressure is forcing its way into both nose and mouth, fighting against the lung power needed to squeeze out words, that are then muffled by the mask itself.

I climbed into bed, lights out happened, and I was in the process of texting my wife good night when she sent over “you’ll never guess who’s on the air.”

I told her I didn’t have a clue. She responded with the name of a DJ that’s been away from the station for over a year dealing with “real life.” It was a surprise to everyone at the station except for our station manager – apparently even from her husband too, who’s also a DJ with the station.

So I spent the next twenty minutes trying desperately to give myself access to be able to talk to our returning DJ, and finally did so. I was in the channel long enough to say “hi, you were missed, how the hell are you” and get a perfunctory conversation before I felt that I really should try and shut things down and get some sleep – after all, this wasn’t a talk-on-your-mobile-until-all-hours-of-the-night study I was wired up for.

I shut things down on my phone and started my sleep sounds app and shut my eyes, trying to unwind mentally and get some rest. (The app, incidentally, is called Relax & Sleep II for Android platforms; it’s free and it’s extremely customizable with the ability to program set combinations of sounds from the library of a few dozen available, as well as the ability to adjust each individual sound’s volume and save “playlists” as favorites that can be recalled with a tap.) And it wasn’t too long afterward that, with the gentle air pressure into my nose feeling almost natural, I dozed off.

The next thing I remember was the knock at the door waking me up at 5:00 am. I had slept for five and a half hours uninterrupted. I cannot remember the last time I had gotten so much sleep in one go.

I was well rested, I was alert, I wasn’t groggy at all. I cleaned the wax off my head, changed clothes, filled in their exit survey, and after a short wait to be picked up was on my way back home, where I slept for another three hours or so.

That Saturday was a busy one – we had visitors in the middle of the afternoon and more visitors later that night for a free-for-all of a radio show. There wasn’t much opportunity for me to sleep during the day, but I noted that I didn’t need to. I wasn’t tired or lethargic at all, although saying I was full of energy might have been stretching it just a bit. I had a great time being social and was even social for a few hours on Sunday as well. It was a good weekend and I had a great time.

Either today or tomorrow, the doctor at the sleep center is going to write my prescription for a CPAP machine and I’ll likely get an in-home visit from the respiratory therapist to get it set up and fit the mask correctly. I’ll be specifically requesting the nose pillows for home use. And for the first time out of the three times I’ve tried a CPAP machine, I’m actually looking forward to it coming in and getting started with it.

And then maybe, just maybe, I can start to keep a more regular sleep schedule again.

Lethargic Despite Intentions

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I woke up this morning intending to be a spitfire, full of energy for whatever the day had in store for me.

By 10:30 I was back in bed.

I suppose that I should explain something at this point in the ongoing lethargy topic that I bring up frequently here. It’s taken a long time for me to get to the point where I would listen to what my body tells me to do. If I was hungry, I’d ignore it; if I was in pain, I wouldn’t take anything for it; if I was tired or fatigued, I’d push myself to stay awake because I might miss something. I still get like that, but those instances are fewer and further between nowadays. If I’m hungry, I’ll get up and feed myself. If I have a headache or backache, I’ll either take something for the pain (head) or pull out the heating pad (back). And if my body is telling me it’s fatigued, I’m much more apt to listen to it and go rest.

Now, a lot of time I’m in bed for maybe an hour, sometimes more, sometimes less. I catch enough of a nap to recharge me for a little while, and eventually I get past that fatigue and into the “awake for good” portion, which usually isn’t until later in the afternoon or evening.

The sleep study I did Monday night proved that I have sleep apnea, something we’ve honestly known for years, but never really put much stock into. The care of the machine is insanely complex, the mask fitting never seemed to seal well, and it was difficult for me to get used to it, which all totaled to near complete non-compliance on my part.

That was before I found out that my blood oxygen level was dropping by almost 25% during the night.

No wonder I’m tired – my heart is working overtime to try and get enough oxygen to my body, restful sleep is being interrupted about every ten minutes or so, which means that eight hours of “sleep” is likely translating to maybe four or five hours of “rest” each night.

So for now I’m going to be more accepting of my fatigue and lethargy. There’s not much I can do for it until I get a prescription for a CPAP machine and start using it – regularly.

But the good thing is that it will likely help alleviate my daytime fatigue, reduce my blood pressure to the point that I could potentially come off of some of my medications, and possibly even help me to better manage my diabetes.

I’m still not crazy about the need to sleep attached to a machine, but given the risks without it and the benefits with it, I think I’m finally going to be compliant with its use. And then we’ll see what happens.

I Am Cyborg

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Okay, not really, but I sure looked like one last night. Alternately my look was referenced as reminiscent of Dune, The Empire Strikes, and the Matrix.

Back on July 21, I mentioned that I was getting a sleep study. Last night was my night.

I showed up at 9:00 pm, pajamas and pillow in my possession, filled out a questionnaire about my day, then was shown to my room and given time to change and relax. After about 40 minutes, a technician came in and began to hook me up. By the time he’d finished, I had several leads attached to my head, a couple to my upper chest, and even two on the outside of each calf. These all led to a central unit that was portable. They taped a microphone to my throat so they could listen for my snoring and also monitor when I needed to go to the bathroom (while that central unit was portable, it still required being plugged into their telemetry network, and so I needed assistance with unplugging from the wall when I needed to relieve myself). They put two cannulas in my nose, one of which had a small attachment that curved down to rest in front of my mouth. The technician helped me get into bed with all the wires attached all over my body and then put a pulse oximeter on my right index finger to measure the amount of oxygen in my blood throughout the night. The lights were turned out, and I rolled onto one side to try and get some sleep.

Sleeping with all those wires around me made me feel like a kitten that was wrapped in an unraveled ball of yarn. It was exceedingly difficult to get off to sleep, and when I finally felt sleep coming on, I would need to shift to get comfortable and the process would start all over again. This happened several times before I actually got some rest. I awoke several times throughout the night, and I estimated that I got maybe two hours and 45 minutes of sleep all night.

At 5:00 am, I was awoken by a knock on the door. It was my technician, who was there to remove all the leads and send me on my way. After that process finished up, I went into the restroom and cleaned up the best I could – to help ensure the leads were securely fastened to my body throughout the night, they used wax underneath the lead and surgical tape over it (the leads on my chest and calves used the standard round adhesive pads, but because it was important for them to check to see if I had restless leg syndrome, they waxed and taped the leads on my calves as well). It took a little doing, but I finally got most of the wax off, changed clothes, filled out an exit questionnaire, and went out to wait for my wife to pick me up. (Remember, we’re a one-car family.)

Once I got home, I bypassed the shower I desperately felt I needed in favor of getting a few more hours of sleep.

Later on this afternoon, they called me with the results. I have sleep apnea, a disorder in which the sufferer has one or more pauses in their breathing while they sleep. During the time I was asleep, I stopped breathing once every ten minutes on average, which was relatively low – but that was enough to drop my blood oxygen level down to as low as 78% – a very disconcerting thing to learn was happening in my sleep. So this Friday night, I go back for a follow-up. This time I’ll be testing some face masks to see which is most comfortable, and then head back to sleep once more so they can measure the pressure that I’ll need in the CPAP that they’ll be prescribing me. (CPAP stands for “continuous positive airway pressure,” which essentially means that throughout the evening, I will have air gently forced into my lungs through the use of either a nasal or face mask that’s strapped to my head.) Once they have that data, they’ll be contacting my insurance and determining which machine will be best for me.

So that was my evening last night. Hope yours was more restful and less wiry.

 

The Tale of Darth Babar

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Yesterday I wrote about how I’ve started the ball rolling towards a sleep study. This will be my third one. My first one said that I had sleep apnea but that I had averaged six times an hour where I stopped breathing – not a particularly severe case, but one that merited a CPAP machine. The second was years after that one, and it said that the number of times I stopped breathing per hour had increased, although I never learned to what degree. They were just a lot more insistent that the CPAP become a thing. It is almost a guarantee that they will have determined my sleep apnea is getting progressively worse over time, and that the CPAP is now no longer an option – I’m going to have to have it if I want to get any sort of restful sleep at all.

I hate CPAP machines. It has always been my impression that, because I’m prone to snoring, a full face mask would be necessary. For many years, I wore a closely trimmed Van Dyke that would interfere with the seal on the mask, and so to make sure the seal was tight enough, I would have to strap the headgear holding the mask in place extra tight. This would not normally be a problem, except that in early 2000 I shaved my head, and only once since have I let it grow out, a decision that my wife immediately demanded be reversed. (She’s also insistent on the Van Dyke, otherwise I look like I’m 12, which is a bad trait in a married 47-year old.) That means that the headgear is so tightly affixed to my skull that it imprints into my skin, and those imprints take at least half the day to fade. They’re obvious on a bald head and very unsightly. I also toss and turn a lot in my sleep, from one side to the other, and as a result dragging the air hose around the bed as I squirm in my sleep becomes somewhat restrictive. Finally, I have a tendency to read in bed until my phone (thank you, Nook app) falls out of my hand and onto my face. The problem here is that full face masks go up the nose and across the bridge in order to achieve a seal, and I’ve been wearing glasses since I was three – meaning that I would have to put my phone down, take off my glasses, put on the mask, and then try to go to sleep while this device gently but insistently tries to force air into my lungs. It’s not something that I relish. But this time I think I’m going to be told that I don’t have a choice anymore, that CPAP usage is going to be mandatory.

I think I’m going to go with a nasal mask this time. This mask only covers the user’s nose or nostrils, and often doesn’t use the extension up the bridge of the nose to reinforce the seal. If I can get a nostrils mask instead of a nose mask, that would be ideal – the only point at which there needs to be a seal is on the nose itself, rather than around it, which would mean a compromised seal due to my mustache. (Do a Google images search for “cpap nasal mask” and you’ll discover what the difference is and see many examples of the kinds of masks that are available.)

Breathing with the first CPAP I had sounded a little like someone using a SCUBA regulator which, when combined with the air hose extending from my face, resulted in my nighttime look being dubbed “Darth Babar.” Fortunately the technology that goes into CPAP machines has greatly improved, making them quieter and considerably smaller. I don’t much like it, but I imagine that Darth Babar is going to be making a reappearance soon.