• The CPAP diaries (snooze-date 1 week)

    Here’s the post that all three of you have been waiting for. It’s been a week with a CPAP machine. How’s it going? Some observations:

    First, data. It’s amazing what the machine (ResMed AirSense 10) provides via sleepyhead software. (Many other machines also provide data.) Nobody else should care about my sleep data, but I do! I won’t bore you with the charts here, now (maybe another time). It’s fascinating to me to scroll through every second of my nightly breathing, see how it changes from waking to sleeping, see when obstructive/central apneas and hypopneas arise (if at all), see what the machine does in response, and my response to its intervention. I’m creating all this data while I sleep!

    For a data geek like me, this is exciting. I look forward to going to bed for this data-generation experience alone. That’s a useful attitude, highly motivating to continue therapy and push through its challenges. There have been some.

    I’ve tolerated the device nearly all night, every night. That suggests things are going well. However, during the first ~5 nights I woke a lot more than (pre-sleep apnea) normal, with some mask discomfort.

    The discomfort took two forms, somewhat related. First, my lower nostrils became irritated, sort of like when you have a cold and wipe your nose a lot. It wasn’t a bad case, but I didn’t want it to get worse. My rule of thumb about this and many other things: don’t ignore small signals of small problems, allowing them to become large signals of large problems. That’s not to say rush to the ED or therapist with everything, but just pay attention, monitor, consider cheap, home remedies, don’t exacerbate, let the body heal, discuss, help the situation to calm, etc.

    The internet helped a great deal here. Many (many, many, many) people on sleep apnea forums recommend lanolin for such irritations. That’s the stuff breastfeeding women often use on sore nipples. I tried it (on my nose, not my nipples). Wow, a miracle product. Where has it been all my life? It cut down my nose irritation in half in one day, and eliminated it in two. This, despite the continued presence of the source of the irritation — my nasal pillows mask. I still apply it at night as a precaution. It only takes a little so an ~$8 tube should last ages.

    I also bumped up my nasal pillow size from small to medium. This made a big difference. Small was the recommendation of the tech that fitted me. But they seemed to dig in too much, exacerbating irritation. Again, sleep apnea forums are helpful here. There I learned, it doesn’t matter what the experts say. If you are more comfortable with another size, so long as it doesn’t introduce air leaks, go for it. (I also tried large. Didn’t work for me.)

    This got me through night 5, but something still wasn’t right. I was waking many times feeling like the straps were pulling the mask way too hard into my face. I thought I had them adjusted as big as they go, but this was a mental block. There are no explicit adjustments on the straps of the AirFit P10. It’s just a split strap, one part of which goes around the back of your head, the other (as instructed) over the top (image here).

    The instructions (written and video) say move the straps together to tighten and apart to loosen. But in every case, they only show “loose” as one strap at the back and one at the top, so I figured that’s as loose as they get. This prompted me to do some online window shopping for other masks. OMG, there are tons. Even within the nasal pillow category there are dozens. To even try one other would be another bunch of nights fiddling. It’s an annoying, difficult process.

    So, before going on a wild ride through the forest of masks, I decided to do some more experimenting with the one I had. I knew the problem: straps too tight, even in the “loose” configuration. Sort of absentmindedly seeking a solution, on night 6, while wearing the mask and reading before sleep, I started fiddling with the straps, just pushing them around. It reminded me of what kids always do with everything — use it/test it in every which way, without regard to “the rules” or what one is suppose to do with a thing, a creative process. To a kid, a strap is not a thing that only goes here and there. It’s just a thing that you can use to do whatever you want. A strap can be a door opener, a way to bundle your toys for carting around the house, a buddy, whatever.

    Lo and behold, by breaking “the rule” (that isn’t a rule, but I had interpreted as such) that a strap had to go across the top of my head, I found a much more comfortable arrangement. I pulled the top strap down to my forehead. Presto! Looser! The mask was no longer jamming up my nose. Lesson learned: experiment, break “the rules.”

    With these adjustments, the last two nights have been great. Perhaps because my sleep quality is much higher, I’ve woken earlier than I have in months, refreshed (today, to my surprise, before 5AM).

    Oh, and the dreams. My gosh, the dreams. I really wasn’t getting much REM sleep before. I thought I simply wasn’t remembering dreaming. Now it’s clear, I just wasn’t dreaming. My nights are loaded with them now. How pleasant.

    Meanwhile, the tendinitis that I presumed could have been exacerbated by stress hormones released during apnea events has largely abated. Naturally, I could be wrong about the cause and cure here, but, whatever, I feel better.

    I’d be naive to think I don’t have more challenges ahead. Maybe (likely), though I feel better, I am only part way there, as it has only been one week with a CPAP machine (and a week before that with Provent). Two weeks is ultra fast for improvement, according to what I’ve heard. A month or more is quite normal.

    But, still, quite good progress. This means a lot to me, and, perhaps, a little bit to the three of you still reading this.

    @afrakt

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