Writer By Day, Hose-Faced Monster By Night

CPAP is weird, but I'm learning to live with it

Week One of Treatment

Not a photo of me. I look weirder. Image from Freepik.com

I recently wrote about my clinical sleep study

I’ve now undergone a total of four sleep studies, including one conducted at home and three in various clinical settings ranging from a defunct exam room to something resembling a Holiday Inn — if Holiday Inn featured one-way mirrors with someone on the other side observing your slumber.

The reports from the first three studies varied. Maybe I qualified for treatment. Or maybe not.

After all, I’m hardly what you think of when you picture someone with sleep apnea. The typical image is of an overweight, thick-necked guy sprawled across a bed, his mouth open as he snores and snorts like a hog with a bullhorn.

I am a relatively slender and fit woman. Who sprawls across her bed with her mouth open, snoring and snorting with every bit as much volume as a PBR-swilling trucker after a 14-hour haul.

As you probably already know, the gold-standard treatment for OSA (Obstructive Sleep Apnea) is CPAP (Continuous Positive Airway Pressure, in case you’re not familiar). I was unenthusiastic about it. The thought of donning headgear and mask and attaching a hose to my head every night didn’t jive with my self-image. Call me vain.

But with the results of sleep study #4 in — nearly 14 apnea “events” per hour (anything over 5 is considered abnormal) and snoring that rates 9 on a scale of 10 — it’s no longer a matter for debate or denial. I know too much about the risks of sleep apnea to my heart and my brain. Besides, I’m tired of being tired.

And there’s my long-suffering husband, but we’ll get to him later.

Therefore, with a mixture of resignation and resolve, I have joined the Hose Head Legion: the 33 million other Americans who use CPAP to sleep. If it’s good enough for Joe Biden, who am I to be squeamish?

I was told starting CPAP would be an adjustment. That's no joke

It’s a fiddly process. The first step was to get set up with an approved CPAP provider. On the appointed day, after filling out a stack of forms (the sleep industry cannot be beaten in its zeal for questionnaires) I was shown to a treatment room.

While I waited for my therapist I was asked to watch a video. It featured an earnest woman in scrubs performing a step-by-step demonstration of how to clean and care for the equipment I was about to receive. There were cleansing rituals of varying intricacy to be performed on a daily, weekly, and monthly basis, along with regularly scheduled replacements of the filter and face mask.

It felt less like I was beginning treatment and more like being given charge of someone’s fish tank.

I thought of the goldfish I brought home from the fair the summer after third grade. I think it was three weeks before I found Goldy floating belly-up in the greenish murk of his neglected fishbowl.

My therapist arrived, dispelling my daydreams

She was an RT (respiratory therapist), like my daughter-in-law, about whom I happily began to boast until the therapist politely but firmly got down to business.

When getting CPAP-equipped, it turns out there is a lot of business down which to get.

First, there’s the machine. It’s honestly a marvel of engineering: small, compact, Bluetooth-enabled, with a wee built-in heated humidifier. Then there is the hose, a long, translucent plastic tube ribbed with a metal coil. I practiced turning the machine on and off, observing the readout on its small screen, and attaching the hose.

Next came the headgear. Think of a horse halter, but designed for a human head. Most involve straps that go around both the top and back of the head. They are surprisingly light and comfortable and manage not to yank on hair.

Having said that, there is no hairstyle that is not rendered ridiculous while wearing them.

At last, the face mask itself

With admirable patience considering she has to go through the same rigamarole several times a day, my therapist introduced me to the range of mask styles from which I could choose.

Some cover only the nose, some only the mouth with little “nasal pillows” that foof air into the wearer’s nostrils. Some, meant for fish-mouthed sleepers like me, cover the entire nose and mouth. Most are designed so the hose attaches to the front of the mask, but there are some — perhaps for stomach sleepers? — in which the hose protrudes from the top of the head.

For some reason, that configuration seemed sadder than all the rest. Not that any of them are exactly sexy.

I tried on several, testing each one while I lay down on a treatment bed with the machine running.

Here’s the good news: CPAP has come a long way

During my very first sleep study back a dozen years ago, I was awakened in the middle of the night for a CPAP “trial.” The breathing apparatus stuck to my nose was loud and insistent, like having my head stuck in a wind tunnel. I couldn’t imagine exhaling with the damn thing on, let alone sleeping.

But today’s machines are quieter than a whisper, smaller than a hotel clock radio, and smart enough to ramp up the pressure gradually while backing off when the wearer exhales.

The masks are lighter and more comfortable too. Since my mouth sometimes falls open (okay, it always does) while I sleep, I chose a full-face style with a soft lining of cushy memory foam and clever closure magnets that are easy to find even in the dark.

I began to feel hopeful, almost exhilarated. What if I could get along with this thing? What if I woke up every morning feeling refreshed instead of hauling myself out of bed like someone tied concrete blocks to my limbs overnight?

My therapist encouraged me to connect my machine to an app that would tell me how I did each night on several metrics: hours of usage, mask seal, and “events” (aka apneas) per hour. The app would also supply me with helpful coaching tips.

I characteristically regard such things with a jaundiced eye. But, deciding to go all in with a willing attitude, I downloaded the app and went home with my new machine and all its peripherals neatly stowed in a handy travel case.

Night One

Several things about my bedtime routine had to change. First was setting the machine up on my bedside table along with all its bits. Easily done and not too bad if not exactly Insta-worthy.

My face had to be clean and any serums and creams applied at least an hour before bedtime, so that meant doing the whole nighttime skincare thing right after dinner.

Goodnight kisses were to be addressed before donning the mask.

And then there was getting over the fact that my husband now has to sleep with someone who looks like the offspring of Darth Vader and Dumbo.

After having a good laugh at my expense, Husband settled down. “Wow, that thing’s quiet,” he said before falling sound asleep.

I lay there, feeling air wisping up my nose. And into my mouth. I pretended I was in a very quiet Top Gun sequel. It felt odd, but not terrible. Eventually, I fell asleep.

But at some point, the machine detected a need for more air pressure. That might have been okay, except tiny puffs escaped here and there from the mask. I’d been told not to worry if the seal wasn’t perfect, but it’s very hard to sleep when it feels as though a hamster is trying to blow out its birthday candles on your chin.

And then I had to get up to pee. I disconnected the hose, trailed off to the loo like a bleary fighter pilot, and went back to bed.

Where I couldn’t get the damn hose reconnected.

After wrestling with what felt like a contrary snake for several minutes, I finally clicked the connector into place, turned the machine back on, and laid my alien-shaped head back down.

The machine reverts to its lowest pressure when it starts, which is barely noticeable, so I slept gratefully. Until the hamsters started blowing out candles again.

This went on until my alarm sounded at 6 AM. Let’s just say I did not arise with a song in my heart.

But my app gave me a score of 95! I had to be doing something right.

Nights Two, Three, and Four

In which I encountered something unexpected and decidedly unpleasant.

Gas.

It turned out that while the contraption was pumping air into my trachea, a significant amount was also being blown down my esophagus.

By the third day I looked and felt like three-day-old road kill, my abdomen painfully distended no matter how unreservedly I belched and blew bum kisses. Plus I was exhausted.

How was this better?

“I can’t function like this,” I told my CPAP therapist over the phone. “And I’m going out of town this weekend. Can I leave the thing at home? I need some rest!”

Clearly accustomed to such resistance, she was sympathetic but unyielding. “Elevate the head of your bed,” she advised. “Drink a glass of warm water before you go to sleep. Try some Gas-X. And yes, you have to take your machine along when you travel. It’s the only way your body is going to get used to it.” As an afterthought, she suggested I try a chin strap or mouth tape to keep my mouth closed inside the mask so air couldn’t enter my mouth.

“Just keep trying, at least four hours a night,” she said. “Every night counts toward your compliance period. It’ll get better. I’ll call you in a couple of weeks.”

A couple of weeks!

As for the compliance period, it’s an insurance thing. You have to rack up 21 nights with at least four hours of usage each, within a 30-day period over the first 90 days. Or insurance won’t foot the bill.

Dispiritingly, my app score had dipped to 56 points. And now I had to drag my torture device with me to a family vacation at the lake!

“You’re supposed to sleep with that thing on?” said my sister-in-law when she saw me settle in for the night. “Oh, my God.”

I grabbed some extra pillows and took another Gas-X.

Night Five: a turning point

The therapist’s remark about sealing my mouth shut finally sank in. I considered a chin strap and rejected it — there was enough stuff draped around my head as it was. But I did find that 3M makes a silicone-backed surgical tape that, when placed across my lips in an X-pattern, kept them comfortably closed and didn’t hurt when I tugged it off in the morning.

Game-changer.

On the sixth morning, I arose, realizing I hadn’t turned off the machine or removed the mask even once. I hadn’t even gotten up to pee.

I’d simply — slept. All night.

I felt clear-headed and almost euphoric. I went all day without feeling the least need for a nap. And the whites of my eyes were actually white!

Not only that, but the app awarded me my first usage badge and a score of 99. I would have baked myself a cake if it weren’t 102 degrees outside.

Nights Six and Seven: same thing

I’m sleeping all night, scoring 100 on my app, and feeling a marked uptick in my energy and sense of well-being.

The gas thing has blown off (sorry).

There is a faintly red, faintly sore spot on the bridge of my nose, so maybe my mask needs some adjustment. Or, as my therapist suggested, if I can keep my mouth shut maybe I can try a smaller mask, the kind with nasal “pillows.”

But even if I have to go to bed every night looking like Darth and Dumbo decided to swing with Hannibal Lecter, getting a real night’s sleep is worth a lot.

And my husband? He’s sleeping better too. Way better. His typical morning demeanor resembles a bear in early spring. It’s best not to approach him until after he’s had his coffee.

This morning he was almost cheery.

It’s weird.