My dad was a champion snorer, could fall asleep anywhere in a minute or two, and had enormous difficulty getting up in the morning. He almost certainly had a severe case of sleep apnea, but he passed away before sleep apnea was widely understood.
You can see where this is going. I snore. I have trouble getting up in the morning, and, worse, my level of energy during the day has been plummeting. This has been going on for some time now. Sorta hard, when I have a full-time job and three businesses!
So I went to my doctor, and, after a certain amount of folderol that I’ll describe later, I have a shiny new diagnosis of sleep apnea and a fancy new machine to keep it from killing me.
How Sleep Apnea Works
During sleep, people relax, and some people relax so much that their breathing is obstructed as they inhale; their tongue shifts backwards or their windpipe closes, causing you to struggle for air and likely snore in the process. If the loss of air is severe enough, your brain wakes you up to allow you to gasp for air (successfully, this time), then you instantly fall back to sleep, after being awake so briefly that you don’t remember it in the morning.
The upshot: your quality of sleep is terrible, making you tired all the time, and the struggle for breath and low oxygen levels can cause all sorts of trouble.
Remedies That Didn’t Work For Me
Well, I don’t know about you, but I prefer being healthy and energetic. There are various minor things you can do about sleep apnea if you have only a mild case, and I tried some of these while I was waiting for the whole diagnostic process to complete:
- Sleep on your side instead of your back. Didn’t stop my snoring, so it probably didn’t help my apnea.
- Decongestants and nasal saline rinse. Ditto.
- Mouth guard to help reposition your lower jaw slightly forward. The one-size-fits-all one I bought didn’t fit.
What Did Work For Me
The gold standard of sleep apnea treatment is the CPAP (continuous positive airway pressure) mask, which is basically just a very low-pressure air compressor with a hose and a mask that goes over your nose, or in some cases your nose and your mouth. This adds a little extra air pressure to make it easy to inhale in spite of your airway’s pesky tendency to close. There are different kinds of CPAP machines, from very basic models to super fancy ones.
The sleep medicine center at the Corvallis Clinic prescribes only the super-fancy automatic CPAP machines with lots of data-collection capabilities. I guess they figure they might as well, since the automatic features and instrumentation will surely save you at least one overnight stay in the sleep lab, so the extra features will pay for themselves.
From my point of view, the advantage of a fancy machine is that I can use the built-in instrumentation to fine-tune the settings until I have them just right. I’m an engineer, after all. (I respect my doctors and keep them informed of what I’m doing, but if there are knobs and switches to adjust, I’m gonna adjust them myself.)
I selected a ResMed S9 AutoSet unit, which has a good reputation. This unit has every conceivable bell and whistle, including a HEPA filter and a built-in thermostatically controlled humidifier, which is pretty nice for a machine whose main purpose isn’t allergy control!
One of the spiffiest features is the “mask test” feature, which tells you whether your mask is leaking too much or not. They tend to leak a little, and it’s kinda scary to be left without any way of telling whether it’s a problem or not.
There’s a bit of a pretense that patients only have access to a few basic settings, but the keypresses that give you access to the provider menu are not much of a secret, since they’re available online in the ResMed S9 AutoSet Clinical Guide, which only took me about a minute to find.
All the sesssions are recorded on an SD card, which you can download into your PC and examine with the ResMed software or the freeware Sleepyhead software. I like the sleepyhead software best.
Here’s a small part of a Sleepyhead chart showing me having a sleep apnea event. The line on the chart goes up when I inhale and down when I exhale. Everything starts out okay, then gets sorta ragged, and at 1:47:15 I pretty much stop breathing for 15 seconds, then take a few big, gasping breaths.
Of course, I didn’t notice anything, because I was asleep at the time.
During my overnight sleep test, before treatment, I averaged 13.8 such events per hour. The first night on my CPAP machine, I averaged only 3.35. After adjusting the settings, I”m averaging about 0.3 events per hour, with none at all on some nights.
So How’s It Working?
My energy is coming back, but more slowly than I’d like. The thing that surprised me most was how much time I’m spending sleeping! But it makes sense (and it turns out that it isn’t unusual). After a long, long time with very poor quality sleep, I have some catching up to do. But my daytime energy is up, my caffeine intake is down, and once I do get up in the morning, I can get to work sooner than before.
Other CPAP Machines
I’ve also tried an XT Fit travel CPAP machine. No bells and whistles, but it gets the job done. I use it rarely, but it packs a lot smaller than the ResMed unit, and is also much less expensive.
How Bad is the Mask?
The masks take some getting used to. Most of them only cover the nose, anyway, so they’re not as claustrophobic as a nose-and-mouth mask, though these don’t bother me, either.
I made the beginner’s mistake of over-tightening the mask, which is very uncomfortable and doesn’t help anything.
I’m using a “nasal pillows” mask at the moment, and there’s some tendency for this to lead to a certain amount of air-puffing out the mouth, and if you breathe through the mouth when you’re asleep, this nullifies the benefit of the CPAP machine. I’m using an elastic chin strap, set without much tightness, to prevent this problem. I noticed that a puff of air tended to escape my mouth just as I fell asleep, and this was keeping me awake!
By the way, CPAP treatment also stops snoring completely. Some people may not think that a mask and a hose and a CPAP machine are very romantic, but a partner who snores is even worse!
The worse part about sleep apnea treatment is that people who need it are completely exhausted, so it seems like a lot of work. It is and it isn’t. Personally, I’m looking forward to having my energy again!
Update, One Year Later
My return to high energy has not been happening as quickly as I expected, but I noticed something interesting: on days when I do a lot of driving, I take a lot of caffeine to make sure I drive safely, and on those days I feel better (more normal) and get more done. This sent me on a quest for non-scary stimulants:
Caffeine. This implies that I need stimulants to achieve a state of normalcy. I’ve experimented with caffeine pills to keep me going. At first, the right dose was 200mg of caffeine every three hours(!), for a total of four pills per day. It was important to take the first one even before getting out of bed. Now, I’m down to three pills per day.
Modafinil. I emailed my sleep doctor and he said that one of the newer “smart drugs,” Modafinil (Provigil) will give me better results without the caffeine jitters. Modafinil is often prescribed for people with sleep apnea who are using their CPAP masks faithfully but are still fatigued, and has an excellent record for safety and lack of weird properties, even with long-term use. I did not know that!
I started out on quite a high dose of modafinil (400 mg per day, half in the morning, half at at lunchtime), and this helped amazingly. The combination of caffeine and modafinil was a real life saver. As I’ve recovered, I’ve tapered off my modafinil usage to 100 mg per day.
Adrafinil. Modafinil is incredibly, appallingly expensive, but there’s an alternative. An older compound, adrafinil, is quite similar to modafinil and is available over-the-counter in the US. I’ve used adrafinil capsules from Absorb Health and they work great.
Other Remedies. See my I’m Tired of Chronic Fatigue post for more details about these and several other effective remedies I’ve used to boost my energy.
My energy is slowly coming back. Some of this is due to the miracle of being able to breathe all night, thanks to my CPAP machine. Some is due to useful remedies, some of which are stimulants, and some aren’t. See my I’m Tired of Chronic Fatigue post for the full list.
As I recover, I need fewer stimulants, but the stimulants are important! It used to take me a couple of hours in the morning to be ready to do much of anything. Now I being work as I drink my first cup of coffee. That’s a huge difference!
A friend suggested that these issues can be cured without medical treatment, through, for example, hypnosis, but that’s not the way I roll. I love self-hypnosis, and I’m sure it’s helping with my returning energy. But a CPAP machine lets me breathe whether my affirmations have taken hold or not. Safety first!