Sleeping With The Enemy

Sleeping With The Enemy

No, I do not think of Kim as the enemy and yes, we sleep together every night. But there is someone else in the bed with me every night as it has been for twenty-seven years. That would be Mr. CPAP (Continuous Positive Airway Pressure), the machine that assists my nighttime breathing so that I do not snore nor have episodes of sleep apnea, which are shallow or paused breathing episodes most often due to the collapse of soft airway tissues in the throat. Snoring has its obvious sleep deprivation issues (for me and Kim) as well as morning throat and trench mouth, but apnea is an even more serious medical condition that can bring on heart problems, stroke and even dementia. If you suffer from excessive sleep interruption, CPAP is most often the answer though by no means the only solution.

Sleep is so essential to wellbeing that there is an entire industry surrounding its fulfillment. The first and most obvious area that receives focus is the pillow. There are many pillow designs that attempt to help position your head to help keep your throat open whether you’re a back-sleeper, side-sleeper or stomach-sleeper. Even if they do help prevent obstruction with proper head placement, few of us can keep ourselves still enough or positioned consistently enough to have a pillow solve our sleep problems. Then there is the new automated beds that raise and lower the head. Quite simply, have a raised head helps keep the airway open, but also is harder to get full rest. There is a reason we recline to sleep. Do you remember the film The Elephant Man about Joseph (not John) Merrick, the unfortunate deformed English man whose large head caused him to sleep with his head raised in order to prevent throat blockage. Eventually, he consciously chooses to sleep flat and falls victim to asphyxia and dies. His was obviously an extreme version of an apnea problem, but the airway blockage problem is the same fundamental problem 6% of the adult population suffers from. Too bad that in 1890 Merrick did not have the benefit of a CPAP machine.

There are many other alternative ways to address the problem beyond pillows and bed adjustments. There are nasal and jaw devices and there are surgical solutions. Like Merrick with his hatred for his pillows and inability to lie flat, CPAP users are always looking for ways to “cut the hose” and free themselves from wearing a CPAP mask all night. Some only work for some people and some are a case of the cure bring worse than the disease. I have pretty much tried everything over the last thirty years and I’m still with Mr. CPAP.

I went for a sleep clinic session thirty years ago any Columbia Presbyterian Hospital, back when these were rare tests. I went into a lab at night and was rigged up with a huge harness with monitors and electrodes all over my head and body such that they could record all my bodily functions. I was then put yo bed in a cozy little decorated room next to a lab with a technician monitoring my sleep and the data gathering underway. I remember falling asleep readily (I was purposefully tired out), but then awakening after four hours or so due to a combination of normal restlessness and the unique discomfort of being wired up to the nines. When the doctor reviewed my results in a week, he to,d me there was no apnea, but that I was a “world-class snorer”. He prescribed a dental appliance to keep my jaw jutted through the night to keep the airway open. The damn appliance, nothing more than a custom-fit mouth guard that jutted the lower jaw out, while feeling ok for a few minutes, became painfully uncomfortable over the course of several hours. All that for a tidy $2,000 price tag. Nevertheless, I would wake up more often than not with the appliance in my hand without knowing I was removing it during the night. So, even trying to get used to it, I found it yo be only marginally helpful.

In those days I had a ski house in Utah at about 7,500 foot altitude. Sleeping at altitude is harder since oxygen is thinner. That caused me to get into a sleep-deprivation conversation with my masseuse, Deb, who said her father, who had apnea, had a CPAP which helped, but which he did not use. These devices are sold by prescription only, but she would sell me his for $400. Despite the bootlegged acquisition and without custom fitting, after getting used to wearing the headgear for a few nights, I found that I liked the improved sleep the very early-days crude device helped me sleep.

For the next twenty-five years I found ways over and over again yo buy CPAP machines of every improving manner. I’ve tried a dozen different mask styles and learned how to adjust the pressure level (something CPAP makers try hard to keep a secret so that you seek clinical advice). The technology has improved continuously and now, my state-of-the-art home machine has a heated humidifier, an automatic ramp-up program, auto-activation (you breathe, it starts), and remote data gathering that records and sends your nightly data via WiFi to an online system that continuously assesses your sleep quality and patterns. I am kept informed about how I am sleeping almost every day by email. We’ve come a long way, baby.

I feel I have more CPAP experience and knowledge than most sleep clinicians at this stage. I have tried every bed and pillow variation and most of the small dental and nasal appliances. I endorse none of them. I also went into NYU and had laser surgery on my throat soft tissues. What an ordeal. Imagine paying good money to smell your flesh searing as the laser cuts off your uvula. Then imagine the worst sore throat you’ve ever had that lasts for three weeks. Then imagine being able to pass half a cheese sandwich through your nose as you try to relearn how to eat and drink. Not fun and not helpful for me.

I have come yo like the comfort of my CPAPs. Yes, I have multiple ones (all equally expensive). I have home ones (Res-Med AirSense 10) and a Res-Med mini for travel. In a nutshell, they work for me. I tend to use them with nasal and nasal-pillow masks versus full-face or nose/mouth masks. They are smaller and less bulky in bed. While I used to say my glasses were my last and first events of the day, now my CPAP prophylactic enjoys that front-seat spot in my life. I still adjust it and change things up. Just today I bootleg changed my max pressure (lowered it) for sleep comfort, and I’ve decided to buy some distilled water to start using the humidifier. Sleep and getting enough of it may be the place I can and do spend my time. I will continue to sleep with the enemy, which is to say, turning Mr. CPAP from an enemy yo a friend so that I do not get inclined like Merrick to recline and succumb to that enemy of everlasting sleep.