Sleep Apnea

[edwardcdg]

Some may benefit from my experience with sleep apnea and the CPAP machine. Here it is.

I was always sleepy, needing mucho coffee and tea to get going in the morning (and I am a morning person). Of course, then I had trouble sleeping, waking up about 1 AM if I had any caffeine after about noon. I was/am substantially overweight by about 100 pounds or so and live a sedentary office life with long days. Maybe those things will change and maybe they won't, but I sure am a candidate for OSA.

My wife was very concerned because she heard me stop breathing and it woke her up; then I would snore (very hard on her sleep). I got very sleepy after lunch and was prone to afternoon naps, most often on weekends, but I had been going out to take naps in my car at lunch for some time by then. After some difficulty getting my attention, she managed to get me to go to a sleep test at a local clinic.

The sleep test went well for the an analysis but the setting was nutty. There were several bedrooms like bunkers in the basement of the clinic with washrooms en-suite. The HVAC was VERY noisy, like a cheap motel--worse; I could turn off the air conditioning in a motel. I told the technician that this was giving me problems sleeping and they should supply earplugs. He said that even so, they got good data on me. What I remember is that the doc told me I woke up 56 times in one hour, making it severe OSA. The doc sent me right next door to get a CPAP with the admonition was that it was urgent for me to start using it. I did so.

I have been using a RemStar Auto, M-series, A-Flex CPAP machine with humidifier for about 20 months now religiously. The technician who fitted my mask was very competent. (He also has sleep apnea, and he is a skinny athlete.) We tried the little triangular face mask first but it was somewhat uncomfortable even after trying different adjustments. I went to the "nose pillow" and have used it ever since. I find it much more comfortable, although sometimes I wake with a little irritation of the nose. After adjusting the headdress, it is fine again. (By the way, do watch the DVD video that comes with the machine. It explains how to adjust the straps and so forth.) Adjusting to the mask was no problem for me as I am used to them in my work.

I instantly benefited from the CPAP--and the humidifier. I get a good night's sleep every night now, even when it is a short night for some reason. I no longer get sleepy after lunch. I no longer need naps all the time. I am no longer am sleepy in the morning. I no longer snore. I use it every night and for the infrequent nap and take it traveling with me. (I have never had a problem with it at airport security. I do keep the original prescription for it in the carrying case just in case, however.)

There is an additional benefit for me. My home is in a damp part of the States, where my testing was done, but I work in Calgary, Alberta, these days which is a very dry climate especially in winter when it gets wicked cold. Most places do not have functioning humidifiers. They are usually out of service in homes, if they even have one. I used to wake up at night choking because my nose was obstructed with dried mucus. (I seem to have some mild allergies that create glue in the back of my sinuses.) The humidifier gives me relief from that.

This equipment is very expensive. The supplies are very expensive, even the simple stuff. For some reason, the doctors and the place where I got my equipment have this idea that somebody else is paying for all of it. Not so. My health insurance in the US is very limited and I have to pay for most or all of these costs myself. The sleep disorders clinic is a gold mine, which is fine, and I was happy to pay the fee as it may have saved my life, but it gripes me that there was no in-home testing available or acceptable. (The sleep doctor owns the clinic. He would not accept any results except his own.) Oh well.

I track the filters carefully and changing them once a week would make sense in the desert in Oman, but not even for Calgary much less the wet climate of my home. Rip-off.

Very recently, I found that the CPAP had started leaking water severely at night. A replacement for the water chamber was REQUIRED by the supplier at my cost--$89 or so which was only 1/3 of the actual cost according to my wife. It turns out that the O-ring wore out. I had been taking the water chamber apart to dry it out when traveling, as instructed.

Things I have learned:

1) Check the filters regularly, but I would be very surprised if either one needed replacement very often. Wash and dry the black foam one when it has gray dust on it. Replace the finer, white filter when it has gray dust on it. This should not be very often.

2) You do not need to replace the water box every 6 months as demanded. Why would you? Keep it clean and never open it up.

3) You do not need to open the water box AT ALL. For travel, empty the water out. Let it dry out for a while if you have the time. If not, if you are really worried about getting water into the electrical parts of the CPAP (a big no-no), carry it separately in a plastic bag. If there is only a little moisture in the vessel, just put it back in the machine. You have to carry it on to the airplane anyway and it should be easy enough to keep it upright in your carry-on.

4) You do not have to take the water box apart to clean it either. (I did so because those were the instructions.) When it gets hard water scale in it, if it does not wash out easily, soak it in warm dilute vinegar for a while, then wash it out. The warning that the deposits will affect heat transfer from the heater to the water for this equipment and will prevent it from working is bunk. Heat transfer is part of my business. Unless the scale builds up to the point where the air passage is blocked, you won't notice the difference. The heater has plenty of extra capacity to overcome any resistance due to fouling. I normally have mine set at the lowest settings and turn it off entirely in the winter because the warm water vapor condenses in the hose and makes gurgling noises late at night. To avoid scale deposits entirely, change the water in it every night.

5) If the water box gasket eventually does leak, open the box, let it dry out, seal the edge with silicone sealant, close it, let it dry and forget about it.

6) The straps on the headdress will wear out. You do not need to buy a new headdress from the vendor. The fancy foam rubber straps can be replaced by sturdy fabric ones when they wear out. Sew them on to the loose ends. Or replace them entirely with fabric or elastic straps. Save a bunch of money.

7) You do not need to replace the entire CPAP machine every 6 months as the vendor wants you to, either. Eventually the little compressor will wear out. Keep the filters clean and never drop the CPAP or get the electronics wet and it should last many years.

I gather that some health insurance makes it possible to replace everything every 6 months, and of course, the local supply house really wants me to do that, but my insurance ain't that good. In any event,what a waste. I have a better idea now of why American health care is so expensive.