Posted by Scott Zechiel on October 21, 1998 at 14:35:33:

I have now lived four nights with my new bed partner, my CPAP machine. I absolutely love it. Instead of feeling like I was over 100 years old, I have suddenly become my actual age again, 34. Actually, I really feel more like I'm just seven or eight because I am suddenly so incredibly happy and energetic.

My only regret right now is that I didn't start the treatment sooner. I first heard of sleep apnea a little over three years ago. When I heard of just a few of the common symptoms, I thought that they were describing me. Out of fear of being a hypochondriac who hears of something and immediately tries to find parallels, I didn't force the issue. About five months later, I had a rash of powerful daytime arrythmias that I didn't like too much, so I went to my now former doctor and had a physical and a 24 hour EKG test done. During that time, he actually asked a couple of questions related to my sleeping habits and my answers should have directed him to feel that there was a need for a sleep study, but they just became a record of answers to questions in his logs. He wasn't concerned, and I never flat out told him to check. I believed that if he were not concerned, I shouldn't be either, and left it at that. He did, of course, suggest weight loss as the cure for everything. Yes, that helps with overall health in numerous ways, but it is so much easier to say than to do and it almost gets insulting.

I would have continued to neglect my own symptoms were it not for an unusual chain of events. A friend and coworker of mine had some unusual things happen to him, and I had some vague knowledge that told me it could be real trouble. When he went to his HMO, the doctor told him something so rediculous as to be laughable. I basically made him go to a real doctor. A visit to a cardiologist resulted in doing a test that I told him on day one should be performed to rule out or conclude one of the obscure but serious conditions he might be suffering from. The test confirmed that he did indeed have one of the conditions just as I suspected, for which he is now being treated.

The thought then occurred to me: Even though I am a computer nerd with an extremely limited knowledge of medical stuff, I had correctly guessed an important condition in a friend whose primary care physician was not even concerned about learning more about. Perhaps, I thought, my own doctor was just as disinterested all along and maybe I should pursue my original belief that I may have sleep apnea further. I went straight to the sleep clinic people.

I had an interview and mini-physical at the Sleep Disorders Center at St. Joseph's Hospital in Orange on September 1. At the conclusion of the interview, they felt that I was a
very strong candidate for having the condition, but only a polysomnographic (PSG) study can tell for sure.

I had the ovvernight sleep study on October 2 and got the results back on October 6. Here, I'll include some e-mails that I sent to my brother at that time describing the study and the results. After that, I'll continue with some fresh material.

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Mail from 10/5
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I spent one of the more unusual nights of my life at the sleep center on Friday. While decorating me with about 25 different sensors, they told me that they would have me sleep on my back for a while and if they collected any data that indicated I had apneas that should be treated, they would wake me up and have me sleep with a CPAP machine.

When I went to bed, I just couldn't sleep at first because it was a little earlier than normal, I was on a bed rather than the floor that I usually sleep on, and I was on my back, a position I rarely fall asleep in but often wake up in. In addition, some of those sensors, especially the air flow sensors under the nostrils and the heavy, squeezing, glowing red pulse oximeter that makes you glow like E.T. just kind of bug you a bit. Somehow, I eventually went to sleep.

At some point around 12:30, I think I choked a little or something, and I woke up. I tried to go back to sleep, but I could tell I would have to get up soon to use the restroom anyway, so I decided to do it all then and get it over with. Since I was wired for sound, all I did was just mention the word "Dave", and he came in instantly. While unhooking me temporarily for my bathroom visit, he said that they had seen some apneas and that when I returned we would try the machine.

He had me sit in bed and hold a very strangely shaped mask over my nose. I was instantly surprised at how soft it was and how it felt like it could just float on my face. When the air came on, however, I was shocked. On my second breath, my ears inflated and I spent a minute or two having problems with my ears. I wondered if this was going to work at all, but the problems subsided and I layed back down with this silly snake clinging onto my face. It wasn't bad, really. It felt strange, of course, but what kept me awake again was the fact they wanted me to try to fall asleep on my back. Just when I thought I would never sleep again, I drifted off and they began to play with the pressure that would be used to keep my airway open.

Dave woke me up at 4:00 because I had apparently disconnected an important sensor. I think it was the pulse oximeter. I used the opportunity to visit the restroom once more. When hooking me back up, Dave indicated that I had slept over two hours with the mask and that they had successfully stopped the apneas. I was free to sleep in any position. I donned the mask again, had him fix a leak, and layed on my side. A strange whisping sound came from the point where the tubing connected to the mask. A slight change is position fixed it. I rolled around for a while and drifted off to sleep again.

Just after 6:00, Dave woke me again for the day. It is really weird to be waken up and then take your next breath through the mask. It also made me very happy because I knew that I could sleep with that thing. I have read some pretty good horror stories on the net about painful masks, odd noises, condensation problems, dry noses, exhalation difficulties, and many others, and I realized that at least on this one night, I was not bothered by any of them.

One thing I noticed on Saturday was that even though I had some much longer than normal periods of wakefulness during the night, I did feel more rested than I normally do. It might be because I wanted that outcome that I perceived that outcome, but I never did get the urge to nap that day which is a rare thing for me.

I will be having a follow up appointment on Tuesday. While there, I will be given the details about frequency, duration, and severity of the apneas. (The technitions are under kind of a gag order, but some information is leaked just by the fact that they bring the machine out.) I will learn what kind of oxygen desaturations I experience. If they found any evidence of having an often-associated disorder known as Restless Legs Syndrome, they will be able to tell me that too, since they had a pair of electrodes on each calf muscle to look for that. Lastly, they will probably prescribe one of those machines. If they do, I hope it goes as well as it did at the lab.

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Mail from 10/7
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I saw some cool graphs yesterday depicting what actually happened as I slept. Early on, I had minor sleep disturbances that kept the oxygen saturations dipping to about 87-88% which corresponds to what happens when you are at about 10,000 ft. That wasn't really too bad, but it wasn't great either. During my first REM cycle, it really stayed about the same.

Over time during a night, however, most people with apneas tend to get worse and their last REM cycle is quite often the one that breaches their thresholds and yields the diagnosis. I didn't have to wait that long.

My second REM cycle wasn't pretty. It had rather pronounced signs of respiratory distress and the oxygen saturation dropped to 72%, or that which you would acheive at about 18000 feet. Another way to look at it is to remember that venous (used) blood is usually at 75% when resting. It was that ugly drop, along with a 30 second period in which I didn't breathe, that prompted the use of the CPAP. They didn't want to wait for the next one.

The graph then shows the pressure they applied and how my oxygen saturation fared. Dips are seen intermittantly until they reached a pressure of 10cmH2O. (They start at 4 and keep raising it.) The graph then shows two REM cycles without any dips while the machine worked its magic. It's pretty cool.

In addition, I was shown how from from the first hour on until they got the pressure right on the CPAP, my heart did
funky things that my old regular doctor should have seen with the 24 hour monitor but didn't care to look for. (Why someone ever gave hime a degree I'll never know.) After the pressure was set on the CPAP, however, I had perfectly normal heart rythms for the rest of the night.

They also gave me an additional number known as the Apnea/Hypopnea Index (AHI) which is an indication of how disturbed the sleep is measured in events/hour. I knew going in that the open-ended scale was as follows:

0 ... Normal ... 5 ... Mild ... 12 ... Moderate ... 30 ... Severe ...

I scored a 64.1 and I didn't even get the chance to show them my best (worst) stuff. A 5:30 AM REM cycle would really have been impressive.

Anyway, a machine is in my near future.

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Ok, back to the fresh material ...

Over the past few weeks, we have found the game by which one acquires a CPAP machine to full of problems. There are sheisters out there waiting to get you in to raw deals with only the most basic equipment. There are doctors whose arrogance stretches the skulls of their inflated egos. But out there, one can find decent people who do care and I eventually found the right people.

My CPAP machine was delivered on Saturday morning by one of the nicest men you could hope to meet. I really got the feeling that even though this was basically a business relationship, he really did care and he obviously became a respiratory therapist for the right reasons. Unlike some of the other people we met, he brought only the best and explained every smallest detail rather than treat me like a stupid puppet. (I'll just note here for anyone interested
that he works for a company called PSA in San Dimas.)

Shortly after he set me up, I tried it out with a mid-morning nap, but the real test came Saturday night. I battled the hose for a while and played with minor mask leaks just a bit, but solved the problem on my own fairly quickly. My most unique solution to the hose problem is to wear a piece of athletic clothing I picked up a few years ago that is basically a shirt made from some fancy spandex-like material that wicks moisture extremely well and run the hose up through it so that mask, hose, and body all turn together throughout the night.

Anyways, I woke up a few times when I rolled over, and of course, to visit the restroom, but that's OK. It's a small price to pay for the ability to oxygenate the body all night long. After nearly nine full hours of sleep, I awoke to greet the world refreshed, a feeling I had long since forgotten. I felt so great that I was giddy with joy, almost to the point of crying. It was a beautiful morning and I felt so alive.

Now, I have had three more nights on CPAP, and while these have been shortened by the fact I had to get up early for work, I can definately feel the difference. I have accomplished more work in the last three days than I usually do in two entire weeks. This is, for me, a fantastic rebirth and I am so very happy.

I know that I may yet find some troubles and I will definately deal with any problems that may rise. I have already seen how great it can be when using these machines and I sincerely hope that anyone who reads this will work through whatever problems they have with CPAP therapy until they too can enjoy the vibrant good life again. Life is too great not to be in it.

Follow Ups:

• Re: First Week on CPAP - Oh What A Feeling! Pat on Camano Island, WA 10/21/98 (0)
• Re: First Week on CPAP - Oh What A Feeling! (LONG) Tynya (Nashville, TN) 10/21/98 (0)

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