Health Update Nov. 15, 2002
Last revision: Dec. 13, 2002
I finished the two week APAP (auto-titration CPAP) study at home in October. It went well. I was able to sleep with it all night (7-9 hrs) after the first night. I'm now not using any CPAP machine and am awaiting a prescription for one after my Pulmonologist gets the results of the study. During the two weeks of use my energy and cognitive abilities began to return. Now that I've been off it a while, the symptoms are slowly returning to what they were, but are not nearly as bad as they were before.
For those keeping tabs on the soap opera, below are more (rambling) details on how it went and what's next in my Quest For Normalcy. I was going to have my wife take a picture of me with the APAP machine hooked up to me to post here, but as usual these days, I forgot.
The story so far:
When we last met, I had my sleep study (polysomnograph) to see if I had sleep apnea. I didn't sleep much during my sleep test so I was afraid they may not have gotten enough data to base a diagnosis on and I would have to have another sleep test in a few months. The results of the study were sent to my Pulmonologist. I was supposed to get together with him to discuss the results and discuss treatment. However, I never used a CPAP machine during the split-night sleep study as planned (since I didn't sleep much) and my Pulmonologist up and broke his shoulder snowmobiling or something at the time so I didn't get together with him. Instead, his office called saying the results indicated a "significant" case of obstructive sleep apnea that needed treatment. I stopped breathing 26 times an hour during the little sleep I got in the sleep study. We decided to have me use a new-fangled APAP machine at home for two weeks to do the CPAP "titration" and as a trial to see if I can tolerate CPAP treatment. A titration is where they adjust the air pressure of a CPAP machine while you sleep to see what level is needed to keep you from stopping breathing. An APAP machine automatically adjusts the air pressure during sleep to whatever is needed moment-to-moment to keep you breathing. You can use an APAP at home so you don't need an attending technician to manually change settings to see what works. It records on a disk what air pressure levels it needs to use to end apneas and hypopneas. The data can then be turned in to the sleep center for analysis. Based on the results a permanent CPAP machine is usually prescribed if you tolerate sleeping with the contraption blowing pressurized air up your nose with a rubber hose. I was waiting to get the machine to try at home last we met...
How the home APAP study went:
I picked up the APAP machine on Wednesday the 9th of October. I was planning on leaving early from work to pick up the machine that day. I only lasted three hours at work before I had to leave due to fatigue, exhaustion, inability to think and other typical symptoms I've been having such as feeling like I was coming down with the flue or something. I went to the sleep center to pick up the APAP machine and get the lowdown on using it. Finally! I had been waiting four months for some relief after reaching the conclusion that I had apnea earlier in the year and seeing my doctor and a Pulmonologist about sleep apnea way back when. It was a long four months after that of fuzzy headedness, inability to concentrate or think, and fatigue.
The first thing I did of course when I got home around 12:30 in the afternoon was strap that sucker (well, blower actually) to my face and take a nap. As usual - despite wearing the mask and having pressurized air blown up my nose - I went to sleep in about 5 minutes. I apparently slept for about 40 minutes until the postman woke me up. I had 4 or 5 "arousals" that I remember due to the air pressure increasing to nip apneas in the bud while I slept. I could feel the pressure crank up which woke me up to some degree. It was like my sinuses were bicycle tires being pumped up with air. That night I slept four hours with it before I took the mask off for the rest of the night. My face was a little sore and irritated from the mask and straps and the air pressure was irritating me. This was actually a good start. You are considered "compliant" with CPAP treatment if you can sleep 5.5 hrs. a night on average with the mask. I did fine at work the next day and crashed when I got home. The second night I slept through the night with the mask on (7 hrs) and did so for the rest of the two weeks (7 to 9 hrs per night). From the second night forward, I didn't even really feel the air pressure anymore or notice it increasing during sleep. So much so, that I was beginning to worry that it wasn't working properly anymore!
I thus had a better than normal adjustment to CPAP treatment in terms of tolerating it. I did have typical minor problems and typical "REM rebound" experiences. The typical minor problems included either getting the straps on the mask too tight so it created sores on my forehead and bridge of my nose or getting them too loose causing air leaks and mouth breathing. I used the humidifier on the APAP after a couple nights which helped with drying of the sinuses and throat (which can cause or be caused by mouth breathing) and I used micropore tape every other night or so on my forehead and nose to reduce skin irritation.
The effects of using the APAP
Many have vivid dreams for days and weeks while using CPAP as they catch up on their sleep by spending most of their time in REM sleep. This is called "REM rebound." I spent a lot of time in REM. I can still remember the dreams I had involving wooly mammoths and giant sheep-like creatures roaming the streets, etc. The first night I dreamt mainly about the APAP machine which in one dream was the size of a large photo copier. It could photo copy, had a small screen where you could watch downloaded videos off the internet, etc.
My daytime symptoms improved during APAP use. I woke up not exactly refreshed but not tired or exhausted and without headaches and fuzzy headedness. The daytime symptoms such as fatigue and cognitive problems would return later in the day, usually in the afternoon or early evening allowing me to work at my job without too much of a problem for a change. I would usually crash and be useless after work though. In a sign that my irritability/crankiness symptoms are improving, my wife Diane says my sense of humor is returning (she says she isn't quite sure yet if this is a positive development or not, but she just doesn't appreciate the finer art of humor). She says I even managed to smile at her before 6 AM one morning, which was appreciated :-).
I returned the APAP with its data card to the sleep center. I am now waiting for a call from my Pulmonologist about the results. I should get a prescription for a permanent CPAP machine since I tolerated the APAP test machine well and my symptoms improved. Since being without a CPAP for a couple weeks, I am still doing better, though still not normal (if I remember what "normal" is). I think I need a month or more on a CPAP to catch up on my sleep and get my energy and cognitive abilities back.
I'm trying to think, but nothin' happens!
The last few months, I have felt like Curly of the Three Stooges who once explained to Moe, "I'm trying to think, but nothin' happens!" [au file or MP3] which has become my favorite MP3 on my Mac's iTunes software. As a test of my cognitive abilities (or lack thereof), I tried working on some articles for this site during APAP use. Before, I usually couldn't sit down and write for more than 10 minutes without getting exhausted, feeling feverish and unable to think much. After a couple days on the APAP I was able to write and concentrate for an hour or two without much problem. It began to feel a little weird being able to think clearly for a change. The last couple days I have been getting tired and fuzzy headed earlier in the day (while at work) so I'm looking forward to getting a permanent CPAP.
My Health (August 10, 2002) My Sleep Study (Sept 10, 2002)
REM Sleep Deprivation
Sleep Apnea UCDavis. Comprehensive article on Sleep Apnea.
Best Available Guide to Understanding Sleep Apnea SleepQuest.com.
Google.com search for "sleep apnea" 163,000 web pages on Apnea.
Getting the 'nitty gritty' on sleep apnea USA Today story about Nitty Gritty Dirt Band founder John McEuen's diagnosis of sleep apnea and how he believes his father had it and that it contributed to his father's early death (he died in his sleep of a heart attack).
Apnea Patient Stories Several individuals' stories. Gives first hand accounts of the symptoms of apnea and its effects on lives.
Respiratory Distress Index (RDI),
Apnea/Hypopnea Index (AHI)
Sleep Apnea: Introduction and Diagnosis