It wasn’t a doctor who first suspected I suffered from sleep apnea. It was my wife. My snoring would often awaken her, and she began to notice something even more unsettling. Every 120 seconds (she repeatedly counted) I briefly stopped breathing. I often felt fatigued throughout the day and fought to keep my eyes open while driving home from work.
And I’m not alone. It’s now estimated that one in four adults between the ages of 30 and 70 have sleep apnea, but most are undiagnosed. The condition is marked by one or more pauses in breathing while you sleep, lasting from a few seconds to minutes, and can occur 30 times or more an hour. Normal breathing then starts again, sometimes with a loud snort or choking sound. Left untreated, it can trigger high blood pressure and double the risk of stroke in some people.
A few years earlier I had been diagnosed with mild sleep apnea. But now the situation had gotten worse, and I could no longer pretend I was sleeping well. It was time to go to the sleep center for another test.
Mining the snooze
Here’s what happened after I showed up for the sleep study: I went to bed in a clinical setting (in a hospital), and a wall-mounted video camera with a microphone captured my every move. Staff members watched the camera’s feed from another room and took notes. And there was the added bonus of having electrodes connected to various points on my body, so changing sleeping positions wasn’t easy.
“It’s hard to sleep when you’re wired all over, but most people get through it,” says Todd Swick, M.D., clinical assistant professor of neurology at the University of Texas Health Sciences Center in Houston and a fellow of the American Academy of Sleep Medicine. The video camera had a microphone, too, so I was able to call out to a technician if, for instance, I needed to be disconnected for a bathroom stop.
The resulting polysomnogram showed when I was awake or asleep, the stage of sleep I was in, when I was breathing (or not), and more. Sleep apnea is measured by something called an Apnea/Hypopnea Index (AHI), which averages how frequently per hour a person stops breathing. But the sleep doctor also analyzes other data, such as oxygen saturation.
My second sleep study showed a significant change from the first. My AHI was now 30, the threshold for severe apnea. At 30 I was waking up an average of every two minutes, or 120 seconds—precisely my wife’s assessment.
Sleeping on it
With the diagnosis settled, I was scheduled for one more study, this time with a continuous positive airway pressure (CPAP) machine, which delivers a steady stream of air to keep airways open. The result: I needed CPAP therapy to bring my apnea score down to a safer level. That morning, I took a CPAP machine home with basic instructions for how to use it, clean it, and replace its supplies.
I must admit that I was a bit apprehensive. I knew that many people who are prescribed a CPAP mask give up after just a few nights. And without nearby technicians I could call upon for help like I did during my sleep study, I was afraid that the first night wouldn’t be easy.
I was right. The CPAP mask against my face felt bigger than it was, the harness around my head was bumpy against the pillow, and the pressurized air seemed too strong. But I made some adjustments, and now I’m beyond the six-month mark of daily use.
Here are some tips I can now share about how to best obtain and use a CPAP machine:
• Health insurance may help with the bill. Sleep studies aren’t cheap; mine were on the expensive side at about $6,800. But my health insurance paid more than 90 percent of the cost. Check with your health insurer before scheduling your sleep study to find out what’s covered.
The cost of the CPAP machine itself, roughly $800 including the humidifier, has been mostly paid for by insurance, as have been supplies. But if you’re paying out of pocket, it might cost about $110 for a full face mask with harness (what I use and replace every three months), and about $10 for a replacement hose. And six micro-fine filters will be $12; they’re replaced once a month. Add in about $25 to replace the humidifier chamber every six months.
• The “ramp” button can help you sleep. CPAP machines deliver air at a pressure your doctor sets for what’s needed to keep your airway open. But when you’re just falling asleep, especially if you’re a newer user, that pressure might feel oppressive—and keep you wide awake. That’s why the machines have a ramp button that starts with lower pressure, then slowly builds.
Should you awaken during the night, you might need to press the ramp button again, though try not to overdo it. “If your CPAP’s ramp duration is 15 minutes and you wake up six times a night," Swick says, “that’s an hour and a half you might have more apneas.”
• A “smart” machine can be useful. Most CPAPs have a removable media card the patient takes in to the doctor on a regular schedule. The newer Philips model I have instead uses a cellular modem to upload my stats to a server. My CPAP also has a smartphone app that I use daily to learn my previous night’s AHI; below 5 indicates “normal.” My doctor can track my progress anytime, and he says I should need no further sleep studies as long as the machine continues to help.
• Mask adjustment is continuous. The harness that holds the CPAP’s mask against your face needs to be tight enough to prevent air from escaping but not so tight that the mask is uncomfortable. As I’ve learned, there’s no single way to adjust my full-face mask, and most nights I need to tighten one of the six straps, which takes seconds. If you’re not comfortable, try adjusting the straps in the hour before bedtime.
• Cleanup isn’t voluntary. Among the instructions I received with the machine were how and when to clean the mask, harness, hose, humidifier reservoir, and air filter. The sleep center also arranged for replacing supplies on a regular schedule. I follow this protocol closely to avoid the possibility of a CPAP-borne respiratory infection.
• Stomach upset is fixable. I called my sleep doctor after using the CPAP machine my first week because I awoke feeling chest and back pain. He wasn’t surprised. Many new CPAP users experience aerophagia, literally the swallowing of air, which can result in feeling bloated. The standard advice is to take simethicone, better known as Gas-X, for relief.
• Skin issues can arise. When I wake up every morning, I notice redness on the bridge of my nose and also creases above my jaw from the pressing of the mask and harness. I was initially concerned but found that applying moisturizer after getting out of the shower worked. Many CPAP users, though, routinely complain about rashes, Swick reports.
In addition to the skin irritation some patients suffer, chemicals used in the manufacturing of the CPAP mask and harness could cause reactions, adds Joseph F. Fowler, Jr., M.D., a clinical professor of dermatology at the University of Louisville. “The silicone in the mask almost never causes an allergy—it’s the dyes, glues, and other chemicals such as rubber accelerators,” he says. “A fairly simple test can determine what kind of allergy it is.”
What else to know
Overall, I’ve had to remind myself that CPAPs aren’t magic, and they take some getting used to (from 30 to 90 days, experts say). No matter how comfortable you are using a CPAP mask, following proper sleep hygiene recommendations will better ensure that your body is ready for sleep by the time you don the mask. This means turning off screens and avoiding heavy meals and drinks in the last hours before bed. “It’s not an anesthesia machine,” Swick says.
Keeping in contact with your doctor and discussing alternatives if you have problems can lead to a nighttime sleep solution that’s right for you. My CPAP machine has done wonders for my sleep and general alertness throughout the day. And it’s also helping me with another goal: a longer life.