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June 22nd, 2018:

Hose Wars, Part 3: I Love It…But I Hate It

This is a series. Start here if you haven’t already.

Yes, I’m back. I didn’t pause the series because I was tired or busy. I was waiting because I wanted more data to analyze. So as of this morning I had four weeks in with the S10, and I decided to see what the trends were, and talk a little more about the experience itself.

In terms of what it was designed to do, the ResMed S10 Autoset is a complete win. If you recall from Part 1, my headband sleep study indicated an AHI of 36, meaning that over the time I was tested, I experienced and average of 36 events an hour. The events are of various species, some of which I still understand poorly. The biggie is obstructive apnea (basically, your soft tissues close your airway temporarily) which encompassed most of the events reported by Sleepyhead, assuming you include “Clear Airway” events with OAs. (I’m still trying to determine the precise difference between the two categories.) I’ve logged relatively little hypopnea (abnormally slow or shallow breathing) and almost no Cheyne-Stokes respiration. The machine is not capable of identifying central apnea events (which are basically an EEG issue) so I have no data on those.

And leaks. Lordy, do I have leaks. Still working on that. Fortunately, the S10 can tell what’s a leak and what’s some sort of breathing irregularity. It reports the leaks so I can try different things to minimize them. Useful, and some engineering is in process. Much of leak management is actually hose management, and the engineering lies in keeping the hose from pulling on the mask. I’ll describe what I end up with after I end up with it.

Now, results. For the first three nights, I tried the full-face mask I bought. It kept me awake, even with a Belsomra pill in me. I took a leftover clonazepam pill to knock me out a little more, and I managed to sleep. However, I have no intention of becoming dependent on a benzo just to sleep with a bigger mask. The USP of Belsomra is that it doesn’t disturb sleep architecture to the degree that benzos and the Z-drugs do. If I can’t do a mask on Belsomra, it’s unclear that I can do APAP at all.

So everything hinges on the “nasal pillow” mask I bought. It’s not exactly comfortable, but I’m able to sleep with it strapped to my face. It’s a ResMed AirFit P10, and has a very good reputation. I may try others as time allows.

Now, I can fall asleep with it…and sleep for about six hours. After six hours, the Belsomra is leaving my system, and there’s no longer enough to keep my orexin receptors neutralized. So come about 3:30 or 4, I can no longer fall back asleep. (I’ve been getting up twice a night for bathroom breaks for 25+ years, usually at 1:30 and 4.) Keeping the mask on if I’m not sleeping does nobody any good, so after my second bathroom break, I take the mask off and shut the machine down. This gives me 6-7 hours of treated sleep, plus another hour or two of untreated sleep. It’s not a perfect solution, but it may be the only solution I can manage. Even bad sleep is better than no sleep, and I’ll take whatever benefit from those last two hours that I can.

The improvement in my AHI has been spectacular. From a sleep study AHI of 36 I’ve gone down to an AHI of less than six on all 28 nights. And on only two nights did it go over 5. Most nights it’s less than 3. Last night, I had only four events across 5.53 hours with the mask on, for an AHI of 0.72. That’s not shabby. In fact, an AHI of less than one is considered no apnea at all. I don’t know why I have more events on some nights than others. That’s a subject of ongoing research.

There have been some weirdnesses. My prescription called for a pressure of 6-18 cm. (The S10 supposedly adjusts pressure to what it needs to clear an event.) What I found is that at least once a night, the pressure was up above 17, and I felt like I was being blown up like a balloon. I would wake up completely, and become so annoyed that I had a hard time falling asleep again. Not useful. So I set the machine to vary only between 6 and 13 cm. Now there are no excursions above 13, and from the graphs I can tell that I can sleep when it’s pumping in the vicinity of 12 cm. Median pressure is 7.7 cm. Given the reported AHIs, nothing of value was lost in the adjustment.

Now the bad news: APAP has taken all the pleasure out of sleeping. It’s a hard thing to describe. I’m aware of the mask as I try to fall asleep. It’s a constant irritation, and without the Belsomra I don’t think I would sleep at all. Relaxing completely is difficult. Maybe it’ll get better with more practice, but after 28 nights I’m thinking that whatever I’m experiencing now is what I’ll be experiencing for the rest of my life, which is nothing if not depressing. I’ve begun looking forward to the final two hours of the night as my reward for suffering through the first six hours.

I’m not sure what, if anything, can be done about this.

Now, one can’t argue with results. I don’t feel like a 10-year-old again, and I’m good with that. I wouldn’t mind feeling like a 20-year-old, but I’m not getting that either. The improvements are incremental but real: I’m getting more ideas, spending more time reading, and more time at the keyboard. I don’t feel a great deal more energetic, but something is getting the work done, and I can only credit that to better sleep.

I’m not sure there will be a Part 4 to this series, but when insights become available I’ll report here. So far…

…so good.