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Hose Wars, Part 2: To Breathe, Perchance to Leak

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

I’m not a good sleeper, and never have been. When my publishing company (now mostly forgotten) collapsed back in 2002, I developed severe insomnia. I was getting as little as three hours of sleep per night, often less, and sometimes none at all. After a couple of weeks of this, I started to hallucinate cute little cartoon devils doing calisthenics at the foot of my bed, along with other things I’m not sure I can describe. Sleep isn’t optional. I sometimes think we sleep in order to dream undisturbed, and that dreams are somehow where our humanity comes from. If we can’t sleep, eventually we start to dream while we’re awake.

My big fear in starting APAP therapy was that I couldn’t sleep with a mask on my face. Had I been a better sleeper, I’d probably have begun thereapy years earlier. I was given two masks: One covered my nose and mouth. This is called a “full-face” mask, even though it doesn’t cover your eyes. The other is harder to describe: It’s a little plastic thing on an elastic strap that inserts a couple of cushioned tubes into your nostrils. These are called “nasal pillow” masks, and they’re a great deal less intrusive than full-face masks.

The whole point of CPAP/APAP therapy is to push enough air into your nose to keep your airway open, and to open it if by some chance it closes. For this to work, you either need a full-face mask so that if your mouth opens it won’t matter, or with a nasal pillow mask you need some way to keep your mouth closed. There are chin straps of various sorts and other things lumped into a category called “headgear.” Yet more stuff to tie myself up in; no thanks. I did the obvious: I used that blue surgical tape you buy at Walgreen’s to tape my mouth shut.

It worked. It worked, at least, until the machine upped the pressure for some reason. The higher pressure blew the tape off one corner of my mouth, which became a massive air leak, one noisy enough to wake me up.

This is my problem in a nutshell: APAP is noisy and uncomfortable, and keeps me awake. The noise I’m getting used to, at least the fairly modest noise from the machine itself. Leaks are a separate issue. I sleep on my side, which means that both kinds of mask eventually contact my pillow. I can position myself carefully when going to sleep, and that generally works. But if I squirm around even a little while I’m asleep, my pillow nudges the mask to one side, making noise, or (with the full-face mask) spraying air into my eyes. That wakes me up in a hurry.

To keep me asleep despite masks and leaks and hoses flapping around, the doc gave me a prescrption for a sleeping pill called Belsomra (suvorexant.) It’s the first of a new class of insomnia treatments that target the orexin receptors in the brain, rather than the GABA receptors. Pills like Ambien (zolpidem) target GABA, and force you to sleep. If you take one and don’t hit the sack, you’ll start dreaming anyway, and say or do dumb things. The orexin receptors keep you awake. Interfere with their operation using an orexin antagonist like Belsomra, and the signals to stay awake go away. You drift off. I’ve taken Ambien, and it always felt like a whack to the back of my head. Boom! I’m out. Belsomra has a gentler touch, and from what I’ve read, it doesn’t affect sleep architecture (i.e., the different stages of sleep like REM) nearly as much as more preemptive pills like Ambien.

It’s expensive, but very fortunately, Medicare covers it. And so far, it’s done a pretty fair job keeping me asleep in spite of mask issues. As for mask issues, there’s a third sort of mask that I’m going to buy and try: A nose mask. This is like a smaller full-face mask that only covers your nose. It may not be any better than nasal pillows, but it’s cheap enough to do the experiment and be sure.

I’ve found that there’s a downside to blowing air up your nose. A couple downsides, actually, but there’s one big one, and that’s where I’ll start next time.


  1. Tom Roderick says:

    YES! Lack of sleep can cause one to hallucinate with crazy images. For a period of about 60 hours back in 1972 while in service I was only able to get a total of perhaps 5 or 6 hours sleep in short naps during that period. Near the end of that time I was seeing very strange things and was really never sure if I was awake or dozing. When I finally was able to sleep I did a continuous stretch of about 14 hours.

    Another note, and I hope it is not painful Jeff. Some of us have very good memories of Coriolis and what you and they did. I learned a LOT!

    1. Of course not! Many people have told me that Coriolis produced some of the best tech books ever published, and I will go to my grave convinced that outside of my relationship with Carol, Coriolis was the finest thing I have ever done.

      It was a painful thing to lose, especially given the circumstances, which I am not at liberty to reveal online. It took me a couple of years to get over, to the extent that someone ever gets over a loss that painful.

      Life is generally good now, and once I get my energy back, I intend to write SFF for the rest of my life. (I may take some time out to do a book or two on FreePascal/Lazarus.)

      Last night I had an AHI of….0.67. Four events in six hours. Most sleep experts consider that pretty much no apnea at all.

  2. RickH says:

    Jeff: I am using the ‘nasal pillows’; and I sleep on my side with the side of my face on the pillow. I have not had any problem with leakage or it being uncomfortable.

    Over the years, I have tried many different designs, including the ‘triangle’ thing over the nose. The nasal pillows have been the best; the others leak or are uncomfortable.

    I don’t need anything to keep my mouth closed while sleeping; I have learned how to do that (or maybe I always knew how).

    So, a recommendation from me for the nasal pillows. YMMV.

  3. SteveF says:

    After a couple of weeks of this, I started to hallucinate cute little cartoon devils doing calisthenics at the foot of my bed, along with other things I’m not sure I can describe.

    Yah, the hallucinations are the best part about missing a lot of sleep.

    No, wait, the headache is the best part. If you do it right, you get tired enough to get a headache that keeps you from getting to sleep. That’s, like, winning or something.

  4. Jim Tubman says:

    Coriolis has not been forgotten by me, and it was appreciated.

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