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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.


  1. RickH says:

    As I have mentioned before, I’ve been using a CPAP for over 10 years. So there are some habits that I’ve developed.

    One is an ‘automatic hose positioning’ response as I move around while sleeping. If I change positions, I automatically grab the hose an reposition it so the nasal pillow (which I really like out of all the ones I have tried over the years) is not disturbed. I know that I reposition the hose while not quite asleep, so I assume that it happens when I move while sleeping. So I rarely get ‘leakage’.

    The other thing I have noticed is that I don’t sleep well without the mask. Lost a nasal pillow on a trip once, and didn’t sleep at all that night. Had to get a replacement while on the road.

    In fact, if I try to nap on the couch during the day, it is not as restful. My ‘snorting’ (gasps of air caused by the apnea) will wake me up. Along with my own snoring. No snoring while sleeping because of the mask.

    And I have learned to keep my mouth shut while sleeping over the years, so don’t have that problem. (I have noticed that learning to keep your mouth shut while awake is also useful. Mouth shut = no stupid talking/talkback.)

    So, I’d encourage you to ‘keep on keeping on’. It is worth it. Sleeping is good stuff.

  2. Michael Riley says:

    I use a similar mask with nasal pillows. About 8 years ago I asked for a second opinion from a different ENT doctor to see if I was perhaps a candidate for surgery to alleviate my sleep apnea. NOT. I was told the same thing… loose the weight.

  3. Jim Dodd says:

    Thanks for this series, Jeff. It’s nice to get an honest opinion on all of this. All other reports I’ve read are either 1) These are wonderful with no problems at all or 2) These are the worst thing ever invented and are the reason my car gets bad gas mileage.

    I’m about your age and I should be using one of these. I imagine going through the same experiments as you’ve described but you’ve given us all a head start.


  4. TRX says:

    Nasal pillows break down loosely into three types: the blue gel seals, the single stiff flap, or the soft double flap. I found the doubles to work best for me. Call me and give me your new mailing address, and I’ll send you some spares to try out. All the masks and pillows are *not* the same shape, even within the same brand.

    On the Sleepyhead forum there are some threads on modifying masks for a better fit. If you haven’t looked through those, it might help. The CPAP stuff all seems to come from Germany, “standard head” seems to be some kind of eastern-European hatchet face; it took me quite a while to find a mask that didn’t leak.

    Once you have some spares in hand you can take the razor knife and glue gun to them…

  5. Bob says:

    “without the Belsomra I don’t think I would sleep at all. Relaxing completely is difficult. Maybe it’ll get better with more practice,”

    I do not have apnea, thank goodness, but I have been a poor sleeper all my life. One thing I have learned is that all sleep medicines affect the structure of your sleep. And the quality of sleep is just as important as how long.

    Another thing is that your body/brain know how to sleep. You just need to get your conscious mind out of the way. A large part of the effect of any sleep medicine is placebo. The flip side is that people become habituated to them. They take the medicine for years even though none of them, including belsomra, are tested or recommended over that long a period.

    A final thought is that you can get used to things that you did not think were possible. About 15 years ago I developed pretty severe tinnitus. It scared the hell out of me. I was sure I would not be able to get even the little sleep I had been getting with it and I literally thought I was going to die. I immediately started taking sleep medicines starting with ambien and proceeding through the benzos. After a couple of years they all stopped working. Plus I found that the side effects made me feel terrible–worse than not sleeping.

    So I just quit taking them. I have not taken any sleep medicine in 12 years. I still have the tinnitus, my brain likes to make noises for some reason, but I sleep about as well as I did before and I am still here :-).

    Good luck. I think you can sleep without the Belsomra but you will have to figure that out for yourself.

  6. Jason Kaczor says:

    Jeff – keep up, it will get better and sleep will become a pleasure again – I was originally prescribed a full face mask, with the forehead bridge… (My apnea rates are about 90 times per hour).

    Would tear it off after about 3 hours, it was horribly uncomfortable.

    When I had a new sleep study last fall (new province, new doctor), they ended up prescribing a BIPAP machine – and, I assumed the standard horrible mask. When he had me use a pillow mask, I laughed – no way that’s going to work, my mouth is going to hang open.

    Well – for me – it was an immediate win – I didn’t even need a training period and my body automatically keeps my mouth closed (although, now I think I might be grinding my teeth)…

    Initially, I lost 30lbs, without changing anything in my life other than getting a full nights sleep.

    I feel great and about 15 years younger.

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