It’s fairly recognized that there’s a lot of people who don’t sleep well. Some of it’s attributed to health issues such as diabetes or being overweight. Some of it occurs because of breathing difficulties.

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I’ve had problems sleeping ever since I was 10, when my dad went to Vietnam. I’ve never overcome anxiety in going to bed, so I tend to stay up late enough to exhaust myself so that I’ll fall asleep easier. Working for oneself makes that easier to do.

Unfortunately, falling asleep easier doesn’t mean one sleeps all that well. My pattern is that the best sleep I get is when I first fall asleep. I’ll sleep anywhere from 45 minutes to 2 hours. After that… well, it gets much rougher.

It was the death of hall of fame football player Reggie White via sleep apnea that led me to first look into this issue. My wife told me that I had a pattern of what I now refer to as “beating up the bed”, and after hitting her a few times while sleeping I realized I had to figure out what I could do about my problem.

I went to a local sleep doctor with high hopes. Within 15 minutes he’d determined I was a candidate for an overnight sleep study. This was the most miserable medical procedure I’d ever had at the time, and I’d had surgery on my breast while still being awake.

The first problem was having to go to “bed” way earlier than I normally did. The second problem was that the “bed” felt like a piece of cardboard, and the pillow had no substance. Since I was used to sleeping with multiple pillows, including a full body pillow, that didn’t bode well. They also hook all these things up on you, which means you have all sorts of tubes and electrodes all over your body; a couple of times during the night I had tubes wrapping around my neck.

I made it through that night, and a week later I was in the doctor’s office where he proceeded to read the report that the person who watched me sleep wrote up for him. That’s the first part of it all; unlike many other vocations, someone else interprets the results and passes them along to the doctor. He looks at them and makes a recommendation as to whether your issue requires a CPAP or not. In my case it did.

To say my first experience with a CPAP went smoothly would be a major lie. I struggled in more ways than one. With a CPAP, which stands for Continuous Positive Airway Pressure, there’s a high level of pressure that the machine is set for to make sure you keep breathing during the night, since sleep apnea often means you stop breathing during the night, which makes your body start fighting to make you breathe, and thus explains why you’re tired. If your issue is just snoring a lot, you might or might not need a CPAP based on what the test shows; I was a mover. lol

You can set up the CPAP where it goes through a process called “ramping”. This means it starts at a low point and then over time, anywhere from 15 minutes to an hour, the pressure increases until it reaches the high point.

The problems with this were many for me.

The first was that the low pressure was too low; I felt like I was breathing heavy from the beginning because I couldn’t get enough air. This eliminated my solution of staying up later so I could fall asleep easily because I got anxiety.

The second was the CPAP was way too noisy. I fell asleep to a fan because I needed some background noise, but the CPAP was much closer and much louder as the air pressure grew.

The third was the high pressure was way too much. Even when it was adjusted down over the course of a few weeks during the testing phase, I’d wake up feeling like I’d had a major workout. Strangely enough, my mind felt more alert but my chest hurt; that wasn’t going to get it done.

The fourth were issues with the masks. The first one made scars break out all over my face, which wasn’t pretty. The second had a leak in the cushion that was supposed to help the overall mask not rub against my face; that was even more non-pretty. The third leaked so much air that I couldn’t get to sleep.

So, after trying it for six months… I quit. I didn’t call the doctor’s office, I canceled all follow up appointments, and moved on with life.

Or so I thought. My sleep issue got worse, and I decided I had to try again. So I made another appointment with the doctor and after a 5-minute visit he said I needed another sleep study. I’m serious; I spent more time with the medical assistant getting my vitals and asking me about medications I was taking than I did with him.

The second test went much different than the first. The sleep lab had been renovated so the bed was more comfortable. However, the guy running the test kept coming into the room and either waking me up or doing some other thing because I was already up. He kept adjusting things on me, which was kind of irritating, but it turns out he was testing different air pressures, trying to see if whatever he was doing would make me feel more rested. I actually did… for about 10 minutes, before exhaustion took over since I slept little.

When I met the doctor again the next week, it was decided I was switching to a BiPAP machine, or Bilevel Positive Airway Pressure. The difference between the two machines were staggering.

First, BiPAPs are much quieter; that was a major relief. Second, a BiPAP alters the air pressure both when you breathe in and breathe out. Therefore, when you first start off with it, you feel like you’re breathing normally, which makes it easier to fall asleep.

Something I was “warned” about when I went to it was that once I got used to it, I’ll never want to fall asleep without wearing it. That turns out to be true; if I’m so tired that I fall asleep without the BiPAP, I wake up as tired as I was when I fell asleep.

Where am I now when I sleep? I sleep better when I sleep… but I still have problems fully sleeping during the night. The doctor said that without medication to help me sleep, all the machines will do is help me sleep better during the night because I’ll breathe better. He was absolutely right on that one. Even though, according to Fitbit, I average around 3 actual hours of sleep a night, I do wake up breathing better and mentally feeling better, even if I still move around a lot.

However, that’s not the end of this story. If you get either a CPAP or BiPAP, there turns out to be a lot of supplies you need, and you have to replace them at least once every 3 to six months, some of them monthly.

In a twist of fate that makes you question the government, every single item that the machines use is considered specific medical equipment. They’ve created HCPCS codes for every single piece, which means you need a prescription to buy these things, whether you get them locally or online. You used to be able to get away with not going to see the doctor for 18 months, but that was changed so you have to visit yearly now, which means your prescription is only good for a year.

A typical visit to the sleep doctor is like this:

* the medical assistant checks your weight and blood pressure, then verifies any medications you’re presenting taking;

* if the medical assistant is any good, he/she will take the Micro SD card out of your unit so the information it’s collected can be downloaded into the computer and a report printed out for the doctor;

* the doctor comes in (or nurse practitioner), looks at the report (unless the MA forgot to take the SD card, which means they have to take it out and give it to someone), asks you a few questions about how you’ve been sleeping;

* the doctor puts the stethoscope to your chest and back, asking you to breathe deeply;

* based on the information received and your answers, either tells you to maintain the status quo or alters the pressure and gives you a script to take to your local CPAP vendor for adjustment (no, they don’t do that in the office; matter of fact, you have to go to a special vendor to get the equipment, which is pretty expensive if you don’t have insurance).

All of this takes between 5 and 10 minutes; that’s it. Unless you still have serious issues, you’re in and out in a shorter period of time than it probably took you to find a parking space (that’s always my issue). And, it turns out, because of the stethoscope checking your breathing in the office, that’s an automatic level 3 established patient visit, as that’s considered “an expanded problem focused examination”. You can try to tell them you’re fine and don’t need them to listen to your breathing, but it probably won’t work. lol Oh yeah, if you’re keeping score and understand procedure codes, this will be a 99213, which of course means they can charge you more… for possibly 5 minutes of time.

If you ever decide to go into medicine, this is the field for you if you don’t want to deal with a lot of complications. Sure, every once in a while you get a patient who might need something a bit more extensive, but it’s rare, and others do most of the work for you. Still, I feel better even though I don’t sleep more, and it’s my choice that I don’t have medication to help me sleep more.

If you have any questions about what I’ve written here, just ask. Overall, I still have to recommend that if you have problems sleeping, snore heavily or wake up always exhausted, go check it out.
 

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