Ravel'd sleeves

So, I had two New Year's Resolutions. One, Do Not Poke the Crazy Lady With a Stick. (I may be violating this one, now.) Second, deal with my stupid sleep issues. So, good on the first one, with the possible violation already mentioned. The sleep issues...oh fucking sigh.

So, I found my CPAP machine. It's really, really old. At least ten years, and I think somewhat older than that. I borrowed a mask from the lab, found my humidifier, and was off to the races. The mask leaked. Something fierce. Now that I'm a sleep tech, leaks bother me a great deal more than they used to. I never liked the hissing noise, but now, I get all alarmed. So, I borrowed a different mask. Yay for the sleep lab. Didn't like that one, either, and developed a new symptom: aerophagia. Literally "air eating." My abdomen was becoming incredibly uncomfortably distended. Burping and farting ensued, providing vastly less relief than one might wish. Really, bodies are incredibly silly.

So, next step, try a nasal pillow mask, which has a great leak rate. I use them in the lab all the time. Also try a chin strap. Yeah, still with the aerophagia. Excellent. So, then to the internet to find instructions on how to adjust the pressure. I found instructions for the Respironics Solo Plus LX. Well, mine's a Solo Plus, no LX, but the instructions worked. The machine had been set on 13 cm H2O, which is a bit high, but you know, not too awful, I wouldn't have thought. At this point, I'm actually pretty severely annoyed. I mean, I used CPAP for fucking _years_ with no problems. But this aerophagia thing is totally unacceptable. So I lower the pressure to 8 cm H2O. No aerophagia. Yay for that. Also, the obstruction thing that I can feel happening when I fall to sleep is gone. So, there's that.

I try to do without the chin strap, which is honestly kind of annoying. I find that I keep on waking up with my mouth open and air hissing out, and I'm pretty sure that the leak is causing the arousals. If I was in the lab, and someone was observing, they could be sure, but really, it seems likely. So, I add back the chin strap. At this point, the nasal pillows start hurting. Sometimes the septum hurts, sometimes the nasal membranes hurt. Fuck with fuck sauce, I think. Really, nasal pillows are really nice in a bunch of ways, but I've never been able to use them because my nose is convinced that it's a special snowflake, and sure enough, we're back to the special snowflake status.

So, I'm on my fourth mask from the lab. Thank god I work for a sleep lab. This wouldn't be possible if I were trying to do it through a normal company. I mean, four masks in the course of two weeks? Each one of which costs in the neighborhood of $200? And, mostly, they don't let you return them. So grateful for my job, once again. So, now I'm using the Respironics Wisp, which actually does work really, really well. It doesn't hurt my nose, it doesn't leak when I lie on my side, it maintains a good seal, and just generally does absolutely everything I ever wanted. So happy with that part.

I look rather ridiculous when I arm myself to do battle with Morpheus these days. First, there's the chin strap, which fits under the chin, around the top of the head, and behind the head, hopefully holding my mouth closed, and is a maroon color. (Yes, yes, I can't keep my mouth closed, even when I sleep. Are you happy you made that joke, now?) Then, there's the eye mask, which lets DDB turn the lights on and off at will without bothering me, and is cobalt blue. Then there's the mask, which fits over the nose, with headgear that goes around the head, which is mostly silicon colored, but with grey cloth bits. Then there's a hose from the mask to the humidifier, which is long and grey and I call my elephant nose. I look pretty silly once I'm kitted out. But the important question: am I sleeping better?

Well... I think so. Some better, at any rate. I am waking up lesso piss less often. (Technically called nocturia, which is a much nicer sounding word, don't you think? Also, a useful clue to disrupted sleep.) I think I'm sleeping more soundly. But, I'm still hating to wake up. Always, forever, hating to wake up. On my days off, I'm still sleeping anything from six to sixteen hours. I have a new keen habit of waking up at five in the morning and being unable to fall asleep again until nine, and then sleep until three in the afternoon. Or, you know, six in the evening. Or some damn thing.

So, I think that the CPAP is helping some, but I think there are still stupid things going on. It is very likely that I have "delayed phase Circadian rhythm disorder" which a fancy term for being a night person. And trying to switch from a night shift to a day shift to a night shift to a day shift is a lot harder than it was when I was in my mid-twenties. (I used to do this when I lived with Peter Larsen. He was on third, I was on first, and I would shift over every weekend for the weekend. I was more resilient, then, which explains many things about our relationship.) The last time I was really worried about my sleep issues, I was on a boat load of psych meds, which I'm not on. And so that clarifies some things. I am certainly considerably less sleepy, even when I'm short of sleep, than I was when I was doped to the gills. So that's all very interesting. But it seems to take an unconscionably long time to fall asleep when I want to go to sleep, I'm having sleep maintenance issues, and in general, I just hate hate hate hate waking up. So, possibly something going on there.

My CPAP machine is old, as I mentioned, and doesn't have recording capability. So I can't download the card and see what it thinks. I do think I should probably have a sleep study done to find out what the best pressure is. I suspect the current pressure may be a little low, but you know, no way to know. I could totally do with a new machine, preferably one that has C-Flex. Which might help with the aerophagia, if I need higher pressures. (C-Flex, or A-Flex, or some other brand-name thingy, depending on the machine, gives a lower pressure on the exhale, which helps with tolerance and some of the problems such as aerophagia.)

I have a new, profound sympathy for my patients. I know so much about this. I have so many resources. And I'm still finding all of this to be complicated and difficult to navigate. The only reason a sleep study looks possible is that I've already met my deductible for this year because of my finger. I don't know if I can afford a new CPAP machine, because that comes out of a different pot of money, and I'm not sure what is and isn't covered. I really do need to return my mask and chin strap to the lab some day, and get my own.

So, annoyed Lydy is annoyed. This seemed so much simpler back a million years ago when I first got my diagnosis. How did it become this difficult? I mean, they whipped a little CPAP on me, I was perfectly happy, I took the mask they gave me, I had no questions, no problems and away I went. Really, honestly, where the fuck did the aerophagia come from? Sigh.

So, adventures in sleeping. Which I'm about to go do. Catch you on the flip side.