Snoring and Breath-Holding
I turned off the TV, and closed my
eyes, to go to sleep.
The snoring began within 5 minutes.
FIDGETING - Turning over - Adjusting sleep position.
GIBBERISH - It is unbelievable, the number and weirdness of
the sounds that I make. Laughing, jibberish, and huh?
BREATH RATE - My breath rate tends to be 16 breaths
per minute while snoring. It takes twice as long to inhale,
as it does to exhale.
I have 2 modes of sleep -
L - LABORED BREATHING - SNORING - It's very hard to get
the air in, so the exhale is fast and forced, to prepare for
the next restricted inhale.
A - APNEA - STOP BREATHING - Holding of the breath,
for no apparent reason, for as long as 30 SECONDS.
And then, breathing in and out vigorously several times to
compensate for the out-of-breath condition.
And then repeat. Repeat again. And again. And again.
N - NORMAL SLEEP BREATHING occurs only sporadically, for
short periods of time - inhale, exhale, pause.
The realization of the severity and
extent of MY sleep apnea problem is sobering. I actually
feel sick, just listening to myself from the night before.
It is now SO EASY to understand how I wake up in the morning
My mean time of breath-holding was 25 seconds.
My doctor's mean time of breath-holding was 45
seconds - which is REALLY bad.
Apnea Breathing Graph
Comparing normal sleep breathing,
with sleep apnea breathing.
Normal sleep breathing consists of rhythmic
breathing, at about 12 breaths per minute for adults. All
breaths are of the same approximate "depth". There is a
pause between the exhalation, and the next inhalation. This
pattern is maintained for MANY minutes, before the sleeper
takes a deep breath, and/or rolls over in bed.
There is nothing rhythmic about sleep apnea breathing.
Breathing is labored and more rapid WHEN it occurs. Great
variation in the "depth" of breath occurs. In my case, I
average about 2 "no breathing" incidents per minute. There
is almost always movement during the gasping, such as head
movement, or shifting position in bed, often accompanied by
moans and other sounds.
Notice how the depth of breath becomes more shallow, just
before breathing ceases.
Notice also that there is no pause between exhalation, and
the next inhalation.
Many others with sleep apnea do not have the "pre-gasp"
breath like I do, but instead go directly from no breathing
to a HUGE gasp, which can frequently awaken them
My apnea gets worse as morning approaches, after 3 AM. This
is supposed to be the time of deep REM sleep. For me, it is
the period of worst apnea - the most events, the
How are you going to get proper rest, when all this is
occurring? You don't. Instead, you arise tired, with high
blood pressure, since your body never gets a chance to
The most frequent cause of sleep apnea is being overweight,
floppy uvula notwithstanding.
Sleep Study -
Polysomnogram (PSG) (Sept.
A Complete Description
My PSG Experience
How it is
supposed to work
How it worked (not)
Go to Watsonville
I told them I do not like to go to Watsonville. The sleep
center has 2 locations - one in Watsonville, and one in
Santa Cruz. I was told that I had to go to Watsonville
ONLY ONCE, for my initial consultation.
I filled out many pages of a survey.
2. "Make yourself comfortable by changing into your
I haven't owned any pajamas in over 50 years.
5. "Give your sleep diary to the technician."
What sleep diary? Not mentioned to me.
7A. They will also inform you that if needed, you may get
up during the night to use the bathroom.
If I wanted to use the restroom, I had to call the
technician, so that she could disconnect me from the
electrical interface, and hang all the wires around my neck,
so I could trot down the hall to the communal bathroom. The
4 wires going down from my neck, through my shirt and pants
to my calves were particularly troublesome. I had to be
careful not to pee on the 4 calf wires.
7B. "There will be a private bathroom in your room for
you to use."
There was one restroom for the 6 sleep rooms.
At full tilt, it could be Grand Central Station.
For each sensor, your skin is abraded, to remove the top
layer of skin. Sticky electrode gel is applied, and then the
sensor is taped to your body. This process takes about 45
minutes, if there are no interruptions (there will be).
A shower is required right after the test, to remove the
very sticky gel you are covered with. You cannot simply
"wipe it off". There is NO shower at the sleep center.
Here is a list of all the sensors attached to your body
4 on the top of your head
4 on your calves - 2 on each one
3 on your chin
2 behind your ears - one on each side
2 eye electrodes - one next to each eye
1 stomach band - 2 wires
1 chest band - 2 wires
1 oximeter sensor on your index finger
1 nasal sensor taped into your nostrils (the worst, because
it obstructs your breathing)
I think I may have missed a couple.
The bed is flat. The sheets are tightly tucked in,
military style. On your back, your toes are squashed. They
WANT you to sleep on your back, because it is typically the
worst case for OSA (Obstructive Sleep Apnea).
1. I sleep on a radically tilted bed, which I devised
2. Both of my feet must be bare, and sticking out into the
3. I require 2 pillows, the top one being high-tech memory
4. I sleep on a memory foam mattress.
5. I CANNOT sleep on my back - I never do. My throat slams
shut, as both nostrils become useless.
6. I usually have a glass of wine before getting into bed -
they insisted upon no booze. Fine. No sleep for me.
The sleep room should be quiet.
My sleep room was noisy.
1. Conversations in the next room
2. Intercom instructions to other participants are clearly
3. People walking outside are clearly heard - thump,
4. The air conditioning was very noisy.
5, There was no remote control for the TV. She had left the
volume on much higher than I usually listen at, and I had to
summon her to turn the d@mned thing off. I usually go to
sleep with the TV on, and then awaken briefly and click it
I live in the country, where it is SILENT at night. I am not
too big on a CITY sleep center, where there is always going
to be some noise.
The infrared camera and IR light sources are physically
and psychologically intrusive.
There were 2 large infrared LED light sources on the
ceiling, pointing directly into your face. They can be seen
in the darkness as a red glow. Although the room appears
dark, every single move you make is recorded as if it were
broad daylight. The knowledge of this will result in you not
being able to act naturally. This made me feel like I was
acting. The microphone duly records all your moans, verbal
outbursts, gasps, and of course, your f@rts and burps.
READY? LIGHTS! CAMERA! ACTION!
GO TO SLEEP, NOW!
No wonder I couldn't sleep.
Your sleep is sensed, measured, recorded, evaluated and
It was horrible. I never lost consciousness (went
to sleep), even once.
- the flat bed impaired my breathing
- the device in my nose reduced air flow a lot
- the tape was very itchy - I carefully scratched
- the air conditioning sounded like a 747 - every 30
- my mouth was super dry - I found myself eating the peeled
skin off my lips
I pleaded to end the test at 2 AM (began at 10 PM), but she
got me to stare at the ceiling for another 3 hours until 5
AM. It was horrible.
The one bright spot was the sleep technician. She was very
personable, patient, informative and obviously highly
experienced. Unfortunately, she was dealing with a tough
cookie. I apologized several times for not being able to
sleep. She said I slept "a little". I don't believe I
Before I left, the technician asked, "You have your
follow-up appointment, right?" I replied, "No, I don't". She
said, "Oh, you should have been given that at your initial
consultation." They did not tell me that, probably because
it was IN WATSONVILLE! In addition, the date and time were
rammed down my throat, with no consultation with me
whatsoever. The appointment was DURING THE MORNING RUSH
HOUR. There is a reason I am self-employed - I DON'T do
commuting, and I DON'T do RUSH HOUR. EVER. FOR ANYTHING.
YAVOL! AUCTUNG! YOU VILL COMPLY! Sleep Nazis.
I drove home at 5:30 AM, and hit the sack. Ahhh, Sweet
Bliss. I slept like a baby until 11:30 AM. Head elevated,
quiet, no electrodes, bare feet hanging out, constant
temperature, no air conditioning, no infrared jammed into my
I recorded the sleep session. I fell asleep in 3 minutes. I
had multiple apneas, per my usual sleep. Yet, I did not
awaken ONCE in over 5 hours.
260 - 450
Just what kind of a "sleep study" is it, that ENSURES you
will NOT BE ABLE to sleep, AT ALL? Huh? HUH? Not a
very good one, I submit.
$9.50 per minute - $571 per hour - $4,000 per night for NOT
SLEEPING A WINK
You MUST conform to THEIR sleeping conditions, even
though they are TOTALLY UNNATURAL AND UNSUITABLE.
They have NO INTEREST in YOUR DAILY, ESTABLISHED
sleeping conditions, which you require for good sleep (or
-- "Forced to go to bed at 10 PM" - I go to bed at
-- "NO alcohol" - I always have a glass of wine before
-- "The flat bed" - Extremely uncomfortable - I sleep on a
tilted bed, angled at 6°.
-- "Sleep on your back" - I NEVER sleep on my back - I can't
-- "Military bedding" - feet are crushed by the tightly
tucked in sheets - My bare feet must hang out.
-- "Noise" - talking and air conditioning - At home in the
mountains, there are only the crickets.
OK. Go sleepy-bye now. Right.
Here are the results of my follow-up -
1. "You have a very bad case of sleep apnea." I
already knew that.
2. I did not sleep at all, yet they say I slept "for
17 minutes", based upon my brain waves.
3. "Medicare will NOT PAY, unless you
sleep for a minimum of 2 hours."
Where the heck was the disclaimer for THAT?
THE ONLY REASON I TOOK THE TEST WAS BECAUSE MEDICARE WAS
GOING TO PAY 80%. And they want me to take the test again?
NO WAY. How do I know the second try will work? "We will
give you a sleeping pill." Why the heck didn't you give me
the sleeping pill the FIRST TIME?
4. I was told that I must repeat the PSG test, AGAIN,
to which I replied, "I only HAVE to do two things, pay taxes
and die - all the rest is up for grabs."
Is the quest for sleep during a test merely a crap-shoot? At
$4,000 a roll, on my dime? I'm done playing. I lost, and it
is time for me to limit my losses. "Couldn't sleep on the
first $4,000? No problem. We will MAKE you sleep on your
second $4,000." Easy for you to say, on my dime. After all,
it's only patient money.
How many times do you think I am going to throw good money
after bad. Fool me once, shame on you; fool me twice, shame
on me. I have no desire to turn a worthless $4,000 into a
worthless $8,000. One definition of crazy is to repeat
identical behavior, while expecting a different outcome.
5. Where is my copy? Where is my data?
What are my parameters? Where is my
evaluation? Where is my prescription? They
gave me NOTHING! NOTHING! Big, big money, and I don't
even get a printout! What a scam.
6. NO CPAP PRESCRIPTION FOR ME! The whole thing was
in vain. Utterly useless. "Just do it again."
Maybe that first P in CPAP should be an R.
7. The whole experience just made me feel like a
noncompliant errant child, too stupid to benefit from any
printed results. This REALLY piffes me off. There is no way
I am going to repeat the unbelievably intrusive test. I gave
it my best shot - they gave me their best shot. It wasn't
8. I was quoted $3,500. The BILL presented was over
I could probably benefit from a CPAP device. I would buy one
right now if I didn't need a prescription. But I will be
darned if I am going to endure that PSG torture again, only
to experience the same sleepless, uninsured outcome.
I think that "Sleep Labs" are far more about milking you
for your money, than about fixing an incredibly obvious
1. The PSG is an uncomfortable intrusive procedure,
and looks like overkill to me. I'm surprised there wasn't an
@nal probe as well.
2. NO EFFORT WHATSOEVER is made to duplicate the
patient's sleeping conditions. They just don't care.
3. They are totally unconcerned with the COSTS to the
patient - What The Heck, just order another test. The PSG is
just the "prelude" for ordering the next test. Next, you are
going to need a "Split Night PSG". That will probably be
inadequate, so then we will schedule you for a "Standard
CPAP Titration". After that, you should have a MSLT -
Multiple Sleep Latency Test, which may indicate the need for
a MWT - Maintenance of Wakefullness Test. Are we at $15
4. All the equipment the sleep lab sells is
TWICE as much as it is any place else! Read price
5. IMHO, CPAP appears inferior to BiPAP in every
respect. So why do they prescribe CPAP?
- - - A. You must come in frequently for "titrating", at
significant cost. An "Auto" unit is best for ALL
- - - B. You must be "upgraded" later, which means
purchasing another device, and taking another test. Some
sleep centers appear to be really big on "starter units",
which must be replaced by a better unit later.
6. IMHO, the words "Auto" and "BiLevel" should be in
the name of your device.
CPAP = Horse and buggy (antique, with high exhalation
BiPAP = Automobile (modern, exhalation pressure reduced)
7. CPAP, VPAP and BiPAP are NOT for everyone.
According to Wikipedia - "A
recent study showed 60% of patients abandon CPAP use
entirely." So don't get your hopes up too high.
8. Virtually ALL CPAP
masks contain Bisphenol A. In spite of the fact that
manufacturers pooh-pooh any criticism, we now know that ANY
Bisphenol A is bad for ANY human being. It emulates female
sex hormones. Terrible for babies, and bad for adults.
How Bad Am
Sometimes, I get sleep apnea, while I AM AWAKE. When
things are slow, I am staring at my computer, seated upright
at my desk. I will spontaneously start gasping, because I
haven't been breathing. So, in addition to obstructive sleep
apnea (OSA), I also suffer from central sleep apnea
Glossary - Sleep Apnea Terms
American Academy of Sleep Medicine
Apnea/ Hypopnia Index
Automatic Positive Airway Pressure
No titration - pressure is set automatically
Aver. Volume Assured Pressure Support
Alveolar Hypoventilation Syndrome
"Air-flow softening" technology
BiLevel Positive Airway Pressure
Body Mass Index
Coronary Artery Disease
Congestive Heart Failure
Centers for Medicare Services
Complex Sleep Apnea
Chronic Obstructive Pulmonary Disease
Continuous Positive Airway Pressure
Central Sleep Apnea
Durable Medical Equipment
ElectroCardioGram (also, EKG)
Event Detection Circuit
Expiratory Positive Airway Pressure
Expiratory Pressure Relief
Epworth Sleepiness Scale
Forced Oscillation Technique
Inspiratory Positive Airway Pressure
Left Ventricular Ejection Fraction
Multiple Sleep Latency Test
Maintenance of Wakefulness Test
Nocturnal Oxygen Therapy
Noninvasive Positive Pressure
Negative Predictive Value
Not REM sleep
Obstructive Sleep Apnea (Syndrome)
Positive Airway Pressure
Pressure Carbon Dioxide
Patient Interface Box
Periodic Limb Movement Disorder
Positive Predicted Value
Respiratory Disturbance Index
Rapid Eye Movement (dream sleep)
Respiratory Effort Related Arousals
Restless Leg Syndrome
Receiver Operating Characteristic
Right Ventricular Impairment
Arterial Oxygen Saturation
Sleep Related Breathing Disorders
Upper Airway Resistance Syndrome
Variable Positive Airway Pressure
The abbreviations above are provided because -
The medical profession (+ other tech professions) love to
bandy about TLAs - Three Letter Acronyms.
1. This helps immensely to keep you from understanding what
they are talking about.
2. This prevents you from asking cogent, vexing
3. They feel your job is to COMPLY, and not question,
because you are an uneducated lay person, unable to
comprehend the technical aspects of your very complicated
SO, memorize the TLAs above, and you too can sound like a
knowledgeable apnea student.
310 - 450
Apnea Solution -
A Description of My BiPAP
CPAP Equipment Be Deregulated? Andrew Senske thinks so.
I totally agree.
I used to design, build, repair, and calibrate precision
electronic equipment FAR more complex than a freaking air
pump. I can "titrate myself", thank you very much.
Especially with an auto-titration unit. That means it sets
your pressure(s) automatically.
I purchased a low-hours Respironics "BiPAP Auto with
Bi-Flex" in excellent condition, from Craig's List. It came
with the integrated humidifier.
I then purchased a mask and hose from Amazon. I selected the
Resmed Optilife Mask, which uses the nasal pillows. I chose
this mask because many of the apnea forum posts I read were
about those who loved it, after switching from a full-face
You can buy all the CPAP and BiPAP DEVICES and
ACCESSORIES you want on Craig's
List, WITHOUT A PRESCRIPTION. The same is true of
You can buy all the CPAP ACCESSORIES you want on
without a prescription. But eBay does not sell CPAP or BiPAP
devices (the pressure pumps), or the complete masks.
However, they offer a large selection of mask parts, hoses
and filters. It is possible to assemble a complete mask, by
buying all the parts separately on eBay, especially the
Swift Mirage II.
Some eBay search results, performed on Sept. 29, 2010
BiPAP - 334
CPAP - 1,312
REMstar - 136 (Respironics)
Resmed - 275 (#2 supplier)
Respironics - 540 (#1 supplier)
Other brands - nothing much at all
Update - First Night -
I read the manuals, installed the filters, and checked
all my settings. I liked the numbers, so I didn't change a
First night observations -
1. NOISE - the whole system is noisy. This is an even
bigger issue for sound recording, because it is much more
difficult to hear your actual breathing, with all that
whirring and hissing. I have wrapped the entire unit with a
pair of old sweat pants to reduce noise. Device cooling
doesn't seem to be an issue.
2. I did not employ the humidifier, because I wanted
simplicity for my first try. In the morning, I decided I
didn't need the humidifier (yet). I did however, install a
cozy over the hose, not for rain out, but for noise
3. The mask was easy to fit, and the Medium-size nasal
pillows sealed pretty well. However, I felt like I couldn't
breathe easily due to the restriction. The hole size on the
Medium pillows is small, compared to the Large pillow. Next,
I must try the Large nasal pillows, not because they fit
better, but because they have much larger holes for air,
which provide 40% more air flow.
Here are the Respironics Optilife nasal pillow
oval-shaped hole sizes -
P = 4 x11 32nds (relative hole area= 44) - hole
S = 5 x 9 32nds (relative hole area= 45) - hole
center-to-center= 22 32nds
M = 6x11 32nds (realtive hole area= 66) - hole
center-to-center= 24 32nds
L = 8x13 32nds (relative hole area= 104) - hole
center-to-center= 26 32nds
4. STENCH - The smell of new plastic and new rubber
makes me gag - I feel like I can't breathe. There are no
instructions with the hose or the mask about GETTING RID OF
THE STINK. There should be. It is terrible. I suggest
running the whole system for 8 hours, disconnected from your
face, to purge some of the chemicals.
5. The BiPAP starts out at about Inhale pressure=10, and
Exhale pressure=4. After auto ramp-up, Inhale pressure = 12,
and Exhale pressure = 6.5.
6. The nasal pillow system is meant to be used with a CLOSED
mouth, at all times. Don't believe me? Try opening your
mouth. HA-HA! You won't do that again, will you? The flapper
valve in your throat goes nuts.
7. Woke up about 4 AM, so it must have been working. Tossed
it off, and went back to sleep, thinking, enough of
Second Night - Second
I replaced the Medium nasal pillows with the Large size
pillows. The seal wasn't quite as good, but the air flow was
noticably better, due to less airflow restriction.
I still feel that it is difficult to breathe out.
Just having the apparatus there, induces a psychological
breathing restriction. When this is combined with actual
restriction, the overall effect is EXTREMELY uncomfortable
Correction - After auto ramp-up, Inhale pressure = 13, and
Exhale pressure = 8.5. I didn't let it fully ramp up
MY CPAP CONCLUSION
I managed four hours the first night, four hours the
second night, and that was it. Done.
I haven't gone back since. Trying to breathe out against the
pressure is intolerable. I don't like it. I don't want it.
It is no wonder that compliance quickly drops for MOST of
those who try CPAP or BiPAP.
Perhaps I abandoned CPAP prematurely, mostly due to my
wretched experience with the sleep center.
I recently had a discussion with a baseball umpire, who
swore up and down how absolutely necessary CPAP was to his
very existence. He was extremely convincing. Add to that my
continuing health problems, and I fired up my BiPAP once
machine again. On my first try, I slept all night, after
adjusting my mask several times. The second night, I slept 7
hours straight, not even getting up to pee once, which is
unheard of for this 68-year-old male. I still don't get that
"new-man" feeling that some have described, but I will
continue to use the machine for awhile, to see what
CPAP REVISITED AGAIN
I am now totally
committed to CPAP. I am very happy with my old BiPAP
--- I sleep through the night
--- I have stopped my big-time napping during the day
I am stilll fiddling with my nose pillows, but I learned how
to adjust them easily if I should wake up.