Diary of an exhausted man

It feels like I've been tired most of my adult life.

I can have the requisite eight hours, no screens, fresh air and dim light and still wake up feeling knackered.

So, when a stranger sees me gazing at breathing apparatus in the local chemist and introduces herself as a 'CPAP disciple', I'm happy to listen.

CPAP stands for Continuous Positive Airway Pressure and it is basically a mask you wear on your face that is powered by a machine which pushes air into your throat to stop your airway closing while you're asleep.

It's for people with obstructive sleep apnoea (OSA); episodes of waking during sleep because they've stopped breathing momentarily.

Over the years, CPAP machines have changed enormously. They're no longer something the size and volume of a noisy bar fridge, with a face-swallowing mask to boot.

Now, a high-tech computer-controlled unit sits quietly on a bedside table blowing air almost silently through a demure rubber 'nasal pillow'.

The stranger raves that her machine changed her life; no energy slumps in the afternoon, losing weight because she has not propping herself up with sugar, being more productive...

Most importantly, she's rising from her bed in the morning refreshed and ready to punch the world in the face.

I like what I'm hearing.

My sleep numbers revealed

A few years earlier, a clinical sleep study suggested I use CPAP, but I had been in denial. Suddenly my interest was reignited.

It turned out the pharmacy offered home sleep studies, where you fit yourself with a belt and sensors hooked up to a memory card, which records your sleep behaviour.

I gave it a go and my old diagnosis returns to slap me in the face.

But it could have been worse. Way worse.

I have 7.2 apnoea 'events' in an hour. An event is where your breathing stops and your blood oxygen levels drop.

The pharmacist told me he has seen figures of 80 per hour, so I am a mild case.

As for blood oxygen, mine drops to 84 per cent when it should hover around 94 to 98 per cent.

Snoring and sleep apnoea

But then comes the snoring.

I'm recorded having just over 1000 snoring events a night. Jet engines are quieter than me, and they keep planes up.

Not all snorers have obstructive sleep apnoea, but all apnoea sufferers snore.

The soft tissue at the back of the throat that vibrates when you snore is the same culprit for airway blockage, causing an apnoea event.

The CPAP machine prevents those blockages occurring by varying internal air pressure.

That way you stay silent, your partner re-discovers they quite like you, and you awake feeling like a champion because you are not wrestling with partial suffocation during sleep.

What could possibly go wrong?

Becoming Mr Curly

I decide to rent a machine for a trial.

I place the head strap on which connects, umbilical like, to the main unit via a pipe that swivels on a join at the crown of my head. I look like Michael Leunig's Mr Curly.

This way I can sleep in any position and not be strangled in the night.

The air flows from the machine to the top of my skull and then gets piped down the sides of my face to arrive at my nostrils via the soft latex nasal pillow.

I turn off the light, shut my eyes and within minutes I'm asleep.

Next morning, I awake sensing something strange. It's dawn.

I feel like the air from my night on the machine has left my head over inflated. It feels so big, I could hang a wicker basket from it, and offer people champagne and a sunrise ballooning adventure.

Yet I'm still tired, while wide awake, if that makes sense.

As the day unfolds, I notice I can focus longer, and not follow thoughts down cul-de-sacs. Or is that just wishful thinking?

Love magnet

So let's talk relationships.

I'm pretty sure strapping a pipe to your face hardly defines you as a love magnet, but then again neither does snoring like a wounded buffalo.

Perhaps it's best not to mention the CPAP thing until the second date, I pondered. Or not at all?

As it turned out my new partner also had something she hadn't mentioned.

Yep, I'd managed to inadvertently hook up with someone on their own CPAP adventure!

One night we fill both our tanks with distilled water, wish each other a breathy good night, clack pipes and turn off the light.

The end of the honeymoon

Three weeks later, and my CPAP trial seems to be over.

Getting to sleep remains easy, but staying there is a nightmare.

Every morning, I'm jolted awake at 4.30am with the machine blowing hard to combat an apnoea event.

So perversely, I'm getting less rest because of it.

I start to avoid the machine altogether, knowing what awaits. It sits next to my bed as a guilty reminder of what I'm not doing.

In the end, the pharmacist prints off all my sleep data and, armed with a dossier of my own failure, I visit a hospital clinic to meet sleep specialist associate professor Mark Howard.

Other options

Mark is the Director of the Victorian Respiratory Support Service at Austin Health and he points out that since my condition is mild, there may be options other than CPAP I could try.

There is the mandibular splint that keeps your jaws in a position which stops soft tissue closing, and the tennis ball strapped to your back so you sleep on your side.

Not that that helps me. Mark notices I am having the same number of events in any position.

He also takes me through the bad decisions I am making every day prior to going to bed; going to sleep too late, using screens in the bedroom, having a blue light charging my mobile devices next to the bed, eating too much before sleep which revs up my metabolism, and how even moderate amounts of alcohol can really get in the way of my airways staying open.

And there is losing weight and getting more exercise.

I feel both chastened and re-enthused.

Pharmacy sleep tests

With the problem of expanding waistlines increasing sleep apnoea cases, Mark Howard believes pharmacy issued tests have a role to play in meeting demand for diagnoses.

But he thinks it is important there is appropriate training, and for some cases, professional intervention from a doctor who is a sleep specialist can help ask the right questions.

"Have I got a different problem? Maybe I've got a thyroid problem, do I have iron deficiency ... could it be one of my medications that's making me feel tired and lousy? Is it depression? Because there's a strong overlap between depression and sleep symptoms as well."

He also believes there is a potential conflict of interest between pharmacists providing apnoea diagnoses while also selling an expensive treatment device like a CPAP machine, when, in some cases, other options could be cheaper and more effective.

A different path

In the end, I gave back the CPAP machine. We didn't get on.

I decide to follow Mark's advice and try to lose around 10 kilos, and see if my sleep apnoea and snoring improves.

That may be enough.

At the very least, I'll be a lighter sleeper even if I continue to sleep lightly.

Do you need a sleep study?

If you think that you may have a sleep problem, the best person to see first is your GP, says Professor David Hillman, vice-chair of the Sleep Health Foundation.

"Having a sleep study without seeing a doctor is not the best way to do it."

Obstructive sleep apnoea is a significant medical condition, he says. People who suffer it often also have high blood pressure, heart disease, depression and diabetes, which may themselves need medical treatment. This, and the variety of treatment operations "need careful consideration". 

"A well-informed GP is a good start."

Will treating sleep apnoea help you live longer?

To this point, science has not proven that treating sleep apnoea will reduce the health risks associated with it.

"A very big Australian study recently published didn't find any reduction in risk, particularly for heart disease," says Associate Professor Howard.

"There may have been a reduction in stroke risk but they weren't able to clearly identify that."

But treating sleep apnoea still leads to more alertness, stable moods, weight loss, better overall health, and less risk of crashing behind the wheel of a vehicle.