My Obstructive Sleep Apnoea Diagnosis
My story: I should have known better…
This is my previously undisclosed and professionally embarrassing story, of failing to recognise my own, sleep apnoea symptoms.
It is NOT a ‘woe is me’ story.
It’s my journey to a diagnosis and my initial struggles.
I share it now, some 3 years into PAP therapy, in the hope it illustrates:
- How easy it is to miss or ignore sleep apnoea symptoms developing
- The difficulty (and delay) sufferers may encounter in obtaining help
The irony is, that I’ve worked in the sleep industry for over 25 years…
I really should have known better.
How it all began…
In 1994, whilst working as a dental technician, I received a prescription to make a custom oral device for sleep apnoea, known as a Mandibular Advancement Device.
Two years later, in a shed in my garden, I set up the first EU specialist dental laboratory (Zacher Sleep Appliances – ZSA) to exclusively make these devices.
Fast forward 11 years and here I am pictured right, wearing a PAP mask, larking around on a training course.
My career had moved into the corporate world (still within the sleep industry) and I found myself snoring.
So, I became a custom anti-snoring device user!
The custom, adjustable, prescription, Mandibular Advancement Device (MAD) kept the peace at home… and as far as I was concerned I had no sleep apnoea symptoms…
Talking about snoring – it’s embarrassing…
The year was now 2009.
My Chance Sleep Apnoea Diagnosis and Timeline to Treatment
In September 2015, I underwent a home sleep apnoea test, as part of a test run of our anonymous sleep apnoea process.
What is a home sleep apnoea test?
My intentions were merely to:
- Provide some real data for our then hospital partner to work with (Royal Papworth Hospital NHS Foundation Trust).
- To ensure all the pieces ‘joined up’ and everything worked as it should.
Much to my surprise and frankly embarrassment, I was anonymously diagnosed by the specialist Consultant Physician with moderate, obstructive sleep apnoea syndrome, or OSAS as it is known.
Yikes!
And this home sleep apnoea test was carried out whilst I was wearing my custom-made anti-snoring device (MAD)…
For the record, I had a BMI of 23, was otherwise fit and healthy, and thought I just snored…
Adrian reflects on some patient stories about snoring and sleep apnea
Then the ‘Fun’ started:
Getting my GP to take me seriously wasn’t easy.
On the 12th October 2015, I contacted the GP and sought a referral to Royal Papworth Hospital, explaining all the above.
Nothing happened.
About a month later…
On the 10th November, I once again contacted the GP.
This time I was taken seriously and after my case had been reviewed by the Clinical Commissioning Group…. (as I wanted to be treated outside of the County I lived in) on the 22nd January 2016, I finally attended my first appointment at Royal Papworth Hospital for assessments such as:
- height
- weight
- medical history
- a review of my ASAP™ diagnosis and GP referral letter
Then on the 2nd March 2016, I collected a loan Automatic PAP (APAP) machine from the hospital. I was to use it for two weeks to determine the optimal therapy pressure my ‘own’ PAP machine would be set at.
(For cost reasons, this process is common practice in the UK. A short loan of an automatic machine to establish your optimum treatment pressure, and then this pressure setting is transferred to the fixed or ‘continuous’ PAP pressure).
I returned to Royal Papworth hospital once again on the 14th March. This time I collected ‘my own’ CPAP machine, set up using the information from the APAP.
Get it?
You will have noticed the passage of time here, no doubt.
Some 4 months after my GP started the ball rolling, I began my lifelong relationship with PAP.
An important point to note here, is that I’d ALREADY UNDERGONE a multi-channel sleep test WITH Consultant Diagnosis and presented this report to my GP.
So, from GP to Consultant this may be considered an accelerated timeline to actually commencing therapy…
Oh, but we’re not done yet…
A 3 month review followed.
Today, I have an updated PAP machine that starts automatically (a nice touch) and a display panel of stats about how I have slept (I can now geek out like anything!)
It also shares my data (with my permission) with the hospital and the PAP machine manufacturer.
But that’s another story…
CPAP Sucks?
Nope, you’re using it wrong!
Around came the 27th April 2017 and I was now struggling badly.
Air was leaking into my eyes, and it felt like the mask was blowing itself off my face during the night! Also, the inside of my nose had become very sore.
I contacted Papworth and the Hospital staff were brilliant. They saw me within a few days of my call.
A new mask and humidifier later and I had overcome the air leaks.
However, throughout May and June, I continued to struggle with a sore nose:
Don’t be tempted to put petroleum jelly up your nose (really harmful to your lungs).
My nose soreness gradually improved as I increased the humidification level, but as a consequence of increased humidification, I ‘enjoyed’ some rainout issues (not going into that now). Check out our PAP guide for more about humidification and rainout.
Follow up appointments in June and the repeat sleep test (despite a terrible night’s sleep in a lousy hotel bed) reported that my sleep apnoea was well treated.
Now, I‘m on an annual review cycle:
I feel massively better, more alert and a whole lot less irritable!
Grrrr… LOL
I must note that I bought a different ‘mask’ than the one I began with, as I made the classic error of over-tightening the straps… also I found I move around a lot at night and displaced the full face mask (you can see what I use now in the big image at the top of this post). Happily these are now stocked by the NHS hospital I attend.
Today, I wouldn’t consider ever going to sleep without using ‘my’ PAP.
Three Key Messages:
1. Sleepiness sneaks up on you.
‘Sleep’ is my industry and has been for over 25 years, yet I failed to recognise my own symptoms.
Only now, do I realise how sleepy I had become.
Today, I’m so much better, that when my wife and our 2 small children fall asleep on long car journeys, I feel proud to be compliant with PAP therapy, because:
I’m alert enough to protect my family, drive safely, and let them sleep.
2. Follow-up of MAD effectiveness is ESSENTIAL.
To be explicit: objective follow up of unimpaired breathing while asleep.
NOT to be confused with dental follow-up… which while certainly necessary is not about the ability to sleep and breathe at the same time.
I believe it makes sense for oral appliance users to have a repeat home sleep apnoea test annually.
In my experience, this just doesn’t happen and as such, it is letting patients down badly.
My personal experience of becoming a ‘silent apnoeaic’ (I thought I was fine as I was wearing my MAD) really concerns me.
How many people are out there, who like me are wearing their MAD, in ignorance of a change in their condition, from benign snoring to OSA?
3. Regulatory systems are counterproductive.
It takes perseverance and a long time to get diagnosed and then established with effective and tolerable therapy.
First you must convince your GP, and then when you’re taken seriously; you begin your months long journey to therapy.
All the while you MUST not drive until proven to be no longer sleepy/drowsy.
Remember, your GP is now compelled to inform the DVLA if you consider driving during this time.
It’s a crazy situation, but today I totally understand why people who drive and have a drowsiness / sleepiness problem, are unwilling to seek help.
Take Home Message
So, that’s my story. Not ‘woe is me’.
I hope that if you’re reading this and either you or someone you love is snoring, you take the situation seriously.
To my shame, I didn’t and I was lucky to be diagnosed, because I am in the industry.
IF YOU SNORE – GET SCREENED FOR OBSTRUCTIVE SLEEP APNOEA BEFORE CONSIDERING ANY TREATMENT OR ‘CURE’
Consult a sleep-trained pharmacist
When ear plugs, self-help and pillows aren’t cutting it – it’s time to get serious.
A sleep-trained pharmacist can direct you to the most appropriate expert to help you stop snoring.
They can also help with lifestyle issues (which may be the underlying reason why you snore).
They will screen you for sleep apnoea and decide if you need further investigation i.e. a sleep study.
If you don’t need a sleep study they can direct you to a sleep-trained dentist for a custom-made, anti-snoring device.
Which is the first way to stop snoring and also treat mild to moderate OSA3, 4.
Conclusion
Yep, PAP is intrusive and you have to persevere with it.
It is not sexy.
Ideally, you want to be in a stable, long-term, supportive relationship. Or single!
Sleep apnoea treatment was absolutely transformational
When you feel more alert, you realise how sleep deprived and frankly, downright unpleasant to know, you were before.
PS. I say ‘sleepy’ when others may say ‘drowsy’.
It’s the same thing.
It just remains for me to say, how lucky and grateful I am, to have a wonderful wife, who stood by me throughout.
Sleep apnoea treatment was absolutely transformational
…you realise how sleep deprived and frankly, downright unpleasant to know, you were before.
I’m 42 years old relatively healthy bmi around 25. I snore a lot and loudly and my girlfriend has told me I have seemed to stop breathing for a second or two in the past and have sometimes woken myself up. How do I persuade my GP to treat this seriously? Thanks.
Hi Roy. Thanks for commenting. As you may know from reading my story, I ‘m NOT a Doctor and therefore cannot give you medical advice.
You are quite right that getting your GP to take you seriously is the first challenge. Regrettably, your GP may not know much about sleep-related breathing disorders, which sadly do not currently form part of their required basic education. They may have attended CPD classes so who knows?
My suggestion would be to initially use our signposting tool, https://snorer.com/how-to-use-snorer-me-signposting/ print out the report and put the outcome in with your letter and GP Guidelines https://snorer.com/gp-guidelines-snoring-sleep-apnoea/ Then post them (with a covering letter) to your GP (leave it a week or so to give them time to read it) and then make an appointment with them.
They will be looking primarily for sleepiness/drowsiness during your normal awake time. The trouble is the assessment is subjective and even then it sadly bears little correlation to the severity of the condition. Furthermore, we ‘forget’ what alertness feels like, so its only when successfully treated do you appreciate how bad you were beforehand.
Hope this helps. Good luck!
Adrian
A most interesting report. I do not, to my thinking, have a problem but it is clearly explained exactly the steps to take if you, or your partner, detect a problem. Thanks.
Thanks for commenting Sylvia. While snoring is easily partner perceived, partners play a vital role observing and most importantly communicating positively about changes in the snorers ability to stay awake and alert.
Its a slippery slope and as my personal story demonstrates, its too easy to ignore the signs, signs a partner or family member may recognise.