Who Was That Masked Man?

Just so that no one gets the wrong idea, my INTENT is to write one entry per week. Today (a Saturday), I have a major release going on at work, and so my day consists of brief flurries of activity punctuating long boring stretches with nothing better to do that scratch the itch created as more hair follicles die.

As before, this is the third posting in a series. If you have not yet read parts 1 or 2, please page down and read "Modern Medicine: Takes My Breath Away" and then "Mr. Vader, Paging Mr. Vader" before continuing on to this one. As always, thanks to the folks at cpaptalk.com for inspiring this series of essays.

Who Was That Masked Man?

As you will no doubt recall (and if you don't, scroll down and read it again!), when we left off, I was just about to put the mask on my face for my first night on CPAP. Before we start, I need to clear up a misconception.

Several people have asked if I meant CRAP, as if I am somehow capable of typing these long essays more or less typo and spelling error free, only to CONSISTENTLY misspell the name of my therapeutic device. The device is called a CPAP machine, pronounced "SEE pap", and it stands (if there's any justice in the world) for "Constant Pain And Puffiness". No, seriously, it's "Continuous Positive Atmospheric Pressure", although what's positive about it I've yet to figure out.

Now, back to where we were, in my bed, about to turn on the machine. By the way, I have to ask any readers who happen to be attractive and female to stop reading right now. I think my wife would accept my inviting the REST of you into our bed, barely, but there are limits.

Are they gone? Good. So, we're in my bed, and I've just put on the mask. Time to turn on the machine. Which button was it now... Oh, right, this one, I'll just press it and WHOOOOSH! Wow. Now that's quite the sensation! Somewhere between being on a roller coaster and being flushed down a toilet, all while lying on your back in your bed. The wonderful feeling of the wind blowing through your hair. Well, not really, unless like me you have facial hair. Or unless you’ve strapped your mask onto some unusual portion of your anatomy. Or unless you’re one of those unfortunate people who sprout crops of nasal hair like you’d shoved sheaves of wheat in each nostril. But I’m not here to make fun of your obvious physical oddities, so it’s time to go on to a discussion of: masks.

The kinds of masks are:

• Those that cover your nose.
• Those that cover your mouth.
• Those that cover both your nose and mouth.
• Those that sit on the floor hissing after having been ripped from your head in frustration and thrown as far as the length of your hose will allow.

(Doctors tell me that this last type of mask has zero therapeutic value, although in my experience, the throwing has a cathartic effect unrivaled since my days of midnight primal screams on the quad in college.)

That’s it, those are your options, barring any advance in pressure delivery technology of which I am not aware, and assuming you are not one of those body modification folks who ran out of places to pierce and decided a tracheotomy would be just the thing.

The Full Face mask is appropriate for those who enjoy not being able to see clearly at night or who enjoy having fantasies of flying an F-16 fighter jet while lying down curled up in the fetal position. "Full Face" is a misnomer, in so far as it really only covers the nose and mouth, putting just enough pressure on the bridge of your nose to leave a little red welt for everyone at work to stare at but never quite comment on. Full Face masks are appropriate for those who enjoy maintaining a feeling of slight paranoia at all times.

I have not tried a mouth only mask, but I understand from those who have that the largest drawback to them is that the human nasal passages were not designed to remain closed during mouth breathing. Many people get clogged sinuses on a regular basis, but few have sinuses which close off completely. As a result, in order to most effectively use an oral mask, you must either use a painful "clip" to keep your nostrils closed, or else shove the nasal equivalent of ear plugs way up in there, which reminds me too much of those cork rifles we had as kids. If you regularly sleep with a partner, I imagine the temptation would be almost overwhelming for your bed-mate to wait until you were asleep and then start adjusting your pressure to see how much is required to get a good shot going, and what kind of distance they can accomplish. Besides, the oral mask conjures up too many painful memories of that canister vacuum we talked about in a previous essay. Which leads us to...

The nose-only mask. These come in two varieties, a true nasal "mask" (which looks light the fighter pilot mask, but only covers your nose) and "nasal pillows". Thank heaven someone came up with nasal pillows, because I never realized just how little sleep my nostrils were getting until I gave them some nice, soft nasal pillows to rest on. Nasal pillows (and variants "nasal prongs", which sounds like something in a medieval dungeon. "Sire, he still won’t talk!" "Break out the nasal prongs!") are odd little plastic bulbs which rest at the opening of your nostrils, forcing air in. And although that’s how it’s been described by other users, to me this description only works if by "rest" you mean "jams inside, pushing and stretching until it feels as though you went to snort your favorite recreational drug and got a ping pong ball instead". (Not that I have ever gone to snort any recreational drug, but if you’re INTENTIONALLY trying to snort ping pong balls, you need more help than I can provide in one of these essays.)

The "mask" style of nasal CPAP interface is an interesting affair, which feels just about wrong in every way. When I first saw one, I thought that the Air Force had finally succeeded in it’s goal to train guinea pigs to fly combat missions, and that I’d accidentally been given the wrong species’ mask. But no, the reason it’s that small is that it fits over your nose only.

One of the brands of nasal mask is called the "Activa", and this mask is so special, it deserves mention on it’s own. What makes it so special is the apparatus used to form a proper seal between mask and face. This consists of a membrane which fills with air as you inhale and deflates as you exhale, the net result being that it feels not so much like a mask as like a beating heart, or perhaps like being groped by someone with a very odd preference in erogenous zones.

One thing all three major types of masks have in common is: You can’t talk when you have one on and the CPAP going. I suppose that would be obvious with the oral masks, and the full face masks, although you CAN talk, you end up sounding like the adults in a Peanuts animated special. You would think that with a nasal mask, you could still speak well, and that’s true as long as your CPAP machine is not turned on. Once it is, however.... about every third word is lost in gasps and hisses and belches and "mouth farts" as the high pressure air shooting into your nostrils escapes through the sealed back of your throat, the result being that you sound amazingly like what one might imagine a snake would, if snakes could talk.

Anyway, I think this concludes my series on sleep apnea. There are certainly other topics I could cover, like the biPAP machine (a machine which makes other machines of BOTH genders mildly uncomfortable) and the Auto-titrating CPAP machine, but as I have used neither, said essay would consist entirely of repeating what others have said about them, and I have no wish to be confused with Senator Joe Biden. My hair (missing though it is) looks better.

Copyright (c) February 22, 2005 by Liam Johnson. http://www.liamjohnson.net