This is an offshoot of the original Liam & Janet blog. That blog has become overrun by Liam's inability to keep his mouth shut when something annoys him. The serious rants there seemed incongruous with the humor columns. The plan for the humor columns continues to be to post a new one every Friday, plus occasional extras when the mood strikes.

Tuesday, February 22, 2005

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 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.

Saturday, February 19, 2005

Mr. Vader... Paging Mr. Vader

More in the continuing saga of the sleep apnea. Again, thanks to the friendly folks at, without whom this experience would be no less bizarre, but would be infinitely less fun.

UPDATE: It's come to my attention that not everyone is familiar with the workings of a BLOG. Newer posts are posted above old. This one is the second in a series (of two, so far). If you have not yet read the first part, please page down to "Modern Medicine: Takes My Breath Away" first, and then come back to this one. Thanks, Liam.

Vader, Paging a Mr. Vader.

I have a game for you. By the time you read this, you have probably already read my diatribe on my first experience with modern sleep disorder medicine. In this article, I made one crucial mistake, and I challenge you to find it. Need a hint? It's in the second to last paragraph. Still missing it?

In that essay, I wrote the fateful phrase "...and told to come back to repeat the procedure...". Innocent enough, right? Can you guess which phrase has gotten the MOST reaction from people? Right, that one. A significant fraction of readers of the essay have said something like "Please let me know when you write the essay on the second visit, I have to read it!" I'm flattered, but...

My second visit was just like my first, only with less sweating and hand wringing, and more of a general resignation as the cart-o-pain was wheeled into the room. Now, I suppose I could just post the first essay again, changing a few key sentences, and say "Look! What you asked for!", but most likely that would not satisfy. I could go into more detail on what happens at a sleep study, but that would be boring ("...and then, when the clock read 12:17am, I rolled over and scratched an itch on my left buttock...").

So now I'm in a bind. My public is calling (even if my public consists primarily of 9 people, 4 of whom are family members who read the first one because I insisted), and I have nothing to give them.

So let's fast forward to the morning AFTER my second sleep test. It's morning, I haven't slept, I have to head over to work, and after all of that, I'm in possession of.... a number. Really, that's what I got. 9. Apparently this number means something. The magic answer to all of my troubles. 9.

It turns out, that's the pressure setting for my CPAP machine. Yeah, that's the problem with modern medicine, they're never content just to DIAGNOSE a problem, they always want to FIX it, too. In this case, the fix is a CPAP (Continuous Positive Atmospheric Pressure) machine. At least that's what they call it, but they can't fool me. When I was a child, my parents had an old "canister style" vacuum cleaner, and you could pull the hose out of it's normal socket and plug it in to the exhaust, and now you had a blower. Sometime between then and now, some enterprising child combined that with a nice game of "playing doctor", and the modern CPAP machine was born. There is an important difference. If you stuck the end of the vacuum cleaner hose into your mouth, you ended up blowing the contents of your nasal passages all over your hands and your shirt and anyone in front of you. Don't ask me how I know this. Let's just all assume I'm so intelligent, I can guess.

The CPAP machine blows at a much lower pressure, and at a much lower volume, but the principle is the same: Force your throat open and air into your lungs, and you'll no longer stop breathing in the night. By the way, you need a doctor's prescription to buy a CPAP machine, and yet to my knowledge there is still no restriction on buying a canister vacuum cleaner, which is also much cheaper. Not that I'm suggesting anything.

When I got my CPAP machine, it came with a fancy setting called "CFLEX". I can only imagine this is for Mr. Universe, as the only part of my body which will still flex is my tongue, and that only... well let's just say I talk in my sleep, and it only gets worse when I'm conscious.

It turns out, getting your CPAP machine is just the START of the fun. Interface technology has come a long way as well, by which I mean, they put something on the END of the hose, and attach that something to your head with straps. That something is called a "mask", and BOY are there options. There are nose-only masks, there are mouth-only masks, there are "full face" masks, and I'll bet if you looked long enough, you could find someone selling a rectally fitted mask. If you find one, I DON'T WANT TO KNOW.

But the "hot ticket" in CPAP masks these days is something called "Nasal Pillows". They call them that because "Nostril Stretchers" wouldn't sell. But actually, they work quite well, if you can breathe through your nose. And if you don't have a cold. And if you don't have an allergy attack. And if you don't have sinus trouble. In other words, about one day a month. The rest of the time I'm on the good old Full Face mask, which looks like a clear plastic version of the mask which "will drop from a compartment above your head, in the event of a loss of cabin pressure". As I'm putting it on at night, I'm always aware that even if my kids have climbed into bed with me, I must put my own mask on first BEFORE helping them.

So, to recap. CPAP machine? Check. Hose connected? Check. Mask connected to hose? Check. Mask on face? Check. Straps cranked down just tight enough to leave nasty red welts on my face for everyone at work to comment on tomorrow? Check. Time to turn on my CPAP machine for the first time. Time to become... Liam Vader, Lord of the Sith... which I shall tell you about next time, as my wife just pointed out that it's midnight, and I've been saying "A few more minutes, hon" for the last hour and a half's worth of "Can we go to bed now?". Besides, the CPAP machine is waiting, and it gets jealous if it thinks I'm sleeping with other hoses.

Good night.

Copyright (c) February 19, 2005 by Liam Johnson.

Thursday, February 17, 2005

Modern Medicine: Takes My Breath Away

Since you so politely sat through the more serious essay, here's the first lighthearted one. My intent was to create an essay similar to one Dave Barry might write (although clearly I'm no Dave Barry). I hope to write new essays perhaps weekly or bi-weekly. --Liam

UPDATE: It's been pointed out to me that this essay was largely inspired by my interactions with friendly folks on a sleep apnea themed website, If you have apnea, or are considering getting it, you should definitely check it out.

Modern Medicine: Takes My Breath Away

How many wires can be attached to one human being?

If you're anything like me, this is not a question you ever really wanted the answer to. Certainly not if the human being was yourself, and CERTAINLY not if you were then expected to sleep.

Welcome to the modern Sleep Study, a procedure whose purpose seems to be to see how much medical equipment is required to prevent a body from losing consciousness... and then to measure how well you sleep.

It was via just such a procedure that I was recently diagnosed with Sleep Apnea (from the Latin root "apnae", literally translated, "Yeah, Right"). Essentially what this diagnosis means is that during the night of my sleep study, while I was sleeping, periodically my throat closed and I stopped breathing. This would concern me, except that with the application of roughly 4700 electrodes to my skin, the discomfort was such that I think my throat was simply trying to end the torture.

I arrived at the Sleep Disorders Center at around 8:30pm on a Wednesday night with excited anticipation (my hospital had received four stars in Zagat's and a recommendation in Fodor's) and was immediately sent to my room to wait for the sleep technician. In hindsight, this was not unlike being sent to my room to await the arrival home of my Dad when I was a child, although so far no one has been willing to tell me what rule I broke. I was definitely in "Time Out".

The wait was approximately an hour, while this sleep technician, this Marquis de Sade of the medical profession, worked his dark arts upon another poor victim. Eventually, he arrived, towing behind him a cart with enough wires and gadgets and gizmos to repair the Hubble Telescope, and possibly even build one from scratch. The first thing he did was take my blood pressure, because clearly having just been confronted with that mass of equipment and having just started imagining all of the cruel and heartless places he planned to put them, I was at my most relaxed. I forget what my reading was, but I believe the pressure at the heart of a small star is lower.

Next, he left the room (leaving my cyborg other half on the cart beside me), telling me to get into my sleeping clothes, and he'd be right back. This was clearly some definition of "right back" of which I am not aware. Sitting there staring at the medical implements o' torture, I estimate I waited through at least two Presidential administrations. Finally, he returned and began laying out wires across my body, asking me to thread some of them in sensitive places where, trust me, you do NOT want wires.

In case you haven't yet grasped the extent of my experience, here is a partial list of the sensors they put on me, which I am not making up or exaggerating in any way:

· Roughly 10 electrodes on my scalp and face, for an EEG.
· Another 4 electrodes on my chest for an EKG.
· Two more on my legs to detect Restless Leg Syndrome.
· A "canula", that little device you sometimes see under the nose of patients who require supplemental oxygen.
· Two straps, around my chest and abdomen, to measure the expansion of breathing.
· And to top it all off: a sensor on my finger to measure my blood oxygen saturation.

(By the way, I highly recommend the blood oxygen sensor. It makes your finger light up like ET's, and turns a part of your body into your own personal portable night light).

Finally, I was entirely wired up (I'd missed yet ANOTHER election by this point, I have NO idea who the President is today. I assume the answer is "Not still Reagan".) and I had to, you guessed it, use the rest room. Fortunately all of the wires conncted to me had been bound behind my head with a medical scrunchy into a pony tail. For those who do not know me, this is the closest my head will ever come to supporting a pony tail, in so far as I have less individual strands of hair on my head than most people have individual fingers. So I trudged carefully into the bathroom, pulling a cart with the end of the pony tail on it, into the bathroom, and got a good look, for the first time, at the future of humanity after the robots take over and start assimilating us. It was not pretty.

Then it was back to bed, for a nice, calm, restful night's sleep (in the sense that a tornado blowing through the New York Stock Exchange in the middle of a trading day is calm and restful), so that the sleep technician could monitor my every breath and movement (and probably more than a couple of undignified personal region scratchings) and tell me whether my sleep was disturbed. Surprisingly, the answer was: Yes, it was. Who'd have thought. And thus was I diagnosed with Sleep Apnea, and told to come back to repeat the procedure, this time with a mask strapped to my face so that they could "titrate" a "pressure" to keep me "breathing".

And thus ends my first sleep study. An uncomfortable, relatively sleepless night, but at least I can report, for those who were concerned, that hospital beds are just as uncomfortable as ever, and hospital blankets have actual cooling systems woven into them, just like always. Nice to know that the classics never change.

Copyright (c) February 17, 2005 by Liam Johnson.

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