The Discovery Phase
Starting in December 2023, I was outside of the home and while I was driving I felt really “out of it”, I felt almost like I was in a dream. I started to panic and I tried to calm myself but couldn’t so I decided to power through my errands. The feeling kept intensifying and by the time I got home I asked my wife to call a friend and went to the emergency room. They said everything was fine.
For the next 8 months, nearly every single day was a struggle. I was tired and zoned out most of the time, I couldn’t focus, I became quite forgetful, my anxiety was at an all-time high. Fears I conquered long ago (such as fear of flying) resurfaced more severely than I ever had, intrusive thoughts became much more intense, basically everything got worse.
I was also gaining weight for the last couple of years and nothing I did changed it. I usually fast and eat 1 meal a day for the last 15 years, and I get a decent amount of steps per day. For about 4 months I tried alternating between swimming / jogging 1 hour daily, and my weight still kept increasing. I went from 65 KG to 80 KG with this routine.
When I feel weird like this, I usually go get my eyes and sinuses checked, and so I did. I saw many doctors during these 8 months and everybody was telling me things are fine and nobody had an answer. Luckily I found a new family doctor and he suspected I might have Obstructive Sleep Apnea and I saw a doctor that suggested I get a sleep study. I battled around 4 months with insurance to get them to approve it. Unfortunately that study also said that I have a mild case of it and suggested I lose weight to improve my symptoms, but
- The devices used were very basic, if the results are inconclusive they usually repeat the study with more advanced devices
- I always knew from the moment I woke up how my day was going to be like in terms of my symptoms, so it’s definitely my sleep that’s causing this
- My weight was just slightly overweight, and losing about 6 KG had zero improvement
I eventually discovered Dr. Wail Yar at MyClinic and he ordered the more advanced test, and MyClinic’s team got it approved through insurance immediately (no 4 month battle this time!). This time we had more conclusive results, I had moderate-to-severe Obstructive Sleep Apnea, I was spending 3+ minutes without oxygen every night.
A lot of things happen in your sleep, when you stop breathing your body panics and disrupts that natural cycle. Your body will produce adrenaline (can increase anxiety) and wake you up so you can deal with whatever is stopping your breathing, you will burn less calories while asleep, and so much more.
Dr Wail set me up with a Resmed Airsense 10 and a Philips DreamWear Nasal Pillows mask.
Per the doctor’s instructions I used them for the first 10 days while awake for an hour to get used to them, it was difficult but I managed.
The First 6 Months With the Device
After the 10 days of getting used to it, the first few weeks were fine but I would wake up with an incredibly and painfully dry throat and mouth. A quick read online showed that is most likely because I am breathing through my mouth, causing all the air pressure to vent out of my mouth. I kept using it regularly regardless of this.
I did notice a lot of improvement by the third month.
- I can dream again! I stopped dreaming for years before this and didn’t know why, only using a CPAP device brought them back
- My anxiety was down
- My focus was back
- My intrusive thoughts were decreasing
- I could do things I became irrationally afraid of again
- My weight finally started going down even though I quit exercising and changed nothing about my diet or routine.
There were days were I felt very fatigued, and they coincided with the days where I was mouth breathing while asleep. I also had days where the device was blasting me with cold air and sometimes even water, further irritating my sinuses and making using the device harder. My mask also happened to have a slit in it at the very front to vent out air I exhale (to prevent rebreathing Co2, which is dangerous), but it blasted my partner and baby with air so I couldn’t sleep next to them anymore.
So I went looking for solutions:
- Chin straps - Something that wraps around your head, and tries to keep your chin up so you don’t open your mouth while asleep
- Mouth tape - A way to forcefully keep your lips shut
- Hybrid full-face masks - A combination of nasal pillows and covering my mouth, to keep the air pressure in in case I opened my mouth
- Heated tubing - Basically a tube that keeps the air hot throughout the entire tube
- Increasing humidity manually - The device has a humidity setting, more humidity should help with the dryness
- Tube hangers/holders - Keep the tube elevated, so that even if water starts to buildup, it doesn’t reach you
I also learned that there are parts that you need to replace regularly (see your manufacturer guidelines) and unfortunately no tier of insurance I found in Saudi covers them. They are:
- Mask
- Headgear
- Humidifier
- Tub
- Filters
Types of Masks
Every person’s face is very different, you may be lucky to find the first mask on your first try or have to try different kinds out until you get to the right one. This can be very expensive unfortunately.
Nasal Pillows
These masks go slightly into each nostril, but can be irritating for some people, especially on the sinuses. These were the best for me in terms of seal.
Nasal Cradle
These masks rest right below your nose, they are very comfortable, they slightly irritated the skin around my nose but it was very bearable. They can also lose their seal more easily than pillows but were overall very secure for me.
Hybrid Full-face
These masks are kind of a blend between full-face and nasal pillows/cradles. They’ll sit under your nose and maybe slightly around it and cover your whole mouth. They are recommended if you can’t stop mouth breathing no matter what you try. They’ll keep the pressure. They’re not great at sealing if you have a lot of facial hair (YMMV).
Full-face Masks
The masks typically cover the bridge of your nose and mouth. They’re usually made out of harder materials so they might not be as comfortable. They’re great if you sleep on your back, but may need to change your pillow for side/stomach sleeping.
Nasal Masks
These masks cover all of your nose. They’re a good fit if pillows/cradles don’t work for you and you don’t need to go full-face.
Things I Tried
Masks
Philips DreamWear Nasal Pillows
I think this is the best mask for those new to CPAP as it is extremely comfortable, even though it didn’t work for me.
Pros
- The most comfortable mask I ever tried
Cons
- It kept sliding the chin strap off of my head, since it’s the over-the-head type, and didn’t stay in place on my bald head (I shave and always keep my head hair-free)
- Does not stay in place while moving in sleep
- Blasts air out of the front, making it annoying for my anyone sleeping next to you
- The velcro on the headgear would often come loose by itself
- The sound of air moving through the mask can wake me up at high pressures
Resmed F40
A hybrid full-face mask.
Pros
- Surprisingly comfortable for my first full-face mask
- Stayed in place while moving in sleep
Cons
- Didn’t help with the issues I had with mouth breathing
- Irritated my seborrheic dermatitis (A mask liner can fix this, but I don’t use this mask often enough, will update if I try one)
- Doesn’t seal well if you have a lot of facial hair
Resmed P10
A nasal pillows mask. The surprising thing for me is even though on the DreamWear size S pillows were perfect for me, on this one only the L was comfortable.
Pros
- Lightweight, barely feel anything on my face
- Minimal headgear, works great with chin strap
- QuietAir venting means no air blasting at your partner
Cons
- Can put too much pressure on nostrils, experiment with different pillow sizes
- Filter needs a bit more cleaning effort (e.g. with a very soft toothbrush or water flosser)
Resmed P30i / N30i
P30i is a nasal pillows mask, N30i is a nasal cradle mask. The nice thing about them is the headergear is shared, you can replace the nasal piece with either the pillows or the cradle.
Pros
- Close to the Philips DreamWear Nasal Pillows in terms of comfort
- N30i is very comfortable, and better for my sinuses
- Headgear is very secure, worked great with the chinstrap
- QuietAir venting means no air blasting at your partner
Cons
- P30i - all the pillow sizes were uncomfortable, even though the P10 L size were great, all sizes here caused pain in my nostrils
- The sound of air moving through the mask can wake me up at high pressures
Overall out of the few masks I tried I found Philips to be more comfortable, and Resmed to be more secure on the head (less leaks).
I would love if there was some hybrid with the pros of the P10 and DreamWear. I think if the DreamWear was more secure on the head and didn’t blast air from the front it would be my favorite.
Stopping Mouth Breathing
Chin Straps (worked)
I tried one that was just super uncomfortable and did nothing for me at all, Dr. Wail suggested I give the one by Resmed a try and it actually worked. It’s very comfortable and I barely mouth breathe.
Mouth Tape (didn’t work)
My mustache made these unusable, I tried 2 different kinds and none worked.
Hybrid Full-face Mask
I tried a Resmed F40; which is surprisingly comfortable, but mouth breathing with it gave me an even dryer mouth and throat, and also irritated the skin around my nose (I have seborrheic dermatitis and this severely aggravated it).
I am also someone who loves growing out my facial hair, and it wouldn’t seal as well as nasal masks. The air would leak out of the sides a lot.
I still found it very useful for days when I have the flu or my nose is very congested, so I keep it around.
What I use Today
Device
- Resmed Airsense 10 - CPAP device
Tubes
- Resmed ClimateLineAir10 - Heated tube to prevent water from building up in tube
Masks
I alternate between the two based on how much my nostrils or skin around my nose is irritated. My preference is the P10.
Tube Holder
- 2 Piece CPAP Holder by AkioPey - Keeps tube lifted to avoid rainout
Pillows
- Contour CPAPMax - Makes hose not get in the way when rolling around in sleep
Chin Strap
- Resmed CPAP Chin Strap - Great for keeping my mouth closed and very comfortable
Other Stuff for Symptoms
- Biotene gel for dry mouth, this helped when I was mouth breathing but I didn’t need it much after the chin strap.
Traveling
There are different devices for traveling, but I don’t use them. Most airlines allow you an extra carry-on for CPAP and I just carry my regular device with me. I also carry the distilled water in a thermos. Most staff at airport and airplanes understand what this is but you may have to explain.
See Saudia’s policy for an example on their support.
Resupplying for Cheaper
Local provider prices are unfortunately around 3x the US price (heated tube costs ~500 SAR in SA compared to 172.5 SAR in USA). When I found out the stuff that worked for me, I order in bulk during discount seasons. Even with expensive shipping and custom fees, it turns out to be much cheaper than buying locally, especially in bulk.
Places I resupply from:
Cleaning Tips
Remember to use the mildest cleaning materials you can find, you are going to be breathing this and its smell every night.
Daily Cleaning
Tools
- Sunset CPAP Mask Wipes - Very gentle wipes
I use wipes every morning when I wake up to clean every part of the mask, especially the ones that touch my nose.
Weekly Cleaning
Tools
- IKEA Rykta Box - Box
- Purdoux CPAP Mask & Hose Soap - A very mild soap
I dunk all of my gear every Friday morning (humidifier, tube, mask, headgear, and chinstrap) in the box and fill it with some soap and warm water (warm, not hot) and I let it soak for about 5 minutes, then hand wash and brush (brush filters only), then rinse it all with water, dry the box, and keep things to dry in it with a towel under.
For the tube I just hang it somewhere to dry.
Closing Notes
Everybody’s face is incredibly different and unique, everything here is my own personal experience and what worked for me may not work for you. Nothing in this post is intended as medical advice, remember to always discuss things with your Doctor before trying out.
Some of the links in this post are affiliate links, I may earn money if you purchase using them.