The mechanics of sleep

I messaged my special one the other morning and commented about how I only managed about six hours of sleep that night.  In her return message, she observed that on nights that precede days off, I tend to get up earlier more often than not, I don’t necessarily get more sleep considering it is a day off, and if necessary, during the course of the day, I can get a nap in (and usually do, not always intentionally).  After thinking about it, I was forced to admit she’s right, that’s what seems to happen.  I may get up to use the bathroom in the morning of a day off, and since I don’t have to be on the go, or getting up to go to work, I can stay up if I wish and accomplish things if there’s a desire to do so, without being rushed.  An interesting observation to be sure.

Too, I’ve been using a CPAP machine for the past 20 years as well.  For a long time when I was working nights, I didn’t get very good sleep during the day, and I mostly attributed it to the fact that I was sleeping during the day and not at night as is considered to be normal.  With the invention and subsequent proliferation of electric, incandescent and fluorescent lights, the possibility of working more than two shifts in a workplace became more common.  Go back to the early years of the 20th century and you don’t find too many businesses able to afford three shifts, mainly because their workers would be in the dark, and if you can’t see what you’re doing, you’re not going to be very productive.

Sleep apnea hadn’t been an issue until fairly recently.  Certain situations and instances when I’d feel particularly tired after sleeping 8-10 hours became more and more common and there were times when my wife told me I’d stop breathing in the middle of the night for a few seconds.  Oxygen deprivation would never set in and I’d invariably turn over and begin breathing normally once more, so it never became a life threatning issue.  Even so, she suggested I speak to my GP about it and he had me scheduled for a sleep study in 1999.

Back then a sleep study was a more involved affair, these days it can be done in your home overnight unless there’s a dire need to do it the old-fashioned way.  Meaning having you to report to a dedicated sleep study lab, be wired up to the machines (as I recall it took a good 45 minutes for all the wiring to be attached to my body) and then attempt to get sleep around 11 at night.  Too, you weren’t allowed to sleep on your side, you had to sleep (or try) on your back, so that you didn’t pull out any of the wires, and the bed was damned uncomfortable.  And you had someone monitoring you all night long, in another room with a light on, albeit somewhat subdued.  The only thing I could equate it to was being in a hospital and being awoken at odd hours to get your BP taken.  Finally, you had to be sure not to have drunk too much beforehand, because you weren’t allowed to get up and go to the bathroom once you were wired to the machines.

Pretty much the most restless sleep I’d had in ages, that I could remember.  When the tech rousted me at 5:30 am and told me I could go, I apologized for not giving him a better reading.  He said it was fine, no one gets much sleep when wired up like a stereo, in an uncomfortable bed, pillows etc.  They get the most that they can and generally get enough in the last couple of hours moreso than in the first ones when the subject is trying to get comfortable.  He said I’d be notified in about a week as to what the results were, but he did mention I stopped breathing more than a couple of times while he was observing.  So he was pretty sure I had sleep apnea, he just couldn’t tell me how bad it was.

I vividly remember driving home from the hospital rather bleary after being dewired from the monitoring machines.  It was right around sunrise, and it was a cold morning.  I had a 30 mile drive home, since the hospital where the sleep study lab was at, was a good ways away from there.  I drove there, had breakfast and then went back to bed, for a nap, which was much more restful than the one I had just previously.  A few days later my doctor referred me to a ENT nearby who confirmed I did indeed have ‘obstructive sleep apnea’ and needed a CPAP machine.  The surgery was available as well, but the machine seemed (to him at least) the better (and cheaper) alternative.

The first machine I got was about the size of a bread box, and cost about $3000.  Fortunately, my insurance covered most of the cost, or else I would have been in Dutch.  It must have been constructed rather solidly as it managed to survive nearly 18 years.  I finally had to get a new one when the motor on the old one burned out.  In that time the provider of the machine actually went through two owners and it was the third that provided me with the unit that I’m using now.

The old one had a serial port for communication, the new one uses WIFI for its connections and communicating with the home base.  The new unit does have a SD card port, but I believe it was put in just as a failsafe in case the WIFI was down or inoperative, so there would be a hard copy of the results for an ENT or other medical person to pull.  In the three years I’ve had the machine, neither my ENT nor the people that provided it have been interested in what’s on the card.

Getting back to the start of this entry, my sleep for the most part with the CPAP is pretty good.  Last night (this entry has been several days in the making, surprise surprise) I slept a little over 9 hours, and when I awoke, I still felt tired.  Right now, about an hour after waking, I feel rested and pretty good.  I should be ok for the remainder of the day.  Most nights I get between 6 and 8 hours of sleep.  Certainly there are nights I don’t, for one reason or another.  But when I’m using the machine and mask, my sleep is FAR better than when I don’t.  Which is why I’m often cautioned by my special one to use it, as opposed to just sleeping on the couch downstairs.  Believe me, I’m trying.


Medical Billing Pachinko

I use a CPAP machine when I sleep.  I have for the past 20 years.   One thing that has always boggled me was the cost of the equipment.  One would think as something becomes more mainstream, the equipment costs would go down.  While that’s true in the case of the machines that pump and filter the air, the masks that direct the air into your nose (and mouth sometimes, depending) are still hideously expensive.  And even with medical insurance, sometimes the costs are ridiculous.

The other thing is the companies that make the masks are incredibly sneaky with the way that they bill them.  Instead of billing as one unit, they break the mask down into 3 or 4 components and then charge a good deal of money for each.  Although attributed to Aristotle, apparently he never said: “the whole is greater than the sum of its parts“.  In this instance, however, the sum of the parts of the mask are greater than if you sold the mask as a whole unit.

Last week I received a bill from the medical supply depot and it broke down the bill into several different medical id codes, which I managed to find online in a PDF that detailed the parts of the mask.  Just coincidentally, nearly identical to the information brochure that came with the mask in its commercial packaging.  Looking at the more informative one, it gave me not only a breakdown of the pieces of the mask and their respective codes, but it also showed me that on my bill (at least it looked to me) that I was charged for the whole mask and two of the respective parts of it.  I’d meant to go there this week to talk to them about it, but with the hullabaloo of what was going on with the car, I had forgotten about it.  At least until I stumbled upon the bill while looking for something else in the pile on my desk.   Seemed like the perfect time to argue my case.

I drove to the supply office and was greeted when I walked through the door.  I asked if there was someone I could speak to about a bill, and the woman who greeted me said she could help.  I laid out my case, showing her the documentation, and the itemized things I was seeing and asking her if she understood what I was getting at.  She did, though she insisted that I had been billed correctly.  She then got out the original bill (which I’d signed the receipt of) and showed me different item codes for the mask.  Sure enough, the mask was broken down into pieces on the bill and charged separately.  Even though the cost of the ‘whole’ mask was more than the cost of the other two pieces.  I still believe I was overcharged.  A facial mask that is made out of cloth, plastic, and silicone should not cost nearly $300.  At least to my mind.   My insurance only covered about $60 (due mostly to my deductible not yet being met) so the rest I had to pay for.  I paid the bill but left dissatisfied.  Not with them, but with what they had to deal with in order to bill patients that come to them.

CPAP masks and machines are huge business nowadays.  25 years ago, I had never heard of them.  But the overabundance of people being obese has ballooned the business to ever greater heights.  More and more companies are getting into the game and charging greater and greater amounts of money.  The costs of the machines is a lot less than it used to be.  The costs of the masks and other equipment involved with the machines have taken up a great amount of the slack.   I equate it to a printer and printer cartridges.  Companies sell a printer for $50-75 and then charge you an arm and a leg for the ink,  since they know you need to have the ink in order to make the printer work.  So you’re somewhat stuck unless you can find a generic seller that can copy the chip that’s used by the printer company.

Fortunately, with the mask that I’m using, the pieces are available on eBay for a LOT less than what the manufacturer charges.  Since it’s (from what I’ve heard and read) one of the most popular models used in the US, there are a good deal of sellers that will vend you the parts, and won’t break the bank.  And the mask is comfortable and doesn’t mark my forehead where the old one did, which is a great improvement.

Just another instance where the way the medical insurance business works here in the US is frustrating.  Even with insurance, it can be a toss-up on getting what you need or getting what you want to make it easier to sleep or live.