My life has significantly improved in the last month thanks to a CPAP machine treating my obstructive sleep apnea. If you are tired all the time or think you are having trouble breathing when you sleep, please read this post. Sleep apnea is a dangerous condition that ruins your quality of life and may lead to early death. You might be able to greatly improve your life with simple treatment. If you’re looking for more information, Apnea Board has been helpful to me.

For the past year and a half I’ve been really tired. Sleeping 8 hours a night and a 90 minute nap in the day, still falling asleep in my chair. I chalked it up to Covid lockdown or something and ignored it for awhile. As far as I knew I was sleeping fine; Ken said I was snoring a lot and sometimes struggling for a breath but he didn’t seem concerned. Finally it clicked and I realized it was not normal. Now I’m using a CPAP and I’m sleeping well and am full of energy.

Diagnosis starts with your doctor, who refers you to a sleep specialist, who listens to your story and takes a look at your airway and orders a sleep study. You can do the study at home, you just borrow a small monitoring kit for a night and they collect and analyze the data. It’s very simple, they produce a score called AHI which quantifies any breathing problems. Most insurance will cover the testing.

Before the test I learned a lot myself with a pulse oximeter that records my blood oxygen every few seconds. It showed me my oxygenation was dropping very low every 50 seconds, all night. That is not normal. Then I took a video of myself sleeping and saw that basically I was not breathing at all normally, just getting the occasional gasp of air. It’s a wonder I’m still alive. The sleep test confirmed severe OSA.

Treatment comes after diagnosis. There’s a bunch of treatment options; my doctor recommended a CPAP machine. These work by pumping higher pressure air into your mouth and nose; the pressure keeps your airway inflated and lets you breathe. A simple CPAP is not a ventilator, it’s not breathing for you, but it’s similar. You turn on the machine, put on a mask sealed to your nose (and mouth if needed) and sleep.

I’ll he honest: a lot of people have a hard time with CPAP, there’s like a 50% rejection rate from people who hate the idea or find the machine uncomfortable. I was highly motivated and literally from the first night the improvement was so enormous that I’ve taken to it enthusiastically. I sleep fine with it, much better actually. My blood oxygen is now well above 90% all night and I have very few breathing incidents any more. I don’t love the thing; the mask is a nuisance, there’s some mild side effects like more farting. But I dislike suffocating in my sleep a lot more than the hassle.

Benefits for me were immediate and enormous. Literally the first morning I was dancing to music while making coffee. I can read in the afternoon without falling asleep. If I take a nap it’s a 10 minute snooze, not a 90 minute snorefest. My blood pressure is lower. (OSA basically creates panic all night and is a terrible strain on your body.) No luck on weight loss yet, that’s a benefit many OSA sufferers report. More energy to exercise though. One thing I’ve noticed in CPAP users; they tend to get very attached to their machines and can’t imagine going a night without them. I didn’t understand that before. Now I do.

Equipment was a bit of a mystery to me at first and the medical system is not great at advising patients. By far the best CPAP machine for basic OSA is the ResMed AirSense 10 AutoSet. The "AutoSet" is key; the machine automatically adjusts to its sensing of your breathing so you don’t have to guess at the right pressure. It’s a really nicely designed piece of equipment. If you’re data-minded be sure to put in an SD Card and get OSCAR to get very detailed second by second info on your breathing while you sleep. The AutoSet goes for about $800 now. Insurance should cover it but they are notoriously a pain in the ass about it. Do not let your insurer bully you into getting inferior equipment. For me it’s the best $800 I’ve ever spent.

The other half of the system is the mask. My first mask was the AirTouch F20, a basic full face mask. It has worked great. After my first month I switched to a smaller AirFit F30i, the way the hose comes out of the top of your head is a big improvement. Note these are both full face masks; if you don’t breathe through your mouth (much) you can probably use a much smaller nasal mask or pillow. A full mask kit is about $150 and again should be covered by insurance.

The medical system wants you to buy all this stuff from a "Durable Medical Equipment supplier" and the quality of those vendors varies enormously. Some are outright scams, including doctor kickbacks. I ended up skipping insurance and buying from CPAP Direct. In theory my insurance will reimburse me but so far that hasn’t worked out. The big pieces require a prescription but you can buy a lot of components and replacement parts, on Amazon without a prescription for much cheaper.

Maintenance is a bit of a hassle. I have to refill the humidifier tank every day. Also clean parts of the mask, other parts need weekly cleaning. The mask is intended to be replaced on a regular schedule; every month for the "pillow" (the part in contact with your face). That’s where ordering cheap replacements on Amazon can save a lot of money, maybe even if you have good insurance.

Conclusion I can’t emphasize enough what an improvement to my life CPAP treatment has been. Obstructive sleep apnea sucks. I encourage anyone reading this who wonders if they have a breathing problem at night to talk to their doctor, or maybe try a pulse oximeter on their own, or address it somehow. CPAP treatment isn’t so hard! It works! I’m enthusiastic enough about it to be writing this blog post and am glad to discuss it privately with anyone who asks.

PS: a special thank you to Obama and the ACA for making it possible to treat and discuss this problem without rendering yourself uninsurable.

  2021-08-13 21:11 Z

Subnautica is one of the best games I’ve played in a long time. It marries a good narrative with excellent gameplay and a rare balance of complex game systems. It’s beautiful too and a nice mix of the pleasure of a well scripted game embedded in what looks like a complex naturally generated world. The rest of this post has lots of spoilers. It’s been five years since the game came out but if you haven’t played it yet I urge you to consider stop reading this post and play it instead.

My first comparison for Subnautica is Firewatch. Yeah, it’s a weird comparison, but it’s more than just a similar rendering style. Both games have a very strong narrative arc, a beginning to an end. Both games plop you alone in the middle of an unknown world with mysteries to explore. And both rely on a sense of wonder, occasional fear, and beauty. But while Firewatch is a great story it’s barely a video game, it’s the quintessential walking simulator. Subnautica manages to deliver both an excellent scripted story and have great gameplay.

The primary gameplay loop in Subnautica is survival crafting games. It’s often compared to Minecraft, Don’t Starve, No Man’s Sky. It’s a fair comparison, a lot of your time in Subnautica is spent finding resources and using them to progress along a tech tree so you can explore more dangerous and rewarding parts of the game. But those other games often end up becoming very resource heavy, rewarding collecting enormous amounts of materials for mass production. Subnautica’s crafting game is much tighter. You only need a few items of each type to build something and you typically only build one thing of that type: one weapon, one upgraded oxygen tank, one Seamoth. You do end up making a lot of food and water but even that is nicely constrained; about a third of the way through once you get one planter full of Marblemelons you’re basically set for life.

I love the subtlety of the tech upgrade tree, how awkward the advanced items are. Most games give the player a power fantasy, by the time you get all the best gear in Minecraft you’re god-tier power. But in Subnautica you never get anything very powerful. You basically never get weapons or armor that let you feel safe from the sea monsters, you are always running or hiding from them. The big crafting achievement in the game is the Cyclops, the big submarine. But it’s fantastically clumsy to manoeuvre and strangely vulnerable to attack. You end up spending the second half living in the Cyclops but it always feels like such an escape to jump back out and just swim free or use the Seamoth.

Exploration in the game is greatly improved by the balance between generated and scripted world. When the game first came out a lot of people thought the game was procedurally generated; that was the hot topic (thanks to Minecraft and No Man’s Sky) and the world is so beautifully detailed. But no, in fact the whole world is static, it plays the same for everyone. Not great for replayability but excellent for game design. The orderly progression through biomes and depths gives them a game a lot of story telling structure. You never quite feel led by the nose but you work your way through signposted encounters: the Aurora, the Degassi bases, the Lost River, the very deeps at the endgame.

That exploration is also where I had a little trouble. The game deliberately is disorienting; you’re never given a map and the mini-map like sonar images are not useful for navigating. All you get are beacon landmarks you place yourself. And the game is a 3d underwater maze, with the second half of the game entirely in cave systems! I finally gave up and used a fan-made map of the Lost River because I’d gotten a little stuck and confused. That was a big help to me. Getting lost is a big part of the game, I don’t mind that being a gameplay element. But video games are such a limited medium we don’t get to use our real-world navigation skills much. That’s why games always have HUDs and minimaps, they replace your innate sense of direction. I felt that lack a little here.

Being lost in the depths of the ocean is part of the fun of the game, the occasional fear. But what really accentuates that is the sound design. The creature noises are fantastic; you’ll be cruising along picking up quartz crystals and thinking you’re safe when you hear the most terrifying moan off in the distance. Stereolocated, and you can hear it’s getting closer. Such terror! Being in the Cyclops and hearing all the creaks of the hull, the thumps as fish smack into your ship. It’s a trick as old as Das Boot but it works remarkably well in the game.

Last note of appreciation for me, the end of the game. Most games like this by the time you reach the end both the player and the game designers are worn out. They’ve shown you all they have and you’re grateful just to read the final boss fight and end screen. Not Subnautica. First there’s no boss fight, that’d be totally wrong for a game with basically no fighting. Instead you have a boss… communion? Final crafting challenge? It’s great. And then, at least the way I played it, there’s a wonderful anticlimax. You’ve solved all the mysteries of the planet and are finally ready to escape but you still have to craft the rocket and take off. Which means one last trip to the surface, one last crafting challenge. I really enjoyed the feeling of scavenging my existing base and submarine for materials to use. That shield generator was hard earned and essential to my submarine survival but now I wouldn’t need it on the planet any more, time to reuse it for the rocket ship to escape. And even that rocket ship had a lot of grace notes; an elaborate launch sequence and the ability to create a time capsule. A very thoughtful farewell in a place most games would just have a single "you win" button to press.

Subnautica really is a masterfully crafted game from start to end. Depth, complexity, beauty. A good story and great gameplay systems to support it. Quite an achievement.

  2021-08-01 16:33 Z