Coffee and RT (Real Talk)

This is a podcast episode called "Coffee and Real Talk with the Respiratory Therapist of the Martinsburg VA." The hosts, Aaron and Mark, discuss obstructive sleep apnea and their own experiences as CPAP patients. Mark shares that his wife noticed he snored a lot and stopped breathing during the night. He eventually decided to get a sleep study, despite being stubborn. Mark describes his experience at the sleep lab and how he struggled to fall back asleep after going to the bathroom. The sleep study revealed that Mark had over 100 respiratory events per hour, leading to a diagnosis of severe sleep apnea. The hosts emphasize the importance of treating sleep apnea due to the potential health risks associated with low oxygen levels and the long-term consequences of untreated sleep apnea. Hello, this is our first podcast episode of Coffee and R.T., Coffee and Real Talk with the Respiratory Therapist of the Martinsburg VA. My name's Aaron and I've been in the field on and off for about 22 years. I'm a former Air Force Respiratory Therapist and I'm now happy to continue working with Vets and I've got my colleague Mark Mothershead and Mark's been in the field for over 30 years. Yeah, it's almost plus the 35, it's definitely 36. Yeah, and where did you graduate from? Shenandoah College of Conservatory of Music, which is now known as Shenandoah University. Uh huh. Uh huh. And that's kind of one of the major, or was one of the major respiratory schools in this area? It was, yeah, for me. They had a program down at J. Sargent Reynolds, which was affiliated with MCV Medical College of Virginia, that's down in Richmond, Virginia. But respiratory therapy for me, for all purposes, was just a couple hours away. I was raised in King George, Virginia, worked at Mary Washington Hospital down there for about 30 years and then had migrated back up this way, living in Stephen City now. But yeah, it's been a ride. Yeah, yeah. Now how long have you been with the VA? The VA, I'm going on, let's see, six, almost seven years now. Okay, okay. And at the VA, we work with, in this particular location in Martinsburg, we work with Vets in the D.C., Maryland, Virginia, West Virginia area. But one of our big populations of patients are CPAP patients. We have, what, over 8,000? Yeah, quite a lot. Yeah. Yeah. And so Mark and I just wanted to take some time and give some good, need-to-know information to our fellow CPAP patients, because both of us, Mark and I, are both CPAP patients ourselves. And so for this first episode, we wanted to just start off by discussing, you know, what is obstructive sleep apnea? Well, what is, let's say, and what were some of the signs and symptoms that made us feel like that we were struggling with it? And if we have time, we'll get into the sleep study that we took. So Mark, do you want to share maybe for a minute about some of your experiences and what led you to even have a sleep study? Absolutely. So I remember there were times where I, my wife, she would gingerly, okay, let's not say gingerly, she would very forcibly sometimes remind me that I snored a lot during the night and kept her awake, you know, forcibly. How did she do that? Anywhere from a plug on the shoulder to, you know, a quick rub on my ribcage, saying, I think you stopped breathing, that type of thing. I knew at some point in time, this was probably in my late 30s, early 40s, that, you know, when I woke up in the morning, I didn't feel refreshed. And being, I guess, partly a respiratory therapist, I was kind of stubborn. You know us medical people, we're the last ones that want to go get something done or get checked, right? Every time. Every time. So anyway, I looked like one for a while and, you know, I was just chronically fatigued. I had some, a little bit of short-term memory loss, but the biggest thing for me was I would lay in the bed for six, seven, eight hours, wake up the next day, and guess what? I felt like I only slept for 30 minutes. And that royally, royally sucked. You know what I'm saying? So anyway, I still struggled with it a little bit longer, and then finally I succumbed to it. All right, I'm just going to go get a sleep study and see. Hopefully it's nothing but, you know, with my wife telling me constantly that, hey, your snoring's bad, you know, your rhythm of breathing's changing from time to time. Wake up your respiratory therapist by, you know, something. No, no, I mean, I finally listened. I guess, you know, I was more stubborn than anything else. I was more stubborn than using smarts of any kind if I've only got any. I mean, some people graduate magma cum laude, summa cum laude. I graduated thanks to laude, but it's all good. So anyway, I went and got the referral and took my first sleep study. Okay. Now, we have a little bit more time. I could go into this, right? Yeah, yeah. Okay. Go into it. So I knew from the profession what it entailed, going into a sleep lab, you know, getting all that stuff wrapped and wired around you, almost to the point where you feel like you're mummified. I mean, you get all that stuff on you, the first thing, and I'm sure you can relate, is, okay, I really can't move too much. I don't want to knock anything off. Right. So number one, that's going to play a little bit with your sleep. And also, two, I dreaded the idea of having to get up and go to the bathroom. Right. So, well, I limited what my drink intake was that evening. I mean, I just downed a sip of water by 6 or 6.30 in the evening, knowing that I had my sleep study around 9 o'clock at night. Yeah. So I arrived there. The folks were really cool. Went in. They were, you know, set you at ease, talk to you while they're applying all that stuff to you. Yeah. What would the room look like that you were in? You know, that was a great question. The room was actually like a hotel room. It was like a relaxed room. It didn't look scientific. It didn't look too medical. It looked like a place that, well, if I just crashed at a friend's house, this is their guest room. Okay. Which was really cool. That's great that you brought that up. And always, too, I noticed that these rooms that I was passing, they had a CPAP machine by the bed. Hmm. So, come later to find out, that CPAP machine is if you do a split night where they start you out and see some things that CPAP can, you know, possibly benefit you for, then they would put you on it for the rest of the night and kind of dial you in. That's where my study went wrong. Oh. No, no, no, no. And that was on a personal, it was on a personal level because, remember, let's go back to the drink. I had hardly nothing. Hmm. I had to get up at 1230 in the morning and go pee. I don't know where it came from, but I had to. I had to urge. So, I hit the little call button, which is really nice because you've got a call button and the technician there that does your sleep study, you know, they're kind of like, oh, there's somebody in the background that, you know, you hear this voice come in the room and they're going to assist you with anything and everything. This is God. Yeah. This is God. Yeah. This is the overlord, if you would. So, anyway, I said, I am so sorry. First I have to say, don't apologize. We get this all the time. You've got to go to the bathroom. Yeah. I do. Yeah. All right. So, the technician came in. He was very thoughtful, very helpful. He kind of helped me, guide me out of the bed, you know, get all that long braid of hair that I had and then escorted me to like right outside the bathroom. I went in, did my thing, came back. Well, Aaron, that's where it messed my study up because I could not go back to sleep for the next hour and a half to almost two hours. I just laid there knowing that I had all this garbage on me. That's what I was going to call it. Everybody will at some point in time. And I'm thinking, how in the world am I going to go back to sleep? Yeah. So, I played there. I tried two, several different positions until finally I think my body was so exhausted, I just drifted off. So, that last drift of two and a half hours to three hours were magic for the technicians because when I got up the next morning, of course, the person, you know, what do you know, shall I say the, their response was, we can't tell you exactly what happened on the study, but the guy winked at me and said, we'll probably see you back again. And, you know, most technicians when they do a test or a therapist when they do a test, you know how we are in the medical field. We're told, don't tell them what's going on. You know, that's the doctor's job. Right. I understand. Okay, whatever. So, anyway, I'm walking out there kind of frustrated because I know that I scored something and how severe is it? Right. So, in about a week or two later, believe it or not, a week had gone by, I got a phone call from the provider saying, hey, guess what? You need CPAP. And I figured, okay, well, that was kind of a no-brainer. We're not quite sure because your sleep study, we really need to titrate you in because your respiratory events were over 100 an hour. Wow, so when you say respiratory events, what are you referring to? Yeah, so respiratory events are any radical type of breathing, whether it affects your pattern, whether it affects your depth of breathing, whether it affects completely the airflow getting in or out at all. So, you know, you've got things like hypopneas where you're not breathing efficiently enough. You have things like where there's apnea, where there's absence of breathing. And this can go on for like a long period of time. You know, people thinking, oh, well, how long do you stop breathing for? Well, anytime I stop breathing for 15, 20, or even 30 seconds, that's scary. Yeah. And if I'm having events like that or similar to 100 and sometimes an hour, that scares the crap out of me, right? So let's get that treated. Yeah. So back to that, too, when you have those events, what's happening, you know as well as I do as a therapist, Aaron, what happens to your oxygenation? Yeah, it just plummets. Right. So now, one night, will that necessarily make the difference? Not necessarily. But what happens if it's on a chronic, untreated basis? Right. What does that do? We learn it does all kinds of things. Short-term memory loss, headaches, cardiac issues. Yeah. Atrial fibrillation is like a number one thing. It doesn't make you show up. We've seen that, too. Yeah. You know, albeit, but you're depriving your body of oxygen. And every time your oxygen levels will drop when you have these events, well, you've got signals that are sending to your brain, hey, we need to do something here. Right. We need to stimulate this body, wake it up, move it, make it jump. Like people, if you've seen them, their legs flail or their arm goes up and then this all of a sudden just drops down and they're having a nap on the couch. The body is doing anything and everything it can to wake up the individual because it's got to get oxygen in the lungs to go out to the brain, to the heart, to all of the many organs. So it's kind of like a built-in secondary mechanism. Okay, so that's all finally good. But every time the brain is interrupted, the brain is not reaching its stages and patterns of rest it needs. Right. You know, you've got stages of sleep you need to attain. You've got REM sleep you need to attain. And if all those things are being set on the counter, shall we say, or pushed by the wayside to constantly monitor something else, then here comes the fatigue. Right. Here comes that feeling of, man, I've been in bed all night. Why can't I go to sleep? I feel like I've slept an hour. Yeah. You know, that type of thing. Exactly. And you've experienced that. Absolutely. And it snowballs. Yeah. It really started to affect my mental health. I feel like I'm kind of prone to melancholy. But I think when I was having untreated OSA, it just snowballed and I fell into a depression. Yeah. I didn't even realize that it was because I wasn't getting good sleep. Exactly. Yeah. Sleep is the foundation of our existence. Yeah. And only since the last, what, 25, let's be realistic, 25 to 30 years has it really been pioneered. Mm-hmm. So, even God rested. On the 7th day, of course, even God rested. No? We're made to finish, right? Yeah. The other thing, too, I wanted to touch on is with those things, with a foundation of sleep being absent, that also affects how you heal. Yes. If you are recovering from something, recovering from surgery, anything like that where your body is trying to physically recover and you're deprived of oxygen from time to time, you're deprived of your brain of rest to maintain those duties and to maintain those responsibilities that have to be channeled out through your body to be done, well, it affects everything. It all comes full circle if we're not getting our proper rest. Absolutely. So, knowing those things as a therapist, even though I still had to switch back from Mark, the guy with sleep apnea, or the respiratory therapist, once I heard that number, it put me as Mark, the guy with sleep apnea. Mm-hmm. And the therapist in me says, okay, dummy, get it fixed. Yeah. All right? Yeah. So, I did, we lined up a second sleep study. Okay. And only because, remember, I ran out of time for the split night. Right. So, on the second sleep study, same technician again, it was actually, I don't know, maybe luck of the draw, but it was a good evening again. I also took sips, took sips of water, even less, and got wrapped all that stuff. And then that second sleep study, it started a little bit later. My lights out time was at 10 o'clock. Okay. But here's the difference. That 10 o'clock lights out, they put CPAP on me first. Right then and there. There was no, okay, let's let him sleep for about an hour or two or three hours and see what he does. Yeah. They put it on me right then and there. How'd that feel? How'd that feel for the first time having CPAP slept on you? That's a good word for that. Let's just say different. Yeah. Without scaring our listeners. Yeah. It's nothing to be scared of, obviously. But it definitely is different because, number one, this is the first night you're going to sleep without something that's on your face. Literally. Like, some folks will sleep with those eye covers or whatever to keep the darkness out and things like that, but this is nothing like that. And not to shy anybody away from it, but it is something that you will eventually grow accustomed to and be used to and wear it as long as you not only feel the benefit, much less know the benefit. At one point in time, they'll be neck and neck on popularity, but I know the benefit in the back of my mind, but the feel of the benefit of it that I've been on it now for a long time outshines the reason. I just know it needs to be there. So they titrated me throughout the night. Now, interestingly enough, when they put you on CPAP, don't be surprised, especially if someone's listening and they haven't gone on yet, they might actually have you start on your back. Because that's where you know as well as I do our apneas are the worst. Usually. So they want to get you at your worst game. Now, for me, that didn't work too well because I'm not a back sleeper to begin with. I usually sleep on my belly or on my side. That's the only time I'm really comfortable. I don't like sleeping on my back. I've never had since I was a kid. But you know the ironic thing, Aaron? What's up? They put that CPAP on me. I closed my eyes. I didn't even have to count sheep and I was probably out in about 20 to 30 minutes. Wow. Laying there. Wow. And the technician said that within the first 15 minutes, I was already in REM sleep. Wow. Because I was so chronically REM deprived. Yep. So. I had a very similar. Mine was a split night. Uh-huh. But when they put the CPAP on me for the second half of the night, I fell asleep very quickly. And when I woke up, I felt more rested. They only had it on me for two hours. Yeah. But I felt more rested than I had in months. Yeah. And I knew. I was like, oh my gosh. I need to get a CPAP. Absolutely. And when that hits you, then that's the only thing you want to do at that point. Especially when you know your events. When you know that, okay, I've admitted that I'm in the crowd, I took a step forward, and now I need to do something about this. And just like with anything, you're always going to have anxieties about it. You're always going to have what ifs. And those are the most damning things, really, that play with your mind. Yeah. What if this doesn't work? What if it blows too hard? What if it just doesn't fit right? And all that. Well, that's where we come in, also, as therapists, to aid, assist, teach desensitization, things like that. Because everybody that's on CPAP has their own journey. Oh, my goodness. If you ask people in the general population that's got an uncle, a father, their granddad, their aunt, their sister, their cousin, there's somebody on CPAP somewhere. Yeah. But here's the difference. You make your own journey from day one. CPAP, in my total and professional opinion, is something that you can fail your way to success. Mmm. What do I mean by that? Yeah, that's good. As long as you're trying, as long as you're doing, you are not failing. Yeah. And I tell almost all of my patients, that's what I teach them, CPAP, if all you're going to put on this machine is two to three hours a night, that's great. Great. That's great. Because you multiply two to three hours a night that they could be getting treated sleep by seven days a week, that's 14 to 21 hours of treated sleep they're getting that they weren't getting last week or last month, or albeit last year, before they embarked on CPAP. And when you start adding those little snippets of treated sleep up, guess where your body's going to feel it? Everywhere. Yeah. It's going to start to say, wait a minute. And I've had both veterans and patients at Mary Washington tell me the same thing. You know what? I'm not doing this five or six hours a night, but I'm still, I'm starting to feel refreshed. Mmm. And they get excited, and you will get excited on it. Yeah. Right now I'm a speed limit. I'm 55. I'll be 56 years old. But I honestly feel like I'm getting the same quality rest that I did when I was in my 20s. Wow. You can't buy that in a bottle. No. You can't. All you have to do is apply yourself and say, I'm going to do this. Yeah. You know, one of my favorite quotes from you that I've heard you say to patients is comfort equals compliance. Yeah. Let's set that up. Let's set that up for me. Yes. I wish I would copyright that, because they don't teach you that in the book. And that was basically from self-experience. Yeah. Comfort equals compliance. And as long as you're comfortable with what you're wearing, you will wear it. You could go home with the most expensive CPAP machine, the coolest looking mask. But if you don't wear it, it's still not doing what it's supposed to do. You've got to be comfortable. Yeah. You've got to be comfortable. There are people out there that absolutely can't wear a face mask. No problem. We'll put you in something nasal. Hey, my mouth opens when I breathe. No problem. We've got a chance track for that for all you claustrophobic folks out there. Hey, and there's a lot of folks that are. Yeah. And we understand that. And we sympathize with that. Then there are some folks that say, you know, just put the mask on me so if my mouth opens, who cares? Both holes are covered. So, you know, it works that way, too. And you know as well as I do, Aaron, there are numerous amount of masks and numerous amount of methodologies that we can try before we just want to say, okay, screw it, I can't wear it anymore. Right. And that's the advantage because everybody, remember, everybody's their own individual, their likes and their dislikes. And the main thing that we want to teach with is whatever mask you have is muscle memory. And a demonstration I do with a lot of my patients that come in with a hat on or they have glasses up on their head is I have them hand me whatever it is. And I say, close your eyes. I put it in their hand and I say, now put it on your head. Keep your eyes closed. They do that. Then they open their eyes. I say, now was that difficult? No, not at all. Of course not. Because you've been doing it over and over and over again. You've got a routine built in. The brain is already built in a routine where you don't need lights on in the room. It doesn't matter what's going on in your environment. You know exactly what to do. And that's muscle memory. The same thing can be achieved with a CPAP mask. Absolutely. It is, as you know. I mean, let me ask you, Eric. When the lights are out, you know where your mask is? Can you put it on? Oh, I always keep it right on my bedpost. Yes. Every night, I don't even have to look. I just reach my hand out, grab my mask, throw it on. Yes, your hand is there, and you've got it, right? Yes. And you know where it's at. Same thing with me. I mean, I've got mine. I'm wearing ankle pillows, the little cushions that go up the nose. Yes. And I just lay that over my machine. As soon as I'm getting to bed, it's like one fell swoop. I grab the pillows, strap it on, hit the button, and I'm out. I've got a cat or two on me, and I'm sleeping. And it doesn't matter if that is. I want to go back, though, to where we were talking about the sleep study, and I had to go to the bathroom, and how sometimes your body will try to wake you up and do things. Do you know what I found that was one of the most biggest weights off my shoulder? When I started wearing CPAP consistently and getting my rest and keeping my oxygen levels up, keeping my airway open, before I was on CPAP, I would get up at a minimum of four times, if not five times, in no piece, to go to the bathroom, because my brain would say, get up, do something, and I felt the urge that I had to go to the bathroom. So in the beginning, of course, I said, oh, boy, it must be the plumbing. Not now. You know, I go to the doctor, we get that checked out, and everything is okay. And even then still, I wasn't putting everything together. You just have to go to the bathroom, don't drink as much. You know, I was sucking down Dr. Pepper like crazy, like it was water back then. And I attributed it to the soda, the caffeine, all that. Don't you know that after I was on CPAP for a while, it eliminated it? Whoa. Wow. For me, that was, or at least it eliminated that mechanism of having to wake me up. Okay? So in the worst case scenario, as of this day, I would have to probably drink about a 32-ounce cup of tea just before I go to bed to get me up once in the night. Wow. Wow. That was a game-changer. Heck yeah. That was a huge game-changer. Man, that's awesome. So everybody's different. Everybody's alert mechanisms by their brain are different. But that was mine. Or one of them. Who knows? There could have been more. I was just too groggy to go through them. But I knew when I had to get up and go to the bathroom, man, it was frustrating. And at the time, when I first started CPAP, I was working night shift. So it was already terrible to have to get up that many times when I don't have my rooms completely blacked out or darkened out. So it feels like, oh, do I really need to get up at this point? Oh, gosh, no. It's only 10 after 12 in the afternoon, and this is like midnight to me. This is my work schedule. Anybody that's ever worked night knows exactly where I'm at. Absolutely. The graveyard shift. Yes. The reason they call it the graveyard shift. Because if you do it too long, they might put you in one. That's right. So anyway, that was something I truly struggled with until I didn't have to worry about it anymore after being on CPAP. And that was the biggest thing for me. That's great. I remember right, right before I went to CPAP, so my obstructive sleep apnea was at its worst. I was 39, 40 years old at the time. And my commute was from Chesapeake Beach, Maryland to Andrews Air Force Base, which is about 20 miles, took me about 35, 40 minutes. I would have to stop on that 40-minute drive, pull over, and nap for 15 minutes. At 39 years old, come on. Yeah, right. So it's been a game changer. Oh, absolutely. I mean, right now, let me ask you, Aaron. Do you feel like you need naps every day? No. Me neither. And that was something that was exciting for me, man. When I came home and I had 20 minutes or 30 minutes to myself, if I could get that, you know, minus the kids, the animals, anything like that, I would try to seclude myself and just even on my day off when I didn't work, I would try to lay down. I don't even have the feeling that I need to. Ironically, when I feel like I need to lay down, I feel like I need to have my mask on or something. Yeah, same for me. So as we mentioned naps, though, it's probably a good point to throw out there too for the guys and gals that are already on CPAP. If you do still want to take naps and do, please wear your CPAP even when you nap, whether it's 20, 30, or 40 minutes, because your respiratory events don't know the difference between night and day. No, really. And they'll just come whenever they're uninvited. So, yeah, uninvite them, shall we say, with CPAP therapy that will help keep the airway open even in the 20 or 30-minute snippets that you can get in if you feel like you need them, just to keep you, you know, well-rested all the way around. Yeah, yeah, that's awesome. Thanks, Mark. I really appreciate you coming. I appreciate you having me on board, Aaron. It's been a pleasure. I look forward to many more conversations that we have. And I know that you're working on something that's going to set up a system where folks want to email us or contact us or go over any topics or any questions. You know, that's great too. It's fantastic what you've got set up here and going, and I thank you for letting me be a part of it, man. Yeah. And I enjoy working by your side. You're one heck of a colleague. Yeah, same here, man. I enjoy coming to work every day, and you're a big part of that reason, pretty much. So next time that we get together, I think we're going to talk about your experience when you actually come to our clinic and get set up with your CPAP machine. So we'll see you next time.