Sleep, Inc. Part III

My third point of contact with sleep apnea and CPAP was with my current husband, who I would consider a CPAP acolyte. I met him in Indiana and we had been dating almost a year before I got my dream job in South Jersey. He has two CPAPs. One for at home and one that was slightly more portable for travel. He would not sleep without it. By this point in my life, I was inured to the noise of the CPAP and the loss of spontaneous intimacy. But he was very happy, and he described going from sleeping without a CPAP to sleeping with a CPAP as life altering. He immediately was getting more sleep and therefore felt more rested during the day.

He is older than me, and when we met he was much larger than he is today. He lost weight because he was diagnosed with diabetes. It was treatable through pills and he didn't need insulin, and he lost a lot of weight quickly. Don't worry, he's still adorable!

Him living in Indiana and me living in South Jersey was difficult, and so he decided to move to New Jersey, we'd get married, and he'd be on my insurance. There were no flaws in this plan until I crashed out at work, and since there's absolutely no reason that anyone need live in South Jersey, we decided to make a change in our lives and relocate to Costa Rica. My husband is a fluent Spanish speaker, and he had traveled through Central America for over 30 years. It was his dream come true. Now, over 6 years later, we've realized we didn't do enough research in our desire to relocate. Not only is Costa Rica expensive as fuck, but the medical care you receive here has its ups and downs.

One of the downs we quickly found was little support for someone needing a CPAP.

What followed could almost be considered comic if it hadn't frustrated my husband so desperately. As I've addressed earlier, CPAPs require a lot of upkeep and maintenance. Parts need to be replaced because of built-in obsolescence. And at this point, my husband was on the luxury model BiPAP, which might as well have been a rare diamond here in Costa Rica. We bought parts here that didn't fit or work. We had parts shipped from the States that didn't fit or work. Even distilled water is more difficult to purchase here.

As I've written elsewhere, it's probably fine if you can afford private healthcare, but we are both using Costa Rica's public healthcare system, and if there is support for people who require CPAPs, it's hidden very well.

My poor husband did his best to jury-rig his BiPAP so that it would still work for him, but he would get frustrated and pull it off in the night because whatever mangled configuration he was using never seemed to work. It was during this time that I realized late one night that he was sleeping fine without a CPAP. Through the whole process, we never stopped to consider that losing weight while treating diabetes might actually cure his sleep apnea. And it did!

It took me a lot to convince him that he didn't need it anymore, but he was finally convinced, and he gave up that fast casual CPAP lifestyle. It ended up in a closet someplace. For him it was because he no longer needed it, but for 50% of other users, the CPAP ends up in the closet regardless of whether it works or not. Some people can't adjust. Some people can't sleep with a steady flow of breath being forced in their faces. A friend described it as "drowning on air." In fact, 8% of users abandon the CPAP after only a single use, and 50% abandon it within a year.

50%.

That number should be familiar if you've kept up with this series. Remember the uvulopalatopharyngoplasty (UPPP henceforth, thank god) surgery? It also has a 50% success rate. So with either option you basically have a yes it will work or no it will the fuck not. And yet despite these numbers, CPAPs are the standard treatment for sleep apnea rather than a one-off surgery that throughout a lifetime, you will likely only need once.

Here's where I get to conjecture. I've never been to a sleep study, though it has been suggested. But I know why I lie awake at night and it's not because of the air going in and out of my lungs, but more the demons in my head. But I've also never considered doing a sleep study because, as my doctor had told me when he first brought it up, most people end up with a sleep apnea diagnosis and a CPAP prescription. In my mind a sleep study is something akin to the free trip you get in exchange for being forcefully imprisoned in a hot sweaty room with a hot sweaty salesman trying to get you to buy a timeshare. My husband experienced no such pressure after his sleep study, but no other options were presented to him. I don't think he's ever heard of the UPPP surgery.

But my conjecture is based on a lifetime of dealing with the United States Health Care System (spoiler alert: not a fan) where profits are maximized over actual public health. It's an irresponsible system that leaves beleaguered families with generational debt. It's a system where treatment is pushed forth instead of a cure. And yes, some things I know can't be cured, and in this specific instance those 50% of people who have embraced the CPAP as a functional way of living are doing well. They are the types who can maintain the CPAP. They are the types who can maintain a saltwater aquarium. They are the types who can either afford the constant upkeep and obsolescence or have great insurance.

But it's simple deduction as to why most people have heard of CPAPs and no one has heard of uvulopalatopharyngoplasty surgery. Profit. The CPAP industry draws in $11 billion in the United States alone, and much like computers or phones, it's a never-ending churn for buyers because the products aren't built to last. Sure, insurance will cover it, but that just causes insurance rates to rise for everyone else to offset that $11 billion. That's chump change to the insurance/medical industry in the States, but it's still disappointing that a reasonable surgery that was the standard 30 years ago is never even discussed, as opposed to CPAPs, which are now so common it's not unheard of to see them on television or jokes being made about them in sitcoms.

I know it's a common joke in the gay bear community (think Brendan Gleeson in Braveheart, but really into quilting or the rarest of mid-century dishware) to which I am adjacent. I've heard the joke on more than one occasion that bear gatherings put a strain on whatever city's power grid because of a sudden large uptick in CPAP use. But it's really not funny.

I've decided to add one more part to this story because of recent developments, so until then, sleep well, I hope.

You can read Part I here.
Part II is available here.
Part IV is coming soon.