Archive for the ‘Notable’ Category.

Snoring, Obstructive Sleep Apnea, and Glorious Sleep

I’ve been using a CPAP since 2015 to stop my snoring and sleep apnea. It’s great! Lemme tell you some things about my experience. I can’t believe I haven’t written more about this!

With a CPAP, I need 1 hr less sleep per night AND I wake up more rested AND my throat doesn’t hurt every day AND my wife tolerates the sound way better than hearing me snore, snoore, snooore, snoooooooore, SILENCE SILENCE SILENCE [oh god is Lee going to die????] SILENCE SILENCE gaaaaaasp! [phew!] snoore [damnit]

If you’re thinking that maybe you want to look into this stuff, here’s what I suggest. Figure out for yourself what your sleep experience is and whether it could be better. What matters is YOUR impression, not mine, and not some doctor’s! That said, it’s hard for you to know what things “should” be like because you are the only one with your sleep condition. I strongly support that you measure what is going on in your sleep-life. Start with the easiest measurements!

  • Keep a sleep log for a few weeks (just write down your daily impressions of sleep every night)
  • Ask your sleep partner what their impression of your sleep is. Ask them a few times over a few weeks.
  • Get a free app like Snoreclock to listen to you sleeping. If you hear your snoring and/or sleep apnea for yourself, you’ll have a better idea as to what’s going on!
  • I tried pointing a webcam at me while sleeping a few times but it kinda weirded me out watching myself sleep!

Keeping a sleep-log for few weeks was useful for me. I noticed that I was more groggy in the morning when I had been snoring (and apnea-ing), even when I’d sleep for 9-10 hours. Actually, sleeping longer was WORSE for me, which makes sense because of having less oxygen going to my brain for longer. Getting input from my wife was somewhat helpful, “Did I snore last night?” “I don’t know but you kept me up all night.” “What?”

You might be tempted to wait to investigate this sleep thing. Maybe you’re thinking you’ll wait until you’ve lost weight. Yes, weight loss usually helps sleep and sleep apnea. But why wait for to lose weight when you can approach the solution from multiple directions? Similarly, meditation helps get rid of headaches, but ibuprofen is in your medicine cabinet! Use it!

I have seen 4 sleep doctors and my impression is to not trust them but instead trust your own experience and research. Every sleep specialist told me “Oh yeah, you need a CPAP” but they couldn’t help me get it working well without me putting in all the work myself to get it working. “You’ve ben using it 4 hours per night, that’s great.” “It doesn’t feel great.” “Well, some people don’t tolerate it any longer.” “Really? You’ve got nothing?” My friend went to a surgeon for his sleep troubles and the surgeon recommended (I’ll let you guess…..) surgery! He never even recommended a sleep study. He wrote me last week “Yeah, that was the weird thing, the doctor who took out the uvula / tonsils / turbinets didn’t even bother getting a sleep study, and I never had one as a followup. So I’m sure it made things better the issue would be if it made them better enough. I’m only now considering that it might not have been sufficient.” Caveat emptor!

My experience is that when I don’t use the CPAP, my throat and tongue relax, blocking my airway. So I snore loudly and have apnea. Apnea means that maybe 20 times an hour while sleeping, I stop breathing for about 30 seconds until my brain says “Hey, wake up and breathe or you’ll die!” This whole unfortunate process means that oxygen saturation goes down, I wake up a little hundreds of times a night, and I just don’t sleep well! But when I’m wearing my CPAP, the air pushes all the wiggly bits out of the way, I don’t snore, don’t apnea and wake up refreshed!

9.9 hours on the CPAP last night, hurray!

At first I had a lot of issues with using it. I struggled for almost a year every night trying to get it to fit well and increase my compliance (ie. how long I would wear it before ripping it off in frustration every night). At first, I wore it 2-3 hours per night, which simply isn’t enough. Now I almost always wake up in the morening wearing it, which is awesome!

Here’s all that I did to wear my mask all night:

Fit – I tried a lot of things to get a better fit. What did it for me was getting a Large full-face mask. I’m using a Resmed Airfit F20. I had been to 4 clinics and… I’ll tell you what, none of them wanted to take the frigging mask out of the package to let me try it on because if it didn’t fit, they’d have to expense it. I finally got a sleep tech at Kaiser Richmond to let me try on some masks. I was the one to ask, strongly, for a Large mask and he opened the package. I wore it for 30 seconds in the clinic and I could immediately tell it felt better than the Mediums that was “supposed” to be the right fit for me.

The right mask got me 80% of the way there. I also shave before bed, it’s no bother with an electric razor. And I wash the mask in hot soapy water every week; if I don’t, I have to keep tightening it to keep it from leaking which eventually doesn’t work well. I had tried a mess of other techniques with moderate success.

Maybe you can use a nose-only mask but when I tried one in the sleep clinic, as I fell asleep, the air would go in my nose and right out my mouth which is wei-eerd!

Other issues I’ve tackled….

Appearance – At the very beginning, I was very concerned about it looking dorky or blocking my view or… blah blah blah. Screw that. No one sees you in bed except people that will ALWAYS want you to wear it since it stops you from snoring. I tried a couple sleep appliances and they all sucked. CPAP is the first line treatment for Obstructive Sleep Apnea (definitely get a free Medscape account and check out that link!). I had tried a tongue suction thing, a chin strap, and a mouthguard and they were silly. The second-line treatment for apnea is ALSO CPAP: a fancy CPAP machine called a BiPAP. Surgery is the distant-third option.

Every sleep specialist I visited knew about the same about sleep and CPAP usage that I did. There’s really not that much to know. If you think your CPAP problems can be resolved by going to yet another specialist, you may be overvaluing their lab-coats. I am still pissed at how much each specialist charged my medical insurance for what I got. My sleep evaluation was ten THOUSAND dollars and the result was them saying, “Yup, you stop breathing because of your snoring. A CPAP will probably help. Here, maybe this one will fit. Good luck. Good bye.” The mask fitting session was terrible, their bedside manner was terrible, their billing was terrible, administrative help terrible.

Here’s the review I wrote for Sleep Diagnostics of Fremont.

I thank them for my sleep apnea diagnosis but my experience could have gone much better. A thousand cuts: they could have warned me about the goop they were going to put in my hair for the polysomnography and not lied about that being in the written materials they gave me. The admin people on the phone were weird and unhelpful in many ways. They didn’t help AT ALL with me getting a mask, which resulted in me spending another YEAR trying to find one that fit better. They asked me to sign paperwork that they hadn’t read themselves “Oh, its standard stuff” they said but it wasn’t. And all this terrible service for charging my insurance $10k. Hurumph.

On my Resmed CPAP, I push these 2 buttons simultaneously to change settings

I adjust the settings on the CPAP myself. My max pressure is set to 13.8, min pressure is 8.8. Last week, for the first time in maybe two years, I adjusted the pressure: I changed the max pressure from 13.6 to 13.8 because Megan was saying I was having multiple apneas in a night. My chest felt a little stretched for a night by the additional pressure but it solved the problem immediately. If you change the settings yourself, do it slowly! If you push the pressure too high, you may get central sleep apnea which means that you never exhale, which could be, you know, bad. If you set it too low, you’ll feel like you’re not getting enough air and you’ll rip the mask off at night. Initially, I changed the settings a moderate amount over a few weeks and it helped. At the very beginning, I kept going back for doctor’s appointments for them to change the settings and it was a big hassle. In a few nights of fiddling, I had it dialed in much better than their settings.

I tried using software to look at my CPAP usage patterns. I used Sleepyhead and ResScan from Resmed, None really helped dial in the reason for me not wearing except to help me focus on the problem. Using the free Snoreclock Android app was helpful. I never paid for it and it worked great. The use-case: It would record audio the whole evening and the next morning it would display red areas on a chart when I was snoring. I’d zoom in and look at the volume chart to see if I may have stopped breathing at any time. Then I’d listen to the zoomed-in audio. One hint: It displays different screens when you rotate your phone.

Here’s another tidbit: the manual says I’m supposed to buy a new mask, mask holder, air hose, and humidifier tray every 3 months or so. At first I was buying the stuff like I was supposed to. I’d buy it through my insurance with a co-pay. But then I figured two things: first, most of the items are much less expensive on Amazon than through insurance ($25 mask instead of $50 COPAY for the same item?!) Second, the only regular maintenance I’ve needed is to replace the air filter every 6 months, wash the mask weekly, and replace the mask and mask holder yearly or so. If I was using a humidifier, I could understand a need to keep things cleaner.

Definitely check out my post from 2017 about CPAP.

Winter Break 2019 Happy-Blog!

It took a couple months to internetify this…

Our Winter Break in December 2019 was just wonderful. Here’s our happy-winter-break-blog!

What a wonderful and relaxing winter break it has been!

December 20th: Megan and Abigail made it to Little Farm to play with the animals. Later we all made it to the Tilden Merry-Go-Round with Vivi, Silvi, and Margot

21st: We made it to another wonderful performance of A Year With Frog and Toad, a fantastic kids musical!

22nd: Abigail and Megan went to make cookies with Caitlin and Ameilia. They had a wonderful time making sugar roll out cookies and chocolate roll out cookies. Made many shapes and decorated them. Abigail went to a 3-hour crafting class at our good friend SarahJane’s store, Bay-Made in Oakland.

24th: we had Christmas lunch at Penelope’s nursing home. Caitlin, Jeff, Amelia, Megan, Abigail, and Lee were there. Chaparral House had a fine buffet with turkey and fixings. After, Amelia and Abigail played in the nearby playground for a good while.

25th: We spent almost all of Christmas day opening presents! It was a leisurely affair. Most of the presents (rightfully so) were for Abigail. Megan cooked the famous Flom Cheesy Souffle that she had started the night before. After receiving the unexpected “gift” of lice from Abigail’s school, we spent much of the day cleaning house and shampooing; in many ways, it was pleasantly cleaning.

On the 26th, we went up to Gail and Walt’s in Santa Rosa. Presents, homemade tamales, cake, cookies, fun on the big backyard tree-swing!

27th: Megan went to the Kabuki Spa in San Francisco while Lee and Abigail stayed home and played with our neighbor Ana at the park.

28th (oop, we forgot to write it down!)

29th Megan and Abigail visited Grandma at Chaparral House. While there, Megan discovered Abigail had more lice! so we went home and deloused our hair and house again! Delousing made us miss Nathaniel’s birthday party. We also had plans to see Charlotte at Picante but she had food poisoning! So the day ended up being house cleaning and head cleaning instead of going out for fun :-) / :-(

30th We went to Ikea on a hint and Lee was ecstatic to finally find food storage containers that all fit together, then off to Costco, then for Vietnamese Sandwiches, the library. Then Megan and Abail were off to the Berkeley Marina for some fun while Lee chillaxed at home. Nice!

31st We went to the Lawrence Hall of Science for the New year’s noon confetti drop. We went with Abigail’s good friend Leia and her mom, Rachel. We ended up spending 4 hrs at LHS, exploring, creating, meeting a Ball Python snake, playing in the water outside, and eating a nice lunch with popsicles! Megan made salmon and asparagus for dinner. After Abigail fell asleep, Megan and Lee watched the ball drop in NYC (at 9pm). After some struggling, they were able to open a tiny bottle of Proseco to celebrate, which they drank from Penelope’s Waterford crystal glasses.

Jan 1st – Hung out at home until Nataliah (babysitter) came over. Megan visited her mom and then Lee met Megan at a games party being hosted by Peter and Mary in Oakland. There, they played games and chatted with folks for a few hours. Upon arriving home. It was discovered that Abigail and Nataliah had made a giant cardboard foosball table!

Jan 2nd – Hung out in the morning, playing at home. Then, Ruth, Megan’s psych intern from Mill Valley came by for a signature and stayed to chat for a while. Then, we all went out to run errands. We first went to Past Time Hardware for stuff to hang pictures/art and a new lightbulb for the kitchen. Then, we went to Solano Ave where we had ice cream first and then chose new calendars at Pegasus Books. Last stop was swinging by Fern’s Garden so Abigail could tell Fern (the owner) that her wish had come true. (Just prior to Christmas, Abigail had made a wish in the store — by throwing a small stone into a sandy tub. She had wished for more stuffies for X-mas and she had gotten 3 new stuffies! Fern let Abigail make a new wish :-) As we were on our way to another errand, Charlotte called to say she was at our old apartment and was available to hang out. Since we were close by, we drove over to meet Charlotte and Rick. We all drove over to King Park, where Abigail played and the adults chatted.

Jan 3rd — Abigail came into our bedroom around 6am and said that she had wet her bed. After getting her cleaned up, she crawled into bed with us and snuggled until about 7am. Meg and Abigail got up together and hung out on the couch. Lee took Abigail to Dr Takao for a flu shot and then played at a nearby park (in Orinda) and then went out to sushi lunch together. While they were away, Megan organized several rooms in the house. For the afternoon, Megan spent much of the time in the kitchen. She made tuna casserole, molasses cookies with brown butter icing, and Chex Mix. Abigail and Lee had a craft competition, and every few minutes Abigail would stand up and yell “Makers, you have 9 hours left!” to count down the time until the judging. Dinner was amazing! And so were the cookies!

Jan 4th – Abigail woke us up around 7:45am — we all slept in! Then, Megan and Abigail made a Christmas tree out of pipe cleaners, from a kit received from Zeke. Mom did one last lice treatment while Lee and Abigail had bfast together. Then Abigail got a treatment. Haircut for Abigail, then lunch at Saul’s with Caitlin & Amelia. Play at a park.

Jan 5th – Lee and Abigail went to a birthday day party for Carter (from school) at bowling alley, then Megan and Abigail went over to Juniper’s house for a playdate. Lee stayed home and worked on Abigail’s legal name change (it’s way easier to decide on your daughter’s name before you leave the hospital!)

Wow, what a Winter Break!

Merry Christmas

Merry Christmas to all! All the presents under our tree! Abigail will wake to a wondrous sight!

Some tidbits worth remembering about this photo…
See the ice cubes in the base of the tree? That’s how we water it! We’ve been fostering a tree from Mount Shasta for the last 3 years. This is sadly the last year for our beloved Fiona. She’ll be planted in the spring to run and play with her friends.
Megan made the stockings! They are beautiful. There will be three but one is still just pinned together. The finished ones are just gorgeous!
The boxes behind the sliding glass door are part of our move! We’ll be moving to a new house at the beginning of January! Berkeley has been wonderful, hello El Cerrito!
There’s lots of wonderful presents for and from family under the tree. The bike is from Noni (my mom)! Thank you Noni!

30 Year Update?

A friend from middle school just Friended me on Facebook and asked “Catch me up on the last 30 years”
My response:

Went to Tufts University, stayed in Boston working tech until a breakup made we want to move away. NYC for a few years with a few relationships til the dot-com bust. Moved home to connect with family and regroup. Two of my friends from that time have since passed. Moved to San Francisco after attending Burning Man in 2004. Loved building really big art, traveled the world a bit with art and work: India is a place of insane contrasts, Americans don’t comprehend the cultural rift we have with Saudi Arabia. I sometimes teach building robots and flame effects. Not loving working in tech, I started toward medicine in 2011, finished my master’s and started work as a pediatric occupational therapist in 2017. Got married in 2014, became a dad to an amazing daughter in 2015. Living in Berkeley and life remains imperfect.

Job Offer!

Today, I was offered a position as an occupational therapist in a nearby public school district!

 

I Passed the Occupational Therapy Board Exam!!!

I passed the occupational therapy board exam!!! I am now a registered occupational therapist!
My business card now reads Lee Sonko, MS, OTR

I expect to be licensed within a month so I can start working as an OT in California!

See my NBCOT certification below:

Life Update

August 2014-May 2016: four semesters of a very intense master’s program with a 5 hr/day, 4 days/week commute (see commuting footnote).

June 2016-May 2017: Two completed internships, got only half way through another one due to a medical problem.

Married June 2014, two months before school started, just two years after we met.

New baby born a week before second semester started.

Two ongoing family conflicts that I won’t discuss here. Both began around 2014. Well, the roots of each conflict probably go back way further but that’s how conflicts go.

Megan told me, almost demanded that I take some time off! So I’ve spend the last couple weeks NOT studying for the boards exam in occupational therapy. Thanks honey!

At the end of May, my master’s degree posted. It’s now “Lee Sonko, M.S.”.

Looking forward, I just started studying for my board certification, hoping to be done in early August.


Footnote about my school commute:

Yes it was a 5 hour/day commute, Kensington to San Jose State.  Driving would have cut an hour a day but was far more stressful. When I drove, it usually took an hour for me to recover. And I couldn’t study while driving. Here was my commute: 15 minute drive down the hill, 55 minute BART from El Cerrito Plaza to Fremont Station, 45 minute bus ride to downtown San Jose, 15 minute walk to school. 2 1/2 hrs door to door. On a good day, I could study for about 45 minutes on the train and 25 on the bus. I got car sick on the bus every time I tried to study, and I needed/chose to study most of the time. It completely sucked.

Lee Sonko, Master of Science

Lee Sonko, Master of Science!

I received a message from San Jose State University today:

I now have two extra letters after my name!

Lee Sonko, MS

 

More letters to follow after I pass the board exam!

Megan, Abigail, and Lee have moved!

If you’re a friend and would like our new address, please write to me!

We now live in a two-bedroom apartment in a four apartment building in North Berkeley, California. The house sits at the end of a long driveway, making it pleasantly secluded in a great neighborhood. We have our own private patio and we open the back fence to a communal 1/4 acre back yard with grass, trees and bocce court!

We live just a few blocks away from a great grocery store (Monterey Market), and a row of stores with a meat market, fish market, cheese market, bakery, Chinese restaurant, pizza place, wine store, coffee shop, and plant nursery! The neighborhood is full of kids under three years old, and just four blocks away is a large playground with everything from tennis courts, swings, and a public pool. We were very cramped in our one bedroom apartment with very few friends or neighbors to talk to.

Right now the place is full of boxes but we are rapidly making headway! We’ll be having a house-warming party soon.

We’re all well. Abigail is growing, drawing, climbing, and telling us about her world all the time. Megan is chilling at home now that her school year has ended. And Lee’s school fieldwork is a refreshing change, with fewer hours and a much more gentle commute.

Lee, Megan, and Abigail

OT Academics Done!

I am finished with the academic portion of my Master of Science degree in Occupational Therapy at San Jose State University!

On May 27th I walked with my cohorts wearing cap and gown in a convocation ceremony.

In the coming months I will do two three-month fieldworks: a skilled nursing facility in Alameda and at a community senior center in San Francisco. In January or February I will take the NBCOT (the occupational therapy certification test) and start as an occupational therapy professional!

See Thank-you’s below the photos!

Here is the Acknowledgements section of my research paper:
The Relationship Between Stress and Life Satisfaction Among Occupational Therapy Graduate Students

Acknowledgements
Firstly, I have thank my loving wife Dr. Megan Flom for helping to make this grand project a reality. She has been there, supporting me from the beginning to the end. Great thanks also go to my brother-in-law Walt Flom for sharing his passion and helping me to appreciate and understand it.

I offer my gratitude to my research professor, Dr. Megan Chang for guiding and supporting this effort. I am also grateful for every professor and every student I have encountered at San Jose State. This has been a period of great growth.

I offer grateful thanks to my parents, Lee J. Sonko and Marlene M. Sonko for a lifetime of continued love and encouragement to follow my passions.

The person I need to thank the most can’t read this note… yet. I must thank my wonderful daughter Abigail for helping me every morning by reminding me of the joys of life and learning. As she says so excitedly, “Book-a-book-a-book-a-book-a-book!”

Lee Sonko
May 2016