Koffee & Kpop

I’ve always been a snorer. In kindergarten, my loud snoring saved me from spending a night in the bus barn. The girl who was supposed to be the bus checker, to check for left backpacks, didn’t tell the bus driver that I was quietly curled up in my seat, possibly as revenge for puking on her new shoes earlier in the year.

When the bus driver cut the engine, she heard my snoring and threw me in the front cab of her pickup truck and drove me home to my worried parents. It’s one of my earliest memories.

I always enjoyed taking the two hour drive to my ex-partner’s family’s home because it meant I had two hours to sleep in the car, being the passenger princess I am. (I never learned how to drive.) I never put two-and-two together, but now realize that sleeping in the upright position meant my airway did not restrict as much, meaning a deeper and more restful sleep. And at the end would be a cup of coffee and a triple chocolate Wawa donut.

It wasn’t until I went home for the summer two years ago that my parents noticed I was not sleeping well, and was jolting myself awake. My dad has been using a CPAP (continuous positive airway pressure) machine for a few years, and several of my close friends (all male, as Obstructive Sleep Apnea [OSA] is twice as common in males) use a CPAP machine, so when I came back to Korea, I decided to schedule a test at a sleep clinic.

I scheduled a test at the Suum Sleep Clinic. Initially, they were very worried about my lack of Korean, but the doctor spoke enough English that the initial few appointments went okay. At my first appointment, they took a few X-rays of my nasal passages and throat, and the doctor put a tube down my airway to judge their condition. That wasn’t painful at all, and he told me I have a narrow airway. They decided that a sleep test would be the appropriate way to go.

I was scheduled to come in at 10pm for an overnight sleep test that would last until 6am, when they would wake me up. I brought pajamas and a toothbrush, but the sleep clinic actually provided me with button-up pajamas so they could more easily hook me up to their equipment. I had a chest monitor, leg monitors, arm monitors, and what felt like a gazillion monitors around my head, including at the corners of my eyes. They applied a kind of sticky glue to attach the monitors but nothing hurt; it was just a little weird. The nurse was very kind.

The room was similar to a small hotel room, complete with a sink and mirror and TV I could watch. I was hooked up behind my head and everything was out of the way. They asked me to come in at 10pm to get all set up and then asked to fall asleep at my usual time, which was midnight. When I was sufficiently sleepy after reading a bit of my book, I pushed a button to let them know I was ready and laid back.

Through an intercom, they gave me a set of instructions I had to complete. They were in English and it was obvious they were reading off a script. I had to move my left leg, then right leg, blink several times, raise my arms at alternating times, etc. They were setting a control setting so if my leg moved a lot in my sleep, the monitor would pick it up as unusual movement.

Surprisingly, I fell asleep and slept through the entire night. In the morning, I went to the bathroom connected to that part of the clinic (it was in two sections, one for consultion and x-rays, and one for the actual sleeping lab and CPAP technician room), and the nurse proceeded to rub a cold gel on my head wherever she had put the sticky glue. She told me it would come off when I showered.

My NHIS-covered cost of the initial sleep test was 130,900 KRW, or approximately $95 USD.

I went back a few weeks for my sleep test connected to a CPAP machine, at the same time (10 pm) and with the same set-up. At this point, I really wanted to ask where they bought their pajamas from because they were cute and comfortable, but I thought that would be weird so I didn’t.

My first night with the CPAP machine went a lot better than I expected it to. Many people are afraid of using a CPAP machine because they will feel like they are suffocating, or become anxious having something on their face. Maybe it’s because I’ve been conditioned to wear a mask for most of the day for several years thanks to Covid-19, but I didn’t find it to be that uncomfortable. I was given a nasal mask that goes over the nose only, and there are holes in the front of the hose where air escapes so you don’t feel like you’re suffocating. I was also set up on a ramping system, meaning the pressure of the air would start low and then increasingly ramp up to the desired pressure when the machine notices that I’m actually asleep.

A person without sleep apnea will have 0 to 5 “events” per hour. “These events must fulfill both of the following criteria: (1) Pattern of progressively more negative esophageal pressure, terminated by a sudden change in pressure to a less negative level and an arousal and (2) The event lasts 10 seconds or longer.”

• People with 5 to 15 events per hour are diagnosed as having mild sleep apnea.
• Moderate sleep apnea is diagnosed as 15 to 30 events per hour.
• Severe sleep apnea is anything more than 30 events per hour.

When my doctor gave me my number, he locked eyes with me and paused, and I knew it was going to be bad, like when another doctor diagnosed me with Covid-19.

My AHI, or apnea-hypopnea index, was 119. I was having 119 events per hour. If I did my math correctly, that means that for every minute, my sleeping was obstructed for at least 20 seconds. (If an event is considered to last for more than 10 seconds.)

No wonder I was so tired all the time. No wonder I felt like a zombie. No wonder sometimes I would spend all of Saturday sleeping, wondering if there was something wrong with me. No wonder I woke up with headaches everyday. No wonder I struggled staying awake during the day.

When I was woken up at 6am, I desperately wanted to sleep more. I didn’t want to go home without a machine. I felt more rested than I had in years. So rested, in fact, that I spent the next two hours walking around the area playing Ingress at 6am until finally heading home and stopping in a cafe for breakfast. My second in-clinic test cost the same amount as the first, 130,900 KRW or $95 USD.

It was a few weeks until I got my machine. The doctor was insistent I brought in a friend who knew both English and Korean and unfortunately, I brought a friend whose English wasn’t that good and he was confused by all the medical talk. I wasn’t really worried by that; my main concern was learning how to use the CPAP machine. The technician explained everything in Korean and I did understand most of it as he showed me how to turn the machine on, how to fill the water tank with distilled water, etc.

When I went home, I pulled out the instructions to find a set of Korean instructions typed on two pieces of paper and a booklet from the manufacturer with the instructions in English in addition to several other languages, as my device was made in Australia. It even came with an Aussie electronic plug in addition to a Korean one. (I felt bad for having my friend tag along, since he was unable to translate most of the medical jargon and could only explain how to use the machine, which I could read myself.)

I was given a ResMed AirSense 10 with a climate-controlled humidifer hose, set at 27 degrees Celsius/80 degrees Fahrenheit. This helps with blowing heated air through my device rather than room temperature air, which can get cold in the Korean winter. Essentially, the machine constantly blows air into my airways to keep them open so I don’t have apneas that jolt me awake.

As with any medical device, there was a learning curve, but it wasn’t that hard to get used to the device as the I felt the benefits right away. Sometimes, I admit, I will take an afternoon nap during the weekends and wake up with a headache and sore throat and regret not plugging into my CPAP. I clean my device as per instructions: once a week, usually on Sunday right before I Skype with my parents. I wash my nasal mask every morning and empty my water tank and let it dry as well. I have used my CPAP every single night, minus the flight I took home last Christmas break. It was too much of a hassle to work with the airline to ensure I had an outlet at my seat and could travel with distilled water, and since I would be sleeping in an upright position, I figured I would be all right and hopefully my snoring wouldn’t be so bad as to be overheard over the plane’s engines.

On average, I use my device for 7 hours 52 minutes, according to the app MyAir. According to my device, I have used it 241/242 nights, for a total of 1904 hours. The best part? The price system. If I consistently use my machine, the price I pay is lower than if I fail to use the machine. Adherence to nightly therapy is as low as 30 to 40 percent, so to encourage people to use the machine, if you use it at least two hours per night for a certain number of nights, your cost is lower than if you use it, say, only once a week. (It used to be four hours, but even two hours can be beneficial, so I think that’s why they lowered it.)

There are a number of conditions that are comorbid with Obstructive Sleep Apnea, including depression, daytime sleepiness, stroke, coronary artery disease, and “you will die sooner than if you are undiagnosed and not on therapy.” My doctor made it very clear that my AHI score was very, very high, and impossible to be solved by without a CPAP machine. This will be a lifelong issue.

My life has changed since using a CPAP machine. I sleep better, obviously, and have more energy. I have steadily lost weight partly because I am more active. I am less depressed. I am able to keep to a more regular sleep schedule that involves sleeping midnight to 8am. If I happen to take a nap on the weekend, they can last from 20 minutes to an hour and I feel rested, instead of like death. (Even better when I remember that I should be using my CPAP machine.)

Today I went to the sleep clinic to switch to a smaller nasal mask as I was having a lot of air leakage that was drying out the sides of my cheeks and causing discomfort to the point where I was finding myself pulling my mask away from my face. Occasionally the pressure will be too high and wake me up, but I simply roll over and reset the machine to start at the lowest pressure and ramp up again. (I know how to adjust my machine’s pressure but I will let the professionals do it when I go back for my next proper appointment.)

What amazed me was that they were able to turn on my CPAP machine without plugging in it. I want to be able to do that too, gosh.

To summarize:

• My initial appointment cost was 24,500 KRW ($17 USD).
• I spent 261,800 KRW ($189 USD) for two nights of an in-clinic sleep test with national insurance.
• I pay approximately 17,800 ($13 USD) KRW monthly for CPAP machine rental.
• A new mask cost 19,000 KRW ($14 USD), to be added to my monthly automatic bank payment next month.

I’ve spent a total of 447,700 KRW ($325 USD) for 2/3rds of a year using a CPAP machine nightly.

But it’s real cost? Priceless.

I recommend that anyone who is having sleep problems go to a sleep clinic to diagnose the problem. Maybe it’s just insomnia that can be cured with medication or a change in daily routine. But it could be a sign of OSA.