09 September 2021

The CPAP Noise Blues

I have previously written about my experience with my CPAP and APAP machines—most recently in 2019. My experience has been positive; I am sleeping better today than I ever have.

One challenge we have had is noise from the machine or me. It can be difficult to diagnose, because if I could hear or sense it, I could probably fix it, but because I am asleep during the noise, it can be difficult to guess what is happening.

There are a few physical clues that the sleeper might receive. 

  1. Eyes dry or crusted could be a leak around the upper nose area.
  2. Before falling asleep, you can usually sense air leaks around the mask, they will not get better when you start to sleep.
  3. Dry mouth could mean that the sleeper is opening their mouth and letting air flow out.
  4. A sore throat might mean that you are snoring in your sleep.

1 and 2 are usually simple fixes with your headgear, unless you need an entirely new fitting.

3 can be fixed with a chinstrap or by getting fitted for a full face mask

4 means you may need another sleep test or to adjust pressure.

Beyond that though, it can be difficult to figure out what is going on.

Never fear though. I have put together a decision tree that might help you and your partner figure out what is happening. Just start in the upper left and follow the questions and answers.

This is the first pass, so I am confident it's not perfect. I think it's a reasonable start.

I appreciate any feedback you may have.



25 August 2021

Next Round of Weight Loss and Health Gain – 2021 COVID Edition

On March 18, 2021, I decided once again to get my health under control.

I weighed about 255 at 5’10”, I have blood pressure and sleep apnea issues, and had lapsed into significant inactivity and poor eating habits during COVID. I had tremendous success in the past by simply going low carb while continuing a pretty intense exercise regimen. I had stopped doing the intense workouts a few years back due to injury, so decided to focus on diet.

But I’m different from some people. Many apply discipline, eat in moderation, and seldom stray. I live for straying. I love good food and drink, and like to binge on whatever during vacations. Then I lose it, don’t monitor for a few years, and gain it all back.

I tend to be all or nothing, so I decided to go with an extreme diet. 

Lyle McDonald has been considered by many to be a leading voice in diet and fitness. Although some consider him rude, he is extremely knowledgeable and bases his guidance on science and experience. He went through some psychological issues a few years back, and is back and generally more polite. Regardless, he knows his stuff. He has a lot of posts from many years back about health, fat loss, and fitness on his website and also sells his books through the website or Amazon. He recently published “The Women’s Book: Vol. 1” and had previously published “A Guide to Flexible Dieting” and “The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner” among other books. The book I decided to use for this surge was "The Rapid Fat Loss Handbook: A Scientific Approach to Crash Dieting" (RFL). You can order from his website as well as the affiliate Amazon links I posted. He gives discounts as well in some cases.

RFL is a protein-sparing modified fast (PSMF) diet. The idea is to lose weight as fast as possible without harming the body in any way. Harm can occur during extended fasts by the wasting of muscle and organs as it converts protein to glucose for your brain (about 50 grams per day). Based on your size and fat level, you eat a set amount of lean protein, unlimited greens, and non-starchy veggies, spices, non-calorie condiments, a bit of fish oil, and otherwise nothing.  Lyle also recommends full bodyweight training at a moderate level a few times per week. This helps stimulate muscle preservation. I did not do that.

Finally, he recommends that you use real food rather than protein shakes or liquid protein. Not that it matters for weight or the diet, but to help you get used to eating real food. It is useful though to have some quick backups for those times when you are just too lazy to do something better, when in a hurry, or out of the proper foods. My go-to simple meal has been 0% Fage yogurt with a scoop of protein powder. For satiety, it is best to use a protein that digests more slowly such as casein or milk protein isolate (MPO). Casein has a chalky mouthfeel, so I used MPO. I designed my own mixes on True Nutrition. Their fish oil pills are also consistent with Lyle's recommended fish oil compositions. If you order from True Nutrition, use the code e4e at checkout for a discount. Of course, I earn a little bit if you do too.

For me, if I ate my requisite protein, it works out to about a pound of lean chicken per day, fish oil pills, and very low cal veggies for perhaps 700 - 800 calories per day.

There are also various free meal and diet break recommendations. And to be completely clear, this is not meant to be a permanent way of eating. It is a diet made to lose fat as quickly as possible, then move into maintenance. 

Has It Worked?

Like a charm. Since March 18, (5 months) I have lost about 50 lbs. I had a few diet breaks: one for a road trip and wedding shower, one for the wedding itself. I ate all I wanted on those trips with little regard for diet.

It is important to bear in mind that the first five pounds or so of weight loss is mostly water weight, lost as your muscles and liver deplete glycogen stores.

To be honest, I have not been super strict in following the diet. I often (maybe twice per week) would have a glass of wine at night, there were some sweets that I ate here and there (rare), and some soda waters with a few grams of sugar. I also indulged a bit beyond what I should have with my free meals. I suspect I might have lost another five pounds or so if I had been religious.

I hope to lose another 20 pounds by the end of the year.

Weight Loss Chart

On the weight loss chart, you can see weight change from about 255 to a little over 205 across five months.

It is quite clear on the chart where I took diet breaks. The first was a road trip through Arches NAtional Park and on to Denver for a wedding shower; the second was the wedding itself.

What About That Protein-Sparing Part?

There are various methods to measure body fat. Essentially anything that is not fat is lean body mass (LBM). So a person with 30% body fat is 70% lean mass. This includes water, muscle, bone, the contents of intestines, blood—everything not fat is LBM. So a 200 lb person with 30% fat would be carrying 60 lbs of fat and 140 of LBM. If that person lost 10 lbs of fat and no LBM, they would now weigh 190 and have 50 Lb of fat and the same 140 of LBM. But now their body fat would be 26.3%.

I used a Tanita impedance scale to measure my body fat. Impedance scales are not accurate. I believe though that using them over time gives a reasonable indication of direction. If someone has better information I would love to hear it, but it’s what I have done and the basis of the graphs below.

Note: the fat and LBM graphs are very noisy. The scale measures electrical resistance through your body and converts that resistance into a percent fat number. The resistance measurement has noise due to hydration and other factors. I included a polynomial best fit on the next two charts

Fat Loss Chart

Importantly, fat loss is about 30 pounds. That's 60% of the total weight. Just for context, 30 pounds is about the same volume as four gallons. Four 1-gallon milk jugs of fat have come out of my body. Wow!

Lean Body Mass Chart

LBM went from about 159 to 150 (using the curve fit line). I am not crazy about that loss, but I have only myself to blame, as resistance exercise would likely have improved that outcome.

e4e Take:

Lyle is a diet and fitness nerd and a great resource. His style can be abrasive, but once you get past that, you will learn a lot.

The PSMF diet is not for everyone, but it is a good approach for me. About 60% of the weight I lost has been fat, which is good considering that only (?!?!) 35% of my body was fat to start. I believe that if I had done resistance workouts as recommended, that 60% number would have been higher.

Shifting over to maintenance has generally been pretty easy for me, the problem I have is maintaining some discipline when I start to slip. I want to be able to live, socialize, and have fun without constantly obsessing about food. I am planning to weigh myself weekly and if I hit some threshold weight, jump back on PSMF for a week or two as convenient. We'll see how that works. Separately, I will ramp up some weight training as COVID further dissipates to see if I can build up my muscle a bit. As we age, it becomes more difficult because of hormones.