Few things are less sexy than snoring, but some people with obstructive sleep apnea, a condition in which people briefly and repeatedly stop breathing during sleep, think the cure is almost worse than the disease.
The most effective treatment is continuous positive airway pressure—or CPAP therapy, in which a specialized machine delivers a steady supply of pressurized air during sleep so people can breathe comfortably through the night. That requires wearing a mask connected to tubing and a bedside unit, something that doesn’t exactly scream “bedroom casual.”
According to the National Sleep Foundation, between 5 and 20 percent of the US population has some degree of sleep apnea. While many people think of apnea as a health problem for fat, aging white men, Raj Dasgupta, a sleep specialist at the University of Southern California, says it's an issue that affects everyone. “We’ve broadened our recognition of obstructive sleep apnea,” he says, adding that improvements in diagnostic technology—no more being wired up like Frankenstein’s monster for a sleep study—have helped break down stereotypes.
That's encouraging news, because getting treatment is critical. In addition to CPAP, Dasgupta says some patients also benefit from dental appliances and surgery, depending on the specifics of their condition.
“Untreated sleep apnea is a risk factor for heart attacks and strokes. Patients can also experience neurocognitive damage—due to low oxygen levels in the brain—and metabolic problems, due to an increased risk for diabetes. Finally, the daytime sleepiness that accompanies many patients with sleep apnea can lead to motor vehicle crashes and poor work performance,” says Andrew Wellman, director of the Sleep Disordered Breathing Lab at Brigham and Women’s Hospital. Proactive diagnosis and treatment are making apnea and CPAP more visible, Dasgupta says, resulting in a better night’s sleep for many Americans. Wellman estimates that there are around 30 million Americans with sleep apnea, but only about six million are using CPAP therapy.
Some patients, however—especially those new to CPAP—struggle with how to navigate it in their dating lives or marriages. “I always say, bring up CPAP and obstructive sleep apnea when the time is right,” Dasgupta says, noting that it doesn’t make a great first date conversation. He also recommends taking some of the sting out with a sense of humor, acknowledging the ludicrousness of the CPAP mask and its Bane-esque vibe.
He also stresses that being on CPAP doesn’t just improve your health. It can also improve your sex life: “It keeps you more alert during the day, which means more dating, more late-night movies, more Netflix.” For men, he adds that CPAP can sometimes help with erectile dysfunction. And for those who like a little more spontaneity in their sex lives: “Let your partner know that putting on your CPAP mask doesn’t mean you don’t want to be intimate,” he says. “The mask can always come off.”
More from VICE:
Paul Hokemeyer, a family therapist in New York City, says that the best way to mitigate feelings of shame or awkwardness is to take charge of the situation and be completely up front about it. "You don't have a machine because you needed another expensive accessory, you need it because you can’t breathe at night. It’s a physiological condition, not an issue of a personal weakness," he says. "So take the bull by the horns and be upfront with your mate.”
Experienced CPAP users agree—you shouldn’t compromise your ability to breathe at night for the sake of your relationship, especially when things get serious. “If the person you're with actually loves you, then they won't judge you if you use a CPAP,” says Gaelynn Lea, a musician (and Tiny Desk Concert winner) who was shy about using her CPAP around her now-husband at first.
“I guess it just did not feel like the most delicate/sexy piece of equipment to bring out at the beginning of a new relationship. Sleep and intimacy are closely linked in my mind, so the idea made me nervous,” she says. As she was 21 years old at the time, she felt like people assumed she was “too young” for CPAP therapy. And even though she’s disabled—Gaelynn has osteogenesis imperfecta, also known as “brittle bone disease”—and therefore used to standing out, it felt like a bridge too far, requiring an adjustment period.
“I got my bi-pap [a related technology] machine back in 2015. By this point I had been married for nine years. I will say it has made things a lot better for us,” says Larry McDonnell, a 36-year-old public employee and martial artist from Charleston, West Virginia with diastrophic dwarfism who has severe apnea due to scoliosis. “Once I was on the bi-pap machine, it was like I was a teenager again.” Getting a good night’s sleep radically improved his sex life and his relationship with his kids—years of poor sleep had made him distant, irritable, and poorly focused.
For McDonnell, who was warned that his apnea was so severe he might have died in his sleep, using bi-pap saved his life. Like many CPAP and bi-pap users, he’s become an ardent evangelist: Be upfront when it comes to talking to new partners, he says. “Chances are you're talking to someone who uses it and the both of you have something in common. Or it is a conversation starter, and the person realizes they are experiencing issues themselves and get tested."
Impromptu trips, one-night stands, and other things that may take people away from home require some planning when you’re using CPAP. Some frequent flyers actually purchase a travel CPAP machine to enable more sleeping flexibility—these devices are extremely small and fit readily in a handbag or backpack, though they tend to be noisier than larger bedside units.
If CPAP has you thinking of a horrifically bulky machine that sounds like a big rig truck, think again. Most manufacturers produce lightweight versions with low decibel levels , and there are a variety of mask styles available, along with tubing that includes in-line mufflers to dampen sound. New CPAPers can experiment to find the best equipment that works for them. “If you learn that your mate uses CPAP therapy," Hokemeyer adds, "tell them you think it’s great and you're delighted they've found something that gives them a solid night's sleep.”
Sometimes, CPAP even creates an unexpected romance. “I do have a couple of patients who see me together,” Dasgupta says. “It’s kind of cute—they tattle on each other, say, ‘He didn’t use it last night.’ In the perfect storybook ending, your partner may have it too.”
Sign up for our newsletter to get the best of Tonic delivered to your inbox.