This extra chapter was cut from The Journey Back to keep the book focused. The physical paperback is $12.95 with free U.S. shipping. Any $17 PDF-and-audiobook bundle is a separate optional digital add-on, not the price of the paperback.
The sleep problem began long before the hospital.
I had snored for as long as I could remember.
My mother told me I snored badly.
My grandparents said the same thing.
After I married Brandy, my snoring became her problem too. It could become so loud at night that she struggled to sleep beside me.
This was not a soft little noise that somebody noticed occasionally.
It sounded bad.
Approximately seventeen years ago, I went through an ear, nose, and throat evaluation. The doctors considered removing my tonsils because of the snoring and airway concerns. They ultimately did not take them out.
Instead, I remember having my nasal turbinates trimmed or reduced, along with work involving my sinuses and a deviated septum.
‘Trimmed turbinates’ is how I remember and describe it, but the medical terminology, date, and full surgical plan should come from the chart.
My son Alex had his tonsils removed when he was young, apparently by the same ENT I remember as either Dr. Willy or Dr. Williams.
At the time, I wondered whether some of the airway problems ran in the family.
Family patterns can matter in sleep apnea, but Alex’s tonsil surgery and my snoring do not prove that we inherited the same condition. Children can have tonsils removed for several reasons, and my own airway involved a different combination of anatomy, symptoms, age, and weight.
What I knew was that snoring had followed me through several generations of my life.
The more serious clue was what happened in the morning.
I could go to bed at nine o’clock, wake at seven, and feel exhausted.
Mathematically, it did not make sense to me.
Ten hours had passed.
How could I still be tired?
The answer was that time in bed was not the same thing as restorative sleep.
Duration mattered, but it was not the only measurement.
Was the sleep continuous?
Was my breathing repeatedly disturbed?
How often did I wake without remembering it?
How much deep sleep and REM sleep did I actually receive?
Did my body spend the night recovering, or did it spend the night repeatedly fighting to maintain an open airway?
I did not know the answers then.
I only knew that I could spend most of the night in bed and wake as if I had hardly rested.
Later, after I had gained weight and become what I call a little fluffy, I returned to the ENT.
The physician looked at me, considered the snoring, exhaustion, weight, and airway history, and said, in substance, ‘You have sleep apnea. I almost do not need the test to know it.’
I need the medical record before quoting him more precisely.
I also need to distinguish a strong clinical suspicion from a formal diagnosis.
My memory is that he explained that documentation for insurance would require additional testing, probably an overnight sleep study or an appropriate home sleep-apnea test.
Those are not minor details.
The apnea-hypopnea index, oxygen levels, number of respiratory events, sleep-study type, and severity category would determine what was actually established.
What I remember vividly is the equipment demonstration.
The physician had a small mask or sample device and showed me how positive airway pressure would work.
I tried to put it over my face.
My body reacted immediately.
I gagged.
I felt as if I might throw up.
I know I sounded pitiful.
Something about having the mask attached to my face created an overwhelming sense that I needed to get it off.
The strange thing is that I do not consider myself claustrophobic.
I have been through MRIs. Those machines are tight. I can lie inside one and fall asleep within a minute.
I have been in other confined spaces without panicking.
At one point, I even imagined that I would enjoy being an aircraft pilot or fighter pilot.
But a mask covering part of my face was different.
I was not afraid of tight spaces.
I was afraid of being unable to escape something attached to my face.
The reaction felt physical before I could reason with it.
The mask touched my face.
I gagged.
My stomach turned.
My mind said, ‘Get this off.’
I joked with the physician that I would never make it as a woman because I could not tolerate anything covering my face. He laughed. The joke was my way of making the moment lighter, but the discomfort underneath it was real.
I did not leave that appointment believing sleep apnea was imaginary.
I left believing the treatment looked impossible for me.
That difference matters.
People sometimes talk about CPAP use as if the patient has made a simple decision between responsibility and irresponsibility.
For me, the mask created a barrier before I ever made it through a normal night.
I could understand what it was supposed to do.
I could believe that keeping the airway open mattered.
I could still feel unable to tolerate the equipment on my face.
The physician mentioned that there could be other devices or ways of approaching the problem. He also discussed weight loss and other factors that might help.
My memory is not clear enough to say which alternatives he specifically recommended, whether we discussed different mask styles, or whether I tried any structured acclimation process.
I do not remember gradually wearing the mask while awake.
I do not remember trying nasal pillows, a nasal mask, a different full-face mask, humidification, pressure adjustments, ramp settings, or a different positive-airway-pressure mode.
I do not remember being fitted for an oral appliance.
I do not remember returning for a systematic troubleshooting process.
That does not mean none of those conversations occurred. It means I cannot claim them without the record.
What I remember is that the first experience felt awful, and I backed away.
I put the problem into a category called, ‘Something I should deal with eventually.’
Eventually can last a very long time.
Meanwhile, the symptoms continued.
I snored.
I could sleep for many hours and wake exhausted.
I gained weight.
I struggled with other health problems.
Years later, after the metabolic crisis, sleep became one of the Regulatory Load variables I could no longer treat as optional.
Looking back, the untreated or incompletely treated breathing problem may have affected sleep quality, but I should not reconstruct every later glucose or blood-pressure reading as if sleep apnea alone caused it.
The body was carrying several Loads at once.
The sleep history was one important part of the picture.
It was not the only part.
Another part involved reflux.
My gastroesophageal reflux disease, or GERD, became severe.
The ENT explained that reflux could travel high enough to irritate the throat and voice box. That is often described as laryngopharyngeal reflux, or LPR, when stomach contents reach the larynx and pharynx.
I could feel the consequences in my voice.
My business depends on talking.
I consult.
I coach.
I help build companies through conversations, presentations, calls, and explanations.
My voice is not a minor accessory to the work.
It is one of the tools of the business.
Yet there were mornings when I could hardly talk before eleven o’clock.
My voice would be hoarse.
I would cough, hack, or clear my throat.
Once the voice finally became usable, I might get two or three hours of talking before I became hoarse again for the rest of the day.
I constantly used Ricola throat drops because I was trying to soothe the irritation and keep speaking.
The drops helped me get through the next conversation.
They did not explain or treat the entire cause.
This created another feedback-loop problem.
My work required talking.
Talking strained an already irritated voice.
The irritation made work harder.
Stress from work could affect sleep and eating.
Poor sleep could leave me more exhausted the next day.
Then I would use something quick, such as another throat drop, more coffee, or food, to push through the work.
The symptoms looked separate when I viewed them one at a time.
Snoring belonged to nighttime.
Hoarseness belonged to my throat.
Reflux belonged to my stomach.
Exhaustion belonged to the morning.
Weight belonged to diet.
Work stress belonged to the business.
But I was one person carrying all of them through the same twenty-four hours.
That does not mean every symptom had one cause.
It means the divisions I created in my mind did not keep the systems from interacting.
The airway surgery had addressed part of my nasal anatomy.
It had not guaranteed that snoring or obstructive sleep apnea would disappear.
Leaving the tonsils in place did not prove they were the continuing cause.
Weight loss might alter risk or severity for some people, but it would not allow me to assume that a diagnosed condition had disappeared without reevaluation.
Reflux could contribute to hoarseness and throat irritation, but hoarseness has other possible causes and requires appropriate evaluation when it persists.
CPAP intolerance did not establish that every form of positive-airway-pressure treatment or every alternative would be intolerable.
It established that the particular experience I had was intolerable to me at that time.
That is the accurate boundary around the story.
I wish I could say that I responded to the first warning with the same monk-like discipline I later brought to food and glucose testing.
I did not.
The mask touched a fear that the glucose meter did not.
I hated lancing my finger, but I could make myself press the button because the procedure lasted a second.
The CPAP mask asked me to accept the sensation on my face while I surrendered consciousness for the night.
That felt completely different.
I could command myself to tolerate one pop from a lancet.
I could not command myself to sleep while my body was shouting that something had to come off my face.
So I chose avoidance.
Avoidance solved the immediate discomfort.
It did not solve the sleep problem.
That is one of the most honest things I can say about the period.
I knew enough to understand that the snoring and exhaustion were not normal.
I had a physician who recognized the likely problem.
I was shown a treatment pathway.
I encountered a barrier and stopped.
Knowledge did not automatically become action.
That happened repeatedly in my life before the hospital.
I knew how to read nutrition labels.
I knew about diabetes.
I knew sleep mattered.
I knew snoring could be more than a joke.
I knew weight and metabolic health were connected.
But knowledge that does not cross the barrier into behavior remains theoretical.
The mask was one barrier I had not crossed.
The proper lesson is not that people who dislike CPAP should abandon treatment.
It is that treatment has to be usable by the person expected to live with it.
If a mask creates gagging, panic, skin problems, air leaks, dryness, pressure discomfort, or a trapped feeling, those problems belong in the medical conversation.
They are not evidence that the underlying sleep apnea is unimportant.
They are obstacles requiring troubleshooting.
Different mask interfaces, gradual acclimation, humidification, pressure review, positive-airway-pressure alternatives, oral appliances, positional approaches, weight management, surgery, and other options may be appropriate in different circumstances. Which options fit depends on the diagnosis, severity, anatomy, medical history, and qualified clinical guidance.
I cannot select the right option from memory or from an Oura Ring.
I need the original records and a current professional evaluation.
That is especially true because approximately seventeen years have passed.
My weight has changed.
My blood pressure history has changed.
My metabolic health has changed.
My age has changed.
The equipment and treatment choices may have changed.
The condition should not be assumed to have remained exactly the same, improved, or worsened without proper testing.
The story begins with my family hearing me snore.
My mother heard it.
My grandparents heard it.
Brandy lost sleep because of it.
Then I began hearing the consequences in the morning.
Ten hours in bed.
Still exhausted.
Later, I heard the consequences in my voice.
Hoarse before eleven.
Two or three useful hours.
Then strained again.
The symptoms kept speaking even when I postponed the problem.
The CPAP mask asked me to listen in a way I was not ready to accept.
I tried it, gagged, felt trapped, and backed away.
For years, I treated that moment as the end of the treatment conversation.
It should have been the beginning of a different conversation.
Not, ‘Can I force myself to tolerate this exact mask?’
But, ‘What is preventing me from using the treatment, and what medically appropriate path can we try next?’
That is what I understand differently now.
The first mask failed.
That did not mean the condition had been treated.
It meant the treatment plan had encountered a human being.
Want to see how I connected the dots?
I wrote The Journey Back to share my experience and explain the Four Metabolic Loads framework. The physical paperback is $12.95 with free U.S. shipping.
→ See The Journey Back Paperback ($12.95)
Educational only, not medical advice. Charles’s experience was alongside physician-supervised care and prescribed medication. Individual results vary. Talk to your doctor.