Mask braindump: my struggles, what I've learned, and how some mask advocacy has been unhelpful

I have a lot of trouble wearing masks. I've learned some things that make it easier, and I've seen some people trying to promote mask-wearing in ways that are unhelpful and counterproductive.  So I thought I'd blog it all here for future reference.

I've already tweeted most of this as I was experiencing it, so if you follow me on Twitter there's nothing new here.

Caveats

1. I am not a medical professional. My explanation of any medical concepts is my own understanding and is not necessarily a perfectly accurate and comprehensive account of every medical consideration. I'm including it because my own understanding helps me figure out how to wear masks better and longer. 


2. Portions of this post describe ways that I misunderstood medical concepts en route to learning more. I'm including them because describing how I misunderstood things is important to understanding how some kinds of mask advocacy were unhelpful. If you read or excerpt only these portions, it's possible you might come away with incorrect information.


My mask-wearing experience

I'd never worn a mask before COVID-19 came along, but I'd never heard of anyone experiencing adverse effects from them either. So when I got my first cloth mask (thank you, Mommy!) I put it on expecting everything to go smoothly.

I was surprised to discover that my body was working harder than it should have been - I was breathing harder, and occasionally getting light-headed. There was even a time or two where I think my judgement was affected!

When the fabric of the mask touched my mouth, I started outright panicking, feeling that I was suffocating even though I knew I wasn't, but even when the mask didn't touch my mouth (and my mother tried multiple variations specifically designed to keep the fabric away from my mouth!) I was always in some degree of distress.

The mask usually becomes untenable after 40 minutes. My irreproducible personal best was one hour, but just the other day (even after I'd proven to my own satisfaction that I get enough oxygen as described below) I could only manage 15 minutes. It's unpredictable, and the unpredictability is an additional worry.

My original (erroneous) self-diagnosis

The problems occur when I wear a mask, in other words when my nose and mouth are covered. Oxygen gets in through our nose and mouth. If you don't get enough oxygen, you die. Falling unconscious is en route to dying. Feeling light-headed is en route to falling unconscious. Therefore, I concluded, I wasn't getting as much oxygen when I wore a mask, because the mask was blocking some of it.

Seemed like a perfectly logical extrapolation from available evidence, and I couldn't imagine any other explanation. 

My concern wasn't that I'd die from lack of oxygen. (I mean, I might, but then I'd be dead so I wouldn't have to worry about it.)  My concern was that I might faint from lack of oxygen. I've only fainted once in my adult life, and that resulted in my head injury, from which I've never fully recovered. I certainly can't risk it happening again!


The pulse ox selfie problem

As I was struggling with all this, a trend emerged of doctors posting selfies of themselves wearing a mask and a pulse oximeter showing a good, high oxygen level, with the general thesis that wearing a mask doesn't decrease your oxygen level, often suggesting or outright stating that if you think it does, you're ignorant or a liar or anti-science.

All of which is very annoying to have saturating your twitter feed when you've just come back from a grocery run of struggling to breathe in a mask!

From this, I saw several possible conclusions:

- If I went to a doctor with this mask breathing problem, I wouldn't be believed.
- Maybe my body works differently than their bodies, and therefore anything they have to say is inapplicable to me.
- Maybe people who struggle with masks simply don't make it through medical school, and then doctors forget they ever existed. 
- Maybe I have an unprecedented problem that medical science has never heard of, but mid-pandemic isn't a time to go down the diagnostic rabbithole that would entail.
- Obviously, from all these pulse oximeters, oxygen level was the crucial issue. I couldn't imagine any other issue, no one was talking about any other issue, so the cause of my problems must be low blood oxygen levels.

Low blood oxygen isn't the cause

All these pulse ox selfies gave me the idea that I might be able to use a pulse oximeter to detect when I was on the verge of fainting, or to convince myself that I wasn't going to faint.  I ran the idea by a friend with medical training, who told me it doesn't work that way - because your blood oxygen could be normal and you could still faint!

She went on to tell me that was what likely happening is I'm hyperventilating from anxiety at wearing the mask (shortly afterwards I learned this is called false suffocation alarm) which is lowering my blood pressure, which is making me light-headed. She also told me about counterpressure - clenching and tensing muscles to temporarily increase blood pressure and possibly prevent fainting.

So I tried counterpressure the next time I had an early glimmer of mask light-headedness, and the effect was immediate. About 80% of the light-headedness vanished instantly, and I could move about safely without fear of fainting.

This immediately proved two things to me:

1. The mask doesn't affect my oxygen levels - if it did, counterpressure wouldn't get immediate results.
2. The light-headedness, and therefore the risk of fainting, is real - if they weren't, the counterpressure wouldn't get results.

Improved, but not cured

Having effectively proven to myself that it isn't lack of oxygen that's making me light-headed, I soon became less uncomfortable in the mask. However, the false suffocation alarm persists, and my body still fights the mask. I counterpressure, my head usually clears, I move forward. If the counterpressure isn't immediately effective, I sit down, get my head down to heart level, regain equilibrium. I've gotten really good at doing this in a way that makes it look like I'm just examining the items on the bottom shelf, so people in the grocery store don't think I'm in distress and approach me.


I've had moments where I completely forgot I was wearing a mask and days where it took an hour for me to feel any symptoms, but I've also had moments where I feel like I'm suffocating even though I know I'm not and days where I feel symptoms after 15 minutes.

Disposable masks might be easier

As I was in the midst of writing this all up, I tried a disposable mask (sold in the grocery store, marked non-medical) for the first time, and found my body didn't panic in it.  I haven't figured out how to keep it from fogging up my glasses (the nose wire is less effective than in cloth masks), but I only rarely have to fight my body or get light-headed, which is a vast improvement! And even when I do have to fight my body, it's glaringly obvious to my brain that I can breathe, so I'm able to better psych myself out of panicking.

Which makes me realize - all the pulse ox selfies I saw were wearing (presumably medical) disposable masks. What if the thing they were insisting is easy is a completely different thing from the thing I was struggling with???


What mask advocates could have done better

The pulse ox selfies were intended to convince people to wear masks, but they were absolutely counter-productive in my case and, I'd imagine, for anyone else who is struggling with masks.


The emphasis on blood oxygen level led me to believe that blood oxygen is the only possible problem, thereby preventing me from finding my way to useful coping mechanisms. The strong "masks are easy and there's no difficulty at all" (or, at most, handwaving it with "masks can be uncomfortable", which is a word I'd apply to skinny jeans and the seats at Massey Hall - getting light-headed in the middle of crossing Yonge St. calls for a stronger adjective) sometimes made me think medical professionals wouldn't believe me and therefore couldn't help me, sometimes made me think I had to just push through my light-headedness (bad idea - the risk of fainting is real, even if the cause isn't low blood oxygen), and sometimes made me think I was experiencing some unprecedented medical problem.

What would have been far more useful would be talk about actual real-life problems that people sometimes have with masks, and how to actually address them in real life.

For example, the fact that I'm not experiencing low blood oxygen isn't relevant, the fact that I'm feeling light-headed is. So it would be useful for doctors advocating for mask usage to talk about how feeling light-headed is something that happens to some people, here's what it means, here's what to do, here's when to worry.

And do the same thing for any other issues people might have with wearing masks.

It would also have been far more useful to talk about different kinds of masks or mask-wearing options and how they address different issues. For example, I find disposable masks significantly easier. Maybe other people with other issues would find other kinds of masks easier.

"Masks are easy" harms your credibility in the eyes of people who struggle with masks, people who haven't tried masks yet themselves but know people who struggle with masks, and people who are afraid of masks. "Here's how to handle mask issues that may arise" is far more credible and useful, and will get more people wearing masks more often.