People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen.
I've suggested 4 people over the last couple of years to get tested based on them casually mentioning some of these symptoms, and all 4 got diagnosed with moderate to severe sleep apnea (which is classified by the number of times you stopped breathing every hour - AHI, and the blood oxygen level). Getting tested is easy and cheap - you can find kits for under $100 which essentially are just a monitor you attach your finger + a few ECG stickers on your body which you use for a couple of nights. You can order them online without talking to a doctor, and you will get a prescription for CPAP if you are diagnosed as positive.
Treatment with CPAP is highly effective in eliminating these symptoms, and also reversing the brain damage (although MRI scans shows that it takes around a year for the gray matter in your brain to restore itself).
The other suggestion I'd make is that if you are overweight or obese, GLP-1 has proven to be also a miracle drug for sleep apnea. Unlike the study mentioned above, that essentially reduced the average AHI of participants by 4, which for almost everyone wouldn't cure them. Drugs like Zepbound have shown that over half are cured from sleep apnea after roughly a year of use. This is in addition to the other health benefits they provide with the weight reduction. Essentially. This unfortunately won't work for everyone, as weight is not the only cause of sleep apnea, but it is by far the most common one.
This is worth pursuing for anyone with the symptoms.
However please do it with a reputable doctor, preferably associated with an established institution. Watch out for some of the specialty clinics and independent practice doctors who treat apnea like a cash cow.
Sleep study scoring is theoretically set by strict rules, but in practice there can be differences between operators and clinics. Some clinics use this to their advantage to push more treatments and equipment and they’ll do it in ways that are most profitable for themselves. If they can’t get you scored high enough on the first sleep study they’ll pressure you to keep coming back for more studies or in some cases to start paying out of pocket after your insurance company starts refusing so many repeat studies with negative results.
The better clinics are not afraid to tell someone they don’t have apnea or that they likely won’t benefit from PAP machine. They also aren’t shy about telling someone that weight management can be the best long term solution for weight-related cases, whereas some clinics won’t mention it because they want you coming back to them for never ending management.
Having been down this path, it’s evident to me that the US has built up a sizable medical equipment industry around CPAP machines and their supplies. The sleep doctors who prescribe them don’t have many alternatives, so it’s the normal treatment they hand out.
So it’s not a surprise that a casual mention of sleep quality ended with a CPAP machine rented by the month. It’s kind of what happened to me.
I’m always on HN talking about myofunctional therapy (my mom is a practitioner in NYC). Recommend looking into it in addition to losing weight as treatment.
I've tried a CPAP machine for 6 weeks and felt no different and gave up. I think I was a 6 on the scale. I wish it had worked though!
Currently I've just given up and embracing feeling relatively tired all the time. I've tried side sleeping devices (woody knows backpack) mandibular advancement splints etc.
So hard to tell (I find anyway) to get to a definitive answer
You should consider getting an Wellue O2 ring. This is something you can use to monitor your oxygen saturation throughout the night. Use it with the CPAP and also otherwise. If your oxygen saturation is better with CPAP - you know that it is working. You will eventually feel better.
The main thing about CPAP is that, and imo almost everyone gets wrong, is that you need to titrate it. CPAP is sold as an Automatic Pressure device, but in practice it doesnt work like that. You almost always need to set it just 1 number below and 1 above your required pressure - more like a fixed pressure device. And getting it working correctly - with all the mask combinations, leaking issues, pressure calliberation, supporting gear like mouth tapes and neck bands - can take months. It is incredibly hard - BUT - it is worth it. The best resource for me has been the reddit to get this right.
The key is to track your saturation everyday with all the small tweaks you make and the only way to do it is using something like the O2 ring.
For some people it takes months to feel any different.
For some people, they don't feel any better but it improves their health.
Did you examine your numbers at all in something like OSCAR? You could get a good idea of how many events you were having at night, and if the CPAP was improving it.
Even if you aren't feeling any better (yet) it could still be helping. You could also have multiple things that are causing you fatigue issues, and maybe fixing only one of them wasn't enough... that doesn't mean that one wasn't also important, though.
Three more things to try if you haven’t, on a “can’t hurt” basis: nightly Avamys spray (might need a scrip depending on where you are), magnesium glycinate before bed, little bits of plastic that go inside the nostril and hold them open.
Also worth a try... B1 (thiamine) seems to help for me. I don't have objective numbers, but I disturb my spouse with my snoring and breathing troubles far less. I believe I have (undiagnosed) central sleep apnea rathee than OSA though, it's been a long time since I had a sleep study, but I had only one event over a few recorded nights... But some nights it's pretty bad.
Sleep apnea can indirectly cause weight gain, but obesity—particularly excess fat on the neck—is the main controllable risk factor for obstructive sleep apnea, so it’s primarily the other way around.
> Treatment with CPAP is highly effective in eliminating these symptoms
… for those who tolerate it. Numbers are all over the place, but roughly people who start it are only 50% likely to still be using it properly after a year.
> People should be more aware of the symptoms of sleep apneas
I'm always a bit puzzled that this needs to be pointed out? I don't have sleep apnea per se, at least not chronically, but I've definitely had bouts of it due to allergy, sickness, stuff like that. The symptoms are the same because the mechanism is the same: I didn't get enough oxygen in the night.
It's always glaringly obvious to me the next day. I feel way more tired and exhausted than I normally would given the amount of sleep. I sometimes had instances of waking up gasping for air.
I really don't need to be told in those instances that there was an issue during the night. My sleep didn't sleep, of course there's something wrong and needs to be looked at?
Like, one time's a fluke, but if it happens a lot...
One, not all sleep apnea patients snore. 20% do not snore
Second, I am not sure what your experience has to do with people that DO have sleep apnea? If you are correct and you do NOT have chronic sleep apnea, then it makes sense you would notice clearly on the nights you did. For someone who has suffered from it for years (or even their whole life), they aren't going to have anything to compare it to. They don't 'feel way more tired and exhausted' then normal because THIS IS THEIR NORMAL. If everything feels the same as it always feels, why would they assume it was sleep apnea?
Just because you experience something a particular way doesn't mean everyone does
It’s typically something that sets in over time (often, but not always with weight gain and age), most people don’t notice because it’s gradual. Especially if they aren’t in normal risk groups. OSA symptoms are easy for an individual (and clinicians) to misatribute
Yeah, but I've met people who think it's "normal" to wake up tired and exhausted even after multiple (or even many) nights of sufficient sleep, time-wise.
I remember one person who thought waking up tired is just part of being an adult?
The original comment said "multiple folds higher chances to be depressed, unemployed", for me that's a bit like saying that being on fire has a very high chance to make you depressed and unemployed.
Yeah, of course that's true, but the effect on performance and well-being after a sleep apnea night is so obvious to me, I don't have to look for the proximate cause...
EDIT: Through the other answer came to me that maybe in other cases, it's not so directly obvious just after waking up.
> > People should be more aware of the symptoms of sleep apneas
>
> I'm always a bit puzzled that this needs to be pointed out?
You're puzzled that most people don't know the symptoms of sleep apnea? Maybe there are big campaigns where you are, but I've never seen any public information about its symptoms.
I think it’s important to know your personal context levels.
You noticed it because it’s happened to you occasionally. What about people who’ve been experiencing it most of their lives? To them, they are just tired all the time and don’t know why. It could be any number of things.
To someone who’s never experienced it, how could they understand?
My wife has bad sleep apnea and has to use a CPAP - neither of us noticed or understood the issue until she did a sleep study to deal with her bad snoring. We knew she was tired all the time, but attributed it to factors like work stress or maybe diet.
The average person’s understanding of sleep apnea is probably around the level of “it exists and they have to wear a device at night” and not much more.
I guess. This is a good answer, it did made me recontextualize.
Maybe it was always that much obvious to me that what should have been a good night of sleep had no, or maybe even a negative, effect on my wellbeing, and therefore something must be wrong during the sleep.
But if the effects are a bit more muted and accumulate more gradually, and you've never heard much about sleep apnea, you might not directly attribute it to the sleep itself.
Fascinating how basic research on noradrenaline and muscarinic receptors from 20 years ago is now translating into a phase 3 drug trial. Four fewer breathing events per hour on average is meaningful. CPAP is effective but compliance is terrible, so having an oral alternative would be huge. Hope AD109 makes it through approval.
I have severe obstructive sleep apnea -- am 6ft and 210. I wear a CPAP and now swear by it. A couple things to help those who try:
1) Make sure you have a CPAP machine with a water tank so the forced air is moist. For me, if the water runs out, that's when I wake up bc my nose dries.
2) Get a spray saline solution for your nose -- not Afrin or drugs (habit inducing) -- just simple and cheap Arm & Hammer Simply Saline.
3) Wear a shirt when you're in bed and put the hose under your shirt so it's hard to roll off.
4) Bonus -- sleep elevated.
Those are my best tips. If you can do the CPAP and suffer the awkwardness, you'll really feel so much better. First time it stuck, I woke up at 4:45 am fully rested and felt as if a heavy weight was lifted off me.
My dad used a CPAP for many years and was quite the evangelist for them due to how significantly it improved his quality of life. At one point, when trying to nudge him toward weight loss and diet changes for type 2 diabetes, I mentioned it may also help with his sleep apnea. He was adamant that the type of sleep apnea he had would exist no matter what and weight loss wouldn't help... apparently his doctor told him this. Fast forward 5 years, he ends up in a program for his diabetes that put him on a pretty extreme elimination diet which led to him losing a pretty significant amount of weight. During that time he kept having to turn the pressure on the CPAP down, until eventually even the lowest setting was too strong and he was able to get off the CPAP completely. For over a decade he talked about how happy that CPAP made him, he almost seemed proud of it. However, he got pretty emotional when he found out he was able to get off of it. As much as it may help, it is still a burden to need a machine to sleep.
I know it's an N of one, but it shows it can help and is worth a shot. Even if it doesn't completely resolve the sleep apnea, there are so many other additional benefits.
After an alert from my Apple Watch and a few extremely rough nights of sleep when my weight hit an all time high, I scheduled a sleep study for myself. It's 2-3 months out still, so I plan to lose what I can while I wait to see how much it can help. Even the first 10 lbs was a significant help and stopped the truly awful sleep I had for a week or two.
I went through the whole process of seeing an ENT, using the machine for the at-home sleep study so insurance would give me a CPAP, then not being able to sleep with a CPAP, and over the course of a couple years I fixed my sleep apnea by fixing my posture and breathing. If you have forward head posture or are not used to breathing through your nose, you might also benefit from this. I think it’s kind of crazy that we do surgeries and take medicine that modifies your brain chemistry for what I believe in many cases is a structural issue.
If you’re curious to try this, read James Nestor’s book Breath, do yoga with breathing exercises, or see a physical therapist. It takes time to fix these structural issues, but you can literally change the shape of your nose, palate, and jaw from just practice.
Here’s a quick exercise you could try. Sit up, relax your body, breathe in through your nose, and feel the breath move up your nose, down to the base of your skull, down your neck, and then as far down your spine as you can. The air isn’t literally moving through these areas, but you should feel a current of sensations moving roughly along that path. As you breathe out, follow the current in the opposite direction. As you tune into this current, your neck and back will naturally straighten a bit, it should feel very natural and even pleasant. Keep your body relaxed and allow your neck and back to align with this current. If you keep doing this regularly it should help improve your posture and breathing. This is basically a pranayama / yoga breathing exercise. If it feels painful, definitely stop and try physical therapy or working with a hatha yoga instructor who can give you more guided instruction.
I used to snore so badly it sounded like, without much exaggeration, a dying elephant. I only did this exercise for a couple years and it slowly improved over that time, and now I sleep quietly.
> what I believe in many cases is a structural issue
Many cases it is not. I'm not trying to be a contrarian but I don't want to plant hope in some people who suffer from sleep apnea thinking it's something they can just do breathing exercises for.
fwiw I really believe it is, my sleep problems come and go based on entirely physical variables--how flexible I feel, how much time I spent "shrimping", how tight my back and neck are.
Personally I would not be surprised at all if in 50-100 years we look back on this era as one where we massively overprescribed CPAP machines to treat an entirely-fixable condition in most people (alongside all the other medical interventions that will turn out to be bandaid fixes for actually fixable problems). I'm aware this is a bit of an outlandish take. But you can tell how many people's breathing and posture is bad just by existing in the world for ten minutes and looking at them. I think it's really an epidemic.
I don’t think it’s an outlandish take at all. You can possibly also put orthotics and spectacles in the list of interventions as solutions to problems largely induced by unnatural adaptations to an unnatural environment.
I had a similar experience, with a slightly different approach (mouth tape and a nose dilator) but seemingly similar outcome. I like that you did it just through exercises with no mechanical intervention. Inspiring.
Thank you! I saw you mentioned mewing in your comment, they teach you that in some pranayama exercises as well and I agree it’s a great addition. It feels unnatural at first but when you get used to it, it’s almost like bracing your palate with your tongue allows you to pull air in through your nose more smoothly and with more power.
I’ve found this is all really worth learning, even if you don’t have sleep apnea. I feel more clear headed and energized when I can breath through my nose now.
That's fascinating, I just did some reading on this - I had not known that the basic technique of "mewing" is very similar if not identical to something that's been practiced in yoga for thousands of years. That in itself doesn't speak to its effectiveness necessarily but on the surface it's a different way to look at it than as just a modern fad.
Regardless, it doesn't cost anything to try, seems no danger in it and it seems logical that it could help.
>basic technique of "mewing" is very similar if not identical to something that's been practiced in yoga for thousands of years
Can you elaborate more on this? I also assume by "mewing" you mean putting the tip of your tongue on your hard palette right behind your upper incisor, and letting the rest of the tongue suction against the hard (and soft) palette. Surprisingly for something that seems to be so "popular" in "broscience" I find it hard to find any canonical definition or technique.
Yup totally, how you breathe during the day is a habit that basically persists at night
So breathing better during the day can be trained, even at an old age, and it improves sleep
Not everyone breathes suboptimally of course, but I think more do than realize it. There’s a reason that breath work is in the traditions of many different cultures, and why it survived
But things like this aren’t necessarily profitable or worth a doctor’s time, so you have to do them yourself, or see therapists, etc
I had a good experience with a myofunctional therapist and posture therapist
Oh you don't say? I'm genuinely curious to know what you reduced your AHI to with these exercises. Or are you just making things up?
Yeah we'll go with fabrications based solely on this sentence "But things like this aren’t necessarily profitable or worth a doctor’s time, so you have to do them yourself, or see therapists, etc"
I thought one of the main issues is that during sleep you lose muscle tone and control, so no matter how much you do myofacial therapy while awake it doesn't really matter much in preventing your tongue from falling back when asleep.
Nestor's book didn't feel right. I don't think he's a crank, or that he's entirely wrong, but the idea that we're breathing wrong feels really unlikely. You don't have to be taught to breathe.
I'm sure that many of the lessons in the book are applicable and there is much to learn. But a lot of it felt like woo, even though I know full well that the author is a well-respected journalist.
I'd really like to hear a sound review from someone who knows the domain better than me.
You sure? Haven't read the book / heard of the author. But after I started freediving and training holding my breath (also called static / dynamic apnea lol) and working a lot on related stuff, I realized I was mostly breathing shallow and with my chest, and not deep with my abdomen.
Now I notice it in others. I don't know if it matters in the end. But I breathe a couple of times a minute and then I hear people next to me quickly breathing in and out constantly like a rabbit. Seems stressful?
Considering how much we use them now it could change the default state significantly, and maybe we do have to consciously relearn the best way to breath.
I haven't read his book, so I don't know how much of a kook or grifter I would judge this guy to be, and I'm always dubious about things, but I try to remember that even kooks and grifters sometimes (not always!) have genuinely useful things in what they're saying. They might not be the best person to say it, and their suggestions might not always be the best way to make use of the useful bits. But just because someone is trying to make money from spreading their message doesn't make it all BS.
To expand on this, the posture is really so important, this muscle the iliopsoas connects inner hip to low back on opposite sides, forward head sometimes also has anterior pelvic tilt, anyways your diaphragm is connected to this muscle and if it’s tight, or holding your pelvic in a tilt, it can make the diaphragm not be able to take full breaths. I’ve done some relaxation stretches you can search for this muscle, like laying down with one knee bent and leg up like a square and other leg straight out or slightly elevated, and “dead bug” yoga, and found my breathing suddenly improved on several occasions.
What a ridiculous post. Please leave the Reddit pseudoscience at the door.
There are researchers actively working and studying people with sleep apnea. They're not suffering from "forward head posture" or "breathing wrong".
I have severe sleep apnea and no amount of "breathing exercises" are going to cause my soft palate to uncollapse itself while I'm trying to get REM sleep.
Its been established head posture is a factor. It’s also intuitive - the posture of your head affects the angle of your airway. This is why some patients wear cervical braces to sleep.
You have no idea what you're talking about and it shows by what you choose to type.
It's not exclusively caused by fitness or lack thereof. A cursory Google search would show you this. It's not "breathing at night", it's literally suffocating in your sleep.
This place used to be full of intellectuals. It's a real shame.
If it's not obvious I meant breathing while sleeping at night in a sleep apnea discussion, I think you need to analyse your own internal bias and possible self-hate.
I'm very sure i have sleep apnea now as i wake up literally in panic where i'm not breathing + have a full bladder and need to go a few times a night (which i've read as a kidney response with sleep apnea).
As i said this all came about with extra weight gain in the past few months.
It only reduces by 4 events per hour. That seems like it might be helpful for someone with mild sleep apnea. But not with moderate or severe sleep apnea.
Adult AHI Severity Levels
Normal: Less than (5) events per hour.
Mild Sleep Apnea: (5) to (14.9) events per hour (frequent minor interruptions).
Moderate Sleep Apnea: (15) to (29.9) events per hour.Severe Sleep Apnea: (30) or more events per hour.
"By mapping the neural circuits that lead to this common condition, work from the Horner lab laid the foundation for AD109, a new treatment developed by researchers in Boston to specifically target the two pathways that contribute to sleep apnea. The daily oral medication contains two drugs: one that increases noradrenaline levels and another that blocks muscarinic receptors.
In a recently published phase 3 randomized clinical trial, people with mild to severe sleep apnea who received AD109 had less airway obstruction and higher oxygen levels than those who received a placebo. On average, per hour of sleep, participants on AD109 had four fewer events where they stopped breathing or had very shallow breathing."
They say later in the article that the pill is a good option for folks that can't or won't use the CPAP.
A CPAP is really effective, so it would be first line treatment. If I couldn't use one but needed it, I'd be happy to have fewer events per hour than all of it. Improvement is better than nothing in this case. Besides, a lot of drugs are improved after the initial breakthrough drug - so this gives hope that we might actually be able to be free of the CPAP for many more folks.
CPAP reduces my AHI from 55-60 down to less than 0.5. For people with severe sleep apnea, an 'improvement' of 4 events per hour does absolutely nothing for their health and provides a false sense of security. Their time, money, and energy is much better spent learning how to adapt to CPAP.
Oof, and here I thought my AHI of 69 was bad (which it kind of is regardless). My condolences. Glad the CPAP helped, it completely and utterly changed my life too.
the cpap is a wonder, I can't sleep without it. I only wish I'd gotten one 10 years sooner. I have whole years of my life missing from my memory - REM sleep is very important to long-term memory formation.
I don't have sleep apnea, as in, my severe snoring doesn't cause significant drops in blood oxygen levels, but it's still severely impacted my life - when my wife and I married, I spent the first night of our honeymoon awake so that she could sleep.
Oh and it's so loud that I'm at risk of damaging my own hearing.
And I bounced off CPAP hard, no matter what I tried, I would eventually remove the mask in my sleep, it was heartbreaking, I was so excited to finally be able to fall asleep beside my wife.
I also tried the mouth guards and would wake up panicking and gagging.
So my only other option currently is self-funding expensive surgery (our public system doesn't fund treatment for severe snoring unless it causes apnoea, and my private health insurance excludes the most expensive portions shrug), which like all surgery, carries no guarantees of success, and also carries the risk that any general anaesthesia application does.
So this is awesome! I just hope it continues proving efficacious and safe.
Not yet it hasn't, but another 10 years of exposure to it will - and I do. :)
I phrased it like that to try to convey the impact my snoring has on anyone near me.
When I got hunting or tramping, and intend to stay at a backcountry hut, I always carry my bivvy bag in case there's other people staying at the hut, if there are, I go sleep in my bivvy bag about 50m away from the hut.
Nothing like waking up and 20 other people all want to beat you.
I found a way to stop removing the mask through smarthome magic: flash my lights if I take off the mask.
Parts:
1. Smarthome coordinator - HomeAssistant/AppDaemon (runs on my desktop)
2. Prescense sensor - e.g. Aqara FP2
3. Smart light - e.g. Phillips Hue
4. Smart Plug/Power Meter - e.g. Kasa ESP25P4
5. Claude Code to write the logic
.....
The alarm goes off if all of the following are true:
1. it's in sleep period (11pm-6am)
2. i am in bed
3. i have been in the bed for at least 3 minutes
4. i have worn the cpap (wattage > 10w for 3 minutes during
sleep period)
....
I can't get around this system at all without walking across the house to my desktop, at which point I'd be too awake to be stupid enough to remove the mask.
Bonus CPAP nerdery: Wireless data collection into homeassistant using a Toshiba W04 SD Card/Wifi Transmitter.
There are some older studies that showed nicotine (not via smoking, which makes sleep apnea worse) had a positive effect on sleep apnea as well due to the stimulation increasing muscular activity in the airways. Obviously lots of downsides too so it never caught on, but this seems to have a similar mechanism.
If you wake up every day feeling like you got hit by a train and also have anxiety, depression, chronic heartburn, or exhaustion (not sleepiness, like a wired but tired) I would highly recommend looking into Upper Airway Respiratory Syndrome (UARS).
UARS was coined by Dr. Christian Guilleminault who was on the team that coined sleep apnea. Over his career he slowly widened his definition of sleep disordered breathing from choking (sleep apnea) to any nasal resistance that causes wake ups.
You be young and perfectly healthy but due to bad anatomy have micro arousals throughout the night. Becuase your young, your body fights through it (cuasing exhuastion) and will wake up up to readjust your airway. You won't remeber any of the wakeups, but many suffer from insomnia from it. The two big issues is large tongue in underdeveloped jaw that falls back and constricts your airway (you can test this with a mallamapati test) or a small nasal passage way.
I had bad sleep apnea until last year, sleeping 8-9 hours a night and usually feeling tired in the morning.
As of the last 12 months it seems to be heald, after I used mouth tape and a nasal dilator consistently for 30 nights in a row. I highly recommend trying this, it was quite cheap (~$20) and the change seems to have been permanent.
I used 3m micro-pore tape that doesn't tear the facial hair, and the nasal dilator I used was called "woody knows", though there are many brands that may work just as well. I barely snore anymore where I used to be a raging snorer according to those in the know and my own audio recordings of myself. Most importantly, I only need about 7 to 7.5 hours of sleep now and I will wake up feeling well rested most days. I can also breathe exclusively through my nose now where before I could not. I can take very big breaths through just the nose and do this now when exercising.
I don't think it's all perfect though as I still often breathe through my mouth. I'm starting to wear the mouth tape at night again as an experiment - it really isn't that annoying.
Relatedly, I recently started looking into "mewing" after a breath-work teacher I took classes with recommended it to me as she has been doing it with good results (improved breathing). It seems related to this as Mew recommends keeping the mouth shut all the time. I intend to try the mewing exercises and see if that helps my breathing further.
The difference maker for me was an app, Snore Lab. that my son told me to try. It said that my snoring was EPIC. That led to my current CPAP use, for which the benefits [no daytime sleepiness, more energy, no food cravings] exceed the hassle [mask wearing, cleaning routine, supplies reordering.]
Four events per hour AHI improvement would not be a meaningful change for my therapy, but this is the beginning of better treatment options in the future.
The best benefit of CPAP is that it thwarts heart arrhythmias which arise from depriving the brain of oxygen.
I see CPAP rightly getting mentioned a lot here. What worked for me was a MJS (Mandible Jaw Splint), it’s basically a mouthguard you sleep with that moves your lower jaw forward and thus brings your tongue forward so it doesn’t obstruct your airways.
Best bet is to get this custom made. Here in Australia there are specialist dentists that do this for you. It’s far easier than CPAP and works just as well for many like myself.
Often folks will use CPAP at home and these mouth guards when travelling.
I think sleep apnea would have killed me had I not gotten the sleep study. I was having 100+ events in the span of a few hours. Anyhow, I use the CPAP everyday. I don't snore anymore and I have maybe 1 event a night. Incredible machine.
I was never diagnosed with sleep apnea but I had an O2 saturation alert when I would sleep side sleeper so I bought a cervical pillow and found a quiet CPAP machine. I add saline and a few drops of very diluted I+KI to the water just to keep anything from growing in it despite changing it daily. I love it. My sleep has never been better. I often forget I have the little nose mask thing. The cervical pillow is awesome, never goes flat. My biggest improvements were from that little cervical pillow.
I highly recommend BongoRX (https://bongorx.com/) if you have sleep apnea and can't deal with CPAP. The mechanism: it makes it a little harder to breathe out, which keeps your airways more open when you breathe in next.
The pictures on the website are a little misleading: it comes with a strap to keep the device in your nostrils, so they don't just fall out in the middle of the night.
Surprisingly the most effective treatment I've found for my own apnea is just wearing an inexpensive soft cervical collar to sleep, but there are lots of different things that can contribute to sleep apnea, so YMMV.
After dealing with unexplained ectopic heartbeats (sometimes PVCs, sometimes PACs) I saw a chain of doctors and that included both getting a sleep study done and seeing a cardiologist.
I was diagnosed with mild apnea (AHI just above 10), but despite the apnea being mild on the AHI scale, my Sp02 blood oxygen percentage was dropping into the low 80%s for extended periods per night down from a normal 95-99% most of the time.
I weigh 180 lbs at 6 foot 2, being overweight was a non-factor in my apnea.
Got a CPAP machine, it helped but even after dialing in my personally optimal pressure settings using the CPAP data with OSCAR my AHI was still kind of all over the place, from under 1 to as much as 6 seemingly randomly per night with no mechanical issues like mask leaks showing up.
Had heard (on reddit /r/CPAP) about some people using soft cervical collars to help with their apnea and I gave it a try and when wearing one my AHI drops down to 0.0 - 0.4 per night. The collar alone helps more consistently in my case than the CPAP machine does.
Basically my sleep apnea is almost entirely due to the fact that when I'm sleeping (even on my side, but worse on my back) I seem to naturally tuck my chin in toward my neck in a way that constricts my upper airway and the collar stops this from happening. This is very much YMMV, there are lots of different causes of apnea.
Great. Something like 60% of OSA cases are linked to obesity. GLP-1 drugs could probably lead to resolution for a lot of them if the Lilly SURMOUNT-OSA trial tells us anything.
Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all.
The preconception that it is mostly obesity related is a dangerous stigma since it prevents a lot of people understanding what is happening and getting treatment.
I started with sleep apnea in my 20s when I was in amazing physical condition. I would jolt awake, heart racing, almost panic attack levels. No idea what was happening.. took me another 15 years to do a sleep study and get diagnosed, and CPAP treatment literally overnight cured the condition. I went from 20-30 events per night to less than 1 on average.
If anyone has any sleep issues at all, or suspects any.. go get a sleep study. It’s not as scary as it sounds and there’s no downside to having one done.
> Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all.
I mean, the person you replied to literally said "60% of cases are linked to obesity"
Which obviously implies that 40% of cases are NOT linked to obesity. You are saying the exact same thing the person you replied to is saying, just without the numbers.
I feel like the person you replied to's comment was not stigmatizing obesity at all, in fact learning that 40% of sleep apnea cases are unrelated to obesity entirely probably educated some people that it was less tied to weight than they believed before.
I wake up without my cpap mask after a few hours every night. In total I might get 6 hours with it after putting it on multiple times.
Doctors think I’m doing fine due to total amount of hours used, and my resmed cpap claims I’m at below 1 event/hour. I’m not doing fine and I think the numbers are lying to me.
I snore a million, my mouth gets dry, and my nose tightens up, so my nasal mask isn’t always that nice to use. Other masks also annoy me.
What do? I haven’t sleep a solid 8 hours for 3-4 years :(
Keep at it - there are a ton of things you can try which will help. Try to use reddit to see what other people are looking at.
If there is one thing I can recommend you - get the Wellue O2 Monitor. This wil montior your O2 saturation through the night - if the saturation is dropping, you know that there is an issue, irrespective of what the resmed cpap claims. The resmed cpap figures cant be trusted imo.
But once you know what the saturation levels are, you can try a LOT of things which might help. Different cpap masks, head of bed elevation, mouth tape, neck straps - what you end up using will depend on your condition. But imo - dont rely on doctors to diagnose and fix you - you will have to do it yourself. Fortunatately there is a ton of people who are trying things out in reddit and extremely unlikely that you have a conditoin which is not fixable.
Just keep at it and track it using the O2 ring and try out what works for you.
Find a mask that doesn't have snap magnets to hold it to your head... if you make it harder to take off, you might wake up and catch yourself taking it off.
Obviously I don’t know you or your specific situation, but I lost 120 pounds taking Zepbound and my apnea is gone. I make sure to take fluticasone in each nostril before I sleep, but getting to a healthy weight eliminated my apnea.
If you aren’t overweight, this might not help, but hopefully it’ll help someone!
I've known more than one person who claims something to the effect of becoming addicted to Flonase. Like now they have to take it only to feel like how they felt before they started taking it.
Rebound inflammation when stopping use is a real effect with long-term use of corticosteroids and can, at least briefly, be worse than the initial symptoms were.
As someone with multiple mild inflammatory disorders I've always been afraid to use steroids consistently lest I have nothing effective when things are worst.
I always thought as a stomach sleeper why not get one of those massage table head rest things, face down symmetrical and wouldn’t gravity help keep things open then? Just have to build it into a cozy bed, not sure if that would be comfortable though.
People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen.
I've suggested 4 people over the last couple of years to get tested based on them casually mentioning some of these symptoms, and all 4 got diagnosed with moderate to severe sleep apnea (which is classified by the number of times you stopped breathing every hour - AHI, and the blood oxygen level). Getting tested is easy and cheap - you can find kits for under $100 which essentially are just a monitor you attach your finger + a few ECG stickers on your body which you use for a couple of nights. You can order them online without talking to a doctor, and you will get a prescription for CPAP if you are diagnosed as positive.
Treatment with CPAP is highly effective in eliminating these symptoms, and also reversing the brain damage (although MRI scans shows that it takes around a year for the gray matter in your brain to restore itself).
The other suggestion I'd make is that if you are overweight or obese, GLP-1 has proven to be also a miracle drug for sleep apnea. Unlike the study mentioned above, that essentially reduced the average AHI of participants by 4, which for almost everyone wouldn't cure them. Drugs like Zepbound have shown that over half are cured from sleep apnea after roughly a year of use. This is in addition to the other health benefits they provide with the weight reduction. Essentially. This unfortunately won't work for everyone, as weight is not the only cause of sleep apnea, but it is by far the most common one.
This is worth pursuing for anyone with the symptoms.
However please do it with a reputable doctor, preferably associated with an established institution. Watch out for some of the specialty clinics and independent practice doctors who treat apnea like a cash cow.
Sleep study scoring is theoretically set by strict rules, but in practice there can be differences between operators and clinics. Some clinics use this to their advantage to push more treatments and equipment and they’ll do it in ways that are most profitable for themselves. If they can’t get you scored high enough on the first sleep study they’ll pressure you to keep coming back for more studies or in some cases to start paying out of pocket after your insurance company starts refusing so many repeat studies with negative results.
The better clinics are not afraid to tell someone they don’t have apnea or that they likely won’t benefit from PAP machine. They also aren’t shy about telling someone that weight management can be the best long term solution for weight-related cases, whereas some clinics won’t mention it because they want you coming back to them for never ending management.
A friend went to one of those clinics. “The diagnosis is sleep apnea. What are your symptoms?”
Having been down this path, it’s evident to me that the US has built up a sizable medical equipment industry around CPAP machines and their supplies. The sleep doctors who prescribe them don’t have many alternatives, so it’s the normal treatment they hand out.
So it’s not a surprise that a casual mention of sleep quality ended with a CPAP machine rented by the month. It’s kind of what happened to me.
Better to outright buy the machine online, then open it up and disable the modem.
I’m always on HN talking about myofunctional therapy (my mom is a practitioner in NYC). Recommend looking into it in addition to losing weight as treatment.
I've tried a CPAP machine for 6 weeks and felt no different and gave up. I think I was a 6 on the scale. I wish it had worked though!
Currently I've just given up and embracing feeling relatively tired all the time. I've tried side sleeping devices (woody knows backpack) mandibular advancement splints etc.
So hard to tell (I find anyway) to get to a definitive answer
You should consider getting an Wellue O2 ring. This is something you can use to monitor your oxygen saturation throughout the night. Use it with the CPAP and also otherwise. If your oxygen saturation is better with CPAP - you know that it is working. You will eventually feel better.
The main thing about CPAP is that, and imo almost everyone gets wrong, is that you need to titrate it. CPAP is sold as an Automatic Pressure device, but in practice it doesnt work like that. You almost always need to set it just 1 number below and 1 above your required pressure - more like a fixed pressure device. And getting it working correctly - with all the mask combinations, leaking issues, pressure calliberation, supporting gear like mouth tapes and neck bands - can take months. It is incredibly hard - BUT - it is worth it. The best resource for me has been the reddit to get this right.
The key is to track your saturation everyday with all the small tweaks you make and the only way to do it is using something like the O2 ring.
For some people it takes months to feel any different.
For some people, they don't feel any better but it improves their health.
Did you examine your numbers at all in something like OSCAR? You could get a good idea of how many events you were having at night, and if the CPAP was improving it.
Even if you aren't feeling any better (yet) it could still be helping. You could also have multiple things that are causing you fatigue issues, and maybe fixing only one of them wasn't enough... that doesn't mean that one wasn't also important, though.
I didn’t have apnea but I had UARS, which works differently. It’s more difficult to diagnose, primarily because it’s more rare.
exactly the same for me (but I gave after 5 weeks, because I didnt felt any different and hated everything about sleeping with the cpap)
Three more things to try if you haven’t, on a “can’t hurt” basis: nightly Avamys spray (might need a scrip depending on where you are), magnesium glycinate before bed, little bits of plastic that go inside the nostril and hold them open.
Also worth a try... B1 (thiamine) seems to help for me. I don't have objective numbers, but I disturb my spouse with my snoring and breathing troubles far less. I believe I have (undiagnosed) central sleep apnea rathee than OSA though, it's been a long time since I had a sleep study, but I had only one event over a few recorded nights... But some nights it's pretty bad.
#1 symptom - fat necks! if you are like me and had a 17" neck at 185 in high school and now boast a 18.5".... you have it!
Why is that?
Sleep apnea can indirectly cause weight gain, but obesity—particularly excess fat on the neck—is the main controllable risk factor for obstructive sleep apnea, so it’s primarily the other way around.
Any brand of test kit you recommend?
> Treatment with CPAP is highly effective in eliminating these symptoms
… for those who tolerate it. Numbers are all over the place, but roughly people who start it are only 50% likely to still be using it properly after a year.
> People should be more aware of the symptoms of sleep apneas
I'm always a bit puzzled that this needs to be pointed out? I don't have sleep apnea per se, at least not chronically, but I've definitely had bouts of it due to allergy, sickness, stuff like that. The symptoms are the same because the mechanism is the same: I didn't get enough oxygen in the night.
It's always glaringly obvious to me the next day. I feel way more tired and exhausted than I normally would given the amount of sleep. I sometimes had instances of waking up gasping for air.
I really don't need to be told in those instances that there was an issue during the night. My sleep didn't sleep, of course there's something wrong and needs to be looked at?
Like, one time's a fluke, but if it happens a lot...
Couple of things to address here...
One, not all sleep apnea patients snore. 20% do not snore
Second, I am not sure what your experience has to do with people that DO have sleep apnea? If you are correct and you do NOT have chronic sleep apnea, then it makes sense you would notice clearly on the nights you did. For someone who has suffered from it for years (or even their whole life), they aren't going to have anything to compare it to. They don't 'feel way more tired and exhausted' then normal because THIS IS THEIR NORMAL. If everything feels the same as it always feels, why would they assume it was sleep apnea?
Just because you experience something a particular way doesn't mean everyone does
It’s typically something that sets in over time (often, but not always with weight gain and age), most people don’t notice because it’s gradual. Especially if they aren’t in normal risk groups. OSA symptoms are easy for an individual (and clinicians) to misatribute
Yeah, but I've met people who think it's "normal" to wake up tired and exhausted even after multiple (or even many) nights of sufficient sleep, time-wise.
I remember one person who thought waking up tired is just part of being an adult?
The original comment said "multiple folds higher chances to be depressed, unemployed", for me that's a bit like saying that being on fire has a very high chance to make you depressed and unemployed.
Yeah, of course that's true, but the effect on performance and well-being after a sleep apnea night is so obvious to me, I don't have to look for the proximate cause...
EDIT: Through the other answer came to me that maybe in other cases, it's not so directly obvious just after waking up.
Waking up tired could be caffeine addiction too, which I think most adults are addicted to
> > People should be more aware of the symptoms of sleep apneas
>
> I'm always a bit puzzled that this needs to be pointed out?
You're puzzled that most people don't know the symptoms of sleep apnea? Maybe there are big campaigns where you are, but I've never seen any public information about its symptoms.
I think it’s important to know your personal context levels.
You noticed it because it’s happened to you occasionally. What about people who’ve been experiencing it most of their lives? To them, they are just tired all the time and don’t know why. It could be any number of things.
To someone who’s never experienced it, how could they understand?
My wife has bad sleep apnea and has to use a CPAP - neither of us noticed or understood the issue until she did a sleep study to deal with her bad snoring. We knew she was tired all the time, but attributed it to factors like work stress or maybe diet.
The average person’s understanding of sleep apnea is probably around the level of “it exists and they have to wear a device at night” and not much more.
I guess. This is a good answer, it did made me recontextualize.
Maybe it was always that much obvious to me that what should have been a good night of sleep had no, or maybe even a negative, effect on my wellbeing, and therefore something must be wrong during the sleep.
But if the effects are a bit more muted and accumulate more gradually, and you've never heard much about sleep apnea, you might not directly attribute it to the sleep itself.
yes, it needs to be pointed out. if you have it for a long time you might not realize it's a fluke (like me)
Fascinating how basic research on noradrenaline and muscarinic receptors from 20 years ago is now translating into a phase 3 drug trial. Four fewer breathing events per hour on average is meaningful. CPAP is effective but compliance is terrible, so having an oral alternative would be huge. Hope AD109 makes it through approval.
One of the drugs in this treatment, oxybutynin (Ditropan), is associated with cognitive impairment[1].
[1]https://www.sciencedirect.com/science/article/pii/S009042952...
I have severe obstructive sleep apnea -- am 6ft and 210. I wear a CPAP and now swear by it. A couple things to help those who try:
1) Make sure you have a CPAP machine with a water tank so the forced air is moist. For me, if the water runs out, that's when I wake up bc my nose dries.
2) Get a spray saline solution for your nose -- not Afrin or drugs (habit inducing) -- just simple and cheap Arm & Hammer Simply Saline.
3) Wear a shirt when you're in bed and put the hose under your shirt so it's hard to roll off.
4) Bonus -- sleep elevated.
Those are my best tips. If you can do the CPAP and suffer the awkwardness, you'll really feel so much better. First time it stuck, I woke up at 4:45 am fully rested and felt as if a heavy weight was lifted off me.
Best luck :)
Have you tried losing weight and if so, did that help?
My dad used a CPAP for many years and was quite the evangelist for them due to how significantly it improved his quality of life. At one point, when trying to nudge him toward weight loss and diet changes for type 2 diabetes, I mentioned it may also help with his sleep apnea. He was adamant that the type of sleep apnea he had would exist no matter what and weight loss wouldn't help... apparently his doctor told him this. Fast forward 5 years, he ends up in a program for his diabetes that put him on a pretty extreme elimination diet which led to him losing a pretty significant amount of weight. During that time he kept having to turn the pressure on the CPAP down, until eventually even the lowest setting was too strong and he was able to get off the CPAP completely. For over a decade he talked about how happy that CPAP made him, he almost seemed proud of it. However, he got pretty emotional when he found out he was able to get off of it. As much as it may help, it is still a burden to need a machine to sleep.
I know it's an N of one, but it shows it can help and is worth a shot. Even if it doesn't completely resolve the sleep apnea, there are so many other additional benefits.
After an alert from my Apple Watch and a few extremely rough nights of sleep when my weight hit an all time high, I scheduled a sleep study for myself. It's 2-3 months out still, so I plan to lose what I can while I wait to see how much it can help. Even the first 10 lbs was a significant help and stopped the truly awful sleep I had for a week or two.
I was diagnosed while skinny. I do have a fat and long tongue though.
I went through the whole process of seeing an ENT, using the machine for the at-home sleep study so insurance would give me a CPAP, then not being able to sleep with a CPAP, and over the course of a couple years I fixed my sleep apnea by fixing my posture and breathing. If you have forward head posture or are not used to breathing through your nose, you might also benefit from this. I think it’s kind of crazy that we do surgeries and take medicine that modifies your brain chemistry for what I believe in many cases is a structural issue.
If you’re curious to try this, read James Nestor’s book Breath, do yoga with breathing exercises, or see a physical therapist. It takes time to fix these structural issues, but you can literally change the shape of your nose, palate, and jaw from just practice.
Here’s a quick exercise you could try. Sit up, relax your body, breathe in through your nose, and feel the breath move up your nose, down to the base of your skull, down your neck, and then as far down your spine as you can. The air isn’t literally moving through these areas, but you should feel a current of sensations moving roughly along that path. As you breathe out, follow the current in the opposite direction. As you tune into this current, your neck and back will naturally straighten a bit, it should feel very natural and even pleasant. Keep your body relaxed and allow your neck and back to align with this current. If you keep doing this regularly it should help improve your posture and breathing. This is basically a pranayama / yoga breathing exercise. If it feels painful, definitely stop and try physical therapy or working with a hatha yoga instructor who can give you more guided instruction.
I used to snore so badly it sounded like, without much exaggeration, a dying elephant. I only did this exercise for a couple years and it slowly improved over that time, and now I sleep quietly.
> what I believe in many cases is a structural issue
Many cases it is not. I'm not trying to be a contrarian but I don't want to plant hope in some people who suffer from sleep apnea thinking it's something they can just do breathing exercises for.
https://www.mayoclinic.org/diseases-conditions/central-sleep...
In MOST cases it actually is a structural issue. The brain anomaly that causes paused and intermittent breathing is much more rare.
fwiw I really believe it is, my sleep problems come and go based on entirely physical variables--how flexible I feel, how much time I spent "shrimping", how tight my back and neck are.
Personally I would not be surprised at all if in 50-100 years we look back on this era as one where we massively overprescribed CPAP machines to treat an entirely-fixable condition in most people (alongside all the other medical interventions that will turn out to be bandaid fixes for actually fixable problems). I'm aware this is a bit of an outlandish take. But you can tell how many people's breathing and posture is bad just by existing in the world for ten minutes and looking at them. I think it's really an epidemic.
I don’t think it’s an outlandish take at all. You can possibly also put orthotics and spectacles in the list of interventions as solutions to problems largely induced by unnatural adaptations to an unnatural environment.
I had a similar experience, with a slightly different approach (mouth tape and a nose dilator) but seemingly similar outcome. I like that you did it just through exercises with no mechanical intervention. Inspiring.
Thank you! I saw you mentioned mewing in your comment, they teach you that in some pranayama exercises as well and I agree it’s a great addition. It feels unnatural at first but when you get used to it, it’s almost like bracing your palate with your tongue allows you to pull air in through your nose more smoothly and with more power.
I’ve found this is all really worth learning, even if you don’t have sleep apnea. I feel more clear headed and energized when I can breath through my nose now.
That's fascinating, I just did some reading on this - I had not known that the basic technique of "mewing" is very similar if not identical to something that's been practiced in yoga for thousands of years. That in itself doesn't speak to its effectiveness necessarily but on the surface it's a different way to look at it than as just a modern fad.
Regardless, it doesn't cost anything to try, seems no danger in it and it seems logical that it could help.
>basic technique of "mewing" is very similar if not identical to something that's been practiced in yoga for thousands of years
Can you elaborate more on this? I also assume by "mewing" you mean putting the tip of your tongue on your hard palette right behind your upper incisor, and letting the rest of the tongue suction against the hard (and soft) palette. Surprisingly for something that seems to be so "popular" in "broscience" I find it hard to find any canonical definition or technique.
Instead of a mouth tape get one of those moldable plastic mouth guard things from amazon. And mold the hole shut.
Yup totally, how you breathe during the day is a habit that basically persists at night
So breathing better during the day can be trained, even at an old age, and it improves sleep
Not everyone breathes suboptimally of course, but I think more do than realize it. There’s a reason that breath work is in the traditions of many different cultures, and why it survived
But things like this aren’t necessarily profitable or worth a doctor’s time, so you have to do them yourself, or see therapists, etc
I had a good experience with a myofunctional therapist and posture therapist
Oh you don't say? I'm genuinely curious to know what you reduced your AHI to with these exercises. Or are you just making things up?
Yeah we'll go with fabrications based solely on this sentence "But things like this aren’t necessarily profitable or worth a doctor’s time, so you have to do them yourself, or see therapists, etc"
I thought one of the main issues is that during sleep you lose muscle tone and control, so no matter how much you do myofacial therapy while awake it doesn't really matter much in preventing your tongue from falling back when asleep.
Nestor's book didn't feel right. I don't think he's a crank, or that he's entirely wrong, but the idea that we're breathing wrong feels really unlikely. You don't have to be taught to breathe.
I'm sure that many of the lessons in the book are applicable and there is much to learn. But a lot of it felt like woo, even though I know full well that the author is a well-respected journalist.
I'd really like to hear a sound review from someone who knows the domain better than me.
> You don't have to be taught to breathe.
You sure? Haven't read the book / heard of the author. But after I started freediving and training holding my breath (also called static / dynamic apnea lol) and working a lot on related stuff, I realized I was mostly breathing shallow and with my chest, and not deep with my abdomen.
Now I notice it in others. I don't know if it matters in the end. But I breathe a couple of times a minute and then I hear people next to me quickly breathing in and out constantly like a rabbit. Seems stressful?
There's also the fact that using digital devices negatively affects our breathing a lot: https://www.npr.org/2024/06/10/1247296780/screen-apnea-why-s...
Considering how much we use them now it could change the default state significantly, and maybe we do have to consciously relearn the best way to breath.
I haven't read his book, so I don't know how much of a kook or grifter I would judge this guy to be, and I'm always dubious about things, but I try to remember that even kooks and grifters sometimes (not always!) have genuinely useful things in what they're saying. They might not be the best person to say it, and their suggestions might not always be the best way to make use of the useful bits. But just because someone is trying to make money from spreading their message doesn't make it all BS.
(I think I'm mostly agreeing with you.)
To expand on this, the posture is really so important, this muscle the iliopsoas connects inner hip to low back on opposite sides, forward head sometimes also has anterior pelvic tilt, anyways your diaphragm is connected to this muscle and if it’s tight, or holding your pelvic in a tilt, it can make the diaphragm not be able to take full breaths. I’ve done some relaxation stretches you can search for this muscle, like laying down with one knee bent and leg up like a square and other leg straight out or slightly elevated, and “dead bug” yoga, and found my breathing suddenly improved on several occasions.
What a ridiculous post. Please leave the Reddit pseudoscience at the door.
There are researchers actively working and studying people with sleep apnea. They're not suffering from "forward head posture" or "breathing wrong".
I have severe sleep apnea and no amount of "breathing exercises" are going to cause my soft palate to uncollapse itself while I'm trying to get REM sleep.
Its been established head posture is a factor. It’s also intuitive - the posture of your head affects the angle of your airway. This is why some patients wear cervical braces to sleep.
Do you run regularly?
Overweight by chance?
I've put on a bit of weight sunce having kids and my breathing at night is much worse than before.
You have no idea what you're talking about and it shows by what you choose to type.
It's not exclusively caused by fitness or lack thereof. A cursory Google search would show you this. It's not "breathing at night", it's literally suffocating in your sleep.
This place used to be full of intellectuals. It's a real shame.
Wow you sound very defensive.
If it's not obvious I meant breathing while sleeping at night in a sleep apnea discussion, I think you need to analyse your own internal bias and possible self-hate.
I'm very sure i have sleep apnea now as i wake up literally in panic where i'm not breathing + have a full bladder and need to go a few times a night (which i've read as a kidney response with sleep apnea).
As i said this all came about with extra weight gain in the past few months.
Yes! It is a shame that this kind of nonsense gets upvoted. Pure snake oil.
It only reduces by 4 events per hour. That seems like it might be helpful for someone with mild sleep apnea. But not with moderate or severe sleep apnea.
Adult AHI Severity Levels
Normal: Less than (5) events per hour.
Mild Sleep Apnea: (5) to (14.9) events per hour (frequent minor interruptions).
Moderate Sleep Apnea: (15) to (29.9) events per hour.Severe Sleep Apnea: (30) or more events per hour.
"By mapping the neural circuits that lead to this common condition, work from the Horner lab laid the foundation for AD109, a new treatment developed by researchers in Boston to specifically target the two pathways that contribute to sleep apnea. The daily oral medication contains two drugs: one that increases noradrenaline levels and another that blocks muscarinic receptors.
In a recently published phase 3 randomized clinical trial, people with mild to severe sleep apnea who received AD109 had less airway obstruction and higher oxygen levels than those who received a placebo. On average, per hour of sleep, participants on AD109 had four fewer events where they stopped breathing or had very shallow breathing."
Yeah, I was excited until I read that. Last time I was tested I had 48 events per hour. 4 wouldn't help me much.
They say later in the article that the pill is a good option for folks that can't or won't use the CPAP.
A CPAP is really effective, so it would be first line treatment. If I couldn't use one but needed it, I'd be happy to have fewer events per hour than all of it. Improvement is better than nothing in this case. Besides, a lot of drugs are improved after the initial breakthrough drug - so this gives hope that we might actually be able to be free of the CPAP for many more folks.
CPAP reduces my AHI from 55-60 down to less than 0.5. For people with severe sleep apnea, an 'improvement' of 4 events per hour does absolutely nothing for their health and provides a false sense of security. Their time, money, and energy is much better spent learning how to adapt to CPAP.
My AHI was 151 when measured. The CPAP has changed my life but I do look forward to any possible way to not need it anymore.
Mine was in the 50s when they measured, which seemed bad enough. CPAP takes it down to about 2 to 3.
Oof, and here I thought my AHI of 69 was bad (which it kind of is regardless). My condolences. Glad the CPAP helped, it completely and utterly changed my life too.
256 here :(
the cpap is a wonder, I can't sleep without it. I only wish I'd gotten one 10 years sooner. I have whole years of my life missing from my memory - REM sleep is very important to long-term memory formation.
Using my CPAP now nets me about 1.5 AHI.
if your doctor tells you to get one, get one.
I don't have sleep apnea, as in, my severe snoring doesn't cause significant drops in blood oxygen levels, but it's still severely impacted my life - when my wife and I married, I spent the first night of our honeymoon awake so that she could sleep.
Oh and it's so loud that I'm at risk of damaging my own hearing.
And I bounced off CPAP hard, no matter what I tried, I would eventually remove the mask in my sleep, it was heartbreaking, I was so excited to finally be able to fall asleep beside my wife.
I also tried the mouth guards and would wake up panicking and gagging.
So my only other option currently is self-funding expensive surgery (our public system doesn't fund treatment for severe snoring unless it causes apnoea, and my private health insurance excludes the most expensive portions shrug), which like all surgery, carries no guarantees of success, and also carries the risk that any general anaesthesia application does.
So this is awesome! I just hope it continues proving efficacious and safe.
You snor so loud it damages your own hearing? Can you wear ear plugs to sleep?
Not yet it hasn't, but another 10 years of exposure to it will - and I do. :)
I phrased it like that to try to convey the impact my snoring has on anyone near me.
When I got hunting or tramping, and intend to stay at a backcountry hut, I always carry my bivvy bag in case there's other people staying at the hut, if there are, I go sleep in my bivvy bag about 50m away from the hut.
Nothing like waking up and 20 other people all want to beat you.
I found a way to stop removing the mask through smarthome magic: flash my lights if I take off the mask.
Parts:
1. Smarthome coordinator - HomeAssistant/AppDaemon (runs on my desktop)
2. Prescense sensor - e.g. Aqara FP2
3. Smart light - e.g. Phillips Hue
4. Smart Plug/Power Meter - e.g. Kasa ESP25P4
5. Claude Code to write the logic
.....
The alarm goes off if all of the following are true:
1. it's in sleep period (11pm-6am)
2. i am in bed
3. i have been in the bed for at least 3 minutes
4. i have worn the cpap (wattage > 10w for 3 minutes during sleep period)
....
I can't get around this system at all without walking across the house to my desktop, at which point I'd be too awake to be stupid enough to remove the mask.
Bonus CPAP nerdery: Wireless data collection into homeassistant using a Toshiba W04 SD Card/Wifi Transmitter.
I think I, ironically, sleep to deeply fir that to work for me, but it's not a bad idea at all!
Then swap out the Phillips Hue for super bright corncob LEDs, or an air siren, or a bed shaker
There are some older studies that showed nicotine (not via smoking, which makes sleep apnea worse) had a positive effect on sleep apnea as well due to the stimulation increasing muscular activity in the airways. Obviously lots of downsides too so it never caught on, but this seems to have a similar mechanism.
If you wake up every day feeling like you got hit by a train and also have anxiety, depression, chronic heartburn, or exhaustion (not sleepiness, like a wired but tired) I would highly recommend looking into Upper Airway Respiratory Syndrome (UARS).
UARS was coined by Dr. Christian Guilleminault who was on the team that coined sleep apnea. Over his career he slowly widened his definition of sleep disordered breathing from choking (sleep apnea) to any nasal resistance that causes wake ups.
You be young and perfectly healthy but due to bad anatomy have micro arousals throughout the night. Becuase your young, your body fights through it (cuasing exhuastion) and will wake up up to readjust your airway. You won't remeber any of the wakeups, but many suffer from insomnia from it. The two big issues is large tongue in underdeveloped jaw that falls back and constricts your airway (you can test this with a mallamapati test) or a small nasal passage way.
I had bad sleep apnea until last year, sleeping 8-9 hours a night and usually feeling tired in the morning.
As of the last 12 months it seems to be heald, after I used mouth tape and a nasal dilator consistently for 30 nights in a row. I highly recommend trying this, it was quite cheap (~$20) and the change seems to have been permanent. I used 3m micro-pore tape that doesn't tear the facial hair, and the nasal dilator I used was called "woody knows", though there are many brands that may work just as well. I barely snore anymore where I used to be a raging snorer according to those in the know and my own audio recordings of myself. Most importantly, I only need about 7 to 7.5 hours of sleep now and I will wake up feeling well rested most days. I can also breathe exclusively through my nose now where before I could not. I can take very big breaths through just the nose and do this now when exercising.
I don't think it's all perfect though as I still often breathe through my mouth. I'm starting to wear the mouth tape at night again as an experiment - it really isn't that annoying.
Relatedly, I recently started looking into "mewing" after a breath-work teacher I took classes with recommended it to me as she has been doing it with good results (improved breathing). It seems related to this as Mew recommends keeping the mouth shut all the time. I intend to try the mewing exercises and see if that helps my breathing further.
STOP-BANG Score for Obstructive Sleep Apnea:
https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive...
The difference maker for me was an app, Snore Lab. that my son told me to try. It said that my snoring was EPIC. That led to my current CPAP use, for which the benefits [no daytime sleepiness, more energy, no food cravings] exceed the hassle [mask wearing, cleaning routine, supplies reordering.]
Four events per hour AHI improvement would not be a meaningful change for my therapy, but this is the beginning of better treatment options in the future.
The best benefit of CPAP is that it thwarts heart arrhythmias which arise from depriving the brain of oxygen.
I see CPAP rightly getting mentioned a lot here. What worked for me was a MJS (Mandible Jaw Splint), it’s basically a mouthguard you sleep with that moves your lower jaw forward and thus brings your tongue forward so it doesn’t obstruct your airways.
Best bet is to get this custom made. Here in Australia there are specialist dentists that do this for you. It’s far easier than CPAP and works just as well for many like myself.
Often folks will use CPAP at home and these mouth guards when travelling.
It's aroxybutynin 2.5 mg/atomoxetine 75 mg. They don't actually say in the article but the development code "AD109" leads to that
So basically a non-stimulant medication for ADHD? Very interesting
I think sleep apnea would have killed me had I not gotten the sleep study. I was having 100+ events in the span of a few hours. Anyhow, I use the CPAP everyday. I don't snore anymore and I have maybe 1 event a night. Incredible machine.
If it spares a respirator this is huge win. Even if might be used before severtiy leads to the unavoidable NIV-respirator with overnight CPAP.
I was never diagnosed with sleep apnea but I had an O2 saturation alert when I would sleep side sleeper so I bought a cervical pillow and found a quiet CPAP machine. I add saline and a few drops of very diluted I+KI to the water just to keep anything from growing in it despite changing it daily. I love it. My sleep has never been better. I often forget I have the little nose mask thing. The cervical pillow is awesome, never goes flat. My biggest improvements were from that little cervical pillow.
I highly recommend BongoRX (https://bongorx.com/) if you have sleep apnea and can't deal with CPAP. The mechanism: it makes it a little harder to breathe out, which keeps your airways more open when you breathe in next.
The pictures on the website are a little misleading: it comes with a strap to keep the device in your nostrils, so they don't just fall out in the middle of the night.
FDA-approved, and does require a prescription...
I might have to try this. Their bland website with last year’s copyright would never have sold me by itself, but a HN comment could
The drug is called AD109, but the title seems misleading as the drug is apparently still under trial, though it has shown good results there so far
Surprisingly the most effective treatment I've found for my own apnea is just wearing an inexpensive soft cervical collar to sleep, but there are lots of different things that can contribute to sleep apnea, so YMMV.
After dealing with unexplained ectopic heartbeats (sometimes PVCs, sometimes PACs) I saw a chain of doctors and that included both getting a sleep study done and seeing a cardiologist.
I was diagnosed with mild apnea (AHI just above 10), but despite the apnea being mild on the AHI scale, my Sp02 blood oxygen percentage was dropping into the low 80%s for extended periods per night down from a normal 95-99% most of the time.
I weigh 180 lbs at 6 foot 2, being overweight was a non-factor in my apnea.
Got a CPAP machine, it helped but even after dialing in my personally optimal pressure settings using the CPAP data with OSCAR my AHI was still kind of all over the place, from under 1 to as much as 6 seemingly randomly per night with no mechanical issues like mask leaks showing up.
Had heard (on reddit /r/CPAP) about some people using soft cervical collars to help with their apnea and I gave it a try and when wearing one my AHI drops down to 0.0 - 0.4 per night. The collar alone helps more consistently in my case than the CPAP machine does.
Basically my sleep apnea is almost entirely due to the fact that when I'm sleeping (even on my side, but worse on my back) I seem to naturally tuck my chin in toward my neck in a way that constricts my upper airway and the collar stops this from happening. This is very much YMMV, there are lots of different causes of apnea.
Great. Something like 60% of OSA cases are linked to obesity. GLP-1 drugs could probably lead to resolution for a lot of them if the Lilly SURMOUNT-OSA trial tells us anything.
Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all.
The preconception that it is mostly obesity related is a dangerous stigma since it prevents a lot of people understanding what is happening and getting treatment.
I started with sleep apnea in my 20s when I was in amazing physical condition. I would jolt awake, heart racing, almost panic attack levels. No idea what was happening.. took me another 15 years to do a sleep study and get diagnosed, and CPAP treatment literally overnight cured the condition. I went from 20-30 events per night to less than 1 on average.
If anyone has any sleep issues at all, or suspects any.. go get a sleep study. It’s not as scary as it sounds and there’s no downside to having one done.
> Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all.
I mean, the person you replied to literally said "60% of cases are linked to obesity"
Which obviously implies that 40% of cases are NOT linked to obesity. You are saying the exact same thing the person you replied to is saying, just without the numbers.
I feel like the person you replied to's comment was not stigmatizing obesity at all, in fact learning that 40% of sleep apnea cases are unrelated to obesity entirely probably educated some people that it was less tied to weight than they believed before.
I wake up without my cpap mask after a few hours every night. In total I might get 6 hours with it after putting it on multiple times.
Doctors think I’m doing fine due to total amount of hours used, and my resmed cpap claims I’m at below 1 event/hour. I’m not doing fine and I think the numbers are lying to me.
I snore a million, my mouth gets dry, and my nose tightens up, so my nasal mask isn’t always that nice to use. Other masks also annoy me.
What do? I haven’t sleep a solid 8 hours for 3-4 years :(
Keep at it - there are a ton of things you can try which will help. Try to use reddit to see what other people are looking at.
If there is one thing I can recommend you - get the Wellue O2 Monitor. This wil montior your O2 saturation through the night - if the saturation is dropping, you know that there is an issue, irrespective of what the resmed cpap claims. The resmed cpap figures cant be trusted imo.
But once you know what the saturation levels are, you can try a LOT of things which might help. Different cpap masks, head of bed elevation, mouth tape, neck straps - what you end up using will depend on your condition. But imo - dont rely on doctors to diagnose and fix you - you will have to do it yourself. Fortunatately there is a ton of people who are trying things out in reddit and extremely unlikely that you have a conditoin which is not fixable.
Just keep at it and track it using the O2 ring and try out what works for you.
Find a mask that doesn't have snap magnets to hold it to your head... if you make it harder to take off, you might wake up and catch yourself taking it off.
Obviously I don’t know you or your specific situation, but I lost 120 pounds taking Zepbound and my apnea is gone. I make sure to take fluticasone in each nostril before I sleep, but getting to a healthy weight eliminated my apnea.
If you aren’t overweight, this might not help, but hopefully it’ll help someone!
I’m 130 kg and know it’s way too much. Hard to gather the energy for loosing weight.
Can you take fluticasone permanently? Sometimes it’s like I just lie down and my nasal congestion gets worse instantly
> Can you take fluticasone permanently?
This is a surprisingly controversial question.
I've known more than one person who claims something to the effect of becoming addicted to Flonase. Like now they have to take it only to feel like how they felt before they started taking it.
Rebound inflammation when stopping use is a real effect with long-term use of corticosteroids and can, at least briefly, be worse than the initial symptoms were.
As someone with multiple mild inflammatory disorders I've always been afraid to use steroids consistently lest I have nothing effective when things are worst.
This is suppose to be a tell tale sign of deviated septum (lying down and losing airflow).
You can‘t get AD109, but unless you live in a shithole country you can order some ambroxol today.
https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0...
I once wrote a summary here:
https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a...
I always thought as a stomach sleeper why not get one of those massage table head rest things, face down symmetrical and wouldn’t gravity help keep things open then? Just have to build it into a cozy bed, not sure if that would be comfortable though.