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Comment by 11thEarlOfMar | Hacker News Reader

Being that this is Hacker News, and thinking completely off the top of my head...

I fixed my sleep apnea by sleeping with an oxymeter on. When breathing was obstructed, my blood oxygen dropped. The oxymeter beeped and woke me up. I changed positions, and went back to sleep, ultimately changing sleep habits to the point that I can get through most nights without awakening. I was able to avoid using a CPAP that way.

Perhaps a muscle tension sensing device, such as https://www.sparkfun.com/products/13723 could serve a similar function. Place the sensors on your jaw muscles while you sleep (may only need to be one of them) and if you clench, it beeps or buzzes and wakes you up. May take some inventiveness to integrate it with power and alert, and then to get it comfortable enough to sleep in. And you'd want to avoid any cords that could wrap around you.

It may not lead to a cure, but might give you an idea of what's going on when you clench at night.

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Sleep apnea is a problem for two reasons: low oxygen saturation is Very Bad, and frequent arousals are Bad.

Sounds like you've managed to address the first issue, but without a sleep study it's impossible to say for sure whether you've addressed the second problem.

Most apneas typically occur during REM sleep, when muscle tone is at its lowest and airways are more likely to collapse. If you frequently wake up during REM (even if it's a micro-arousal), your sleep architecture is broken.

It boggles the mind that sleep apnea severity is diagnosed on number of events (AHI) without considering when those events occur. Maybe you have an AHI of 3, but if they all happen during 2 hours of REM, you basically wake up 24 times during REM, which sounds a lot worse than 3 events per hour.

Sauce: have sleep apnea, hate the machine, but have learned to live with it.

Right, but the AHI is specifically to aid in initial and ongoing treatment. If you’re hitting a certain threshold of events with a PAP, it probably means you need more pressure, even if that AHI can indicate a fairly large range in reduction of sleep quality.

I fixed my sleep apnea using a Velumount device, which is simply a piece of wire you stick in your throat before you go to sleep, and it keeps the important part of throat unblocked during the night. One of those things that truly deserve to be called "life hacks".

Learning how to use it is a lot of "fun" (expect to spend half of the day vomiting until you learn how to insert it properly), but afterwards it works like magic.

I would recommend to try it, and verify by oxymeter how it works.

I would love to try this, but I don't believe they are available in the US. Are they custom made?

According to velumount.ch (and the other location sites), it does need a fitting session to mould it. I wasn't able to find a price list for my country and the doctor who would do the fitting is in another city, so it is pricey overall it seems. Especially if the Swiss pricing is anything to go by.

The product itself seems like it's supposed to be malleable to adjust to the individual, which kind of makes the fitting session + workshop seem like rent seeking. Just give me an instruction booklet with FAQ and warnings.

Not sure if I understood it correctly, but the branch in Hungary seems to do it for 120000 HFT = 350 EUR.

If you have a friend who is a customer, he could (this is cheating) buy one for you (pretending it is a replacement for him), and explain to you how to use it. You save a lot of money, but the disadvantage is that it is not fitted for you. I am not sure what difference it makes.

So, if that is an option, I would recommend buying one via friend, testing it (with oxymeter), and if you are satisfied, follow the official channels (through Hungary). At the moment you are sure the solution works for you, I think it is worth the money, considering how costly and/or inconvenient are the alternative solutions. (Then you can do an extra test whether having the wire fitted for you is an improvement.)

(It would probably also make sense to take photos of the wire immediately after you buy, so that you can try making duplicates later when the original piece breaks or loses shape.)

Their web page says Switzerland, Germany, Netherlands, Austria, Hungary, South Africa, India. Note that the prices may differ.

Yes, the wires are custom shaped. (But they work even if you use a version shaped for someone else with similar head size. I don't know how much difference it makes compared to shaping specifically for you.)

Surgery is an option for those who are not obese, despite what you may have been told or read. Worth looking into, however, only few surgeons in the world are properly trained to specifically to diagnose and treat the very delicate upper airway.

I dislike my CPAP as much as the next person, but I had to sleep without it recently and the next day was essentially ruined. It’s an astonishing difference in mental clarity and mood, at least for me. I’m not entirely sure how I dealt with life before.

I had trouble with sleep apnea.

Long ago, I suspected it and was able to adjust by just sleeping on my side.

Then years later, I was having more trouble. I took the test and found I had mild sleep apnea and they gave me a machine to try.

I hated it and gave it back (looking back they gave me a terrible default setup and a huge facemask that most people immediately switch out)

My solution was to get a mouthguard. The way it works is it keeps your jaw aligned at night, so airway+tongue are less likely to obstruct your breathing. Just search for "boil and bite" type mouthguards on amazon, they're inexpensive and pretty easy to use.

What I found interesting during the mouthguard stage is that I probably have had bruxism all along. I have one part of the bone structure in my mouth that grew bigger possibly from clenching over the years.

In the end, that only worked well for maybe 6 months before I started noticing the trouble again, so I went for the cpap. I had to make it work and ended up working with a heated hose and the nasal pillow style nosepiece. I'm pretty good now. (one more piece of advice, keep it clean with alcohol and you'll be much better off)

I had trouble for years with both sleep apnoea and bruxing in my sleep.

I tried all sorts, from mouthguards to oximeter alarms, and nothing really helped, if anything, they generally worsened my sleep - I'm a light sleeper at the best of times.

A visit to the doctor revealed that I was pre-diabetic, and he advised that I shed some weight - I was 250lbs, and I brought myself down to 180lbs over about six months.

The sleep apnoea and bruxism both went away with the weight, and a decade on, haven't returned. I suspect that the additional weight was making my airway collapse in the night, and that would then result in me bruxing as I quietly asphyxiated in my sleep, before I'd wake up gasping in a puddle of sweat.

I had thought for the longest time that the root cause was stress, and that it was therefore untreatable without major lifestyle changes which weren't tenable at the time - but the stress went on for years after I lost the weight, without bruxing or apnoea. I suppose, at root, the stress was the cause, as I sure as hell comfort ate my way out of my misery and into size 40 jeans.

I do, once in a blue moon, still do the choke and grind routine, but it's usually only if I've gone to bed really quite drunk.

Obviously this isn't a one-size-fits-all solution, as sleep apnoea and bruxism can be brought about by any number of causes, but this was a solution for me, and might be for others who are in the same situation I was in.

Congratulations on the dedication to lose the weight and maintain the loss.

I’m a grinder myself and my weight yo-yos between 200-250LB. My grinding is definitely related to weight. If my BMI is below 25%, the grinding stops. Pop back up and it starts again.

Stress plays a role in daytime clenching but it is far less when I’m in better shape.

> "boil and bite" type mouthguards on Amazon

These can work but feel pretty horrible to sleep with. If you can afford it, your dentist can make you a slim fit top guard that is far more comfortable. I wear one and it's 100% fixed my jaw tension and tooth grind damage problems.

There is also a new type of fitted double guard which holds your jaw slightly open to alleviate apnea. They're expensive but depending on your country's healthcare you may get a rebate if prescribed one after a sleep study.

If your finances/healthcare don't permit the above, I recommend trimming down the boil and bite guard with scissors, you don't need most of that plastic. It will still suck compared a proper dental guard.

Do you use water in your CPAP? I never felt it added any benefit and I just leave the chamber empty..Consequently, the CPAP pump and hoses remain dry, and I haven't needed to clean them often at all.

I just did the recommendations, and use distilled water in the water tank.

I was lots more successful with humidified air. If you have a raw throat, or if you have a stuffed up nose, humidity will take care of it. Another way to help is to drink enough fluids.

Note that I turned down the default temperature and humidity.

As to the cleaning - you need to clean it anyway. Your exhalations do go down the tube backwards. When I first started using it I would get tired of cleaning and put it off and got a really bad head cold.

Interesting. There are three products I found on the market made for this, but one is unavailable to consumers, the other has temporarily ceased production, and the third I have but have not been able to get working.

I’m trying some electrode gel on the one I have. If that doesn’t work, I’ll look into the sensor you linked. The process you described is exactly what these devices do: biofeedback.

Forgot, for those interested, the products are:

* grindcare: has studies, out of production

* bruxrelief: no consumer product yet. No biofeedback

* sleep guard: trying to get it to work

Yes, sleep apnea is associated with bruxism. I couldn’t tolerate cpap, sleeping on my tummy or side helps some.

What type of mask were you using? I find the nasal pillows to pretty comfortable. Also, was your machine and auto-titrating CPAP? That helps alot

i think i tried nasal pillows. not auto-titrating. Probably didn't give it enough time to get adjusted... but my sleep is better now anyway.

CPAP is not something to avoid but to embrace. I love my machine. I sleep on my back again. I hardly wake during the night. I can breath fresh hair even with a pillow over my head. It's just lovely.

Hey, which oxymeter do you use? Thank you.

Facelake.

Uses 2 AAA batteries. Good for 3-4 nights.

Which model?

FL350 fingertip.

If you can spend more, I'd suggest the wrist type. The fingertip can be a little uncomfortable being clamped to your finger all night.

Thanks. In a previous comment you said that “The oxymeter beeped and woke me up.” Is this the same oxymeter? I read the FAQ for the FL350 and it doesn’t have an alarm.

I double checked and the one I use is an old model (FL100) that appears to have been discontinued. The FL350 mostly resembles it, though it appears you are correct that the FL350 does not have an alarm. My apologies for the misdirection.

This one does have an alarm: https://www.amazon.com/Wellue-Fingertip-Saturation-Batteries...

FYI, if you have an Apple watch, it is believed that they will be adding PulseOx to it with iOS14. Apparently the hardware is already capable.

iOS 14 (and watchOS 7) are already in beta; has this feature already made it into that?

Even if that's added in watchOS 7 (which is what I'm guessing you meant, not iOS 14 alone), what would be required is a software mechanism to alert the user below a particular threshold. Given Apple's history, I doubt if this feature would be enabled for currently sold devices even if the hardware supports it. Apple may have its own reasons not to support certain features available in hardware, including reliability factors, and not just profit motives alone. So I'm kinda doubtful of the feature being enabled and working as the GP described in the devices being sold now (before new versions arrive later this year).

Sorry to be specific what I meant was that iOS14 has an API to read pulseox readings from an Apple Watch and then you can do what you want with it (like make an app to alert on it).

Presumably yes it would need support in WatchOS 7.

I read that PulseOx readings on watches are unreliable, and the ones that measure your finger are much more accurate.

Would that still be true of a more expensive device, like the Apple Watch?

I'm also wondering about this, hopefully someone can give us an answer.

> Perhaps a muscle tension sensing device

I gave a muscle tension based anti bruxism device called GrindAlert a serious try perhaps a decade ago, and it didn't help me.

> When breathing was obstructed, my blood oxygen dropped. The oxymeter beeped and woke me up.

That's basically what your body already does natively, though.

can you recommend any device for the sleep apnea? I'm experiencing some symptoms and would love to proactively do something about it.

Yes, get a CPAP. You have to go to a sleep doctor, get tested and then you can get one. I have one and it absolutely changed my life, nearly everyone says that. It effectively fixes obstructive sleep apnea.

It's been recently suggested to me by my psychiatrist that I take a sleep study. I know this might seem dumb, but my biggest hesitation is that the mere any of being watched by someone will make it extremely difficult for me to actually fall asleep. I generally have a tough time falling asleep outside of my comfort zone e.g. at a friend's place.

Was this a problem for you? I have a feeling a sleep medication would help with this but won't that interfere with the study?

Having done two sleep studies, the first time it took me 45 minutes to fall asleep, so they gave me a (low dose) Xanax the next time, you can share this concern with your doctor and they should be able to address it.

It can be weird. My most recent study was quite comfy and unobtrusive. And they often start with a “DIY” home study these days. I put mine off for a long time, for various reasons...but when I started falling asleep driving home from work, I relented. I now sleep with a bipap machine (really well-designed device by ResMed), and it has changed my life.

It's super weird and you will not sleep well. But they account for that in the results. You can't use any sleep aids, but that's sort of the point.

At the end of the day, you will eventually fall asleep and hit deep sleep and they'll get the measurements they need.

No one sleeps well knowing they are being watched and hooked up to all those sensors. :)

You can do an at-home sleep study where you wear a cannula attached to a small machine. That's how I did my sleep study and it was sufficient to prescribe me an APAP machine.

My sleep study with Kaiser just involved wearing a wristband computer thing on my wrist that recorded data from an optical sensor on my finger while I slept at home. Nobody was watching.

I can imagine (purely from reading Why We Sleep) that sleep aids medication would ruin the study, and won't help you sleep anyway

Make sure you are tired. No caffiene that day and get up early. I did the sleep test with all the wires and video on me and it did not bother me once I got used to it and realized it was good for me. Also, they have take home sleep tests now so really there's no excuse. It could save your life, please do it!

You can try a few mouth guards that can be purchased off of Amazon which may work to varying degrees based on the cause of your sleep apnea. From my experience this[0] model had the best results. These type of mouth guards tend to work if you have collapse in the area behind your tongue, which may or may not be the case (more likely if you are overweight). An Alaxostent is another option if you're experiencing soft-palate collapse; however, it's expensive and hard to know if it will help before the fact.

It's possible that you're experiencing collapse in both areas; and it's also possible that neither device will work, depending on the severity of your sleep apnea; namely if you're overweight. I had "mild" sleep apnea that left me VERY fatigued because it was characterized by mild hypopneas (slight secessions in breathing) at an incredible frequency which stopped me from reaching REM throughout the night. The devices helped.

To ameliorate the situation completely I found a great doctor out of USC who ended up performing 4 procedures and 3 surgeries. I had my uvula cut, my tongue burned, my palate ablated, and a few other things. It was an incredible headache during the time but well worth it and now don't need a CPAP. Also worth mentioning that I had some gut dysbiosis at the time which can masquerade as sleep apnea. Good luck to you.

[0] https://www.amazon.com/Eliminator-Sleep-Custom-Bruxism-Mouth...

Sleep apnea came up in another thread about a month ago [0] where someone posted this:

> This may sound crazy, but for those who can't tolerate a CPAP, an effective alternative is playing the didgeridoo.

They linked a study [1] that actually tested this and found it to be helpful.

0: https://news.ycombinator.com/item?id=23430332

1: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/

Interesting. Guessing this has to do with humming (or generally, vibration) increasing endogenous nitric oxide production ~15x [0]. Nitric oxide is a vasodilator, which could mitigate sleep apnea caused by a deviated septum.

0: https://pubmed.ncbi.nlm.nih.gov/12119224/

It could also just be a strengthening of the diaphragm, lungs, and throat.

I actually have ordered a harmonica as one of my long shot attempts to fix this. Was inspired by the didgeridoo post. Apparently some hospitals use harmonicas for respiratory patients.

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