Hacker News Reader

Comment by agrue | Hacker News Reader

Sleep apnea is strange.

Good news! We have a diagnosis, sleep apnea. You're bad at sleeping now, the thing everybody has to do all night long every day since birth. The solution is to wear a modern iron lung whenever you want or need to sleep forever. Many times it's because people are overweight but you aren't.

Is that really all there is for treatment? No throat exercises or therapeutic sleeping positions? No diets? No botox injections for your uvula or a daily pill to obviate breathing while sleeping?

View on HN

Diagnosed at 24 with sleep apnea. I tried a bunch of things.

What worked for me was regular cardio exercise and daily doses of high absorption magnesium.

The magnesium is absolutely unproven pseudoscience nonsense that can't possibly work. But if I stop taking it my sleep suffers massively.

I take magnesium for migraine and vertigo. Very much not a believer in supplements -- before this, I went through years of specialists prescribing various pharmaceuticals with various side effects. These days the problem is under control without any meds; I just take magnesium (specifically, a mix of l-threonate, glycinate and taurate), telling myself every day that it's probably unrelated to my feeling better. Like you said, it couldn't possibly be working as well as it seems to. But if I stop, my condition mysteriously gets worse. If it's a placebo.. eh, who cares?

>> Very much not a believer in supplements

…why?

Vitamin, mineral, and nutrient deficiencies are a very well known science.

Sure, but the supplement industry is 99% woo and most of what is sold has no proven benefit. In general people most people taking supplements don't have any known deficiency (including me, blood tests show my mag levels are fine).

"Known deficiency" is a thorny issue in itself. The various serum levels and necessary intakes vary widely by individual. And recommended daily allowances for many kinds of vitamins and minerals are set conservatively low to avoid overdoses from people chugging the bottle.

"levels are fine" can still mean fine, too low or too high for your individual need. As long as you don't overdose, trying out a supplement nonetheless can be worth a shot, but of course it can also be a waste of money.

Unfortunately, "normal values" in medicine aren't as normal as one would like.

Yep. I didn't mention it but with magnesium testing, blood tests may not catch an issue; you can be deficient in a particular organ (e.g. brain) and fine in others.

But realistically, very little of the $100 billion+ supplement industry is built on anything medically necessary. Yes, I have a waste basket diagnosis with an unclear cause that's helped by a specific supplement, but there are quite literally dozens (perhaps even hundreds) of other supplements that the snake oil merchants swear up and down are essential for the same condition, and they'd happily claim that whatever deficiency exists is undetectable. That's why I "don't believe" in supplements in general.

When I'm deep into half-marathon+ training, I (personally, not scientifically) observe that I become zinc and magnesium deficient. I simply will not recover, I will feel extremely fatigued, etc. There's a lot of controversy over this, but I more or less have to take ZMA to sleep at night, to remain asleep at night, and to recover from the training load I am putting my body through (I also carry a 2-3x per week lifting load regardless of my running schedule).

> The magnesium is absolutely unproven pseudoscience nonsense that can't possibly work.

With so many systems in the body, you really have to wonder how many people actually have a _single_ issue that's causing _all_ their problems. It's much more logical that your experiences are the result of emergent phenomenon from the interaction of multiple issues. In that case, perhaps you're simply treating a secondary condition that's vastly improving the outcomes with what you view as your primary condition?

Could you share your magnesium preparation and dose? If you are deficient in magnesium, the mechanism I would guess is that neck muscles are unable to relax and constrict the action of weaker muscles used for breathing.

https://drbvitamins.com/products/doctor-s-best-high-absorpti...

That's the good stuff. Constantly hard to find in Canada.

Edit: also this is literally the first time anyone has ever provided me with any idea if why it might actually work. So seriously, thank you for that.

I’ve read that a lot of people, especially men, are deficient in magnesium. It’s an essential mineral so I wouldn’t call your use of it pseudoscience by any stretch.

Presuming that there is no causation, a placebo that works is still an effective treatment.

> The solution is to wear a modern iron lung whenever you want or need to sleep forever

Calling it an iron lung is extremely disingenuous.

The Iron Lung uses negative pressure and had to be used 24x7 to keep the patient alive because their lungs weren't able work on their own. They had no mobility and were confined to a bed for the rest of their lives.

CPAP / APAP machines use positive pressure and only assist with breathing while asleep, when apnea events occur. It does not replace lung functionality, it only assists.

Yeah, having to use a CPAP/APAP at night can be bothersome, some people have a very hard time adjusting to using one. However, comparing it to using an iron lung is ridiculous.

> The solution is to wear a modern iron lung whenever you want or need to sleep forever

Iron lung use was not 24/7 for all patients. Saying so might be considered by some to be extremely disingenuous or even ridiculous.

https://www.npr.org/2021/10/25/1047691984/decades-after-poli...

I genuinely thought it was a life sentence, something I was taught in school. Thank you for pointing this out, I honestly didn't know.

It's hyperbole, but the comparison isn't without some merit. My grandma stopped using it because it's troublesome, and I've heard many people voice the same. Getting into an iron lung each night would also be ... troublesome.

You don't climb in and out of an iron lung. If you're using one you're in it 24x7.

Iron lung use was not 24x7 for all patients. Saying so might be considered by some to be extremely disingenuous or even ridiculous.

https://www.npr.org/2021/10/25/1047691984/decades-after-poli...

Iirc iron lungs are better than CPAP, as the positive pressure caused by CPAP, if too big can stress the lungs.

Iron lungs use negative pressure so they don't suffer from this

Nothing works anywhere near as well as PAP therapy. Certainly not diets (overweight is often an effect of apnea, not a cause). Sleeping positions can help in the case of positional apnea, but certainly not for everyone. Botox injections anywhere will have to be repeated regularly. Fucking with the uvala (like in UPPP surgery) can actually worsen sleep apnea and has all kinds of nasty infection and side effect risks.

PAP therapy works. The biggest problem with it is that it has a bad reputation, which is largely caused by doctors and sleep clinics not doing their fucking jobs. Patients are often sent home with a CPAP machine, titrated to some semi-random setting which happened to be fine for the night of their sleep study in an artificial environment. And that's it. Goodbye and good luck. That's such a messed up way of treating people with a life-long ailment ...

Thanks for your detailed response, but the things I listed were entirely in jest. I don't think the uvula causes sleep apnea and don't believe a pill would be able to obviate breathing while sleeping.

Haha I totally missed that, my bad! The uvula thing is pretty scary, some people have it removed entirely in an effort to treat sleep apnea, and from what I hear it seems to help at first, but then often gets worse again (maybe because scar tissue is less strong than regular tissue?).

>No throat exercises or therapeutic sleeping positions? No diets? No botox injections for your uvula or a daily pill to obviate breathing while sleeping?

Since OP's apnea is not obstructive, sleeping position, botox, etc. won't make a difference.

This is what I was talking about. The patient has apnea type b. The prognosis remains Bad at Sleeping, use iron lung type b with no alternatives.

Most people have type a and use iron lung type a, there are some treatments for this type but most people opt for the iron lung.

To me, it certainly seems to suggest an environmental cause (or at least significant contributor). Certainly doesn't seem evolutionarily adaptive for such a large proportion of the population to live with profound mental and physical fatigue.

Obesity is an obvious confounder, but these seemingly frequent front-page HN sleep apnea posts usually abound with anecdotes of normal / thin individuals with significant issues.

Thank you, this is what I'm driving at. The conversation includes very little discussion of cause or actual treatment beyond symptom mitigation.

Always wondered if not most of our sleep issues would go away if we spent a few days or weeks camping in the wild without electricity. Unfortunately not a long term solution.

An easy hypothesis to check given the millions of people who do exactly that each summer. The answer appears to be that if your sleep quality issues are lifestyle related and you are simply unable to make yourself practice sleep 'hygiene', then yes, it shift your sleep cycle to fall asleep earlier. If you do already practice proper sleep hygiene but still can't sleep normally, or if you have any kind of physical problem like sleep apnea, then no.

I read a book called Breath by James Nestor, it’s all about the benefits of nose breathing. Anecdotally this has completely fixed my sleep apnea/ snoring/ energy levels/ etc. Highly recommended!

Wait, people aren't breathing through noses?

I'm not sure if it started this way, but I mostly breathe through my mouth at night due to significant congestion in my nasal passage. If I use a nasal rinse or flonase it helps but if I'm not diligent it regresses immediately.

Give this a shot for a week or two. Just jam these up there. It will be uncomfortable at first but you get used to it. Really opens you up and takes away a ton of resistance in nasal breathing.

https://a.co/d/18eLtdw

I found that I have to consciously close my mouth and "tell myself" to breath only through my nose.

When I do this i sleep better.

You sleep better by consciously breathing through your nose at night? Or during the day?

Probably by falling asleep with their mouth closed so that they breathe through their nose for the night.

yes this

I know someone who has to make a "vacuum seal" with their mouth, that is, make some slight suction on the inside so that they won't drool in the night. Is it anything like that?

um... not consciously no.

I think its more just being mindful. Something i feel we could all benefit from doing more of.

> I think its more just being mindful. Something i feel we could all benefit from doing more of.

Absolutely, I'm always surprised by the lack of this in some people. Like are they not self-aware or concerned at all? Just floating through the world existing? Ignorance is bliss but I sure wouldn't want to live like that myself.

too much stimulation. the ways in which we are and can be stimulated are increasingly devisable and persistent. Information or stimulation addiction is a thing...

Hah, preaching to the choir here, ADHD brain that basically shuts down unless there is a constant supply of new and interesting stimuli. I usually can't even get enough, so I end up sleeping for 13 hours and then not even staying up for 8 afterwards. I literally need "stimulants" in order to even have a 24-hour schedule, lol.

I had to have my deviated septum surgically corrected back in my late teens before I was capable of breathing consistently through my nose. Even simple things like chewing with my mouth closed were difficult because I couldn't breath well enough with my nose only.

Nope, usually feel like I don't get enough air.

lots of people with chronic allergic or non-allergic rhinitis aren't able to breathe through their nose.

I thought I'd get a freebie there (like when you lose weight just by cutting soda - which I already don't drink. Another freebie lost), but when I paid attention I am breathing exclusively through my nose and to make matters worse my tongue is in the mewing position. So this is already the best case scenario for my weight, sleep and jawline. Bummer.

What are the best strategies for increasing nose breathing?

Look into the EASE procedure by Dr. Kasey Li

Have you tried this? does this work?

It helped me. I no longer wake up feeling congested. The impact on sleep was more subtle. I had some prior complications so I wasn’t able to expand as much as the avg patient.

I would also suggest looking into the Oxygen Advantage system. Just finished reading the Breathing Cure by Patrick McKeown, makes some interesting claims but mostly found helpful exercises to retrain nasal breathing

His book "Deep" remains one of my very favorite books of all books, and I've turned a fair stack of pages. It's a different kind of medicine though; for me, it revived my soul, if there is such a thing.

Assoc https://hubermanlab.com/how-to-breathe-correctly-for-optimal...

I lost the ability to change positions while sleeping after having open-heart surgery and having to sleep immobile for months. I wish I knew how to get that back. My searches online yield nothing.

I have sleep apnea, not overweight. I wish there was more research poured into a solution that isn't pseudoscience junk or predatory.

Grateful to the inventors of the cpap though, changed my life.

If it’s obstructive, you can learn to play the digeredoo

After about 3-4 months you should notice your condition improve

There absolutely are therapeutic sleeping positions. Sleep on your side.

Google it for yourself or https://www.sleepcycle.com/sleep-apnea/optimal-sleep-positio....

My journey was:

1) side sleep - didn't work after a while

2) cpap with giant over-the-nose mask - I couldn't stand it and I rejected it

3) a boil-and-bite mouthguard to keep my jaw in place and not sliding back - didn't work after a while

4) same cpap as #2, but with nasal pillows - has worked since then

by the way, I had to really learn to breathe through my nose for #4. I guess I didn't always do that, especially with allergies.

losing weight, exercise - good for me, but didn't solve it

this worked for me for a while but in the last year, I've started getting episodes even though I've taught myself to sleep on my side, breathe through my mouth, keep my airway open by tilting my chin away from my chest, etc.. these kinds of techniques only work so well.

Reply on news.ycombinator.com