Sleep apnea pill shows striking success in large clinical trial
science.org
science.org
You may not know it, but your tongue may be tied. It is one of many possibilities causing OSA.
I made this: Do I have tongue tie? Self assessment https://do-i-have-tongue-tie.vercel.app/
Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/
Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/
Jawhacks on Youtube, discussing Airway health https://www.youtube.com/@JawHacks/search?query=sleep%20apnea
Ultimately, to REALLY fix Sleep Disordered Breathing, usually you want maxillomandibular advancement - to move your jaws forward, which physically enlarges your pharyngeal airway which is where the actual collapse happens. Collapse that shouldn't be able to reach the point of increased airway resistance with a skeletally sound airway.
Many people also have nasal breathing issues, and while this can be caused by a deviated septum or severe turbinate hypertrophy,usually nasal throughout correlates with the cross-section of the nasal cavity, which is most effectively addressed by bone-borne(not tooth-based!) palatal expansion.
Yeah that's the ticket. I use a mouth retainer for this, but I've found more often than not these days that it comes out sometime during the night. I may look into these exercise to supplement.
Sleep apnea can be a disqualifying condition for pilots, so I like to be 1000% certain and have plans A, B, and C ready to go before seeking treatment.
Idk how to target loss in just my neck.
Im pretty sure my neck from teenage wrestling and my adult hobby of bjj is messing me up a little .
Also annoying for getting fitted shirts lol
It's not as simple as you make it seem. There are some things that are "easy" to fix, like a deviated septum, but surgical treatments are often very complex, very expensive, come with a lot of risks of complications, and in some cases only last for a limited amount of time.
> Didgeridoo playing as alternative treatment
Apart from the practical issues (who wants to spend half an hour playing the didgeridoo every day?), it's not a solution. The majority of participants in the trial still had an AHI of 11. Their sleep is still shit, their long term health is still impacted.
> Myofunctional Therapy to Treat Obstructive Sleep Apnea
Same thing. A reduction in AHI of 50% is impressive at face value, but it's not a solution.
It would be great if everyone on CPAP would be offered a comprehensive programme to strengthen their airway. If this could lead to reduced pressures for instance, that would be great. But neither study looked into that, which is a shame.
Looks like they buried the lede:
> possible side effects from atomoxetine such as signs that sleep isn’t as restorative while on AD109 or an increase in blood levels of C reactive protein [..] “Atomoxetine also increases heart rate and diastolic blood pressure a little bit,”
That's ... unsettling. So you're reducing events at the cost of increased blood pressure and heart rate? That's not good.
> the treated participants experienced 56% fewer instances during sleep where their breathing grew shallow or ceased
That sounds impressive at face value, but is probably pointless? So you have an AHI of 40, and now you have an AHI of 18? You're still getting crap sleep. Correctly titrated CPAP reduces events by ~99%.
> In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour.
That sounds much better. Can these 22% be identified based on some criteria? So that they can be treated in this way?
> AD109 caused a “meaningful” reduction in the depth and duration of patients’ periods of low blood oxygen
"Meaningful"? If there is any significant saturation, your sleep is going to be shit. Again, correctly titrated CPAP eliminates desaturation entirely.
As far as I can tell, there's no polysomnography data to be examined anywhere. How was this tested? Are they just looking at AHI? In which case this is meaningless. Are these folks' sleep architectures restored? Or are they still having a bunch of events during REM which renders their REM sleep useless?
[1] https://www.cpaponline.com.au/wp-content/uploads/2020/05/cpa...
It sucks. I have an OA now. And it also sucks.
- a proper night's sleep
- moisture that ensures I don't wake up with a massive sinus headache that destroys my morning
- letting my partner have a proper night's sleep
Any one of the 3 would be worth the minor inconveniences of a CPAP.
Took me 1-2 nights to be used to it when I tried it.
I’m interested in this: how’s the CPAP noise perceived by the partners?
I don’t snore and usually wake up quickly when doing the "apnea noise", stopping before waking her up. In the meantime I read that CPAP produce a a constant sound + an inconstant sound from the air coming in and out. She needs quietness to sleep and disturbing her sleep refrained me to try it out. Non trivial price is also a factor through, otherwise I would have tried it since a long time.
I recently found an online service that repaired one of mine, and it's quiet now.
There is also mask noise. If my nostril mask slips out a bit, there will be noise. Not too big a deal.
One fix that I think would work for most people is a white noise machine. It's briefly annoying, but after a while (a few nights at most is my personal guess) you stop noticing it, and it drowns out other noise.
This is my experience, I've tried swapping out tubes, the water container, but the noise is just unbearable and I can't even fall asleep while wearing it.
I was always tired. Falling asleep was a chore. Waking up was worse.
I pushed back against the sleep study for so long because I feared the mask. The sleep study was the best night of sleep I could ever remember.
Nasal Pillow CPAP, even with the little extra burden when travelling, has changed my life for the better - full stop.
The morning after my first real sleep in ~5 years was an unreal improvement. It felt like I was snatched from my death bed and back to normal.
I use the nostril mask, and it doesn't really bother me. The full face mask experience is a lot worse.
PS Technically, it blows!
There is an adjustment period, turbinates can swell up from the extra airflow, and it might be uncomfortable for a while. And some people have such awful septum deviations that they're breathing through a straw. But most people are fine.
I know it's annoying at first, took me a couple months to really get use to, but if you put in the effort to find a mask that works for you, it's 100% worth it. I dealt with bad sleep for 15 years before getting one, and I'll never go back.
But it also makes sleep way more comfortable. I slept the entire night in my mask the first night, I was so worried about it and it turned out to be a non-issue. I love my mask.
Ultimately, the question becomes "is higher quality of sleep with some tradeoffs more or less healthy overall, than not getting enough sleep at all?", as research keeps showing how important sleep is. So even if this increases heart rate and diastolic blood pressure, does it raise it more than a couple of decades of not being able to sleep would do?
Anyone under 60 who hears heavy mechanical breathing expects someone to get choked in the next 5 minutes.
Usually the preferred approach in cases like this is to trial the medication and revert back to the prior treatment plan if symptoms worsen. Obviously, this is only viable if the worst-case negative outcome is temporary, easily reversible, and not life threatening.
As far as the meds go, I read this as something for someone who either can't or won't use a CPAP.CPAP would still be the go to treatment, and this would just fill in the gaps.
But I willingly wear it every night, and a paltry 56% improvement or whatever it was won't tempt me in the least to give it up. Living without adequate oxygen and sleep is hell. I'm seriously convinced I have permanent brain damage from it. (Admittedly, that could just be age.)
My point is that this is not something you wear because your doctor says you should. You wear it because life is shit without it.
And this is for traditional OSA in men - people with Upper Airway Resistance Syndrome(mostly identical mechanism as OSA, less oxygen desaturation, more arousals, slightly different symptoms) which is how SDB tends to manifest in women and younger people, the problem is way, way harder. In a community I used to hang out in, I'd say maybe 1 person in 10 actually benefitted from CPAP/BiPAP more than it hurt their sleep quality.
That 4 hours is just another symptom of a medical establishment that's not interested in treating patients, but is only interested in numbers. If you want maximum benefits from CPAP, you have to wear it all night every night. If you can't do that, there's a problem that needs to be addressed.
It would be more accurate to say that 40% of people who are offered CPAP are not receiving proper guidance and followup. This is not their fault. This is not CPAP's fault. This is one of medicine's biggest failures.
And yeah, UARS is an entirely different shitshow. It's finally starting to be recognized, hopefully that will lead to improvements for patients.
There are some cases of people have complex sleep apnea, or having awfully non-compliant airways that require uncomfortably high pressures. But the vast majority of people can tolerate PAP just fine.
There are certainly improvements to be made. And thankfully some of them are being worked on (e.g. VCOM or KPAP). And some people could benefit from bilevel or even ASV, and it's a shame that those are often way harder to get. But even if we're being generous, the article's suggestion of 22% of patients who can get by on just the drugs is incredibly underwhelming compared to PAP.
I think it may be in some cases, but not the majority. Talking to my sleep doctor recently I don't think she thinks so either. She starts everyone out on AutoPAP with 5-20 ramp as the standard now. Either way I think people who can't tolerate CPAP will welcoming having a drug as an option before more extreme measures like the Inspire device and Maxillomandibular advancement.
also, I think the default cover-the-whole-nose mask for sleep apnea isn't really good. Maybe people pull it off. I found the nasal pillows a significant improvement (maybe that's what P10 is?
Believe me the introduction of CPAP into this person's life was a f*ing disaster for her and everyone who was around her that year! She went to see ~11 doctors, finally quit the CPAP on her own, without any doctor's suggestion. Things got better immediately. Then out of desperation she went to a Chinese herbal doctor. Somehow after that the cough began to die down. I make no claims for Chinese herbal cures - I'm amazed anything worked after that year.
While apnea is real, CPAP looks like a scam to me, for the sleep clinics and especially for the CPAP makers and suppliers.
It just underscores how batshit crazy people are and the low quality of some so-called "medical cures". Sometimes that includes "snake-oil salesmen", a category into which I now put CPAP vendors.
100% not a scam. Was life changing for me, and the two other coworkers I know who are on it.
Yeah, but so is Jesus to some people.
That said, I find the pneumonia story a little tough to swallow. Correlation is not always causation. CPAP machines don't spontaneously spawn new diseases. Does she use the humidifier? What water does she use? Does she change it every day?
2) If you're prone to nightmares, waking up with something covering your face that causes bizarre sensations when you try to breathe through your mouth or speak may disturb you enough to tear it off.
I started CPAP about a decade ago and in the beginning I would take the mask off in the middle of the night, while sleeping-- completely unaware of what I was doing.
My doctor said this is common with many patients.
Frustrated, I started taping the mask to my face with medical tape.
I only stopped taping up my face when I was able to make it through the night without waking up to my sleeping self trying to rip the mask off.
Tough to know how much of this is patients not being able to tolerate vs doctors giving people barely calibrated machines and next to no support or training. It’s very common to be given your cpap at the default pressure range (4-20). When I told my doctor I still wasn’t sleeping, she offered to refer me to a shrink.
That is to say that I agree: basically nobody outside of sleep clinics seems to know how they work, and even they don't provide much more expertise than you can get from publicly available information and tools.
I understand that this might be a viable option for people who simply cannot tolerate CPAP therapy, have tried alternatives and found them lacking, and aren't surgical candidates... but I certainly hope it never becomes a first line treatment. My concern would also be that insurance companies will see this as a much cheaper option and try to force it on people who would otherwise tolerate CPAP therapy.
Given that atomoxetine is an sNRI, and norepinephrine modulates both alertness and muscle tone, I would bet dollars to doughnuts that what this treatment is doing is mostly helping people who have inadequate muscle tone in their pharynx at night due to inadequate NE levels, restore that muscle tone, and thereby keep their airways unblocked. These people aren't going to get insomnia from having their NE levels increased — because insomnia in sNRI use is a symptom of excess NE, while in these people, NE is just being brought up to a neurotypical level.
(In other words, the same logic that explains why [correctly dosed] dopaminergic stimulants don't make people with ADHD manic — but applied to NE dysfunction rather than DA dysfunction.)
I love mine (wearing it as I type this actually), and I'd say my girlfriend loves it more than I do since I no longer sound like I'm dying in my sleep and gasping for air every 20 seconds
I tried it for less than a week and had to stop because there were VERY painful side effects _down there_.
I’m also a CPAP user and I’d 100% keep using it rather than go back on atomoxetine.
I have no idea what HN's tolerance is for the relevant medical language, so I'll put it like this: when I was on atomoxetine and after engaging in ahem activities, my pelvic floor muscle would stay contracted for something like 10 minutes. Not only was it super painful but it also made it so that I couldn't urinate at all until those 10 minutes had passed.
It was the weirdest thing.
This shows an improvement in AHI, but no change in any markers of actual sleep restorative function (I'd use the term "quality" but the sleep health industry has stolen that term to mean measures of sleep time).
When looking at sleep time the study shows no change in most of the sleep architecture, but a significant decrease in REM time, which can have effects on emotional wellbeing, irritability, and potentially depression.
This study showed no change in ESS (subjective measures of daytime sleepiness), but did show a change in PROMIS, which is a longer term measure of fatigue.
I've been recommending to anyone on CPAP that they give mandibular splint, which is a biteplate which shifts the jaw in order to hold the airway open, and is much easier, lower cost, and effective for many people. It also does not show a reduction in REM.
However, I also don't believe there is any reason that a sleep study which has full PSG relies only on sleep time, and none of the bio/neurological measures of health which are easily available, such as HRV, delta power, spindle activity, etc. etc.
That's it. It sounds trivial. But my biggest problem[1] with the CPAP is that it feels like it's smothering me. I can get more air in, faster, without the CPAP, and I still vividly remember the initial months when I would rip it off in frustration just to be able to breathe.
The thing is, I wasn't wrong. When I go to bed, I move around a little to adjust my pillow and lean over to grab the headpiece and turn it on, and all that movement means my oxygen requirements are temporarily higher. Putting on the CPAP immediately restricts airflow, so of course I hate it even though I can forcibly breathe through it.
But timing it so that it adds airflow (during an inhale) makes me feel like it's helping, not smothering. I can still breathe a little harder while settling down, but psychologically it feels way better to have it helping me breathe instead of fighting me. I wish someone had suggested this early on.
I don't have an answer for my upcoming 12-hour overnight flight, though. Other than a long series of 5-minute half-naps, watching a lot of movies, and sacrificing the first day to stumble around and catch up on rest. (Which, to be fair, I'd be doing anyway with the time change.)
[1] Well, the other problem is the noise. My partner is a light sleeper, and if she's suffering during the night from my noise, I'll be suffering during the day. We've largely resolved that with a white noise machine closer to her, and learning how to maintain a proper seal with various strap adjustments and position shifts. I only get a shove in the night once every few months at this point. It's almost like she feels entitled to sleep at night too...
... but also as @elric has said, getting it set up properly is important. The first few weeks it felt restrictive, I complained and the hospital cranked up the initial pressure from 4 units to 6 units, and it's been great ever since.
Things that've helped:
1) Using body pillows to force sleeping on side, which straightens the neck (versus face-down) — also lessens low-back pain
2) DENTAL GUARD (a 3D-printed plastic insert which form-fits my teeth, slightly opening jaw-angle/mouth)
3) Losing weight — YES, sleep apnea is worsened by excess weight
4) Pseudoephedrine (an hour before sleep) — but be careful cause too much and you won't ever sleep
YMMV; I am not a doctor (just fat guy with apnea).
Best of luck!
That solved it for me.
I've been wanting to try one from the dentist, but they're pretty pricey.
I prefer/recommend the flexible plastic type, which doesn't last as long but is so much easier to make a habit of wearing (because it is comfortable, unlike the solid plastic which was difficult to <snap> into place around teeth).
The flexible form-fit is so much better than my previous attempt at an off-the-shelf sport mouthguard (the type that you boil and then bite down on == sucks); it doesn't ever fall off my teeth during the night, and requires me to intentionally remove it before morning coffee.
For $350 I get a few years of quality sleep — worth it! I keep a second mouthguard in my toolbox [blue collar electrician] for when I'm experience stress on jobsites...
1. Sometimes I hardly notice it. Newer models are very quiet and portable. I'd even go as far as saying the mask is comfortable to wear, like a security blanket for the face.
2. Practically nothing filters out dust and cat hair better than my CPAP. An N95 mask might do better, but would be ridiculously uncomfortable by comparison.
3. It's a humidifier strapped to my face. No more discomfort trying to sleep through dry weather seasons.
It all makes some sense, I think - it would be bad, evolutionarily, if we couldn't get used to the sensation of breathing, even if it happens to be slightly weird for whatever reason.
This was also a very difficult financial decision for me, but like you already said:
>although I was skeptical at first, the cost was worth it.
A medicine that treated sleep apnea would be revolutionary for so many people.
That's not really much of an issue. There's an adjustment period, and there's a bit of an art to finding an appropriate mask. One that fits perfectly fine for you might have an exhaust port that blows air in your partner's face. Or the one that your partner can't hear at all might sound thunderously loud in your ears.
But all in all, your partner would much rather have you sleep with a mask than choke all night.
Careful skepticism of new treatments is always warranted, but even if it only helps 5% of patients with OSA in absolute terms that’s a huge population impact.
Skepticism is very much warranted. CPAP is the gold standard because nothing has come along that comes even close. I'm much more optimistic about an upcoming generation of micro-implants that stimulate various throat muscles than I am about pharmaceutical treatments using stimulants.
Edit: to be clear, I am not dismissive of any OSA patient's concerns. But most of their issues are a consequence of shitty titration and poor support from their sleep docs.
Yes yes love conquers everything and whatnot. Doesn't change the fact that some people need absolute silence to fall asleep and a CPAP machine is very disturbing to them. So they have to sleep with earplugs which, again, is an issue for other reasons.
Please don't generalize your own experience with your partner onto all of us.
I had a friend stay with me for a week or so, and they use a CPAP machine. Due to the poor sound insulation in the house, I could hear the machine from the guest bedroom to mine. It was one of the few times when I had to find some really long-form content on youtube to leave it playing all night on the tv in my bedroom to drown out the repetitiveness of the CPAP machine. For the first few hours of the first night I ended up waking up two or three times an hour because of the repetitive sound of the machine before I realized it.
I used to use a CPAP but now use an approved dental appliance (fancy word for an expensive mouth guard that readjusts your jaw). I would incorporate a spray that actually helps, if only just a little.
This reminds me of some studies I read about weird uses for nicotine. Trials have been run where people with sleep apnea wore nicotine patches with a reduction in episodes. The theory is it keeps the brain stimulated allowing, paradoxically, people to get better sleep. Things like this: https://pubmed.ncbi.nlm.nih.gov/3965253/
Doctors have no desire in getting people hooked on nicotine though, even if there's a net benefit, so it's great if they're finding other medications for the task.
Nicotine harms sleep quality. People wearing patches to bed typically experience bizarre nightmares. Then factor in the cardiac risks.
Moreover, the pharmacology of atomoxetine and nicotine are very different.
Clinical effects of locally delivered nicotine in obstructive sleep apnea syndrome https://pubmed.ncbi.nlm.nih.gov/12756424/
Effects of nicotine on sleep during consumption, withdrawal and replacement therapy https://pubmed.ncbi.nlm.nih.gov/19345124/
Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review https://pubmed.ncbi.nlm.nih.gov/26346395/
Impact of Nicotine and Other Stimulants on Sleep in Young Adults https://pubmed.ncbi.nlm.nih.gov/30461442/
All I do now is use now is a piece of kinesthetic tape to make sure my mouth stays closed and that somehow works. I’d just done another sleep study to see if I had options other than the bipap because it’s been filling me with air since I was intubated and put on life support overnight a few years ago. I’ve been miserable the past few years and doctors couldn’t figure out how to fix it. Bipap helped a bit but not completely.
I’d even turned down the cpap and then bipap to the lowest settings, which was enough to help me have a great night of sleep, but still the balloon effect. Then I was chatting with a family member and they mentioned trying and liking taping, something they saw on TikTok, and I told them it was a terrible idea. They assured me it was helping them avoid the snore and they woke up less dehydrated and better rested.
So I gave it a go. I wear my Apple Watch when I sleep and have been able to confirm on at least 3 occasions before I started taping that the sleep apnea stats always lined up with when I was experiencing the effects of apnea. The first night I taped but still used the mask and was fine the next day albeit filled up with air. Then I tried a night taping without my cpap and someone to monitor me and make sure I didn’t die and I couldn’t believe when I woke up in the morning completely rested and not feeling awful from the balloon effect.
I’m not suggesting what worked for me will work for anyone else, but thought I’d share as my quality of life has gone way up the past few months.
Last week I asked my PCP about a middle-ear blockage, and he said the F.P. should do the trick, and perhaps also relieve the dry, itchy eyes I've been suffering.
I suspect that I have been dealing with OSA for several years now, so... the nighttime dosing seems like a good idea. We'll see how it goes!
And as the article states, there are questions that aren't addressed - does the reduction in obstructive events change the clinical symptoms such as daytime sleepiness? Intuitively you would think it does, but it should be measured in the trial. I also didn't see anything about adverse events during the trial. Seems like taking a stimulant might cause insomnia in some patients.
> In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour.
This surprised me - 5 obstructive events per hour is "complete control of the disease"?
It looks like this is the clinical trial: https://clinicaltrials.gov/study/NCT05813275
Does it make a sleeper want to be on their side? Is it a weight loss drug? Targeted area antiinflammatory? Cavity dialation?
For some snorers,bit would be an improvement based on that standard in my experience.
Exercise staying fit. Not getting fat and not drinking alcohol work for me.
PS: there are many people with OSA with normal BMI who also don't drink.
> scientists in Boston a decade ago identified a combination of two existing medications that kept the upper airway open by jointly stimulating the relevant muscles, particularly the genioglossus, a workhorse that forms most of the base of the tongue and is critical to keeping the throat open.
Please don't do this. See my other comment for more suggestions, but try losing weight and/or sleeping with body pillows [i.e. on your side] before you go mutilating your jaw.
>I used a dental appliance and that worked really well
Same — perhaps you need it to be thicker (i.e. spread your jaw just a bit more).
Unfortunately it isn't approved yet and isn't commercially available as a result.
Guessing this will never see the light of day as insomnia is going to be a major side effect. Preventing sleep apnea by preventing sleep is not exactly a great trade-off.
* https://www.healio.com/news/pulmonology/20250518/platform-li...
I went from ~220 lbs/100 kg to ~160 lbs/ 73 kg. I had to dial back my CPAP over time and eventually switched to a mouth guard which can treat both OSA and TMD.
Some people just have fat tongues (Ladies, 1 at a time please!) unfortunately
My observations are that I'm more likely to breathe through my nose when sleeping after taking B1, and that my nasal passages seem clearer, but I don't notice anything else (other than vitamin shop smell in urine).
A neighbor suggested B1, and while I couldn't find any quality research, it falls into my bucket of 'if it's not obviously harmful... If it's stupid and it works, it's not stupid' and a bottle of b1 supplements is inexpensive. You'll know after a couple nights if it's helpful for you.
I had a palette expander when I was young for orthodonic reasons. Fun times.
Also the idea of having something implanted in me that zaps me just feels... Weird, compared to just have a regular old tube glued to my nostrils
She laughed, and said of course taping your mouth is stupid. Which I assumed, but had a friend of mine suggest it because it "changed his life". It's manosphere stuff.
It works well to stop me breathing through my mouth.
I don't have sleep apnea but had a tendency to breath through my mouth at night. It worked almost immediately for me. And what's more, after my body got used to it, I could have a stuffy nose before sleeping, stick on the tape, and when I lie down, my nose would clear up, like it was conditioned to do that.
10/10 would recommend
I've been using nasal strips for the last few weeks and those events have stopped. I swear I also feel better during the day.
"Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction."
https://pubmed.ncbi.nlm.nih.gov/31521518/
"Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA."
Sounds like you're breathing through your mouth.
I believe most people with Sleep Aonea tend to have High Blood Pressure, this could be concerning.
Every heart attack story I know of off the top of my head involves a man who didn’t want to take his blood pressure meds.
Blood pressure medication has numerous side effects.
Increased blood pressure during sleep is the worst kind of hypertension ("reverse dipping").
Stay in shape, eat clean an exercise, once it's gone it's gone for good
Which one do you think the drug companies like?
50% of Americans have hypertension, 75% are overweight or obese, there is a massive overlap between the two
No, not at all. Getting rid of your hypertension through lifestyle doesn't mean it's gone for good. You have to maintain that lifestyle. And, even if you do, if your hypertension is genetic you're probably just delaying the inevitable.