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> That's ... unsettling. So you're reducing events at the cost of increased blood pressure and heart rate? That's not good.

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?

Yeah, apnea already tends to come with cardiovascular risks. If this pill can give you a full night's rest with 90% of apnea's BP increase, it still seems like a bargain.

The problem with CPAP is that 40% of patients don't tolerate it even for the 4h/night defined as treatment compliance, while most of the rest use it less than the full duration of the night, with studies demonstrating that treatment compliance depends on efficacy.

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.

I will keep beating this horse to death, but the vast majority of those who cannot tolerate CPAP are improperly titrated and/or have a mask that isn't right for them and/or are having leaks. Often all of the above.

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.

I don't know why you're so insistent that anybody who can't tolerate CPAP its a titration or fitment issue. I've talked to people who have loads of interaction with sleep doctors, mask fitment specialists, trying different CPAP/AutoPAP/BiPAP/auto-titration settings and I'm one of them. I'm glad medical science is pursuing other treatments that can help the 40% who can't tolerate CPAP and maybe help some of those who don't want to be tethered to a machine every night.

Because it usually is an issue of titration or mask fit.

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.

>Because it usually is an issue of titration or mask fit.

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.

What are the side effects of cpap and does it cure sleep apnea or do you have to use it forever?

I never had a problem with adopting CPAP. It's been transformative for me, sleep quality is literally 10 times better than without, I wake up feeling awful if I have a nap without it. Why would someone keep a mask on for 4 hours, then take it off? does not make sense to me.

Congrats to you. 40% of people probably wish they could tolerate it.

restlessness, semi wakefulness doing dumb actions.

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?

It took me a year to get used to my mask, and I use a pillow mask. The difference with and without is night and day, yeah, but man adapting fucking _sucked_.

I know someone who snored like crazy, would quit breathing at night and was diagnosed with sleep apnea. She got a CPAP and tried to use it for a year. Snoring was worse although it helped her not stop breathing. But it gave her some form of pneumonia or some such and she began coughing all night! Then it spread to daytime. Then everyone around her started getting the cough. I had to take antibiotics to shake off the infection I got from being around her.

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.

As someone who has used one and who has family members that use one, I can tell you they 100% work and it would be insane not to use one once you discover how different your sleep is. You immediately notice a difference, and there is no question the treatment is effective.

Your claim is that CPAP gave this person a _communicable_ chest infection, which was then cured by herbal medicine? How could that possibly happen unless your local distilled water supply was contaminated with tuberculosis bacteria?

Improper cleaning maybe. People get Legionnaire's from shitty motel rooms with AC units that don't drain correctly, so it isn't that farfetched for a closed loop respirator full of moisture to harbor nasty pathogens all the same.

Yes, you can get infections from poorly maintained CPAPs (or respirators -- are those a scam, too?) but that's not going to spread to your whole family.

What part of "I make no claims for Chinese herbal cures" did you not understand?

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.

> While apnea is real, CPAP looks like a scam to me, for the sleep clinics and especially for the CPAP makers and suppliers.

100% not a scam. Was life changing for me, and the two other coworkers I know who are on it.

*"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.

Well... instantly measurably dropped my blood pressure and stopped me nodding off to sleep while on the way to and from work. But I guess Jesus performs all sorts of objectively measurable miracles too.

I would say that CPAP is more of a Holy Spirit miracle, but why place limits on that?

What? No, CPAP makes my sleep measurably (literally) better. But yeah, different people react to them in various ways. A relative couldn't keep hers on all night for a month, while I put mine on the first night and slept like the dead, better than I had in years.

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?

1) People who are not fully awake often do things for no clear reason -- I regularly wake up finding that I have no memory of removing my mask after 2-5 hours.

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 pretty regularly take my socks off while sleeping and occasionally take my pants off, no way is my sleeping self not going to take a mask off.

> Why would someone keep a mask on for 4 hours, then take 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.

> 40% of patients don't tolerate it

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.

I was in the hospital for a month and was specifically prescribed BiPAP while I was there. I was completely unable to tolerate it and the technicians sent up to adjust it for me did not know how to access the clinician settings -- they just fiddled with the patient-facing controls, which are very limited. These were people who I am sure have lots of experience working on respirators and oxygen, but at least three different people clearly had no idea how to begin adjusting a ResMed BiPAP. Eventually, I was strong enough to get out of bed and adjust the settings myself, and finally I could get a good night's sleep.

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.

Sounds right, and even with the clinical settings, you need to experiment. It took me a year of obsessing over my OSCAR data to dial it in.

I’ve started with a cpap recently and my biggest issue is that it interferes with snuggling with my wife, that may seem trivial but it can have a big impact on my mood

Not even just that, full face masks aren't nearly as bad as they are made out to be. I use the Resmed AirTouch F20. Nasal masks are just too uncomfortable for me. And it's really not that big a deal, certainly not as ridiculous as the pictures I see on articles like this.

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.

>>Can these 22% be identified based on some criteria?

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.

These aren't drugs that I'd choose to take when a proven therapy like the use of a CPAP exist, the list of potential serious adverse reactions isn't trivial at all. Most amusingly insomnia is a known risk of atomoxetine.

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.

> Most amusingly insomnia is a known risk of atomoxetine.

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.)

CPAPs have a bad rep?

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 wonder if everyone I know just has a bad apnea doctor or something. The full face masks are super common among the handful of people I personally know. You can always tell the people who use them because they have indents around their face either from the mask or the elastic straps that hold them on.

The issue with nose pillow with Resmed or other CPAP is that I often rip them off from my face while sleeping, so I get to use CPAP only a couple of hours or even less. It may have to do with my stuffy nose, but that one is even harder to cure (yes, I use saline solutions to wash my nose, but it helps only so much).

I had a nose only mask and ending up switching to one that covers mouth and nose for that reason. It worked for me.

I’m almost totally unfamiliar with CPAP, and the mask you linked looks like something I’d never want to be stuck wearing every night. Now, I wouldn’t let appearances drive my use of a medical device, and I’d use it if a doctor said I should, but I doubt people’s opinions are being driven by the exact type of mask they see.

I hated, hated wearing my CPAP, even with nasal pillows instead of a facemask. It makes me feel inadequate as a human. Worse than eyeglasses. And for the first half year or so, it was awful to wear; I'd reach the morning and find I'd ripped it off in disgust somewhere in the night and didn't even remember it.

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.

CPAP wouldn’t have such a bad rep if George Lucas hadn’t released Star Wars.

Anyone under 60 who hears heavy mechanical breathing expects someone to get choked in the next 5 minutes.

Do you wear a cpap?

It sucks. I have an OA now. And it also sucks.

I do. It's not the greatest, but you get used to it, and it makes sleep a hell of a lot better.

My CPAP provides 3 massive life changing benefits:

- 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.

My CPAP does the first two. But generally if you get event the tiniest leak (and it's hard to stop all the leaks) it's very noisy for my partner. My masks leaks so little that I have between 0 and 1 events per hour but it's still annoyingly loud so my partner usually sleeps in our guest bedroom. If I could take a pill instead I would do so gladly. That being said my CPAP machine typically reduces events by 98% or so, so 56% just isn't going to cut it.

Luckily my partner likes to sleep with a large fan; the noise of the CPAP blends well with that. But you're right about the leak noise -- about once a month I do get swatted in the middle of the night to adjust my mask.

There are cheap white noise machines that can cover the CPAP noise, without producing wind.

Took me 1-2 nights to be used to it when I tried it.

> letting my partner have a proper night's sleep

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.

Unless there’s a leak (and there shouldn’t be) CPAPs are much quieter than you think they are. The only time I even notice mine (Resmed with P10 nasal pillows) is when using it from a battery during a power outage when everything is dead quiet. If you have any kind of background noise (fan hum, AC, air purifier, living near a freeway) you probably won’t even notice it.

A new Resmed machine is inaudible to my ears. But after 1-2 years, all 3 of mine has developed some kind of noise.

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.

> A new Resmed machine is inaudible to my ears. But after 1-2 years, all 3 of mine has developed some kind of 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.

This place silenced and returned mine within a week: https://cpap-repair.com/

Nice, and I can use HSA funds for the repair..so that's a plus..

Godspeed!

My wife has been on a CPAP since before we got married almost twelve years ago. It’s extremely quiet—I can’t usually hear it at all.

My partner has never heard any “cpap noise”. I just asked.

Different ones have different sound profiles. Even the quietest isn’t my favorite so I use a https://getsnooz.com which are pricey but easily the best white noise machines I’ve used. The noise machine even on very quiet is enough to mask the inconsistent breathing sound. That’d be my best advice on it.

I have one of these, I believe I got the first batch from Kickstarter when they first came out. It's still working flawlessly on my nightstand. It's not just a digital white noise maker, that's why I really like it. Authentic sound.

My partners prefer it to my not-breathing for 30 seconds or more, then gasping for air.

I can't agree more!

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.

I do, a ResMed AirSense 11 with a ResMed Mirage FX. Wonderful sleep, wonderful comfort, and no need for the water supplement.

Yes, I don't think a lot of people realize that it's possible to run the AirSense 11 (I don't know about other models/brands) without distilled water. Resmed even sells "ResMed AirSense & AirCurve 11 Side Cover", which takes the place of the water tank.

My humidifier broke years ago and I haven't bothered to replace my unit. It gives me a little extra space to sneak a few more things onto flights by stuffing them in the CPAP bag where the humidifier would go. (I don't remember what model number I have, it's ancient, but the humidifier is easily detachable.)

They sell the same cover for the AirSense 10 as well, I just bought one.

I wear one, and it’s great. I much prefer it to surgery or drugs.

I've been using CPAP for 10 years, and it's pretty much the best thing that ever happened to me!

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!

I started with full face -- I thought I needed to because I was a mouth breather at night. But with the nostril mask I breathe through my nose.

It's a common issue. If you breathe through your mouth at night, it's often because you can't get enough air because your airway is compromised. Once you add PAP, that problem goes away, and many people can revert to nasal breathing.

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 assumed that my need for CPAP was mostly because I'm old and overweight. But I've always been a mouth breather even when I wasn't overweight, so it seems it could be more than my weight issues.

Untreated sleep apnea is often a cause of overweight. Being obese can contribute to sleep apnea, but unless you're extremely obese, it's rarely the cause.

I tape my mouth shut and use the CPAP nostril mask, work great, I wake fully refreshed.

That was my plan, I expected to need the tape. But I tried it without the tape and found it unnecessary. Have you tried without the tape? Worth a try if you haven't.

I use one, and I love it. I'd probably continue to use it (or something like it) even if my apnea was cured. Breathing purified, warmed, perfectly humidified air piped directly to my nose is wonderful.

I've been using one for 4 years, and would never go back to sleeping without it.

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.

My cpap mask doesn’t suck at all. It blows. (Wokka wokka!)

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.