Sleep research led to a new sleep apnea drug
temertymedicine.utoronto.ca
temertymedicine.utoronto.ca
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.
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...
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.
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.
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.
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
>
> 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.
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
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.
My experience is that it has a noticable effect about 30 minutes after ingesting. I'm currently taking 100 mg tablets. I had done a liquid suspension, but tablets are easier and more consistent.
If you don't notice a difference in the first few nights, it probably doesn't work for you, but b1 seems pretty inexpensive to try.
It doesn't seem to be like some things where you have to use it for two weeks before you notice a difference; but also there's not much (if any?) residual effect. Maybe I can forget to take it one night, but on the second morning, my spouse will ask me if I've been taking my B1. But, sometimes I do have episodes when I have been consistent, so not a silver bullet.
Annoyingly, this symptom had been discussed with numerous doctors for over a decade. I got zero constructive advice from the medical establishment. In most cases, they even showed disinterest and moved on as quickly as possible. Beyond worthless.
On a lark, I fed an AI a two sentence prompt and one follow-up question, and it was able to piece together data and give me the suggestion with solid reasoning behind why it might work. In less than 30 seconds.
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.
But sleep apnea is really bad for your heart and lungs and does damage to them over time.
A friend of my wife suggested a doctor and he said that even though my iron levels were in the normal range, people with restless leg syndrome (which I’ve had my whole life) often have sleep issues and benefit from iron supplements.
Within days of starting taking them my tiredness went away. I went from being tired every day for nearly two years to maybe taking a handful of naps for fun in the last three years. Really life changing.
My PCP didn’t understand why I’d be taking iron, but accepts that it works. My sleep charts still aren’t great. Little to no deep sleep, but CPAP didn’t help with that either.
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.
They also do OTA updates.
However they also can perform an enforcement function: compliance. Insurers will penalize users of the device for not using it enough.
This isn’t something I know much about just have seen it discussed, I don’t think all jurisdictions allow insurers to access this data for enforcement but it does seem to happen in USA.
I think what happens is the insurers agree to pay for the device in installments. But they will cancel those payments if the person isn’t using it.
But disabling the modem won’t fix that problem, you’d still get caught by the cf recorded data, or failing to provide it.
Insurance companies are tired of paying thousands of dollars in machines and supplies that don't go used, so they instead 'rent' the machines from medical equipment suppliers, and use the machine's usage data to determine that you are still using it (and thus continue to pay for treatment). Typically after a year or so of usage they get 'paid for' but there's still ongoing compliance monitoring to get insurance to pay for supplies.
The sleep lab and sleep doctors can also remotely review the usage and make adjustments as needed. One example is using the humidity sensors in ResMed units to adjust the humidification settings remotely. I was with a doctor that showed usage logs together and noted the bedroom was severely dry and thus we needed to adjust the humidifier to run hotter to compensate.
„Oral myology plays also an important role in the management of patients with sleep breathing disorders and snoring where oropharyngeal exercises were found to reduce the severity and primary symptoms of obstructive sleep apnea. Poor positioning of the tongue affects breathing and allows a series of events to occur that can affect the orofacial complex. Patients with sleep apnea and other breathing difficulties usually have decreased tone and mobility in the cheek, tongue, lip, and soft palate, and sensory alterations due to a tendency to engage in mouth breathing rather than nasal breathing. In treatment of sleep apnea, oral myology therapy involves a series of exercises designed to improve tongue position and tongue function for a better control of the extrinsic tongue muscles and place the tongue in a ‘‘proper posture during function and at rest.’’“
From https://en.wikipedia.org/wiki/Oral_myology#Sleep_apnea_and_s...
I will need to look into it, I’ve been thinking about getting a cpap for a while but they seem too noisy and annoying to maintain
The bigger problem is habituation to the mask/hose setup. If you sleep on your back you’ll have it easy. Side and stomach sleepers or people who turn a lot will have a harder time getting used to it.
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.
Saying that I have a CPAP machine and love it.
… 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.
The drug reduces AHI by 4. It could only cure very mild sleep apnea. Otherwise it seems most useful as an additional treatment with CPAP.
It could also help raise awareness of sleep apnea - try the drug first. Don't see any changes? Ok now try CPAP.
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 :)
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.
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.
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.
Regardless, it doesn't cost anything to try, seems no danger in it and it seems logical that it could help.
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.
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.
(I think I'm mostly agreeing with you.)
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.
That’s where I would disagree. Sure there’s a baseline of breathing that everyone does otherwise they’d be dead, but I think the ceiling towards skillful breathing is very high. The difference is more obvious under athletic conditions like if you’re running or biking, just improving your breathing rhythm can improve your performance. There’s even a proper way to breathe if you’re weightlifting, some people might pick it up naturally but I know it’s also commonly taught.
In psychology I’m pretty sure it’s well established and not pseudo science that certain breathing rhythms can increase your energy or decrease your anxiety, I think I read that they teach box breathing to some parts of the military to help keep them calm during missions.
So there’s definitely a range of breathing ability for specific tasks.
I think, probably, there's some structural elements that can make mouth breathing more attractive or easier. But, mouth breathing doesn't actually work well for the breathing part. So, for those people, they experience obstructive sleep apnea. For others, they don't. I have spoken to sprinters who have told me that even sprinting is easier to do with nose breathing. But, for others, they cannot even sleep while nose breathing.
So, I definitely believe there are structural elements at play with breathing.
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...
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 would like to also include cancers since we cause most of them but that is maybe a different category. Although I have heard of theories that suggest diet can reduce skin cancer (e.g. the mediterranean diet phenomenon) as well as one that suggests exercise can reduce prostate cancer (by strengthening the muscles surrounding veins to prevent testosterone from leaking into the prostate), and of course smoking-related cancers are entirely preventable, so I would not be surprised if there are a lot more that are prevented by health lifestyles.
Generally it doesn't seem to work to just tell people to be healthy, though; to really get any of this work you need society at large to be structured in a healthy way so that it becomes the default instead of an act of willpower. But that seems.. imminently doable, if people want to do it. However it's a huge change, so it takes a movement. For example you pretty much have to make people's lifestyles more walking-oriented, which means rearranging society completely.
As a math and physics expert, you also claim to be proficient at body movement. Go off king, I'll wait. And AHDH huh? Cancer, uhuh. You're a pyschoholigist and doctor too.
Keep going Dunning-Kruger.
F'n hell yn.
Like: for example, it seems fairly obvious that some societal-level change happened around the 70s or 80s that triggered our modern obesity epidemics. My personal best guess is that it was the rise of processed foods messing up people's gut bacteria, but I have no actual idea. Nonetheless: you can spend as much time and energy (as a society) as you want curing obesity, but if ultimately the cause is in our food quality, then the "right" fix is obviously to fix that. The same claim applies to skin cancer and dietary connections: if the Mediterranean diet or general food quality is responsible for lower incidence of cancers in those places, then ... food quality should be fixed, right? (and sun exposure, of course, is another variable that you can just do things about).
You don't have to be an expert to think that has some validity. It's obvious. I am just quoting the expert theories, anyway.
The point really is: interventions like 'change the quality of food in America' are not things doctors can, like, prescribe to people. But they are things we can aspire to do. They will just take social movements instead of medical treatments to pull off.
I suffer from obstructive sleep apnea, but I would never, ever tell people that their sleep apnea HAS to be obstructive too.
It's like telling a Type 1 Diabetic that they had a friend with diabetes that "cured" themselves with diet. We're talking about two different problems, and we don't discount the Type 1 Diabetic because there are Type 2 Diabetics.
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
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"
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.
Overweight by chance?
I've put on a bit of weight sunce having kids and my breathing at night is much worse than before.
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.
Turns out it was you who are polluting this community with low IQ takes.
Could it possible be due to musculature and structure of the palate and tongue? And, if it is, could therapy help mitigate it?
I mean, just consider the conditions physical therapy can help with today. Is it really so out of the question that physical therapy could help obstructive sleep apnea?
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.
https://www.sleepfiles.com/OSCAR/
On the machine I have (ResMed AirSense 10) the data gets written to an SD card I can pull out and import into OSCAR to see what the machine detected about my sleep apnea events.
I also (not always, but when I'm testing changes) use a continuous pulse oximeter to test my SpO2 blood oxygen % over the entire night. The data from this can either be combined with the data from the CPAP machine, or used on its own to test things like how I do with the collar and no CPAP machine, since the SpO2 drops are the dangerous thing I'm trying to avoid by eliminating the apnea events.
I use the Wellue SleepU for SpO2 monitoring but there are a lot of similar devices (the kind with finger tip sensors are generally more accurate than the wristwatch based solutions).
I’d urge you to speak with a maxilofacial surgeon, they will confirm it by taking detailed X-rays of your jaw and will be able to identify that your airway is likely impacted by the recession.
Usually the causal chain is such: Recessed jaw due to poor development as a child, likely a pacifier or a stomach sleeper > causes your tongue to not have enough space and puts backward pressure on the airway constricting it > poor sleep.
Usually people with recessed jaws have a variety of other mouth related problems too like mouth breathing, gum recession, abnormal amounts of cavities, bruxism, pain and poor bite. If youre lucky a dentist might have caught some of that and flagged it to you but usually they send you to an ortho who magically discovers that this can all be solved by pulling some teeth as a teenager and giving you braces.
This actually makes the situation much worse and you only find out in your mid to late 20s.
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."
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.
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.
More generally, since I was young, I always slept part of the night with my mouth open and woke up in the morning with a terribly dry mouth.
Now I have solved my problem with two simple things, without any medication: during the day, I am always careful to breathe only through my nose (except during intense physical effort), and at night, I just use mouth tape to keep my mouth closed all night long.
Since I started using the tape on my mouth, I sleep well and I no longer experience nighttime panic (due to apnea?). At the beginning, I was scared of having the tape keep my mouth closed, but I very quickly got used to it and now I barely notice it.
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.
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.
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.
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.
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.
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.
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...
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.
The sleep medicine industry uses compliant long term cpap patients as the denominator in order to conclude it’s “extremely effective”. If you stop cpap therapy after a year (or even years!) of it not working, they will blame patient compliance not the machine. The machine manufacturers (who incidentally happen to fund most sleep research) have made a variety of machines and settings, and thus there is always another setting to adjust or device to try before concluding cpap won’t help. The assumption is that it’s “extremely effective” and thus, all failures are attributed to compliance. “You just need to find a better doctor to help with the titration”, or “you need a different type of mask”, or “turn off the autoset and up the pressure”, or “it can takes years to adapt to the machine and see improvement”, or my favorite “you may feel much worse and get very little sleep but the science says you need cpap, even if it’s not helping the apnea and maybe even making it worse.” Indeed, the research literature show cpap is potentially iatrogenic, inducing or increasing (central) sleep apnea in some patients. The solution the industry has marketed, a different type of cpap device for CSA called asv, about twice the cost of a regular cpap, actually increased mortality in a major trial iirc. So yeah, if you don’t give up after years and dozens of machines and doctors and weekly titration appointments and none of that helping at all and maybe even making the apnea worse or even killing you (if you have HF, the main cause of CSA, then yes, cpap is “extremely effective” or there wouldn’t be a multibillion dollar business behind it propped up by insurers who can presumably use cpap patient non-compliance to deny future insurance claims related to the cardiovascular system or metabolic dysfunction.
[1]https://www.sciencedirect.com/science/article/pii/S009042952...
https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive...
But by far the most critical part of getting CPAP to work was using an open source program to review the SD card raw data every morning, learning the interplay between max/min pressure, temperature, humidity, and ramp. Gaining access to the admin controls on my AirSense and fiddling it myself over weeks to find the right settings--this was the only way I made it work. The idea of waiting 6 months to make a change to the pressure was bonkers to me. Especially, for some reason, my brain is shit the next morning if I over oxygenate with too high max pressure overnight, worse than not wearing it at all!
But once you dial in the settings. It's magic.
Also, yes, they're pretty cool. I don't love that I seem to need mine right now, but at least I know a guy. :)
https://news.stanford.edu/stories/2020/07/toll-shrinking-jaw...
I realised I was affected by this in 2023 and have been researching it and trying to spread the word about it since.
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...
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.
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.
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 :(
If you aren’t overweight, this might not help, but hopefully it’ll help someone!
Can you take fluticasone permanently? Sometimes it’s like I just lie down and my nasal congestion gets worse instantly
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.
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.