People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen.
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.
This is worth pursuing for anyone with the symptoms.
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.
A friend went to one of those clinics. “The diagnosis is sleep apnea. What are your symptoms?”
Get 2 opinions. And yes about weight - some people won’t have Apnea if they get their BMI to like 25 or whatever.
Saying that I have a CPAP machine and love it.
Multiple opinions won't necessarily help unless you research first. I'm not sure about other disciplines but in orthodontics for example there is a very definite split between whether they are "airway focused" or mainstream. I saw 6 or 7 different doctors, dentists and orthos in the UK over a period of about 10 years and none of them saw anything wrong with my jaws. Saw an airway focused ortho and a surgeon specialising in maxillo-mandibular advancement surgery and they recommended aggressive surgery. I agree with them, mainstream medicine is ignoring an epidemic of jaw underdevelopment because it challenges current practices in orthodontics.
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Having been down this path, it’s evident to me that the US has built up a sizable medical equipment industry around CPAP machines and their supplies. The sleep doctors who prescribe them don’t have many alternatives, so it’s the normal treatment they hand out.
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.
Better to outright buy the machine online, then open it up and disable the modem.
Why in the world does a CPAP machine need a modem?
Most have a cf slot to store the sleep data, it’s how the doctor / clinician can see if it’s working, make adjustments to pressure etc. but for convenience they can just upload the data directly.
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.
Many patients starting out CPAP therapy go noncompliant because they have various issues or concerns with the machine, mask comfort, etc.
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.
I’m always on HN talking about myofunctional therapy (my mom is a practitioner in NYC). Recommend looking into it in addition to losing weight as treatment.
First time I see that term
„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
Mine is not noisy! It requires minor weekly cleaning, not a big deal.
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.
What model do you have?
Currently doing myo, and Buteyko! Glad to see someone else here. I've also done a MARPE.
100% agree. I can cleanly divide my life into before and after treatment for sleep apnea, I didn't realize I wasn't supposed to feel awful and tired all the time.
Yes the lead is buried in the article.
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.
I bought a connected oxymeter (viatom). I wore it overnight on my finger with the phone nearby. The graph on the app shows exact values through the night so you can see how many time oxygen drops and for how long. It's not quite as good as the real thing but should give you an idea, and it's cheap.
I've tried a CPAP machine for 6 weeks and felt no different and gave up. I think I was a 6 on the scale. I wish it had worked though!
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
Depending on what’s going on, have your iron levels checked as well. I was tired all of the time and two doctors diagnosed sleep apnea and put me on a cpap. Didn’t help. I had to take hour long naps every day.
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.
You should consider getting an Wellue O2 ring. This is something you can use to monitor your oxygen saturation throughout the night. Use it with the CPAP and also otherwise. If your oxygen saturation is better with CPAP - you know that it is working. You will eventually feel better.
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.
For some people it takes months to feel any different.
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.
I think one problem is that a lot of sleep doctors are essentially CPAP salespeople and they will just keep pushing that even if you protest that you don't feel any better. I got better answers from an ENT doc who did a Drug-Induced Sleep Endoscopy and told me mechanically why I was not breathing well at night.
I didn’t have apnea but I had UARS, which works differently. It’s more difficult to diagnose, primarily because it’s more rare.
exactly the same for me (but I gave after 5 weeks, because I didnt felt any different and hated everything about sleeping with the cpap)
If you truly have sleep apnea it’s not just about feeling refreshed. There could be other reasons you’re tired.
But sleep apnea is really bad for your heart and lungs and does damage to them over time.
Three more things to try if you haven’t, on a “can’t hurt” basis: nightly Avamys spray (might need a scrip depending on where you are), magnesium glycinate before bed, little bits of plastic that go inside the nostril and hold them open.
I just discovered magnesium glycinate provides significant relief for my night sweats. I might have some undiagnosed apnea, but the sweats have been the only apparent symptom (and may be caused by a completely unrelated problem). Taking 400mg before bed seems to have turned off the symptom like a switch. YMMV, of course.
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.
Also worth a try... B1 (thiamine) seems to help for me. I don't have objective numbers, but I disturb my spouse with my snoring and breathing troubles far less. I believe I have (undiagnosed) central sleep apnea rathee than OSA though, it's been a long time since I had a sleep study, but I had only one event over a few recorded nights... But some nights it's pretty bad.
Thanks, ordered some, will give it a shot
Awesome, I hope it's helpful for you!
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.
Would you had precise kits references to share? It is quite hard to figure out what has cheap electronic versus what works. Thanks!
#1 symptom - fat necks! if you are like me and had a 17" neck at 185 in high school and now boast a 18.5".... you have it!
Why is that?
Sleep apnea can indirectly cause weight gain, but obesity—particularly excess fat on the neck—is the main controllable risk factor for obstructive sleep apnea, so it’s primarily the other way around.
Any brand of test kit you recommend?
> Treatment with CPAP is highly effective in eliminating these symptoms
… 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.
That seems -- quite high actually?
I don’t know but I wonder if people that have insomnia or similar difficulty falling asleep (anxiety, etc) struggle with a CPAP. I am fortunate to fall asleep very easily, usually within 3-5 minutes or even faster. And I use a CPAP (nose saddles not a full mask), and prefer it to not using one while sleeping. The way it just opens all passageways is relaxing and I think helps fall asleep even more quickly.
> People should be more aware of the symptoms of sleep apneas
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...
Couple of things to address here...
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
It’s typically something that sets in over time (often, but not always with weight gain and age), most people don’t notice because it’s gradual. Especially if they aren’t in normal risk groups. OSA symptoms are easy for an individual (and clinicians) to misatribute
Yeah, but I've met people who think it's "normal" to wake up tired and exhausted even after multiple (or even many) nights of sufficient sleep, time-wise.
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.
Waking up tired could be caffeine addiction too, which I think most adults are addicted to
I’m addicted to caffeine and don’t wake up tired. Maybe you have sleep apnea.
> > People should be more aware of the symptoms of sleep apneas
>
> 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.
I think it’s important to know your personal context levels.
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.
I guess. This is a good answer, it did made me recontextualize.
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.
yes, it needs to be pointed out. if you have it for a long time you might not realize it's a fluke (like me)