Sleep apnea is a structural issue, either soft or bone. CPAP helps, but it doesn't address the root cause. Fixing it is a matter of airway geometry, with many obstructions along the way. Bodybuilders or wrestlers, otherwise in good health, can suffer from OSA because of too much muscle in their neck.
You may not know it, but your tongue may be tied. It is one of many possibilities causing OSA.
You're right, and Inspiratory Muscle Training is an easier alternative to playing didgeridoo, and it's very important to mention Mandibular Advancement Devices and soft cervical collars(since neck-jaw position matters, this is a big part of why apnea is worse on your back), but the thing is- it's unlikely to be enough.
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.
justinator · 22h ago
>usually you want maxillomandibular advancement
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.
bigjimmyk3 · 4h ago
The only maxillomandibular advancement with which I'm familiar is a surgical procedure, rather than an exercise therapy. It involves repositioning both the mandible and your upper jaw (as the name implies) by cutting and repositioning both.
elric · 11h ago
> CPAP helps, but it doesn't address the root cause. Fixing it is a matter of airway geometry, with many obstructions along the way.
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.
morjom · 23h ago
Central Sleep Apnea exists aswell.
grapesodaaaaa · 23h ago
This sent me down a rabbit hole, but high altitude periodic breathing seems related for some people living at high altitude.
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.
briankelly · 22h ago
If jaw placement is an issue you can get corrective surgery without an apnea diagnosis (AFAIK). There’s a lot of info on Reddit, you can generally tell from your side profile or bite if it is a potential culprit.
tayo42 · 17h ago
What do you former wrestlers do?
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
elric · 1d ago
I swear CPAP wouldn't get such a bad rep if the media would stop using pictures of men with obscenely large full face masks. The most commonly used CPAP mask is probably the minimalist Resmed P10 [1]. It looks a lot less intimidating than a bulky full face mask. And in most cases, full face masks aren't needed (no sources to cite, but titrating to the correct pressure allows most people to breathe through their noses).
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?
> 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?
hombre_fatal · 21h ago
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.
Llamamoe · 1d ago
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.
garyclarke27 · 1d ago
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.
djur · 13h ago
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.
Suppafly · 2h ago
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.
os2warpman · 7h ago
> 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.
VectorLock · 22h ago
Congrats to you. 40% of people probably wish they could tolerate it.
frosting1337 · 19h ago
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_.
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?
giardini · 15h ago
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.
latentsea · 12h ago
> 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.
djur · 13h ago
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?
DangitBobby · 14h ago
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.
sirtaj · 12h ago
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?
schwartzworld · 20h ago
> 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.
djur · 13h ago
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.
schwartzworld · 8h ago
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.
InfiniteRand · 8h ago
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
elric · 1d ago
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.
VectorLock · 22h ago
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.
elric · 21h ago
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.
VectorLock · 19h ago
>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.
mywrathacademia · 7h ago
What are the side effects of cpap and does it cure sleep apnea or do you have to use it forever?
Suppafly · 2h ago
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.
scuff3d · 1d ago
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.
sensanaty · 19h ago
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
spanktheuser · 1d ago
>>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.
rlifer · 16h ago
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).
DangitBobby · 14h ago
I had a nose only mask and ending up switching to one that covers mouth and nose for that reason. It worked for me.
balls187 · 1d ago
Do you wear a cpap?
It sucks. I have an OA now. And it also sucks.
BurningFrog · 1d ago
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!
bryanlarsen · 1d ago
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.
elric · 1d ago
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.
bryanlarsen · 1d ago
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.
elric · 1d ago
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.
garyclarke27 · 1d ago
I tape my mouth shut and use the CPAP nostril mask, work great, I wake fully refreshed.
bryanlarsen · 2h ago
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.
bryanlarsen · 1d ago
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.
TimPC · 1d ago
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.
bryanlarsen · 1d ago
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.
BurningFrog · 1d ago
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.
jprd · 1d ago
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.
aziaziazi · 1d ago
> 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.
BurningFrog · 1d ago
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.
subsaharancoder · 18h ago
> 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.
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.
johng · 19h ago
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.
AdamH12113 · 1d ago
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.
D-Coder · 1d ago
My partners prefer it to my not-breathing for 30 seconds or more, then gasping for air.
op00to · 1d ago
My partner has never heard any “cpap noise”. I just asked.
philwelch · 1d ago
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.
scuff3d · 1d ago
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.
op00to · 1d ago
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.
christophilus · 1d ago
I wear one, and it’s great. I much prefer it to surgery or drugs.
elric · 1d ago
I do. It's not the greatest, but you get used to it, and it makes sleep a hell of a lot better.
Diti · 1d ago
I do, a ResMed AirSense 11 with a ResMed Mirage FX. Wonderful sleep, wonderful comfort, and no need for the water supplement.
TMWNN · 21h ago
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.
sfink · 13h ago
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.)
russelg · 8h ago
They sell the same cover for the AirSense 10 as well, I just bought one.
seattle_spring · 1d ago
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.
EA-3167 · 1d ago
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.
derefr · 22h ago
> 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.)
wat10000 · 1d ago
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.
sfink · 13h ago
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.
AStonesThrow · 1d ago
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.
pedalpete · 20h ago
When looking at any of these studies in CPAP, and sleep in general, we need to be looking deeper than just the AHI (hypopnia index, how many times you stopped breathing), and directly at EEG measures of restorative function and other biomarkers.
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.
piperswe · 1d ago
Atomoxetine can have some super nasty side effects, and I wouldn't be surprised if it only works for some people. It's a fickle drug in my experience.
msarnoff · 1d ago
This comment needs to be higher. Atomoxetine is also known as Strattera and is prescribed for ADHD.
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.
javawizard · 1d ago
Same!
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.
sfink · 1d ago
One thing that I've found very helpful, and wish my doctor had mentioned: when putting on the CPAP (nasal pillows in my case), time turning it one with your breathing such that the machine first kicks in during an inhale.
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...
robterrell · 1d ago
I got a travel CPAP and it's been a huge unlock for me for international flights. Last flight I took to Europe I picked a 9 pm flight and had 6 hours of actual good sleep on the plane.
jiayo · 22h ago
Similar experience. I liken it to merging onto a freeway: you want to get up to speed first, then change lanes. If you don't, it feels like you're always fighing the pressure. If you equalize the pressure correctly breathing is as easy (easier) than without the mask.
jrm4 · 1d ago
Having used multiple machines; some are "better" at this than others -- might be time for you to just get a new one? Probably technically you want an APAP.
lrasinen · 23h ago
My preferred method (Resmed Mirage FX) is to put the mask on, but without the hose connected. Then turn the machine on, wait until I can hear the air whooshing out of the hose and then clip the hose to the mask.
... 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.
ProllyInfamous · 1d ago
I am a fattie (BMI 36.5). I also have sleep apnea. Wearing a CPAP, I couldn't ever get any sleep (toss&turner).
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).
blarg1 · 23h ago
> 3) Losing weight — YES, sleep apnea is worsened by excess weight
That solved it for me.
johntash · 20h ago
What kind of dental guard did you get? One from an actual dentist, or one of those pre-made ones off of amazon/etc?
I've been wanting to try one from the dentist, but they're pretty pricey.
ProllyInfamous · 14h ago
My dentist created mine, in house, using his 3D-printer (after scanning my mouth with a stereoscopic camera). I am not sure which type of plastic is used, but I wasn't satisfied with the purchase until we had tried different [softer] plastics.
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...
mrlatinos · 16h ago
Not OP but we sound very similar. I wear a CPAP as well as a night guard. My dentist ordered me a "Max Occlusal Guard H/S Daytime" - it covers my upper teeth, has a hard outer shell and a softer lining. It's very thin and I can use it during the day (as long as I'm not talking) to prevent bruxism. I've used the cheaper Amazon ones - the ones from your dentist are well worth the cost.
therealdrag0 · 20h ago
I don’t think I have true apnea, but mouthguard+earplugs+concave-eye-mask really helps me.
err4nt · 1d ago
Thanks for sharing, I'll try some of these out!
ProllyInfamous · 1d ago
If you attempt body pillows, get TWO (so when you roll to other side you don't have to wake up in order to swap pillow placement). But the dental guard ($$$ — worth it, IMHO) is the best solution on my list (I'm sure CPAP is ideal, but if I ever even could fall asleep, I'd wake up de-masked).
Best of luck!
evanjrowley · 1d ago
I must be in the minority of CPAP users who would use it even if I stopped having OSA. Why? A few reasons:
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.
12_throw_away · 21h ago
Yep - my first 4 weeks, I just hated the feeling of air getting forced into my airways. And then 2 weeks ago, it flipped on a dime ... I guess my brain decided "this is what sleepy-time breathing feels like", and now it's a very relaxing sensation.
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.
mywrathacademia · 6h ago
Sounds like a side effect of cpap is addiction? Does it cure sleep apnea or do you have to use it forever?
iamjackg · 6h ago
It doesn't cure it, the same way wearing glasses doesn't cure poor eyesight.
mrlatinos · 16h ago
It took me a LONG time to adjust to CPAP and now I totally agree on all points. I got hooked when I was sick with a nasal infection because of point #3 (plus it was the only thing that allowed me to breathe).
pstuart · 1d ago
4. There's some pretty powerful conditioning in associating it with sleep and it helps tell the brain it's time to shutdown for the night.
TMWNN · 21h ago
I wouldn't use it without sleep apnea because of the annoyance with the hose. But I agree that otherwise my nasal mask is hardly noticeable.
evanjrowley · 6h ago
The hose became easier for me to deal with after I used a bungee cord together with a wall hook to keep it mounted above the bed.
TMWNN · 6h ago
I use a hook too, plus a mask with the hose connection at the top of the head. Looks ridiculous, but it's better than the usual "oxygen mask" hose setup, even with a nasal mask. Both things help, but I'll never get completely used to the hose's annoyance.
sensanaty · 19h ago
Yeah same. If a tubeless variant were to somehow be invented (portals?), I'd be a happy chappy
N00dlesHead · 1d ago
I cant use a cpap so anything else worth trying is good for me. I have nocturnal seizures, need a sports guard to keep from biting chunks off my tongue while sleeping, plus a deviated septum. Cpap doesnt work for me theres no air flow,so Im waiting on both surgery on my nose (going on 3 years) and a mouth guard to pull my jaw forward which is taking forever as well. I havent had a decent sleep in years
gosub100 · 1d ago
this won't solve all your problems, but replacing the sports guard with a rubber one that is meant for bruxism, or even better, paying the $400 and getting a custom one from your dentist, will help a lot. the sports guards aren't soft enough to prevent damage to the surface of your teeth. My custom dental guard has lasted for several years, and although I was skeptical at first, the cost was worth it.
therealdrag0 · 20h ago
You can get a custom fit one by mail for like $200.
johntash · 20h ago
Do you have a recommendation on where? I think my dentist said the cost was > $3,000 so I never went through with it.
gosub100 · 6h ago
Your dentist is probably owned by private equity
ProllyInfamous · 23h ago
>paying the $400 and getting a custom one from your dentist
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.
gp · 1d ago
I worry about developing sleep apnea, not only for the effects on my health, but also on my relationship with my partner.
A medicine that treated sleep apnea would be revolutionary for so many people.
elric · 1d ago
> also on my relationship with my partner
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.
binoct · 1d ago
Those who can tolerate the general CPAP experience, have bed partners who tolerate it, and don’t experience detrimental effects should absolutely use it when there are no comparable solutions. However there are lots of perfectly legitimate reasons why not everyone can, and having alternatives (which do also come with side effects) to consider is amazing for the community overall. It’s legitimately great that it sounds like CPAP treatment has been effective for you (as it has for me, mostly), but your comments end up sounding quite dismissive of the challenges faced by other patients.
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.
elric · 1d ago
Almost everyone can tolerate CPAP. The problem is that the medical establishment sucks at helping people adjust and is awful at properly titrating them. Followup is abysmal. If they did a better job of that, compliance numbers would skyrocket.
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.
aaronblohowiak · 1d ago
*Apap > cpap, but most people call apap cpap …
elric · 1d ago
I disagree. APAP is reactive, by the time it kicks in you've already had an event. But if it works for you, all the better.
Citizen8396 · 1d ago
You nailed it. CPAP ultimately fails for something like 50% of patients.
gertop · 1d ago
> That's not really much of an issue.
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.
genocidicbunny · 23h ago
Or alternatively, they need the noise, but cannot tolerate rhythmic noise. A CPAP machine to me isn't disturbing because of the noise -- if anything I would prefer some noise to drown out the mild tinnitus. It would be disturbing because it would be a fairly repetitive noise, and my brain would very quickly lock onto it and not allow itself to relax and let me sleep. Even a lot of 'random noise' videos on youtube end up being repetitive enough to trigger this.
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.
yetihehe · 1d ago
There are already nasal and throat sprays that help. I use throat spray and it helps a lot for getting better sleep for me and wife.
malnourish · 1d ago
Call me curious. Where do these sprays fall between homeopathy and verifiable?
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.
yetihehe · 1d ago
It's verifiable. They act on your uvula by stiffening it. Nasal spray acts on this too, but it also decongests your nose. It's not helping for all reasons of snoring, but for me it helps a lot. Unfortunately, if I spray at 22, it typically works only until about 5 in the morning and next application is not that good, but it's much better than full night of snoring.
petercooper · 1d ago
“Atomoxetine also increases heart rate and diastolic blood pressure a little bit,”
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.
Citizen8396 · 20h ago
That study is from 1985; subsequent studies have found no such utility for nicotine.
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.
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.
petesergeant · 1d ago
A similar fix for me was a nasal steroid taken every night. Got me off the CPAP
cmrdporcupine · 1d ago
Any long term side-effects from that?
petesergeant · 16h ago
Not that I could find, and the doctors seemed pretty happy with it (and it was one who suggested I try it). I'm taking Fluticasone Propionate.
AStonesThrow · 16h ago
I took my first spritz today of F.P.
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!
petesergeant · 8h ago
My understanding is it’ll take a little while for the effect to build up. Good luck!
lzy · 16h ago
This looks promising, especially for folks who can't tolerate CPAP. Wonder how it performs long-term and if it messes with REM cycles. Also curious about cost and insurance coverage—sleep treatments tend to get expensie fast. Hope follow-up studies confirm these results without major side effects.
cjbgkagh · 1d ago
It is Tirzepatide which is a GLP-1 agonist, like Semaglutide (Ozempic). I don't know how much of the co-occurring issues from sleep apnea are caused by the sleep apnea or are comorbidities for something else. I suspect quite a lot of the later. I think we're going to find that GLP-1 agonists are really good for a lot of things beyond obesity including many auto-immune conditions which I think underlies many mental conditions.
felideon · 23h ago
Hmm? Article says it’s a combination of atomoxetine and aroxybutynin.
cjbgkagh · 23h ago
Ah, you are correct, for some reason only the later mentioned previously approved drug was retained in memory.
mmmBacon · 1d ago
I would love to try this. I couldn’t tolerate CPAP. I used a dental appliance and that worked really well for a while, although was not perfect. I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm. I’ve started with extensive orthodontic treatment and it’s super uncomfortable. The thought of the surgery is also fairly terrifying. So if there’s a pill that could help, I’d sign up in about a millisecond.
ProllyInfamous · 1d ago
>I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm.
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).
linsomniac · 1d ago
There's also a new "KPAP" (KairosPAP) that is a different air delivery algorithm that people tend to find much more comfortable. Rather than being a constant air delivery, it's a little kick at just the right time, is my understanding. https://sleepdoctor.com/pages/cpap/kairospap-kpap
Citizen8396 · 1d ago
It does look interesting, especially for patients with a low arousal threshold (those who are easily disturbed or woken up from sleep).
Unfortunately it isn't approved yet and isn't commercially available as a result.
linsomniac · 1d ago
Correct, but it also sounds like it might become available within the next year, though I did reach out to them and ask and received no response. It looks like the last updates on it were almost a year ago, so it makes me wonder if they've hit some kind of snag. They are planning on releasing their own hardware, but my ENT expects it may become available for many available "autoPAP" machines as a firmware upgrade.
wincy · 1d ago
Zepbound is actually FDA approved for the treatment of sleep apnea. It’s helped me sleep much better after losing 60 pounds due to this drug.
declan_roberts · 1d ago
These peptides are actually a cure because they treat the underlying disease upstream to many of these pathologies.
rowanseymour · 1d ago
I've had problems with obstructive sleep apnea for a couple of years. Tried CPAP/BPAP for a month and hated it so much I'm now trying to see what I can fix with surgery even though surgeries like maxilofacial sound horrific. I currently have a MARPE device installed to slowly splitting my palate bone down the middle to expand that. A pill sounds wonderful..
toast0 · 1d ago
I've been taking a B1 (thiamine) suplement before bed and it significantly reduces reports of snoring and apnea from my sleeping partner. I think my apnea is more central than obstructive though.
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.
Citizen8396 · 1d ago
You might want to consider an oral appliance. There's no guarantee you will tolerate them or get the desired effect, but the same goes for surgery. Oral surgeries often have dentists who are certified in sleep medicine who can create a custom, medical-grade appliance for you.
I tried everything I could find on Amazon but obviously that crap doesn't work. I can believe something custom made could help but my orthodontist persuaded me the only really solution was surgery or CPAP.
ianburrell · 1d ago
There are specialized dentists that make appliances. My understanding is custom works much better cause fits perfectly instead of having to mold it. If you can, go to dentist that has experience. They are expensive, mine was $3k.
Citizen8396 · 21h ago
Insurance will sometimes cover them whole or in part, but it can be a difficult process.
nanipunani · 1d ago
People using a CPAP - have you looked at Inspire? [1]. My pulmonologist friend highly recommends it. The device has very high success rate and is now in the 5th generation of development.
My problem is that I want to avoid surgery at all costs, and the inspire only has a 10 year battery life after which they have to open you up again.
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
bagels · 1d ago
Is it an implanted device? The website makes it really hard to find out how it is worn, or if it is surgically implanted.
sooperserieous · 4h ago
It is implanted. I had a consult to get one and decided without too much uncertainty that it was not for me. I like the other benefits (as noted in other comments) of CPAP that would be lost and my wife doesn't notice the little noise over the fan she runs all night anyway :)
I've tried them, but if you have facial hair they don't stick well and come off too easily. Instead, I've been using 3M micropore tape - just the right amount of adhesive, my skin feels fine, and cheap too.
It works well to stop me breathing through my mouth.
linsomniac · 1d ago
What process do you use for taping, full mouth, full mouth with slits, "soul patch" strip in the middle?
GordonS · 1d ago
I tried slits, but unfortunately that didn't work for me - has to be the full mouth. It's far from ideal, but it's that or CPAP, or no sleep...
whacked_new · 1d ago
I have been doing something like this, every day, for several years now. I started with a more gentle kind of tape that doesn't go over your lips. But after trying different kinds of tape, I just stick a small piece of medical tape over my lips now.
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
bagels · 1d ago
Seems really dangerous to block the airway. If you get a runny, bloody, stuffed or otherwise blocked nose, seems like you can suffer some bad outcomes.
pimlottc · 22h ago
It’s normally a small piece of tape less than the width of your mouth. It’s more about keeping your lips together than creating an air-tight seal.
Drunkfoowl · 1d ago
I spoke with my ENT about this. I was treating anxiety triggered shortness of breath, and found that nose breathing was able to calm me if I box breathe.
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.
polishdude20 · 1d ago
I don't have sleep apnea but during allergy season my nose does like to get stuffed at night causing my mouth the get really dry which causes me to wake up a few times.
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.
Citizen8396 · 1d ago
Fluticasone can be especially helpful for people with allergies and/or OSA.
"Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction."
"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."
I find the most effective nasal sprays also give me terrible withdrawal symptoms. Like, I'd use them for a few days at night, alternating nostrils and then when I stop, my nose is closed shut for the next few days.
Citizen8396 · 21h ago
This is common with Afrin (oxymetazoline). It’s only meant for short term use for this reason. This shouldn’t be the case with fluticasone.
TremendousJudge · 1d ago
Some nasal sprays have salt in them in addition to whatever drug they have, which unblocks the nose immediately but is extremely addictive. The ones that have just the drug don't have this issue in my experience
Noob question: could this drug help with snoring as well?
gonzo41 · 1d ago
Or try, no booze, lose a bit of weight, increase cardio activity and sleep on your side. This works pretty well for obstructive but sadly not central apnea.
Citizen8396 · 1d ago
OSA is not always positional. Further, there are patients with normal BMI who also don't drink.
malnourish · 1d ago
While I agree with you and have done this myself, if you're going to make lifestyle change recommendations, at least spell "lose" correctly ;)
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.
sensanaty · 19h ago
I suspect I've had apnea since I was a kid, and that was when I was swimming 9x a week and doing swim comps all the time.
Some people just have fat tongues (Ladies, 1 at a time please!) unfortunately
ikekkdcjkfke · 1d ago
Central apnea is where your brain actively decides it doesn't want to breathe anymore? Nice..
eurekin · 1d ago
Any way to discern one from another?
Citizen8396 · 1d ago
A sleep study. Central and obstructive sleep apnea aren't mutually exclusive, either.
kazinator · 1d ago
Death apnea is proving much more elusive.
IAmGraydon · 1d ago
>One of the medications, atomoxetine, approved by the U.S. Food and Drug Administration (FDA) in 2002 for attention-deficit/hyperactivity disorder, increases levels of the excitatory neurotransmitter norepinephrine by blocking its reuptake from neuronal synapses.
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.
xyst · 1d ago
I’m all for more options to improve sleep quality for OSA. However gains seem minimal over existing alternative therapies (ie, "mandibular advancement devices").
refurb · 1d ago
It's definitely an interesting outcome and nice to see such a significant improvement in a clinical trial.
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"?
Five events is the threshold at which (mild) sleep apnea can be diagnosed.
AtlasBarfed · 1d ago
A drug that deals with physical obstruction???
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.
BurningFrog · 1d ago
From the article:
> 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.
binoct · 1d ago
Glad it worked for you. Not everyone with sleep apnea is an overweight alcoholic. Plenty of drugs help with diseases involving muscle tone, why is that so surprising?
Citizen8396 · 1d ago
It happens to stimulate nerves in the airway such that it reduces collapse and obstruction.
PS: there are many people with OSA with normal BMI who also don't drink.
Elinvynia · 1d ago
Not every case of sleep apnea is obstructive. With central sleep apnea no amount of weight loss, surgery and repositioning will fix the problem.
jmclnx · 1d ago
>Atomoxetine also increases heart rate and diastolic blood pressure a little bit,
I believe most people with Sleep Aonea tend to have High Blood Pressure, this could be concerning.
Citizen8396 · 1d ago
OSA causes high blood pressure; treating it could theoretically result in an overall reduction in blood pressure. If this gets approved, it would likely be at the provider's discretion. I imagine it won't get blindly prescribed to people with severe cardiac risk factors, but it may stop some from getting to that point.
Etheryte · 1d ago
We have numerous good options to deal with high blood pressure, I wouldn't say this is really a problem. Many people take medicine for high blood pressure and live the rest of their lives completely unhampered.
lm28469 · 1d ago
Virtually any pill you have to take for life has negative side effects. Medicine made serious progress in all kind of ways but we don't have magic pills yet, even simple things like fixing a broken bone "only" has a 90-95% success rate without complications.
Stay in shape, eat clean an exercise, once it's gone it's gone for good
const_cast · 20h ago
> Stay in shape, eat clean an exercise, once it's gone it's gone for good
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.
AaronAPU · 1d ago
Many people have high blood pressure in spite of being in the top percentage of health and fitness. It gets tiring seeing people blame it on lack of exercise. Genetics is a thing.
lm28469 · 1d ago
Sure, that being said 75% of the west is overweight or obese... which aggravates basically any illness you can think of. Statistically speaking the extreme vast majority of people with high blood pressure, or anything else for that matter, aren't in the top percentage of anything positive health or fitness related
Etheryte · 1d ago
This largely misses the point. While many people develop high blood pressure due to lifestyle choices, there's also a large amount of people who have high blood pressure for completely unrelated reasons. Staying fit and healthy is good, but it doesn't protect you against the genetic lottery.
lm28469 · 1d ago
Hypertension isn't a boolean flag, exercising and having a clean diet helps tremendously regardless.
50% of Americans have hypertension, 75% are overweight or obese, there is a massive overlap between the two
AtlasBarfed · 1d ago
AI can be timed for cures, or for "health regimens".
Which one do you think the drug companies like?
hombre_fatal · 1d ago
Many people don’t take them nor do they want the side effects, so of course it’s a problem.
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.
Etheryte · 1d ago
This is a good example of survivorship bias. You're fixated on the few heart attacks you do know and overlooking the vast troves of people who never developed issues once treated.
const_cast · 20h ago
No, the survivorship bias is having high blood pressure and being fine. It greatly increases your risk of heart attack, stroke, and heart failure. Hypertension is dangerous in the long-term. Most smokers don't die of lung cancer - they die of hypertension.
elric · 1d ago
> live the rest of their lives completely unhampered
Blood pressure medication has numerous side effects.
Increased blood pressure during sleep is the worst kind of hypertension ("reverse dipping").
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.
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.
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
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...
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?
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.
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.
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.
100% not a scam. Was life changing for me, and the two other coworkers I know who are on it.
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?
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.
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.
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.
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
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.
It sucks. I have an OA now. And it also sucks.
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.
- 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 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’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 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.
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.)
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.
Anyone under 60 who hears heavy mechanical breathing expects someone to get choked in the next 5 minutes.
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.
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.
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).
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...
Best of luck!
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!
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.
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.
https://en.wikipedia.org/wiki/Mandibular_advancement_splint
https://www.inspiresleep.com/en-us/
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
https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130008d.pdf
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
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.
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."
https://pubmed.ncbi.nlm.nih.gov/31383235/
Sounds like you're breathing through your mouth.
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
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.
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.
> 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.
PS: there are many people with OSA with normal BMI who also don't drink.
I believe most people with Sleep Aonea tend to have High Blood Pressure, this could be concerning.
Stay in shape, eat clean an exercise, once it's gone it's gone for good
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.
50% of Americans have hypertension, 75% are overweight or obese, there is a massive overlap between the two
Which one do you think the drug companies like?
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").