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.
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.
> 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.
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.
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?
Yeah, apnea already tends to come with cardiovascular risks. If this pill can give you a full night's rest with 90% of apnea's BP increase, it still seems like a bargain.
The problem with CPAP is that 40% of patients don't tolerate it even for the 4h/night defined as treatment compliance, while most of the rest use it less than the full duration of the night, with studies demonstrating that treatment compliance depends on efficacy.
And this is for traditional OSA in men - people with Upper Airway Resistance Syndrome(mostly identical mechanism as OSA, less oxygen desaturation, more arousals, slightly different symptoms) which is how SDB tends to manifest in women and younger people, the problem is way, way harder. In a community I used to hang out in, I'd say maybe 1 person in 10 actually benefitted from CPAP/BiPAP more than it hurt their sleep quality.
I 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.
Tough to know how much of this is patients not being able to tolerate vs doctors giving people barely calibrated machines and next to no support or training. It’s very common to be given your cpap at the default pressure range (4-20). When I told my doctor I still wasn’t sleeping, she offered to refer me to a shrink.
I’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
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.
Not even just that, full face masks aren't nearly as bad as they are made out to be. I use the Resmed AirTouch F20. Nasal masks are just too uncomfortable for me. And it's really not that big a deal, certainly not as ridiculous as the pictures I see on articles like this.
As far as the meds go, I read this as something for someone who either can't or won't use a CPAP.CPAP would still be the go to treatment, and this would just fill in the gaps.
>>Can these 22% be identified based on some criteria?
Usually the preferred approach in cases like this is to trial the medication and revert back to the prior treatment plan if symptoms worsen. Obviously, this is only viable if the worst-case negative outcome is temporary, easily reversible, and not life threatening.
These aren't drugs that I'd choose to take when a proven therapy like the use of a CPAP exist, the list of potential serious adverse reactions isn't trivial at all. Most amusingly insomnia is a known risk of atomoxetine.
I understand that this might be a viable option for people who simply cannot tolerate CPAP therapy, have tried alternatives and found them lacking, and aren't surgical candidates... but I certainly hope it never becomes a first line treatment. My concern would also be that insurance companies will see this as a much cheaper option and try to force it on people who would otherwise tolerate CPAP therapy.
> Most amusingly insomnia is a known risk of atomoxetine.
Given that atomoxetine is an sNRI, and norepinephrine modulates both alertness and muscle tone, I would bet dollars to doughnuts that what this treatment is doing is mostly helping people who have inadequate muscle tone in their pharynx at night due to inadequate NE levels, restore that muscle tone, and thereby keep their airways unblocked. These people aren't going to get insomnia from having their NE levels increased — because insomnia in sNRI use is a symptom of excess NE, while in these people, NE is just being brought up to a neurotypical level.
(In other words, the same logic that explains why [correctly dosed] dopaminergic stimulants don't make people with ADHD manic — but applied to NE dysfunction rather than DA dysfunction.)
I love mine (wearing it as I type this actually), and I'd say my girlfriend loves it more than I do since I no longer sound like I'm dying in my sleep and gasping for air every 20 seconds
I wonder if everyone I know just has a bad apnea doctor or something. The full face masks are super common among the handful of people I personally know. You can always tell the people who use them because they have indents around their face either from the mask or the elastic straps that hold them on.
The issue with nose pillow with Resmed or other CPAP is that I often rip them off from my face while sleeping, so I get to use CPAP only a couple of hours or even less. It may have to do with my stuffy nose, but that one is even harder to cure (yes, I use saline solutions to wash my nose, but it helps only so much).
I’m almost totally unfamiliar with CPAP, and the mask you linked looks like something I’d never want to be stuck wearing every night. Now, I wouldn’t let appearances drive my use of a medical device, and I’d use it if a doctor said I should, but I doubt people’s opinions are being driven by the exact type of mask they see.
I hated, hated wearing my CPAP, even with nasal pillows instead of a facemask. It makes me feel inadequate as a human. Worse than eyeglasses. And for the first half year or so, it was awful to wear; I'd reach the morning and find I'd ripped it off in disgust somewhere in the night and didn't even remember it.
But I willingly wear it every night, and a paltry 56% improvement or whatever it was won't tempt me in the least to give it up. Living without adequate oxygen and sleep is hell. I'm seriously convinced I have permanent brain damage from it. (Admittedly, that could just be age.)
My point is that this is not something you wear because your doctor says you should. You wear it because life is shit without it.
I've been using one for 4 years, and would never go back to sleeping without it.
I know it's annoying at first, took me a couple months to really get use to, but if you put in the effort to find a mask that works for you, it's 100% worth it. I dealt with bad sleep for 15 years before getting one, and I'll never go back.
My cpap mask doesn’t suck at all. It blows. (Wokka wokka!)
But it also makes sleep way more comfortable. I slept the entire night in my mask the first night, I was so worried about it and it turned out to be a non-issue. I love my mask.
I use one, and I love it. I'd probably continue to use it (or something like it) even if my apnea was cured. Breathing purified, warmed, perfectly humidified air piped directly to my nose is wonderful.
I 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.
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.
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...
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.
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.
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.
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.
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.
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...
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).
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.
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.
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).
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
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.
Readit News
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.
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
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.
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.
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 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.
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.
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.
I understand that this might be a viable option for people who simply cannot tolerate CPAP therapy, have tried alternatives and found them lacking, and aren't surgical candidates... but I certainly hope it never becomes a first line treatment. My concern would also be that insurance companies will see this as a much cheaper option and try to force it on people who would otherwise tolerate CPAP therapy.
Given that atomoxetine is an sNRI, and norepinephrine modulates both alertness and muscle tone, I would bet dollars to doughnuts that what this treatment is doing is mostly helping people who have inadequate muscle tone in their pharynx at night due to inadequate NE levels, restore that muscle tone, and thereby keep their airways unblocked. These people aren't going to get insomnia from having their NE levels increased — because insomnia in sNRI use is a symptom of excess NE, while in these people, NE is just being brought up to a neurotypical level.
(In other words, the same logic that explains why [correctly dosed] dopaminergic stimulants don't make people with ADHD manic — but applied to NE dysfunction rather than DA dysfunction.)
I love mine (wearing it as I type this actually), and I'd say my girlfriend loves it more than I do since I no longer sound like I'm dying in my sleep and gasping for air every 20 seconds
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.
Deleted Comment
Anyone under 60 who hears heavy mechanical breathing expects someone to get choked in the next 5 minutes.
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!
- 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.
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 tried it for less than a week and had to stop because there were VERY painful side effects _down there_.
I’m also a CPAP user and I’d 100% keep using it rather than go back on atomoxetine.
I have no idea what HN's tolerance is for the relevant medical language, so I'll put it like this: when I was on atomoxetine and after engaging in ahem activities, my pelvic floor muscle would stay contracted for something like 10 minutes. Not only was it super painful but it also made it so that I couldn't urinate at all until those 10 minutes had passed.
It was the weirdest thing.
This shows an improvement in AHI, but no change in any markers of actual sleep restorative function (I'd use the term "quality" but the sleep health industry has stolen that term to mean measures of sleep time).
When looking at sleep time the study shows no change in most of the sleep architecture, but a significant decrease in REM time, which can have effects on emotional wellbeing, irritability, and potentially depression.
This study showed no change in ESS (subjective measures of daytime sleepiness), but did show a change in PROMIS, which is a longer term measure of fatigue.
I've been recommending to anyone on CPAP that they give mandibular splint, which is a biteplate which shifts the jaw in order to hold the airway open, and is much easier, lower cost, and effective for many people. It also does not show a reduction in REM.
However, I also don't believe there is any reason that a sleep study which has full PSG relies only on sleep time, and none of the bio/neurological measures of health which are easily available, such as HRV, delta power, spindle activity, etc. etc.
That's it. It sounds trivial. But my biggest problem[1] with the CPAP is that it feels like it's smothering me. I can get more air in, faster, without the CPAP, and I still vividly remember the initial months when I would rip it off in frustration just to be able to breathe.
The thing is, I wasn't wrong. When I go to bed, I move around a little to adjust my pillow and lean over to grab the headpiece and turn it on, and all that movement means my oxygen requirements are temporarily higher. Putting on the CPAP immediately restricts airflow, so of course I hate it even though I can forcibly breathe through it.
But timing it so that it adds airflow (during an inhale) makes me feel like it's helping, not smothering. I can still breathe a little harder while settling down, but psychologically it feels way better to have it helping me breathe instead of fighting me. I wish someone had suggested this early on.
I don't have an answer for my upcoming 12-hour overnight flight, though. Other than a long series of 5-minute half-naps, watching a lot of movies, and sacrificing the first day to stumble around and catch up on rest. (Which, to be fair, I'd be doing anyway with the time change.)
[1] Well, the other problem is the noise. My partner is a light sleeper, and if she's suffering during the night from my noise, I'll be suffering during the day. We've largely resolved that with a white noise machine closer to her, and learning how to maintain a proper seal with various strap adjustments and position shifts. I only get a shove in the night once every few months at this point. It's almost like she feels entitled to sleep at night too...
Deleted Comment
... 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.