This may sound crazy, but for those who can't tolerate a CPAP, an effective alternative is playing the didgeridoo.[1]

Anecdotally my wife and kids were complaining about my snoring, and I bought one for $40 off Amazon. Not only has my snoring improved, but my lung capacity has improved. Plus it's just fun to play.

[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/

Yes, fixing out the lung capacity, musculature of the diaphragm, throat, tongue, etc is really the cure. And loosing excess weight if that is the case. CPAP, while effective and life changing is a band aid that the medical industry can make money on. I don't hear anyone saying that the CPAP should be used in conjunction with restorative exercises. I'm glad you found this solution.

Sacrificed months of productivity to fast off 70 pounds in hope it would fix sleep apnea. It didn't.

But hey, I’m sure you feel better 70lbs lighter in other ways; 70lbs of weight loss is a serious achievement!

How was your productivity affected during your weight loss?

Vitamin D deficiency is linked to teeth grinding and is correlated to sleep apnea patients. It might be worth it to take a 5000 IU pill along with sunshine walks close to solar noon to see if it improves your situation.

I use dminder to track my estimated vitamin d levels.

I did this pretty regularly and when a routine blood test showed my serum vitamin D at the top of the range, I was told to lay off the daily 5000 IU vitamin D, there is indeed such a thing as too much.

What was the impact of being in top of the range? Were you noticing something adverse?

No impact anybody could measure or otherwise determine for me at the time, but if you keep going and it does get too high you get too much calcium in various places which can cause a series of problems.

Any regret ?

I snored so loudly that when I was in basic training that they made me sleep all of the way at the opposite end of the open-bay barracks we were in.

I was 18 and near the height of physical perfection.

As far back as 10 years old I remember feeling miserable every single morning even after getting a full night's sleep.

At age 35 I got a CPAP and finally fixed a quarter century of piss-poor sleep.

Another good idea if you snore, is to literally tape your mouth closed at night. This feels super weird at first but it seems to have many positive effects for some people.

I was a HUGE snorer and rarely felt fully rested from 8 hours of sleep, woke up sore etc. Now my quality and quantity of sleep is totally different, it's really amazing.

It might not solve everyone's problems, especially if you have something really badly wrong, but it's a near-free, easy intervention and it probably won't hurt you to try it for a few nights. They make fancy tape, purpose-built for this, such as [0], but you could probably also use scotch tape or masking tape or whatever you have.

Also interestingly, after 2 weeks of taping, I developed the habit of sleeping with closed mouth even without the tape, so arguably this has cured my snoring permanently. This is the closest thing to "one weird trick" which I've ever seen in real life.

[0] https://www.snorelab.com/somnifix-mouth-strips-review/

I second this. I've been taping my mouth closed at night for the past year, and it has improved my sleep dramatically -- completely eliminated my snoring and drooling.

I found surgical micropore tape to be best. It's cheap, breathable, and easy to obtain. From trial and error, my two main recommendations are to first apply it to the back of your hand to reduce the adhesiveness, and fold a corner over before applying. Both of these make it much more convenient to remove, particularly if you need to do so in a hurry (e.g. needing to sneeze).

This is so frustrating. Surely millions or billions of humans having terrible sleep is not just some genetic abnormality, and we did not evolve to have terrible sleep only fixed by modern technology. There must be some underlying issue that can be addressed for the majority of people.

I got diagnosed with sleep apnea and asked about this, since I'm not overweight. The doctor said it's more about the structure of the mouth and throat than obesity. There is an area at the back of the tongue that gathers more fat and can block the throat, but palette structure is a big factor. Along with jaw size and throat size.

I remember reading not too long ago on HN an article about our dental health in modern times: https://www.scientificamerican.com/article/why-we-have-so-ma...

It could be our diet contributing to smaller jaws/palettes that increase the prevalence sleep apnea?

This absolutely makes sense to me. It explains why it affects anyone, not just overweight people or people who do not exercise. Our mouths evolved to masticate much larger amounts of low calorie and high fiber food. If this theory is correct, it is still unfortunate that it is not easily solved with something like exercise alone and often requires either braces or CPAP.

I’m not so sure about that, men and women largely have the same diets yet I think sleep apnea disproportionately affects men.

YES! Read "Jaws" by Kahn [1] to find out why. If you're are familiar at all with Jared Diamond's books (Guns, Germs, and Steel) or have read Sapiens, it should be a piece of cake to understand. I bought this book for 4 people with sleep apnea or unresolved dental problems.

This book was published in 2018, and it's not yet common knowledge. Doctors I have been to don't get it, I have doctors in my family that don't get it.

It's historical and scientific, but it has a lot of practical implications for raising children too. A child's facial structure is surprisingly malleable (by lifestyle), and it determines how they breathe, which in turns affects everything else. Just like food, breath is at the base of your physiology, and affects all aspects of your health (dental health, mental health, and more!)

-----

Summary:

Agriculture and diet are fundamental reasons behind recent and huge changes in our jaw and airway development. They change us faster than our genes do. (epigenetics)

Another profound change that is faster than evolution is the development of speech.

In other words, apes and dogs don't have sleep apnea because they don't have agriculture, and they can't vocalize like we do. It's a crazy problem that requires an explanation -- your throat and neck tissue literally strangles you while you're sleeping, giving you heart attacks and many other problems.

There are a lot of practical implications, like breathing through the nose rather than the mouth (another article about this was recently on the front page of HN), and what foods you and your children eat.

[1] https://www.amazon.com/Jaws-Hidden-Epidemic-Sandra-Kahn/dp/1...

There are a bunch of other books that touch on the related subjects, like "The Dental Diet", "Sleep Interrupted", etc.

I was interested to discover fairly recently that human jaws don't develop fully if you don't work them by chewing tough stuff growing up. Hence not enough space for wisdom teeth requiring surgical removal and other issues.

Very interesting. I wonder if there are hard and edible chewing gums to give young kids to help with this issue.

The chewing issue is part of it, but far from the whole picture. I recommend reading Jaws, as it's relevant to anyone whose kids will have dental work (which is basically everyone).

Part of the thesis is that braces and wisdom tooth removal are overapplied. People who disagree with that have to answer why ancient people and animals don't need similarly large amounts of dental work (answer: their jaws are a lot healthier than ours due to their environment.)

A related but separate issue in children is mouth breathing, and the chain of causation is also explained in the book.

Same goes for myopia and crooked teeth.

I've asked my optometrists and orthodontists what cause these problems and just got shrugs and big bills.

Academic research seems pretty confident now (in the last few years) that myopia is mostly caused by lack of exposure to daylight when very young.

My impression (from briefly skimming papers about this a few years ago) was that there is clear evidence that myopia is strongly related to not spending enough time outside as a child, but it’s not clear to what extent the effect being outside has on eye development is from focusing the eyes far away vs. being in very bright surroundings.

I believe that someone did some studies involving outdoor schools or similar, that was considered to differentiate between those factors - being outdoors and reading was better than being indoors and reading.

Poor indoor air quality.

My entire academic life was affected by always being sleepy. Falling asleep in band class in high school with the saxophone in my mouth, etc. I was a track & field athelete and was in good shape. Finally got a cpap as an adult, along with vitamin d supplements, has improved it.

I'm pretty sure healthcare providers everywhere inform people who need to exercise and lose weight that they need to exercise and lose weight. Not really fair to ding them for making money on other treatments for people who can't bring themselves to do it the natural way.

In my experience this is actually rare. I've heard many similar stories to mine here from friends and family, but briefly, my own recent experience with this kind of thing:

I saw four doctors across two states trying to resolve a certain medical condition, which happens to be very common, has very negative effects, and has low recovery rates.

They prescribed a couple different medications, and mentioned that the disorder is "associated with" a list of a bunch of things related to lifestyle and diet. (These items were never brought up again by any doctor after their initial brief mention: it was a kind of "going through the motions" with each doctor—part of the obligatory informative synopsis of the disorder.)

The medications did practically nothing, and experimenting with briefly removing different items on the list from my life did practically nothing. Meanwhile my life was severely negatively impacted by this for ~4 years.

Eventually I decide to "get healthier" in a general way with an improved diet, insistence on regularly getting sufficient sleep, reduced alcohol consumption, and regular strength training.

A few months later the condition was at about 50%, and now it's at a point where I'm barely bothered by it.

I'm also a Type 1 diabetic and ran into a similar thing there: the recommendations given to me by doctors were incompatible with the blood sugar ranges they described as desirable. So I did my own research and discovered that basically everyone who had really good numbers was doing massive carbohydrate reduction in addition to taking insulin.

What it came down to in both cases: doctors will not prescribe lifestyle changes. They may mention them, but their core solution is likely to be a medication + tweaking dosage—even if this is by comparison far less useful.

I do think there's a legitimate reason, though: most people are simply not willing to make these kind of lifestyle changes. However, for those who are willing to do it, there's a good chance they'll lack the info on how effective it can be, because it's not what their doctor is going to emphasize.

(I'd urge anyone who thinks my cases may be uncommon to try this: if you know someone who resolved a medical condition by general lifestyle improvements like diet, sleep, exercise etc.—see if they made the changes because a doctor recommended it or if the motivation come from somewhere else.)

Its not actually less useful, because typically very few people follow through on lifestyle improvements. When I went through medical school they did not skip this -- we were all taught well how much of an impact lifestyle change would affect outcomes across various diseases, and even then how little change was required (e.g. 10 lbs lost makes a drastic difference for those overweight). There is simply a very low uptake of lifestyle change and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight). Its a cultural thing in that, in America at least, we don't have good cultural norms around food and activity that promote a healthy lifestyle. Which is unfortunate, given that is the primary influence (that we can control, obviously genes matter more) of many chronic health conditions.

Interesting to hear that confirmed. (I do mention that it was my best guess in my original comment ;).

It still seems problematic to have it just missing from the presentation of options[0] merely because most people won't follow through, though. The ones who are willing to follow through (probably the ones who care most deeply about resolving the thing) aren't given a fair opportunity.

Additionally, it seems like a self-perpetuating problem: I would bet a significant part of the unwillingness to make lifestyle changes in order to treat medical conditions is a consequence of Americans' expectation that illnesses are treated by medications (which comes in a large part from doctors emphasizing this). The entire situation has a kind of consumerist framing: you get sick, you purchase a thing which you then consume which treats you. That kind of perspective was strongly instilled in me until my experience with type 1 diabetes. Growing up in the U.S., I just thought that's how things worked: our medicine was that good, and it covered most illnesses.

If you go into it with that kind of expectation, it comes off as a very tall order to say, give up pizza. There's this feeling of, "I took my time and money and paid for a doctor, they didn't give me anything, and now they're asking me to do work?"

So maybe it's just a kind of a broken, self-reinforcing cycle. But I suspect it's a little more insidious than that too: there is an obvious financial incentive for things to be structured this way. I have a hard time imagining that has no impact.

[0] Not that it wasn't "brought up," it was in both of my cases. But: not only was it relatively un-emphasized, it was described as "possibly having an effect". The accurate presentation would have been: this can be much more effective than the medicine I can prescribe—but it will also require much more effort from you.

One of medical practitioners' patient compliance problems is you've built an aura around your profession as miracle workers with magic bullets. And while sometimes you swing and hit a grand slam, more often than not you hit the ball foul. Which is okay, as long as you keep working with the patient to find a solution to their complaint.

Slow and steady usually wins the race, but magic bullets pay better.

Look at the rebellion that doctor started in New York, with his youtube videos about how futile and absurd it was to ventilate lucid/non-distressed SARS-CoV-2 patients, solely on the basis of their oxygen saturation meter readings. Later reports from the front line said 'hey we're doing much better not ventilating our COVID-19 patients even when their oxygen saturations are super-low...'

> and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight).

/methinks it is simplistic and wrong to decree that a calorie is a calorie.

My working hypothesis is that bad medical advice is the primary etiological factor behind most cases of morbid obesity. Decades ago the medical industry decreed saturated fats as the cause of heart disease, and advocated fat-free diets, or low-saturated-fat diets failing that.

Butter has been vindicated of the charges against it, but I have yet to see an official apology for giving bad advice. Indeed, the heart profiteers are still [1] flogging a dead horse [2].

My retired-MD uncle recently came to visit, and shared that he now makes his own salad dressing to avoid the cheap oils in commercial salad dressings. He had some great stories of patients he'd helped (trauma from car accidents and knifings), but also of exercises in medical futility (e.g. cancer).

Why doesn't conventional medicine warn patients of the hazards of cheap oils? Now is the perfect time. You could refer to Wikipedia's article on Prostaglandins [0], and speculate that minority America's overconsumption of Omega-6 oils is one factor in their susceptibility to the SARS-CoV-2 (emotional stress is another factor).

[0] https://en.wikipedia.org/wiki/Prostaglandin

[1] https://www.heart.org/en/news/2018/05/01/advisory-replacing-...

[2] https://en.wikipedia.org/wiki/Flogging_a_dead_horse

I recently discovered a health problem and must have been told by five different doctors that there are longterm drugs that can help but I should focus on eating well, exercising and losing weight.

You may be right, I've never been diagnosed and put on CPAP personally and can't say whether that is true or not. But in general the western medicine has come to a point that it tends to offer solutions that are quite good at reducing the symptoms and generally don't address the underlying cause. It may be incompetence of the system or it may as well be financial incentives, slightly steered towards not providing a cure and but milking the patients for more money with symptom reducers. But on you're right on one thing though, a lot patients are lazy and would choose the quick fix over doing some of the work themselves.

> while effective and life changing is a band aid that the medical industry can make money on

This is a really dangerous comment.

Yes, it's true that, for some, weight loss is all that's needed.

There are people who need CPAP and no sort of 'lung capacity' and musculature exercises will help. A former coworker even had central sleep apnea. Exercise that.

Exercise helps with everything, but it doesn't mean one will be cured and stop needing CPAP. CPAP isn't that profitable even, considering how long the machines last and that supplies can be found elsewhere, so there's little incentive for medical providers to push them. In fact, in some countries, you'd be hard pressed to find insurers providing CPAP machines, as they are expensive.

The only ROI they might have is with less future hospitalizations due to serious conditions. Untreated sleep apnea can massively increase the chances of heart attacks, strokes and many other conditions.

To be fair, CPAP was originally developed for people with severe sleep apnoea and other neuromuscular disorders that have no other option.

> CPAP ... is a band aid that the medical industry can make money on.

Incredibly uninformed.

Singing also appears to reduce snoring and sleep apnea by strengthening the pharyngeal muscles.[1]

[1] https://file.scirp.org/Html/5-2460085_31850.htm

I just ordered one, for $35 dollars what's the worse that could happen? Looks like fun, and if I don't use it hey, I have a cool didgeridoo that people can ask about at parties.

Might some other instruments work too? Harmonica played in blues style (with bends) seems to work the palate muscles pretty hard.

Not that I don’t love didgeridoo music :-/

I remember being fairly asthmatic as a kid until a year of clarinet. I also enjoyed rather suddenly being able to hold my breath over the duration of a nearby bridge in car trips, a talent I lorded over my brother who hadn't opted for a wind instrument...

In my case, I doubled my lung capacity through swimming, which did wonders for my health.

What measurement of lung capacity? That's pretty awesome and maybe I should look into it haha.

Any measurement you like: volume of air, duration I can hold my breath, and most relevantly, how quickly I get "winded".

There are specific swimming exercises you can do, as part of a routine, that build lung capacity.

(Results may not generalize. It worked for me.)

I imagine that anything that taxes lung capacity will help. I’ve picked up the French Horn in quarantine, and it seems to be strengthening several mouth and jaw muscles, along with the improvements to lung capacity you’d expect.

Great tip, thanks! I ordered one as well. I've had respiratory issues since I was a child and this sounds like a fun way to work on it.

I love the didgeridoo. One of my favorite albums to listen to while working is Aphex Twin's 'Digeridoo'. It's worth checking out.

Wow I always wanted to play didgeridoo, but now I definitely want to buy one! Does you have any suggestions on which one to order?

I just got a cheap knockoff on Amazon, because I've got young kids who are... destructive... However at least so far, the cheap one seems to work really well and I haven't any problems as a novice player.

The study I read about apnea said people were given simple plastic didgeridoos. Authentic ones are $100-$2000, and a plastic one with beeswax was $35 on Amazon.

Which one did you get?

Got this low-priced bamboo didgeridoo off Amazon[1] for $35. It's definitely not authentic or the best in the world, but it's surprisingly well constructed and aesthetic.

[1] https://www.amazon.com/Meinl-Percussion-DDG1-BK-Didgeridoo-P...

Thanks!

I asked a doctor about it and he said that since I'm not obese nor overweight, and I don't regularly wake up gasping, then I'm not a candidate.

I've had fitful sleep as far as I can remember. I wake up (and remember it) probably 4-5 times a night and I've been told I toss and turn all the time. I find if I take a calmant or a substance I can sleep through the night.

I have chronic inflammation includes Achilles' pain just as you describe. I'm in my lower 40's. I'm also a weightlifter and I do calisthenics - both of these activities 4-5 times a week. Oh, but I sit in front of a PC 12+ hours a day!

Had terrible quality sleep for years. Snored, and had various other problems. But I am young and my BMI is 18 so I got brushed off by sleep lab after one night of testing didn't show apneas. Eventually figured out it was all due to my nose which barely functioned after healing crooked from an accident as a child. Septoplasty changed my life.

BMI of 19 with severe sleep apnea checking in. Never woke up gasping, never struggled staying awake, but I did feel like I enjoyed the occasional afternoon nap, and my partner reported snoring.

It’s worth getting checked out. I ended up going the dental appliance route because CPAP machines feel like a torture device to me. Anecdotally it’s made a noticeable difference. Haven’t had a nap in ages.

Same. When I was 28, I presented with terrible TMJ pain. Turns out my sleep apnea led to grinding my teeth at night, putting horrible strain on my TMJ all night. Got a mandibular advancement device (MAD) and fixed both issues in like day. Changed my life, slept great, felt great. But, these devices only work for 8-10 years before your jaw permanently changes and your bit starts misaligning your teeth. So I slowly transitioned over to CPAP when I felt my teeth no longer snapped back into place in the morning. After 3 years of CPAP and no MAD, my jaw is 95% back to normal. So keep that in mind. I'd also recommend getting a back-up dental appliance in case yours breaks, or learning how to use CPAP now while you don't need it. Some of the worst stress of my life was when my MAD broke and it took months to get a new one...ugh, I still have latent traumatic responses thinking about that point in my life. I had moved jobs and insurance so finding someone who would do it required significant searching. Medical insurance hates paying for MADs, you gotta make sure you have a solid TMJ disorder diagnosis from an MD and then find a dentist that will do it.

What does the dental appliance do?

Pulls your lower jaw forward to make room at the back of your throat. I had the Somnodent Air [0] for several years, but switched to a CPAP when my lower molars started to cant forward.

[0]: https://somnomed.com/en/dentists/somnodent/somnodent-air/

Please go see a sleep doctor, not a GP. I was diagnosed in my late 30s, and I was definitely not overweight at the time. In retrospect, many things that I thought were normal (or even positive) turned out to be very clear symptoms of chronic sleep deprivation.

I'm super curious - what were symptoms of your sleep deprivation that you took to be positive qualities?

I'll second this. I had sleep apnea but I don't remember ever waking up gasping - not even once. I only know about it because my wife said I'd stop breathing while I was sleeping.

Aside from sleepiness, what sort of symptoms did you have? Are you referring to mood disorder and/or inflammation?

One that really stands out is how quickly and easily I could fall asleep. Like, on a commuter bus, or watching a movie with people. And how I'd be asleep within seconds of getting into bed. I thought I was 'sleep efficient', turns I was just sleep deprived, but thought it was normal.

Your doctor is WRONG!

I spent 2 extra years barely half awake because I thought that, being thin, I could not have sleep apnea. Nor did I wake up gasping.

The 4 main risk factors are overweight, being male, over 40, and current or past smoker. But some get it while being 0/4.

Sleep apnea is one of the best serious medical conditions you can have, since the CPAP machine fixes it completely, with very minor discomfort!

The CPAP does not "fix it completely" for everyone. That is FALSE. Granted, the machine should make a noticeable difference, but it does not restore "normal" sleep in all patients. I would be interested to see statistics from a "CPAP satisfaction" survey. Instead of solely looking at AHI, ask patients to rate their sleep. There are at least a couple of commenters in this thread who are telling us the CPAP has not restored their sleep to "normal". CPAP may be the "Gold Standard" in OSA treatment but it is not the "Holy Grail" for everyone suffering from sleep disordered breathing.

Sure, I should have added "for most people" and "almost".

Wow. After reading these comments, I'm definitely going to look into it. I always found the idea of a sleep study (which my insurance btw refused to approve so it'd be out of pocket) annoying because ... heh, well, I was worried I would barely sleep at all in a clinical setting. Ironic, perhaps.

In my case, the sleep study was done at home. I just have to wear some gear at night for a week or something.

Then a week of CPAP machine for free to feel if it's helping (I feel no improvement, although wife said there was no snoring with the machine).

A (healthy-weight) roommate of mine would regularly stop breathing in his sleep. He was convinced he was fine until his girlfriend finally got him to do a sleep study. Got his CPAP machine shortly after!

Could fitful sleep be a symptom of overtraining?

Yes! But I'm extremely careful not to overtrain, also I've taken weeks off, etc., it's all the same.

My 5 days a week, btw, is not 5 days of very long workouts. This is a tangent but I used to do 3 days of 1.5+ hour workouts including heavy weight training (squats), and HIIT or other conditioning. All functional movements, no bodybuilding or anything. Now, I do 5 days a week of short 25-35m workouts. My body composition is way better and I feel less pain overall.

Agreed. But a CPAP is only as a good as your usage, too many people "have" one but don't use it.

A lot of it is comfort. So try switching from a full-face to nose pillow-style mask. Or alternative headgear. Or even talk to your doctor about lowering the pressure if it is the noise (better to have less effective treatment, than none at all).

PS - A lot of, frankly, older doctors are still not prescribing Auto-CPAPs for people who may be suitable. If you're currently set on a fixed pressure, and your machine is a common Auto-CPAP (variable pressure) maybe seek a second opinion from a different (younger?) doctor. Auto-CPAPs are medically certified for many Sleep Apnea suffers, doctors just haven't adapted or haven't been re-trained, so they're chronically under-prescribed. Auto-CPAP improves your comfort, not your treatment, which improves adherence.

When I say the same thing about Prozac, people react with anger. It's strange.

A sleep study is definitely one of the best things I ever did. It helped uncover some undiagnosed narcolepsy, and I've been able to manage it since then. Even knowing that it existed was helpful. (For example, lots of stress was caused by getting jobs that expect you to have your butt in the seat from 9am to 5pm. Other jobs exist.)

So yes. Sleep study good! Go do one!

I'm glad Prozac worked for you. It made me impotent in my 20s and I felt like I was being dropped down an elevator shaft for months after discontinuing it.

Luckily, there are a lot of different anti-depressants out there that work better for some folks than others. Unfortunately, we aren't yet knowledgeable enough to know who will get a bad reaction before it happens.

I'm horribly sorry you've had such an extreme reaction. Hopefully, though, you've found some things that work for you.

> being dropped down an elevator shaft

What do you mean by this?

It causes vestibular symptoms. This creates the sensation of motion without movement.

Incidentally, if you’ve never had true vertigo, it is very disconcerting how much a sensory organ malfunction can affect your perception of the world. It is a kind of spatial psychosis that you can observe objectively.

Ddg for SSRI withdrawal symptoms.

I knew about SSRI withdrawal symptoms, even experienced "brain zaps" first hand, but never heard about the vestibular thing.

Getting an APAP (auto-adjusting machine) was automated to the point that the barrier to entry is pretty darn low.

An at-home study required me to sit through dead obvious instruction on how to equip and use the machine. Once I was prescribed a machine as a result of the study, the most time-consuming part was picking up a machine and sitting with a nurse to try on various masks.

Since the machine itself is set to what the CPAP community calls "lazy doctor mode" meaning it's just set to auto-adjust itself in a range and the newer machines use cell data to automatically upload usage data, once you take it home you're done. My only follow up visit was over the phone. And there is an open source project for reading the data which will appeal to the HN crowd: https://www.sleepfiles.com/OSCAR/

I’m not in a position to do a sleep study. But I’d like to self-monitor my sleep and oxygen levels. Do you know of any DIY projects in that area? In the future fitbits and Apple watches should automatically include sleep / oxygen quality. It’ll take getting past the FDA, but for the low cost of having that info bs the benefits society would gain... well DIy seems like a good way to trail blaze.

The best pulse ox I’ve found is the O2Ring. It’s more comfortable than any other pulse ox I’ve used, it samples at a high rate and produces absolutely gorgeous output. The downsides: I don’t believe it integrates with OSCAR, and it’s a whopping $180.

https://www.amazon.com/dp/B07T5L57M4/

I can't comment on how accurate it is, but my Garmin Vivosmart measures sleep pulse ox.

I got a CPAP for obstructive sleep apnea and it resulted in absolutely zero benefits after several months. It did cost quite a bit and take time to clean, though. I'm very skeptical about the positive effects of CPAP for all but the most severely affected individuals.

One trick you can try which I found really helps is, if you can, to shave before bed. I get a much better seal with a full face mask this way. Over time, you may find the cleaning gets easier. It is crazy how much you have to learn on your own about this condition. You should not have to get advice from random people on the internet; the field of sleep medicine w/r/t OSA treatment is still woefully underdeveloped. Once you get the machine, if your AHI looks good, there is not much more the sleep doc will do for you. The "treatment is working" even though your sleep may continue to suffer, e.g., you continue to wake up throughout the night. A CPAP cannot not measure the time awake after your sleep is interrupted, while you wait to fall asleep again. As far as the CPAP diagnostics indicate, the treatment is working.

If you stick with it, you should see some benefits, such that if you cease using it for a night, you will notice the effect. Good luck.

You're all going to think I am a crazy, but I instead elected to tape my mouth closed with 3m tape right when I go to bed. This to me is superior and should be your first port. Not only did it fix my apnoea and huge lack of energy during the day, but also my chronic sinus issues that had plagued me for years. Its also a lot cheaper, much easier to use / travel with and gets me into a good habit of nose breathing during the day. A CPAP machine is still reinforcing the poor habit that may well have contributed to your sleep abnormalities in the first place. Mouth Breathing. It costs $2 for a roll of 3m tape, so it's not like it costs a lot if its really not working for you.

Mouth breathing is horrendous for your health and well being. There is a good reason why it was ostracized in the past ("mouth breather" was an insult). It was a clear sign of poor health in an individual.

It's one of the best unknown health hacks out there.

https://askthedentist.com/mouth-tape-better-sleep/

How did you verify that it “fixed your apnea”?

A CPAP does not require mouth breathing. Nasal pillows require you to breathe through your nose. If necessary they shut your mouth with a chin strap. A piece of 3m tape sounds dangerous for someone if the problem is nasal obstruction or rhinitis rather than their mouth dangling open. They might not be able to gasp for breath and experience an even worse apnea.

I read Sleep by Nick Littlehales and he mentions that taping your mouth closed is one technique you can use - I think I recall he says some British athletes (cyclists?) use it - but doesn't recommend it for anyone with a medical problem.

> How did you verify that it “fixed your apnea”?

My wife and waking up feeling like I did after a nights sleep as a child.

I would go even further: try to train yourself to use your nose all the time, specially around sleeping. Think of keeping your mouth closed before sleeping and if you wake up noticeably having breathed through your mouth take a mental note to change. It worked for me (no tape required).

(Whatever works for anyone of course. If other methods still leave bad sleep, by all means use a machine!)

> You're all going to think I am a crazy

It's only crazy that you're not using a medical device that's built for this! Your head's in the right place, though. ;)

https://goodmorningsnoresolution.com/

> Mouth breathing is horrendous for your health and well being.

I completely agree with this, but using an APAP and breathing through one's mouth are unrelated. There are full-face masks that let one breath through the mouth, but the mask that came included with my machine was a nose pillow. Since air is continually being pushed through my nose, breathing through the mouth is very hard to do.

> medical device that's built for this!

You don't need to spend $90 on some patented thing. Use simple 3M Micropore Surgical Tape 2.5cm x 9.14m, its what every one else uses for mouth taping and its exactly what a lot of dentists will suggest is used, although a few more folks are using SomniFix Sleep Strips as well. Tape works absolutely fine though, and its the consensus go to by most users.

> and its the consensus go to by most users

I can't attest to relatively popularity, but this device was independently suggested by both my dentist and my ENT. It works really well.

Tape seems like a great option too, but it seems like it'd come off easily? I might give it a shot.

Good point, you know if this works for you, that is all that matters at the end of the day.

The tape stays on very well. You want Micropore Surgical Tape - 2.5cm x 9.14m. Also it helps if you don't have a beard. This was the only down side for me, but I will take the better sleep / improved health over a beard.

Literally 2' of elastic fabric and some velcro...

Have you used this? I wonder if it would be helpful for teeth grinding.

> You're all going to think I am a nutball, but I instead started to tape my mouth closed with 3m tape

Wait, while sleeping or during the day? If while sleeping, isn't it dangerous?

No, not at all. I heard it first from a dentist and its quite common, well more common than would be expected. Its also perfectly safe, if your nose becomes congested you rip it off in your sleep.

It fixed my apnoea and chronic sinus issues. Seems I was constantly developing nasal polyps from mouth breathing all night.

Here is a dentist recommending mouth taping:

https://askthedentist.com/mouth-tape-better-sleep/

Thanks, that's really interesting. I might try it, if I can figure out how to keep my mustache and beard intact :)

Also have a mustache and beard. Just ordered https://smile.amazon.com/Sleep-Strips-SomniFix-Breathing-Nig... . We'll see how it goes. Still sounds insane but hey, It's easy enough to try.

Awesome, give a it few days to adjust to. Its common to wake up and find your tore it off on your sleep and its suck on your pillow or forehead :)

Just keep putting it on at night, and before you know it you will wake up in the morning and have completely forget you still have it on.

It sounds like potentially, yes.

https://www.forbes.com/sites/ninashapiro/2019/10/18/keep-you...

Dr. Li does surgery for sleep apnea. I was referred to him once for evaluation for a surgical procedure only he does (EASE/TPD) and which I was told that the referring doctor had seen a lot of effectiveness in improving sleep apnea in their patients. He seemed like he knew his stuff and was very up-front about being conservative about making predictions in my case.

I would be a little sceptical of someone whose whole career is based on nasal surgery to fix apnea playing down a simple non evasive alternative. He lists zero studies to back his premise of it being dangerous.

> You're all going to think I am a crazy, but I instead elected to tape my mouth closed with 3m tape.

It does sound a little crazy, but only because I'm surprised there's not a more comfortable solution. Tape on my mouth would prevent me from falling asleep.

Is there not some sort of mouthguard that blocks airflow, and thereby achieves the same result in a more comfortable, less sticky situation?

Its a little weird the first night, but after 1-2 minutes its strangeness dispersers. In a way its no different to holding your nose. You can get mouthguards, but they don't work very well. You end up drooling all over the pillow and half gasping for air and spitting it out. All you need is a nice single strip of 3m tape.

https://www.everydayhealth.com/sleep/mouth-taping-cheapest-l...

I found it helpful to work on nose breath power. I needed to for boxing as I was mouth breathing. So on my jogs I started to nose breath took some time to get the throughput I needed but sleep improved and general breathing feels much improved.

Can you provide some articles/videos for techniques? I've been a mouth breather my whole life and wonder if I could improve my running performance by switching technique.

These 2 exercises worked for me. I did this 5 days a week (around 15-30 mins) and it took approx 4 weeks to get to a predominantly nose breathing situation.

1. Jog slowly at a pace that is comfortable while breathing through your nose. 2. Speed up pace until you feel like you will need to breathe through your mouth stay there for 10-20 seconds. 3. Slow your pace back down to where it's comfortable. 4. Adjust your pace up and down between these zones in intervals. 5. Over time increase pace and interval length.

- It's ok to take some mouth breaths as you continue practicing. The goal is to increase % of breathes via nose. - When you get the hang of that try it while jumping a rope.

Seated breathing exercise, do with shirt off to observe abdominal and chest region while practicing: 1. Sit comfortable, good upright posture. 2. Breathe in fully and hold for 2 seconds. 3. Sip in as much more breathe you can and hold 2 seconds. 4. Sip in the final amount you can and hold for 2-3 seconds. 5. Exhale out fully and hold for 2 seconds. 6. Exhale out tiny bit more and hold for 2 seconds. 7. Exhale out tiny bit more and hold for 2-3 seconds. 8. Repeat from step 2.

- I found this really good to do in a park or in nature.

These two where my main exercises on top of using that in boxing. - In a fairly short amount of time I was able to get a full lung breathe through the nose easily.

Good luck.

When you say exhale, do you mean from the mouth or nose? Does it matter?

I tried both. In through nose out through mouth is easier and could be a good step before going only nose.

Hey, OP here.

Tape your mouth at night! On your easy runs, breath solely through your nose.

For the record, I am an ultra runner. Nose breathing is hugely beneficial for endurance athletes. I have seen my pace come up while heart rate / perceived effort remains the same.

I did the last years entire Montane Spine Challenger just breathing through my nose (108 mile race).

This doesn’t work when you have UARS unfortunately.

And even if you're young, if you find yourself waking up at night with your heart racing, excessive snoring, etc, get it checked out. I got a CPAP machine at 20, and it's hard to overstate the impact. You can even just straight up buy them these days and adjust the settings yourself, sometimes the insurance premium on the sleep study is as high as the cost of the machine.

How feasible is that, though - to just up and buy one and set it up yourself? I'm honestly asking, not criticizing.

Buying them is easy enough gh at least - you can buy them on amazon

where can you buy them without a prescription?

There are online sites that will sell you one...basically the way I understand it is they will do a phone consult with a licensed physician. The perscription is required if you want your insurance to pay for it.

The cost is not insignifigant. Cost of the machine itself is around $1000, and then perhaps $150-200 in supplies every 3 months.

Totally worth it though. Life changing.

> If your doctor tells you to do a sleep study, do it.

All I got in return is a $500 inconclusive.

Cervical cancer screenings save women's lives: Cervical cancer is an insane beast that often has no symptoms when it is the most treatable. Many, many women get abnormal or inconclusive results once or twice during their lives. It can be a variety of causes, even! This doesn't change the fact that they save lives or seriously increase some people's quality of life.

The sleep studies are similar. Someone getting an inconclusive result doesn't negate all the folks that have been helped by it - and honestly, doesn't rule it out. The money bit is just a shameful side effect of the health care system where you live and I'm guessing it is part of the sting of an inconclusive result.

Why did you even comment this? He's saying the upside is worth it.

I also got an inconclusive, but my dad has apnea and a sleep study basically changed his life. The possibility of that is clearly worth 500$

Because to some people $500 is a lot and doctor visits are often useless. "See a doctor" is default advice, but it can be very expensive advice.

This a USA healthcare problem, and you should flag it as such.

I am in the USA, and my cheap ass insurance covered the sleep study in full.

CPAP machine, however, is upon deductible, so I have postponed it upon I'll have spent the deductible on something like CT.

Why? If going to a doctor is free for you, you know that.

Doctor are not free to me, I pay taxes. What I was trying to say, your example is an USA problem, most people do not have to decide if seeing a doctor is a financial decision. So your case is not universal, and should be mentioned.

They're slowly moving to "at home" sleep studies, so hopefully the cost will come down. Essentially they just loan you a bunch of monitors on a chest belt, teach you how to put it on, and you return it the next day for your consultation.

Here's a video showing how to install the monitor:

https://www.youtube.com/watch?v=FHvydhYu85o

It is still a "developing area" but I think it will be the norm eventually. It *should reduce the cost (but YMMV, as US healthcare costs don't conform to normal logic).

Yeah, a couple of years ago, I had an at-home sleep study. It was free for me with Kaiser insurance, so I guess the cost was neglectable.

That really sucks. When did you do the test - and was it in a clinic or at home?

I do encourage you to keep trying if you have reason to think you have sleep apnea. Maybe get a home O2 monitor to help you decide if it's worth spending the money on another sleep study.

Mine was a hell of a lot more expensive than that. $3,000. The doctor refused to treat me until I had one, even though my fatigue was the same as it was 10 years ago when I had another sleep study with no issues.

So damned frustrating.

Thanks. I didn't know that it could be inconclusive, or how much it costs.

That said, it's not always a magic bullet.

I got a cpap after a sleep study found I had 80+ breathing interruptions in the short overnight test window.

It easily brought them down to <10, but I feel no better in the morning, and it makes the occasional nap much more of a hassle.

The value is absolutely there in the greatly reduced likelihood of death in my sleep, and the white noise is better than snoring when sleeping around others. But I wouldn't want to get people's hopes up about it providing them the bad sleep panacea they desire.

Read forums http://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html and http://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Foru... often CPAP requires fine tuning with most doctors can't be arsed to do.

Get OSCAR software it will help you fine tune the CPAP settings. https://www.sleepfiles.com/OSCAR/

Often people are given the cheapest CPAP machines that won't auto-adjust themselves. Guess what, at least for Medicare it's all the same price so the cheaper the machine the more profit for the DME! The forums will guide you to how to get the best from your machine.

I fine tuned my CPAP based on what I learned and it really improved my AHI. You say "<10" but if you mean AHI that's not good enough. Even doctors want <5. Mine is <1.

> Guess what, at least for Medicare it's all the same price so the cheaper the machine the more profit for the DME! The forums will guide you to how to get the best from your machine.

Medicare is not "for all" yet, so a lot of people won't be helped by this.

Yeah, I've been provided with a CPAP machine for a week, and although it reduces the breath interruptions, just like in your case, it does not improve the quality of the sleep perceivably, just like in your case.

So I decided not to buy it after the week of the free test drive.

Did you get see different sleep docs after you realised the change with the CPAP was not as dramatic as you had hoped?

Did you ever figure it out?

I suspect I might have some sleep disturbance. It's really hard for me to sleep on my back, I wake up constantly and snoor so I just sleep on my stomach instead.

Yeah that sounds like possible sleep apnea. Have you looked into doing a sleep study?

No, I have small children at the moment so my sleep is disturbed by that but as soon as they start sleeping normally through the night I'm going to have it checked out.

I had a sleep study done but was so uncomfortable I couldn't fall asleep...all the wires and crap. Waste of money.

Same for me. It took me 3 goes to get enough data for a diagnosis. Don't give up.

Same happened to me. I felt pressured into sleeping and as a result, I could not sleep.

I was in the same situation, very hard for me to fall asleep. Finally the technician gave me a pill, perhaps Ambien. I fell asleep and they got the data they needed.

If only it was so easy. I was told, in Germany, I have to wait 2+ months for the next appointment.

That's the one consolation to those of us in the maddeningly expensive US system. You can usually find someone who will get you scheduled in very short order.

Don't let the wait deter you. If you do need the machine, it can really improve your life.

I live in Bali. I had some chest pains for a few months so saw a specialist. He tested with stethoscope and said sounded fine. He gave me the option of taking a CT thorax. Went downstairs to radiology. They could do the CT scan right away. They had a deal going for COVID of blood test + CT thorax for $120 USD (whereas the CT Thorax a lone would have been $170).

So I took the test and got the results 2 days later and saw the specialist. He showed me the full scan said it's all clear. He then asked if I had insurance. I said no... he walked me to the billing desk and said no charge. What a legend.

Turns out chest pains was from GERD.

I assume you're not an Indonesian local…? How does the hospital prevent frivolous checkups from hypochondriacs?

Yes I'm an expat. I'm not sure other than needing to see a doctor before the specialist to get a referral and needing to see the specialist before going to radiology.

Unfortunately had to leave the country for some time, will miss this chance for now. Thanks for the recommendation though.

In my country, the UK, it’s not unusual at all to have to wait 2-3 months for a hospital appointment. People shit on America’s health system a lot (and in many cases for perfectly valid reasons), but I think they don’t quite consider the alternative.

You can buy your way past the queues either per treatment or with private insurance in the UK and still pay far less than in the US.

Most of us wait because the prioritisation is by clinical need, and is usually 'good enough' and some because they can't afford it.

Are you paying less, all in? (e.g., taxes)

We are, yes. But the average American would be shocked at the "customer experience" the average patient gets from the NHS. No such thing as a free lunch etc.

And I think if you have private insurance (i.e: double paying), you'll probably be paying more than the average American. I don't know for sure though.

The per capita expenditure on Medicaid and Medicare in the US is substantially higher than the per capita expenditure on the NHS, but Medicare and Medicaid only cover about 20% of the US population.

On top of that UK private insurance is much cheaper because it is 'top up' - you're usually expected to see NHS GP's first etc. and use NHS emergency rooms.

As such while it is possible to end up paying more if you're very high income, very few people in the UK will pay more even with private insurance.

>double paying

You also have to factor in the (very large) public expenditure on healthcare in the USA. Americans also pay for part of their healthcare through taxes.

I am not sure what you mean by “average American” but millions of people in this country rely on emergency room visits for their health care needs. I suspect the NHS provides a superior “patient” experience.

Average usually refers to the mean or median. The uninsured folks you refer do not make up the majority required to reach “average” criteria.

You're not wrong, but here's a big raspberry for those (often the press) that use average to mean median.

Yes, the portion of my taxes that goes to the NHS plus what my employer pays in private insurance is less than what Medicaid and Medicare costs per taxpayer in the US.

Can you do it in private clinic (for a reasonable amount of money)?

Here in Croatia, I could wait a couple of months or I could pay around $300 to have it done privately.

I remember getting a sleep study where they titrated for my cpap pressure. I woke up leaving that morning feeling like superman. It was as though a long fog was lifted from my brain.

I've been using CPAP for 9 years now and I can't imagine my life without it.

I wonder if it would be helpful to allow people who experience sleep issues to just get a CPAP machine and try it out, instead of having to go through a sleep study.

Most people aren't good at assessing their own fatigue. A sleep study gives one quantifiable information about the quality of one's sleep.

So may people find their CPAP uncomfortable when they first use it, that it's unlikely they'll use it properly. Having a first use under the watchful eyes of a physician could be a good idea.

Then again, some people also get one and then don't use it, so maybe it's more of the same.

Yes, I'm sure it's not as good as having a proper sleep study but if the end result is that more people who need them get them it would be a positive outcome.

Also, a doctor can show you how to use one, you would not necessarily be completely on your own.

Sleep studies are just such a hassle (and expensive, depending on where you live), and if you have a weird sleep schedule it can be difficult to even fall asleep in time.

Being able to just rent a CPAP machine for a couple of days and have a doctor show you how to use it would be a good option to have.

I bought a wearable blood oxygen meter as I was concerned I had apnea. A previous study was inconclusive (I don’t think I slept the whole night). If I sleep on my back, I’m certain I have apnea, but haven’t validated with the o2 meter. Sleeping on my stomach, my o2 levels were acceptable all night. Once I confirm apnea on my back, I’ll probably get another sleep study (I’ve gained at least 30lbs since the last), and a CPAP... just like my father.

> I bought a wearable blood oxygen meter as I was concerned I had apnea

Any recommendation?

Not the OP but I use a Garmin Vivosmart 4 for this purpose - it is the cheapest Garmin I found with the SpOx functionality. I have a feeling it reads lower than a fingertip device due to its wrist location but it is very helpful to compare measurements across nights to see how things went.

It's already just like that here in california. They schedule a free in-home sleep study, then lend you (again, for free) a CPAP machine for a week. Then you decide if you want to keep (buy) it.

I've wondered that, too. Between my insurance company and me, we spent a combined $1000 on deciding whether I should get one. That's more than a low-end unit costs.

Thanks for your comment. My doctor did tell me to, and I forgot. Once I feel safer around COVID, I'll schedule my appointment.