I feel like that doesn't place enough weight on the bull hypothesis- the devices are bad because most things are bad, because being good is hard.

Might be that, but on a meta level: the studies are too expensive and too big of a hassle, because there's not enough demand, because not enough people are being directed to make them, instead having their problems rounded up to e.g. obesity, because that's much easier for everyone than getting a test that's very expensive... You can see a feedback loop forming here.

This, definitely this. Though apneas aren’t a component, I have a severe neurological sleep disorder that went undiagnosed largely due to physicians not ordering a sleep study. Even a sleep generalist I saw favored assuming psychological insomnia and regurgitated behavioral advice like no screens before bed and asked if I tried melatonin. As my sleep debt piled up and my sanity diminished each day, I threw my hands in the air and checked myself into the best behavioral health hospital in the U.S. They did a sleep study and low and behold I was having 100s, sometimes 1000+ involuntary movements per night while sleeping. On the road to recovery now!

Can you say more about the diagnosis and the treatment?

I've had severe primary insomnia my entire life that appears to be getting worse with age and I rather rationally wonder for how much longer life will be worth living.

Prior to diagnosis and treatment I was beginning to wake up up pretty much every 60-90 minutes through the night and then I'd do the only thing that helped at the time which is smoke some cannabis, fall back asleep, wake up 90 mins later, rinse repeat until dawn. I always woke up exhausted, even if i managed to only awake a few times through the night. Muscle pain and severe cognitive deficiency

Basically with my disorder (Periodic Limb Movement Disorder or PLMD) it's categorized by episodes of 100s of rhythmic body movements which will sometimes wake me up, but even if they don't I wake up very tired from the movements.

The current treatment has been nightly diazepam (aka valium). The first-line medication for PLMD in the US is actually a dopamine agonist called Mirapex that is often used to treat parkinson's disease. The American Scholar published a piece about Mirapex in September titled "The Degradation Drug," [https://theamericanscholar.org/the-degradation-drug/] It's a medication known to cause dramatic personality changes and life altering compulsions like gambling and even child pornography. Evidence of efficacy for this specific condition is so thin it absolutely blows my mind this medication is handed out thoughtlessly (they really just want to delay prescribing a heavy sedative), I've told my neurologist I will never touch a dopamine agonist again and caution others to do plenty of reading before going on one

Can I ask what symptoms you had as a skinny / sporty individual with sleep apnea?

Needing 11-12 hours of sleep a night, frequent dreams of drowning or not being able to breath, daily headaches, falling asleep no matter how much you wish to remain awake (such as during school lecture or driving). . . And if you can, have your partner watch you sleep. Mine was what did it for me, she said I worried her half to death, and thought one day she would wake up to find me dead (I frequently would stop breathing, then suddenly gasp awake, and of course, I snored like a monster).

My boss has this, he is 35 and not fat at all. His father died from heart attack when he was young. Poor sleep (more like never enough), for some probably unrelated reason got much worse during covid. Always a bit tired, always subpar with physical workouts, but never as extreme as falling asleep when you don't want to. Mentally working on maybe 50%, but he is super smart so still plenty of room. He snored according to his exwife.

He went for tests, first time doctors thought machine was broken, his readings on apnea were off the charts. Second test confirmed it. Worst case they had seen, now has machine for sleeping and feels 100% better on everything. He believes his father had the same and its what killed him. Internal organs getting hammered over years, especially heart.

Either sleepy or tired-but-wired feeling. Reflux. Mouth breathing during sleep(dry/stinky mouth), jerking awake while falling asleep, waking up with a headache, breathless or more tired than you went to sleep. Bruxism. ADHD-like and memory problems. Low blood pressure with cold extremities. Nightmares.

I've been dealing with similar problems for a few years now, ever since all my wisdom teeth were removed.

I have wondered if children's diets precipipate this problem. Because so many kids grow up with varying levels of processsed or pre-digested foods (pulverized fruit pouches, not enough crunchy whole foods that require chewing etc) the jaw does not develop fully - so wisdom teeth removals and orthodontics for expansion seems like standard of care nowadays - but really it should not be that way. These cases should be rare but instead they are assumed common and normal. I quick search about this shows there is a relationship but I havent looked much into the details.

Genetics, lack of breast feeding, soft foods, etc probably influence poor jaw development. Also mouth breathing due to allergies and nasal blockages, bad tongue placement, probably other factors. My snoring improved a lot in adult years when I learned to keep my mouth closed and breath through my nose. My tongue position was so bad that an ent suggested tongue ablation, but instead I learned to deliberately thrust my tongue against my palate. It's difficult because in childhood I basically learned to mouth breathe because my nose was always blocked. That probably caused a lot of my problems with cavities and poor jaw growth. I was also bottle fed mushy foods for the first few years, instead of having more solid foods. I did use a night palatal expander as a kid, but wasn't too consistent in turning the key and my parents weren't really persistent with it.

Idk why this is getting downvoted.

There's a book called 'Breath' by james nestor where he devotes a lot of time to this theory.

The book itself is mixed in terms of scientific quality but I found the stuff about diet influencing face shape to be very convincing.

If your mouth doesnt grow properly then your airways will also be too narrow and you will have obstructed breathing.

They do, yes. There's a substantial body of research showing that soft diets lead to undersize jaws in a number of mammals, humans are just semi-unique in that our airways are very soft and floppy and it doesn't take much for collapse to start happening.

If you can't switch your diet to one that involves chewing for the sake of your kid, try and make chewing gum a regular snack.

Look at the book 'Nutrition and Physical Degeneration' [1] by Weston Price [2], a dentist who travelled around the world in the 1930's comparing facial development and health of traditional cultures eating unprocessed diets to those who switched to a western diet.

There's also the more recent book 'Jaws' [3] looking at the orthodontic industry and ideas John Mew.

[1] https://gutenberg.net.au/ebooks02/0200251h.html [2] https://en.wikipedia.org/wiki/Weston_A._Price [3] https://www.goodreads.com/book/show/35804366-jaws

I'd look into your diet.

Calcium is a massive stimulant when it combines with the catecholamines.

Omega 3's lower osteoclasts which release calcium from the bones unfortunately the western diet is high in omega 6's which will kill you slowly and contribute to poor health outcomes over a few decades. If you increase your omega-3's, your neutrophils will increase in size and B12 helps prevent neutrophils from hyper segmenting, which means a better quality of neutrophils. As vitamin C is stored in neutrophils, making it a highly toxic environment for pathgoens, your vitamin C levels will also increase. High vitamin C helps increase the iron content in the body, and Iron based Reactive Oxygen Species (FeROS) generate the most amount of heat in the body, which is why we feel warmer as kids compared to elderly people.

Vit K2-MK4 can also help reduce calcium from the bloodstream, I take 5mg of this before bed and sleep very well, better than benzodiazepines, anti-histamines targeting the receptors in the brain which block the feedback look that affects sleep, and other herbal sleep remedies.

If you are aware of the concept of having a glass milk and biscuit before bed, this is because casomorphine in casein in cows milk constitutes about 80%-90% of the protein in cows milk, and casomorphine is a biologically active opioid peptide very similar to morphine!

Tyrosine found in food, like cheese can act as a stimulate, especially if your copper intake is high, which could explain why the RDA for copper has recently been lowered even though copper is needed to make some interleukins which target a wide range of cancers! Tyrosine can make noradrenaline in the brain, a stimulant, which could explain the idea that eating cheese gives people nightmares. When Tyrosine is combined with Cysteine, it improves the mucous membranes so could help reduce your dry stinky mouth, the two make pheomelanin, which is better than just tyrosine on its own which makes eumelanin, although both an an antioxidant effect in the brain.

Thats just an outline of some of the things that can happen in your body when you eat, but some chemicals are better taken when you wake up (copper, tyrosine, cooked English breakfast), some are better taken when you want to go to sleep (carbs, tryptophan).

I mention carbs and tryptophan, because tryptophan is blocked or crowded out by about 5 or 6 other amino acids at the blood brain barrier which reduces the ability to get serotonin and melatonin precursors into the brain. The Kynurenic pathway which converts about 95% of tryptophan into about < 10% of nicotinic acid, at night is a good way of increasing your growth hormone release, because nicotinic acid increases growth hormone, but fat blunts this response, hence carbs at night. Growth hormone, increases the number of neutrophils, again aiding a healthy immune system, whilst you get good quality sleep.

Also remember that RDA's should be viewed as the minimum recommended amount for a maintenance dose of you are considered healthy. GP's never ask about people's diets, because they prescribe licenced drugs, where any liability falls back on the drug company, and most people don't have the resource to fight big business as they generally have met the legal requirements laid out in law.

Not saying all drugs are bad, but I think we underestimate the importance of diet and how the food has changed over the last few decades to get us to eat more!

But Carbs are sugar and sugar spikes insulin and that breaks healthy ketosis. Sugar is completely alien to human body. But i would really want to read your blog regularly if one exists!

I've rationalized that this is a combination of getting older, ADHD, and childhood trauma. Will have to look more into apnea.

It could be all of the above. I was diagnosed with "mild" sleep apnea and a CPAP hasn't really made an improvement on my day-to-day.

The main difference is that occasionally I used to wake up feeling completely hung over and near death, and now that no longer happens if I'm using my CPAP.

Most days, I am still tired - I am learning that is probably due to depression/anxiety (working on treatment now), ADHD (can't treat it until the former is stable), and poor stress management (undiagnosed autistic kid with zero social/emotional support).

The problem with CPAP is that it prevents full airway collapse and apneas very effectively, but often just converts them into subtler collapse ending with arousals. It also introduces its own disruption through expiratory resistance, reducing arterial CO2, patient-ventilator asynchrony if you're using any EPR or bilevel features, etc... bleh.

CPAP doesn't always provide adequate treatment. Some reading: https://web.archive.org/web/20211006015015/https://sleepbrea... and a webinar: https://www.youtube.com/watch?t=1321&v=Syv7YcHbTCI

I actually have a write-up on a pet theory that a substantial proportion of ADHD cases are likely undiagnosed non-apneic sleep disordered breathing: https://gist.github.com/Asmageddon/4a952260c0fc9875f477d6813...

Why not measure REM cycles in your analysis is disrupted phases of sleep is the root cause of the memory issues?

> Low blood pressure

Low blood pressure for UARS, but high blood pressure with OSAS.

Traditional OSA as found in elderly/obese people yes. But a lot of young people are still on the UARS side of symptom presentation even when they cross the threshold for OSA.

Many advice trying a CPAP device first instead of going for a sleep study if you suspect apnea for this exact reason. The sleep tests are expensive and often not accurate.

*likely US based medical advice

A sleep test is $100 ($75 USD) here.

Yes, it costs you an arm and a leg in the US if you don’t have a good insurance

My sleep study cost roughly $2300 with insurance (US). I purchased my own machine and supplies because going through insurance requires you to rent the machine. It phones home and if you don’t use it every night it impacts your coverage! No thanks. You need a script to purchase the machine too which you need a sleep study to get. Then billed periodically for supplies. Also, the initial settings they configured for the machine did not work and I had to adjust them on my own using an application called OSCAR. The website CPAP talk is a great place for folks who are new to using a machine btw. I definitely still feel ridiculous putting a mask on every night but it has been absolutely life changing for my energy levels and health. Please do not delay if you think you have this - I promise it is worth it!

Heh, pretty excited that my cpap machine is coming today

I was quoted 3k for a psg by my sleep specialist. I went and got one from axg sleep diagnostics out in Sacramento, for around 600

That's Jason Sazama a.k.a. TheLankyLefty27. He's good, he knows about UARS and flow limitation. His experience with bilevel/ASV modalities is very limited though.

In my neck of the American woods, you can't get a sleep study without a referral from a primary care doctor, and they are only done by pulmonologists.

But you can get your testosterone tested no problem!

Isn’t a CPAP more without insurance coverage?

The problem is that CPAP really sucks, and if you're more on the UARS side(arousals over apneas and hypopneas), or have poor nasal breathing, it's likely to disrupt your sleep more than it helps it.

There are at home sleep tests. Basically a wristband that measures your sleep. Then you take it back to the clinic and they read the results. I don't remember how much it was but it wasn't too much.

Yes, I was a young fit 23 year old, like, six pack abs and muscular.

I finally got my sleep study, and I had 79 AHI! When I went to get the equipment, they thought I would be severely obese.

It changed my life, but I worry how much long term damage was done until then. My friend told me when I slept over (around age 14) that I would literally stop breathing and he thought I was dead. Then I would suddenly gasp awake.

Anyways, if you're having trouble remaining awake, definitely get tested. If you have everyday headaches, get tested! Life can be much better.

Few medical doctors seem to grasp statistics. They solely consider trends, so it sucks to be a patient who is an outlier. Especially considering lifestyle factors and genetics aren't always properly controlled for in studies.

Just look at how something like different dosages of alcohol affects different populations!

I personally have a high BMI and high creatinine levels. No, I'm not obese with messed up kidneys (which the doctors thought); I just lift a lot and supplement with creatine.

Of course, doctors tend to be overworked, so I don't doubt they would be able to think clearly if they worked normal shifts and got adequate rest.

The intensity of my sleep apnea varies from night to night, and you might be similar?

Based on oxygen levels, mine also varies from subclinial to "medium" apnea. I was deemed not to have sleep apnea based on the take-home test or the in-hospital test... but I wore my oxygen-logging ring during the in-hospital test to check it was calibrated to the hospital's equipment (it was), and the specialist then diagnosed me based on my measurements of oxygen levels on other nights.

What brand is your ring? I know some doctors that would love that!

* * *

I have a "Wellue Checkme O2 wrist oxygen monitor". (The Oura ring didn't measure blood oxygen back then.)

What are O2 levels that suggest sleep apnea?

This page has some really good info: https://www.beverlyhillstmjheadachepain.com/sleep-apnea/puls....

It appears that going below 94% 5 times per hour would indicate mild sleep apnea.

Oxygen saturation is something of a red herring when it comes to sleep apnea diagnosis. Sure, having significant desaturation (<85%) is not good for you. But what will really wreck you is the arousals. Someone here mentioned an AHI of 70, that doesn't just mean you're not breathing right seventy times per hour, it also means you're waking up seventy times per hour. With that many arousals, your saturation might not budge all that much, but you're basically not getting any sleep at all.

And while we're on the subject, AHI is also pretty terrible. You could have an AHI of say, 5, which means "you don't have sleep apnea", but if you're sleeping 8 hours and these events only occur during the 2 hours of REM, then you've got an AHI of 20 during REM sleep, which will still wreck you.

Apnea is nearly universal among older weightlifters. It is not well understood, but it seems that relatively small changes to the physiology of the neck end up interfering with breathing. Many healthy and strong people don't have any idea what is making them feel bad until many other alternative explanations are eliminated.

I wonder if there's a more simple remedy like a tilted bedframe or a hammock or something.

There are products that are essentially an inflatable backpack you can wear while sleeping, ensuring you never roll over on your back (laying on your back makes it easier for your tongue and other soft neck meat to obstruct your airways, so anything to avoid that can help a bit).

When I was in my early 20s, I weighed under 60kg (which put me at a BMI of 19ish). I was tired all the time. I went through the usual gauntlet of tests, including a sleep study. The doctors couldn't find any explanation, and after months of this I sort of got used to it.

The months turned into years, and in my mid 30s, my upstairs neighbour complained about my loud snoring. Back to tests, another sleep study. Diagnosis: sleep apnea. They then asked me why I never got treatment in the first place, because apparently that first sleep study indicated sleep apnea ... but because the AHI was on the lower end, and because I was young and skinny, the doctor didn't think it was relevant for me to know.

Sigh.

AHI really doesn't mean anything besides the trivial: the density of apneas and hypopneas (relative to the applied definition of both) https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.13066