Remix clone Hacker News

Tangentially related, but very important to me and hopefully helpful to others here: I have sleep apnea. So do most of the men in my family. Though I am overweight, I haven't always been, but I have always had the condition, as have they. For those who don't know, sleep apnea is a condition where you stop breathing in your sleep, wake up slightly to fix that and start breathing again, and then fall back asleep. It sounds like choking in your sleep. In my case, I was doing this more than 70 times an hour - often multiple times a minute! My blood oxygen was as low as 67% - a threshold that would have me on a ventilator, were it happening in a hospital.

Until I got my apnea treated, I never slept well. I had not had a really good night's sleep in years, and I hadn't had a great night's sleep as an adult probably ever. In school - decades ago - I fell asleep in class regularly and napped every day. Despite this, I have been successful, but I can't help but wonder who I'd be if I hadn't had that problem. What's worse, because you do not actually sleep, whatever happens during sleep that repairs your body doesn't really happen. Sleep apnea massively increases your risk for heart disease, stroke, and many other serious conditions.

Sleep apnea is treated with CPAP - continuous positive airway pressure - from a machine that sits on your bedside. You wear a mask like Bane and it forces air into your throat and opens it, making it easier to breathe. CPAP is not a cure, because it doesn't fix the underlying anatomical issue, but properly calibrated it results in complete remission. I now sleep normally. From a sleep perspective, I feel amazing, better than I have in years. For the first time in my life, I can rely on feeling good in the morning if I get enough hours of sleep in. Even four hours on the CPAP is better than eight or nine hours without it. (Also, over time, your brain becomes conditioned that CPAP = sleep, and you zonk out within minutes of putting it on.)

It is costly and time consuming, yes, and CPAP machines are a huge lifestyle adjustment. But good lord, is it worth it. I have never felt or slept better. In the years since my diagnosis I have not slept a single night without my CPAP and I don't think I ever will again, unless some magical cure comes out.

If you have struggled with insomnia, snoring, or feeling wakeful after sleep, I beg you to get a sleep study and look into whether apnea, or another similar condition, could be the cause.

▲

lxgr 9 days ago | parent | next [-]

Do you know if fitness trackers with integrated pulse oximeters can detect sleep apnea?

My Apple Watch has an oximeter (I bought it before that feature was pulled in the US), and there's a "sleep apnea notifications" section in the "Health" app, but I'm not sure if the absence of notifications implies an absence of a problem.

Would sleep apnea always be visible as a lower blood oxygen level when sleeping, or can there be negative effects even without that?

	▲	canucker2016 9 days ago \| parent \| next [-]
		While the Oura ring won't alert the user to sleep apnea, one person with an Oura ring looked at the accumulated data from their Oura ring and could see the signs of sleep apnea - https://www.tomsguide.com/features/my-oura-ring-helped-me-di... Ringconn, similar to Oura without the compulsory subscription, claims to be able to detect sleep apnea with 90.7% accuracy. see https://ringconn.com/blogs/news/understanding-sleep-apnea-an...
	▲	ivraatiems 9 days ago \| parent \| prev \| next [-]
		I'm not a doctor, can't give medical advice. This is my understanding: > Would sleep apnea always be visible as a lower blood oxygen level when sleeping, or can there be negative effects even without that? It would not always be visible, no, if your AHI was low enough. It is still damaging even if your blood oxygen is okay, because you are waking up to keep it that way. You're not getting enough sleep as a result. You might try the recording trick I mentioned below to listen for sounds of it, but if you're unsure at all, I'd consider seeing a sleep doc.
	▲	ShakataGaNai 9 days ago \| parent \| prev \| next [-]
		Lower blood ox could just be you sleeping on your arm. Among other things. If you're concerned with Sleep apnea testing is very easy these days. You goto a sleep specialist, they give you a little kit you take home, you put it on for one night, they look at the data. Done! It's not like even a decade or so ago where it's "goto sleep lab", most of it's done at home now for the initial investigation.
	▲	dehrmann 9 days ago \| parent \| prev \| next [-]
		Newer Apple Watches are able to detect signs consistent with sleep apnea (which is legally distinct from actually diagnosing it).
	▲	torial 9 days ago \| parent \| prev [-]
		RingConn Gen 2 has built-in Apnea monitoring -- so far I am loving it. It provides a picture of my sleep apnea when I'm not using the CPAP (because the CPAP can be uncomfortable after a while).

▲

ein0p 9 days ago | parent | prev | next [-]

FWIW I had moderate sleep apnea (nowhere near as bad as what you're describing) and I "cured" it by forcing myself to breathe through my nose at least 90% of the time, including when sleeping. Some people tape their mouth shut, but I can't do that - I have a beard. Breathing through the nose seems to have fixed the permanently runny nose as well, I don't know why. I know it's all individual and what worked for me might not work for everyone, but IMO it's worth a try. The downside is, until the corresponding musculature regains strength you will feel like you're out of air. It'll take 3-4 weeks to fully adjust. It'll pass, don't worry.

▲

r00fus 9 days ago | parent | prev | next [-]

My hypopnea (pre-apnea) is getting resolved as I have lost a lot of weight by following a program using GLP-1 meds. I also no longer have knee discomfort when hiking or doing long climbs on my bike (used to wear a sleeve beforehand to do that). Not to mention, I just look and feel better.

CPAP is a life-saver for sure, but treating your underlying causes of apnea can often help as well.

▲

4gotunameagain 9 days ago | parent | prev | next [-]

CPAP is a very American solution, pay money and treat the symptom with minimal effort but not the underlying cause.

The vast majority of cases of sleep apnea can be cured with weight loss, exercise, nasal breathing exercises..

▲

ivraatiems 9 days ago | parent | next [-]

That is simply not true. Anecdotally, three people in my family including myself have sleep apnea. I am the only overweight one. The others are a normal or even low BMI. Also, I had sleep apnea when I wasn't overweight.

Studies show that non-overweight or obese people with sleep apnea are extremely common and make up between 20 and 40% of all apnea sufferers:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC5181619/

2. https://www.nature.com/articles/s41440-024-01669-9

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC9130173/#:~:text=Ap...

4. https://ejo.springeropen.com/articles/10.1186/s43163-024-006...

5. https://home.liebertpub.com/publications/respiratory-care/68...

"Nasal breathing exercises" cannot overcome physiology and cannot help you if you are sleeping and have no conscious control over your muscles. Apnea is caused by physiology and while it can be made worse by weight, weight loss alone does not fix it. It may bring some people's apneas down to an acceptable level, but that is not the case for all or even most patients.

Your advice is roughly the same as telling people to skip their flu or COVID shots and hope their diet and exercise keeps them from getting sick. It's not that diet and exercise are bad for you, but they aren't the same as an exact treatment for the problem you have.

▲

arisbe__ 8 days ago | parent [-]

Medicine is wholly corrupt. If a hypothetical drug existed that was radically cheap and improved general health outcomes by 25%-50%, the institution of medicine and insurance by logic of self-preservation would not allow to exist or be known.

Such a drug would undermine things as they stand and so institutional self-preservation is now the primary purpose trumping any sort of too good actual solution.

You will learn more operating orthogonal to such a corrupt anti-inquiry, science-theatre. Just as a doctor-spouse (an unpaid friend-consultant) will always give you better advice than a paid doctor.

...Im saying if you are willing to read the research you are probably willing to run some n-of-1 quasi experiments.

For example dont use a computer, TV or phone for a month. Don't sit under LED or Fluroescent Lights for a month...I dont know, just try dumb things and you will learn faster than professionals "games".

This is because we operate in a low bar expectation brought on by arrogance of theory over experiment.

When crowd sourced n-of-1 combinatorial design apps drop for patients and scale to large enough, ... this point will make sense

▲

ivraatiems 8 days ago | parent [-]

All of your posts on this thread, honestly are some of the most bizarre I've ever seen on this site.

I'm here saying: "this treatment massively improved my life and might have actually saved it!" and your response is "this shows medicine is wholly corrupt and cannot be trusted."

It's especially odd given that CPAP is a non-invasive low-to-no-side-effect solution whose only real drawback is that the machines are expensive and hard to calibrate, and don't work if you don't use them. We're not talking about a new drug or vaccine or something. We're literally just talking about helping people breathe easier. And it's not like I am using the CPAP blindly with no idea whether it's working. I can literally tell every day just by existing in a rested state that it is working.

I'm not saying there isn't some theoretical better treatment out there. But it seems like you think I should... not use the treatment I have because the people who produced it might be corrupt?

I genuinely don't see how these things follow or are even related.

And for what it's worth, I do have a doctor-spouse, and she demanded I get a CPAP and is happy every day that I have one.

	▲	arisbe__ 5 days ago \| parent [-]
		I know I was a bit over-the-top, but I stand by this logic that is far more general than "CPAP-as-an-answer" (but I do personally think it applies here but that is moreso speculation): > "...If a hypothetical drug existed that was radically cheap and improved general health outcomes by 25%-50%, the institution of medicine and insurance by logic of self-preservation would not allow to exist or be known." The reasoning is that there is a large capacity and infrastructure of trained professionals and insurance expectational-warp. If the medical visits and drug prescriptions were decimated the financial side of things would collapse. The reason they turn a blind eye to what we think of as truth-oriented science is that early career professionals have mortgages and debt and so are themselves locked-in to playing their cards in favor of institutional self-preservation. When this gets out of hand they begin to habitualize a rationalization-like thinking that is purely self-serving. I am of the opinion that we are far past the point of corruption (it is unconscious in the professionals themselves), but it is mostly a question of debt thresholds and group psychology. My reasons for saying you should yourself as a sleep apnea patient should just figure it out is that that is how pessimistic I am about such professional blindness. To be honest I'm leaving out the main problem with CPAP because by your response you just aren't ready to engage in creative thought (no offense that is almost all of humanity). Most of the intellectual and professional world sets a bar so damn low its like they are playing limbo. Meanwhile patients are like zombified robots programmed to trust the white lab coats like lambs to the slaughter. Just like political debate is self-perpetuating such that a negatively defined identity is preserved and valued over mediation and understanding, most professionals use their brain power to self-sabotage away from institutional-skeptical inquiry as its too uncomfortable to self-sacrifice reputation, income and eventually their careers.

▲

arisbe__ 8 days ago | parent | prev [-]

100% and it's rather sad people cant see through it as medical rent seeking.

▲

arisbe__ 8 days ago | parent | prev | next [-]

Do you think they even want to understand apnea? It seems to me there is a toxic incentive situation here. I'd bet money a full blown set of variable controls will be found to solve this problem and come from outside sleep medicine.

Its not magic, its that modern professionalized science is devoid of inquiry.

▲

yosame 8 days ago | parent [-]

In countries with subsidised health care there's still an incentive to solve these problems, since the solution will lower healthcare costs.

	▲	arisbe__ 5 days ago \| parent [-]
		And how many out-of-box variables have they had patients control for? If it's less than 25 I think medicine has been hijacked by the consumer wanting to not participate in the medical-inquiry process. I could solve the issue with perhaps 1000-5000 serious patient-subjects, a small amount of funding and a friggen smart phone app. Also a non-corrupt government should seem to want to lower healthcare costs. But just because politicians say that doesn't mean much because the incentives of government too are poisoned. They don't in practice (and in sum) want to lower healthcare costs. Why would you think that? It's self-sacrifice that is needed. Most medicine will collapse in my lifetime, and the professionals, politicians and lobbyists brought this upon themselves (and unfortunately us).

▲

vkou 9 days ago | parent | prev | next [-]

So, it's not all sunshine and flowers. It sounds like your calibration process was successful, but when its not, you end up with a range of problems, including the ever-fun one of 'my stomach has been pumped full of air overnight and I feel like a balloon ready to burst' - every single morning.

▲

swah 9 days ago | parent | prev [-]

Is there any chance that Apple Watch or wife would not notice a severe apnea condition?

	▲	instagib 9 days ago \| parent \| next [-]
		No and yes for wife or a video recording. Get a sleep study for 100%. My suggestion is an elevated sleep position by increasing your head position with two stacked pillows or raising the head of the bed. It mechanically helps sleep apnea. It got me from a high Apnea-Hypopnea Index (AHI) score to a very low one with the cpap. The Apple Watch has not shown an ability to identify sleep disturbances or sleep apnea when it should according to my cpap AHI score and when napping/sleeping without a cpap. Blood oxygen measurements are basically useless from my research unless you need oxygen because you are so sick you cannot walk short distances. Everyone seems to have a different % they function well at asleep or awake. I have also used a much more accurate and faster reading device than the Apple Watch.
	▲	ivraatiems 9 days ago \| parent \| prev \| next [-]
		No idea about Apple Watch, but wife, definitely. My wife noticed it. (She's also a doctor, but anyone can identify the sound of choking and gasping, which is what it sounds like.) I can't give medical advice, but: Record yourself on your phone overnight and listen back. If you hear loud snoring with gaps or pauses in between, and especially any sort of choking, gasping, or coughing sound, and you don't remember doing it... definitely look into it further.
	▲	vkou 9 days ago \| parent \| prev [-]
		A severe condition is very noticeable. The sleeping person stops breathing for up to a minute or two, and then does a sudden gasp for air. And this repeats all night long.