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I'm a dentist who regularly treats OSA with dental appliances; they work by posturing the mandible forward with a maxillary and mandibular (two-arch) device as

I'm a dentist who regularly treats OSA with dental appliances; they work by posturing the mandible forward with a maxillary and mandibular (two-arch) device as a way to increase the cross sectional area of the posterior airway, reducing apneic events -- but it is important to know that the gold standard remains the positive airway pressure (CPAP) device. I would also like to point out that I see an incredible amount of fat-shaming that is rooted in a drumbeat of research that (correctly) shows lower health risks in many areas when BMI is lowered. In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea.

SantalBlush 7y ago
Nobody who fat shames has shown me research about the efficacy of fat shaming on weight reduction. That's not necessarily because the research doesn't exist, it's because they just don't care.
- rhino369 7y ago
  Nobody wants to be fat and most are already pretty ashamed about it. The big over-eaters (like myself) are sort of like addicts, but its a drug we really can't quit. It's like trying to manage your alcoholism by drinking 2 drinks a day instead of 10. It's easy to think "why doesn't the pig just eat less." I used to think that way until my diagnosed thyroid conditions (which made me skinny by default) was treated. Karma. Though some fat acceptance groups go too far when they criticize doctors for telling them to lose weight.
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DiffEq 7y ago
I understand what you are saying but, economically, treating the symptom rather than the cause is expensive; somehow there needs to be some way to create a cost high enough to encourage people to attack the cause of the problem; and shame can be a useful way to increase the cost. So "fat shaming", although politically incorrect these days, should not be thrown out as a way to encourage behavior that benefits society as a whole and the person as whole. If there was a high enough cost to being fat then you would see it would become practical and maintainable.
- sneak 7y ago
  If literally not being able to breathe isn’t enough, people being dickheads probably isn’t going to do it. Please think harder.
  - pjc50 7y ago
    Indeed. For some people it's easier to commit suicide than it is to lose weight. Shame is not an ethical treatment method.
  - DiffEq 7y ago
    Well you don't have to be "a dick" to shame somebody. Just tell them the truth and help them realize the toll they take on society and themselves when they choose certain actions over others. When they come to realize and understand the truth they will feel the shame they ought to feel...and thus pay a small part of the cost to others that they have incurred. Do you believe that a smoker that has thrown a cigarette out the window and burned down a home should not have to feel shame because of their actions? If you do then the obese ought to as well. Their obesity exacts great cost to the medical system that we all have to bear, it takes from their productivity that they could offer to others (society and their own family) and benefit from themselves in a multitude of ways. Their actions are the same as the careless cigarette smoker...selfish. And selfish actions are shameful and that shame should be felt. We should not try to be so "noble" as to protect them from it. When we do the selfishness tends to proliferate.
    - 7y ago
john_moscow 7y ago
>In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea. Sorry, but I have to call BS on that. Having lost ~50 lbs last year (after my blood pressure started getting scary), I can tell you it's all about planning and self-discipline. You plan a diet that fills your stomach and provides the major types of nutrients, yet gives less calories that your body burns every day, and you stick to it for a couple of months. No bullshit, no cheat days, no "let me just have that 500cal chocolate bar as an exception". And it works like clockwork, solving a bunch of health problems on the way. As a matter of fact, I would call it very unethical to comfort people into an unhealthy lifestyle associated with major health risks and shorter life expectancy just to get an extra buck from treating numerous symptoms, instead of giving them a strong motivation to resolve the underlying cause.
- AnIdiotOnTheNet 7y ago
  > Having lost ~50 lbs last year Trust me, it's too soon to say what you're saying. Source: lost >150lbs and kept it off for the past decade.
  - john_moscow 7y ago
    Maybe. I've actually implemented a rather complex set of rules to maintain my weight and it has been working so far. I keep a rough estimate of the calorie intake every day and try to keep it within reasonable bounds. I do make exceptions (hey I still love eating 2 pounds of steak with 3 pints of beer), but those days are followed by heavy dieting days to bring the calorie balance back. I also have a high-watermark/low-watermark system for my weight, so in case it runs away (like during holidays or trips), I am still 1.5-2.5 weeks away from reaching my normal weight.
    - AnIdiotOnTheNet 7y ago
      I'll level with you: the easiest part for me so far was the initial weight loss. I got down to 15lbs less than I am now and it was much easier than it has been since. It's like my body adjusted and got much more conservative but it took a year or two. Maybe that won't be true in your case, but give it time before you make an assessment about the difficulty.
cosmojg 7y ago
> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea. Thank you for this comment! I'd like to emphasize this point in particular. It took me a long time to come to this realization on my own, and I regret putting my brother under so much pressure to lose weight out of my own concern for his health. I likely did more harm than good with my efforts, only worsening his mental and physical health. While losing weight solves a lot of problems, the decision to do so is one's own, and for some, it's an unreasonably difficult task. Not everyone is like you, and not every body is like yours. The best you can do to help someone suffering the consequences of excess weight is to be compassionate and supportive. Feel free to offer solutions and perspectives, but leave your emotions out of it. Respect the dignity and autonomy of others.
AnIdiotOnTheNet 7y ago
I'd just like to chime in as someone who has lost and kept off about half his bodyweight, that yeah, losing significant amounts of weight is a very demanding undertaking. It requires a significant lifestyle change, large investments of time, is emotionally and cognitively draining, and to top it all off does not positively impact your quality of life nearly as much as is touted. To be successful at it requires a level of obsession that qualifies as an eating disorder in its own. I track every calorie I eat, and weigh myself everyday. I have to hate seeing those numbers go up. I have to feel shame at overeating and not allow myself to make excuses for it, lest I become complacent. I can't keep food in my house. I avoid social gatherings because there's almost always food involved. You might think you can just not partake but it doesn't work like that, your brain thinks you're starving and has all sorts of ways to wear down your will and convince you it is ok to eat. It's kind of a living hell. Based on personal experience, I am quite confident that physicians have absolutely no idea how to give actionable advice in this area, and nutritional specialists are only slightly better. None of them care about your suffering, because that isn't something they measure. I guess what I'm saying is that yeah, it is possible for anyone to lose and keep off significant amounts of weight, but basically none of you have any idea what it really takes.
- astockwell 7y ago
  Thanks for your comment, how long have you been at it? Edit: Saw your note below > "150+ lbs, the past decade"
- issa 7y ago
  I couldn't agree with this more. It is possible for me to lose and keep off weight if I literally devote all my energy towards it. It's important to remember that everyone is different. Some people would struggle to gain 100 pounds, others could do it easily, and most people understand that. But for some reason when it comes to losing weight instead of gaining, understanding goes out the window.
  - sdwa 7y ago
    Losing weight is hard (speaking from experience), but ultimately it's still just a question of physics. Eat less, eat food which will fill you for longer (breakfast: porridge, lunch: fruit, nuts, etc.), and eat a reasonably healthy meal you've cooked each night. Meanwhile, eat smaller portions and do some exercise. Your body can't defy the laws of physics, so you will lose weight. It is that simple. Overthinking it and coming up with horse shit reasons why it's totally fine to eat the amount you're eating and blaming some external factor (e.g. one's body) is the problem.
mynegation 7y ago
CPAP is 800CAD here (though only about 200 after insurance) and dental appliances are even more expensive and not covered by insurance. Anecdata: I know that going over a certain weight triggers apnea and snoring for me so I try to stay under it - less expensive, less intrusive, better for the health overall. Research like this is both interesting and important to me. It is not about fat-shaming, it is about knowing the options. I understand that there are people for whom weight loss mai not be attainable or maintainable but it certainly will help to a great number of people.
rukittenme 7y ago
> for many people weight loss is neither practical nor maintainable Hard disagree. As for practicality, weight loss is a function of thermodynamics. Caloric deficit == weight reduction. Doesn't matter your physiology. As for maintainability, well that certainly depends on how a person is taught to diet. If you tell someone they need to eat less to lose weight (which is what almost every diet does) then, yes, it will be hard to maintain. If you tell someone to eat more (low calorie) food then weight loss is easy. Most obese, untrained people will very readily drop tons of fat weight with little stimulus. When I diet (whether the intention is gaining or losing weight) I'm probably eating 2x as much food as an obese person who is wondering to themselves "why is my metabolism so slow?". It's not. The foods I eat just contain less energy than the foods they're eating.
- AnIdiotOnTheNet 7y ago
  > Caloric deficit == weight reduction. Doesn't matter your physiology. True. This is the one piece of weight loss advice that multiple scientific disciplines agree on. However, being true does not make it easy.
  - rukittenme 7y ago
    Did you miss the part where I describe how to make it easier? Did you miss the part where I criticize diet culture from preaching starvation as some sort of virtue. > If you tell someone they need to eat less to lose weight (which is what almost every diet does) then, yes, it will be hard to maintain.
    - AnIdiotOnTheNet 7y ago
      Yes. your advice is not significantly different than common advice on how to make it easy, and my personal experience with trying many, many things is that it is never actually easy.
      - rukittenme 7y ago
        I do it and have done it many times. You're not sacrificing anything by buying products with fewer calories in them. Just read the label.
spelunker 7y ago
Got a CPAP about a year ago, changed my life. Weight issues aside I also have a big neck which means I'll probably have OSA even if I achieve a normal BMI. Anyway, highly recommend a sleep study for anyone here who has symptoms like waking up feeling tired, dozing off in the afternoon, etc.
- SubiculumCode 7y ago
  amen is all I have to say to that. Don't hesitate or worry what your significant other will think, just get one. Best part: You can sleep with a cover over your face and still breathe fresh air.
grawprog 7y ago
>it is important to understand that for many people weight loss is neither practical nor maintainable People need to stop eating processed sugar. Losing and keeping off weight is easy. As soon as I stopped eating, candy, baked shit from coffee shops and crap, fast food, and stopped drinking pop, it became hard to gain weight. That shit's poison. It gives your body nothing. Cutting out nearly all processed sugary food is the easiest way to lose weight with basically no effort. I didn't change my lifestyle, I don't count calories or exercise to any regime. I sat for hours a day at my last job. I just stopped eating garbage and eating food that's actually food. I'm 5'8", I'd been over 200lbs for years and years. I can't get above 150lbs now and all I do is not eat sugar or processed crap. I eat tons of cheese and meat, I have at least one kind of grain and vegetable with each meal. If the main ingredients of something are chemicals and sugar. It's not food. Don't eat it. Your body will be healthy, you'll lose weight. It's a pretty simple concept. These things give your body nothing. Your body needs certain things to make new cells and perform biological functions, eat those things and you'll be healthy. Eat garbage and poison and you won't be. Eta: Sorry for the tone of my post. I've sat and watched a good friend of mine slipping in and out of a diabetic coma in a hospital brought on directly by the food he eats and to this day he still refuses to change his diet in anyway and I'm honestly worried it's going to kill him. This topic makes me a little more unreasonable than usual.
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- lazyasciiart 7y ago
  You have a friend who will probably die before he changes what he eats and you still call it "easy"?
  - grawprog 7y ago
    He's in his 50's and doesn't believe the food causes problems and just doesn't care. It's not a matter of a lack of willpower or trying, in his case it's a lack of giving any kind of fucks.
- mikedilger 7y ago
soperj 7y ago
> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable So you're saying that even though the obesity epidemic is an entirely new thing, that there's no way that these people can lose weight and keep it off? It might require a lifestyle change, but saying it's not possible because change is hard is bullshit.
- viro 7y ago
  what if your current life situation doesn't allow you time to go to the gym or spend any time at all meal planning??
  - soperj 7y ago
    Change your life situation? I guess I've worked 77 hour weeks (11 hour days, 3 weeks on 3 days off). No kids at the time, but still had to make my lunches every day because otherwise you didn't eat (working in the field). Meal planning actually saves you time.
- icebraining 7y ago
  Maybe most can, which doesn't mean there aren't many who can't. Fat people aren't a new thing.
  - soperj 7y ago
    The amount of them percentage wise is.
elric 7y ago
As someone with OSA - and a busted TMJ, so no mandibular advancement for me -, let me tell you: CPAP sucks. Sure, you die slower, you snore a hell of a lot less, and you feel more rested and energized. That's all (truly, no snark) great. But it sucks. Spontaneous sleepovers become impossible. Travel becomes a chore. Sleeping with bedfellows now comes with a noisy attachment. You have to rent or buy a relatively expensive machine. You have to get annual checkups, and you have to give up a fair amount of privacy to prove you are complying with the therapy... Not that much fun.
- tdburn 7y ago
  Have you looked into the portable CPAPs they are much smaller, Resmed has one. Still a pain but nice for travel. I’ve also seen online cpap companies that send you a at home test that qualifies for coverage.
- chubot 7y ago
  Have you tried the alternative dental appliance? Lots of people don't seem to know about it, but I'm using one and it works: https://news.ycombinator.com/item?id=22014204 https://news.ycombinator.com/item?id=22014204 I even heard on Joe Rogan that he has to use one. Not sure why more people don't know about it. I guess it depends on whether your doctor or dentist diagnoses it, but that shouldn't be the case. They should exchange more information!
- RickS 7y ago
  Agreed, sadly. I have a CPAP and it's just deeply unpleasant to use. It isn't worth it. Dismal compliance numbers say that many to most people who try CPAP feel similarly.
djsumdog 7y ago
Weight affects so much more though. It's not just sleep apnea, but heart disease and diabetes as well. Any type of surgery risk is greatly increased by obesity. Look at history. Even for people working desk jobs, Americans were much less obese than they are today. It's a systemic problem. Go into any gas station and try to grab a snack without sugar. It's difficult to impossible. We have more sugar and starch in our food today. I agree it's not necessarily a personal problem. It's a problem with the entire food industry and access to cheap sugar. It's starting to affect people in other western countries too and we are missing a lot of education about the dangers of starch and sugar.
at_a_remove 7y ago
Forgive my ignorance in this area -- these dental appliances, do they permanently reshape the jaw over time?
mikedilger 7y ago
Just adding another datapoint: With no particular dieting, I tend to hover around 95kg. I was able to get down to 80kg with smart dieting. But I was miserable at that weight.. I couldn't concentrate when programming, my brain kept interrupting me with hunger signals. I put the weight back on; I'd rather not live the rest of my life in hunger-misery. 20 years later and I'm still fine with that decision. I get plenty of exercise and eat lots of vegetables and take other steps to be healthy, but significant sustained weight loss with it's side effects is no longer desirable... until medicine comes up with a pill that removes the hunger itself w/o nasty side effects.
chubot 7y ago
Wow great to see a dentist here! I've had a lot of experience with sleep apnea in the last couple years, and it seems to be under control now after about 5 remedies, the most of important of which is a dental appliance. The other ones were sleep position, weight loss, and breathing habits, as you might imagine. What do you mean by "gold standard"? Is it because it's more effective for severe sleep apnea? From my perspective, the dental appliance is easier to use, and is better for traveling. I also tried a CPAP but couldn't get the hang of it. It's also super creepy that CPAPs all seem to have a cell modem that spies on you. (OK, that info also helps the doctor, but still.) I know a couple other people who are having problems with CPAP, and the doctor has not even made them aware of the dental appliance. They're surprised when I tell them there's an alternative. And one of these people is a doctor himself! I feel like sleep apnea is being treated very poorly given how common it is, probably for economic reasons. I know everyone wants to say this about their pet cause -- but it does seem like an "epidemic". The "epidemic" of weight gain seems to be an obvious reason for this. FWIW my BMI is now normal (less than 25, 166-169 at 5'9"), and I still need the dental appliance and to sleep on my side. Either one alone doesn't cut it. I've also been meaning to write a article about "Why AHI is wrong", which is basically because outliers determine outcomes and AHI doesn't measure outliers. It's a "count". It has a lot of the fallacies that Nassim Taleb talks about in his books. The AVERAGE minute of sleep doesn't matter; the WORST minute of sleep matters. The worst minute can ruin your whole night's sleep (or at least a REM's cycle worth of sleep), or it can cause you to have a heart attack and die. My AHI is 6 or 7, and most doctors have dismissed that as not important. However my sleep quality has improved greatly with all these remedies. Several minor health problems have cleared up all at once. The thing that motivated me to get treated was that I crushed a tooth in my sleep, which many doctors don't realize is related to sleep apnea (but my dentist did thankfully). But I think of all the people who did NOT happen to crush a tooth and are undiagnosed. I guess it's one of those things that kills you over 20 years and used to be called "getting old". But really it was amazing to me how many problems can have the same fundamental cause. FWIW I highly recommend this book about the "sleep breathing paradigm". It's written by an ENT who has observed a lot of these things in his practice. A key point is that he actually looks at your airway and sees if your tongue obstructs your airway when lying down. I went to 2 ENTs and neither of them did that. They don't understand the mechanism behind sleep apnea! It's geometry and gravity. This book is not popular, which is a shame. Don't judge a book by its cover :) It's a bit dense but that will be fine for HN readers. https://www.amazon.com/Sleep-Interrupted-physician-reveals-reason/dp/0980236738/ref=as_li_ss_tl?_encoding=UTF8&qid=1505313761&sr=8-1&linkCode=sl1&tag=doctorcom03-20&linkId=0fc71871ff1f9ad14df58ff8f1aa5c66 https://www.amazon.com/Sleep-Interrupted-physician-reveals-r...
nooron 7y ago
Hey, are you referring to the SUAD Device? I am thinking about getting one and curious if there is an alternative. I have heard mixed things about their quality. Thank you for sharing your knowledge with us.
kup0 7y ago
Proper and adequate sleep is also an important part of weight loss, so I find it naive to only attempt to fix the weight issue. It's a vicious catch-22 to not be able to breathe enough to sleep well enough to lose weight so that one can breathe in the first place.
romdev 7y ago
On topic: losing weight has a positive effect for sleep apnea. This is interesting, but something I had intuited from the small sampling of those I know with sleep apnea and weight problems. There are other factors that seem causal, like smoking, that would be interesting to hear about. Off topic: losing weight is hard to do for many people.

SantalBlush 7y ago

Nobody who fat shames has shown me research about the efficacy of fat shaming on weight reduction. That's not necessarily because the research doesn't exist, it's because they just don't care.

rhino369 7y ago
Nobody wants to be fat and most are already pretty ashamed about it. The big over-eaters (like myself) are sort of like addicts, but its a drug we really can't quit. It's like trying to manage your alcoholism by drinking 2 drinks a day instead of 10. It's easy to think "why doesn't the pig just eat less." I used to think that way until my diagnosed thyroid conditions (which made me skinny by default) was treated. Karma. Though some fat acceptance groups go too far when they criticize doctors for telling them to lose weight.
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DiffEq 7y ago

I understand what you are saying but, economically, treating the symptom rather than the cause is expensive; somehow there needs to be some way to create a cost high enough to encourage people to attack the cause of the problem; and shame can be a useful way to increase the cost. So "fat shaming", although politically incorrect these days, should not be thrown out as a way to encourage behavior that benefits society as a whole and the person as whole. If there was a high enough cost to being fat then you would see it would become practical and maintainable.

sneak 7y ago
If literally not being able to breathe isn’t enough, people being dickheads probably isn’t going to do it. Please think harder.
- pjc50 7y ago
  Indeed. For some people it's easier to commit suicide than it is to lose weight. Shame is not an ethical treatment method.
- DiffEq 7y ago
  Well you don't have to be "a dick" to shame somebody. Just tell them the truth and help them realize the toll they take on society and themselves when they choose certain actions over others. When they come to realize and understand the truth they will feel the shame they ought to feel...and thus pay a small part of the cost to others that they have incurred. Do you believe that a smoker that has thrown a cigarette out the window and burned down a home should not have to feel shame because of their actions? If you do then the obese ought to as well. Their obesity exacts great cost to the medical system that we all have to bear, it takes from their productivity that they could offer to others (society and their own family) and benefit from themselves in a multitude of ways. Their actions are the same as the careless cigarette smoker...selfish. And selfish actions are shameful and that shame should be felt. We should not try to be so "noble" as to protect them from it. When we do the selfishness tends to proliferate.
  - 7y ago

john_moscow 7y ago

>In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea. Sorry, but I have to call BS on that. Having lost ~50 lbs last year (after my blood pressure started getting scary), I can tell you it's all about planning and self-discipline. You plan a diet that fills your stomach and provides the major types of nutrients, yet gives less calories that your body burns every day, and you stick to it for a couple of months. No bullshit, no cheat days, no "let me just have that 500cal chocolate bar as an exception". And it works like clockwork, solving a bunch of health problems on the way. As a matter of fact, I would call it very unethical to comfort people into an unhealthy lifestyle associated with major health risks and shorter life expectancy just to get an extra buck from treating numerous symptoms, instead of giving them a strong motivation to resolve the underlying cause.

AnIdiotOnTheNet 7y ago
> Having lost ~50 lbs last year Trust me, it's too soon to say what you're saying. Source: lost >150lbs and kept it off for the past decade.
- john_moscow 7y ago
  Maybe. I've actually implemented a rather complex set of rules to maintain my weight and it has been working so far. I keep a rough estimate of the calorie intake every day and try to keep it within reasonable bounds. I do make exceptions (hey I still love eating 2 pounds of steak with 3 pints of beer), but those days are followed by heavy dieting days to bring the calorie balance back. I also have a high-watermark/low-watermark system for my weight, so in case it runs away (like during holidays or trips), I am still 1.5-2.5 weeks away from reaching my normal weight.
  - AnIdiotOnTheNet 7y ago
    I'll level with you: the easiest part for me so far was the initial weight loss. I got down to 15lbs less than I am now and it was much easier than it has been since. It's like my body adjusted and got much more conservative but it took a year or two. Maybe that won't be true in your case, but give it time before you make an assessment about the difficulty.

cosmojg 7y ago

> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea. Thank you for this comment! I'd like to emphasize this point in particular. It took me a long time to come to this realization on my own, and I regret putting my brother under so much pressure to lose weight out of my own concern for his health. I likely did more harm than good with my efforts, only worsening his mental and physical health. While losing weight solves a lot of problems, the decision to do so is one's own, and for some, it's an unreasonably difficult task. Not everyone is like you, and not every body is like yours. The best you can do to help someone suffering the consequences of excess weight is to be compassionate and supportive. Feel free to offer solutions and perspectives, but leave your emotions out of it. Respect the dignity and autonomy of others.

AnIdiotOnTheNet 7y ago

I'd just like to chime in as someone who has lost and kept off about half his bodyweight, that yeah, losing significant amounts of weight is a very demanding undertaking. It requires a significant lifestyle change, large investments of time, is emotionally and cognitively draining, and to top it all off does not positively impact your quality of life nearly as much as is touted. To be successful at it requires a level of obsession that qualifies as an eating disorder in its own. I track every calorie I eat, and weigh myself everyday. I have to hate seeing those numbers go up. I have to feel shame at overeating and not allow myself to make excuses for it, lest I become complacent. I can't keep food in my house. I avoid social gatherings because there's almost always food involved. You might think you can just not partake but it doesn't work like that, your brain thinks you're starving and has all sorts of ways to wear down your will and convince you it is ok to eat. It's kind of a living hell. Based on personal experience, I am quite confident that physicians have absolutely no idea how to give actionable advice in this area, and nutritional specialists are only slightly better. None of them care about your suffering, because that isn't something they measure. I guess what I'm saying is that yeah, it is possible for anyone to lose and keep off significant amounts of weight, but basically none of you have any idea what it really takes.

astockwell 7y ago
Thanks for your comment, how long have you been at it? Edit: Saw your note below > "150+ lbs, the past decade"
issa 7y ago
I couldn't agree with this more. It is possible for me to lose and keep off weight if I literally devote all my energy towards it. It's important to remember that everyone is different. Some people would struggle to gain 100 pounds, others could do it easily, and most people understand that. But for some reason when it comes to losing weight instead of gaining, understanding goes out the window.
- sdwa 7y ago
  Losing weight is hard (speaking from experience), but ultimately it's still just a question of physics. Eat less, eat food which will fill you for longer (breakfast: porridge, lunch: fruit, nuts, etc.), and eat a reasonably healthy meal you've cooked each night. Meanwhile, eat smaller portions and do some exercise. Your body can't defy the laws of physics, so you will lose weight. It is that simple. Overthinking it and coming up with horse shit reasons why it's totally fine to eat the amount you're eating and blaming some external factor (e.g. one's body) is the problem.

mynegation 7y ago

CPAP is 800CAD here (though only about 200 after insurance) and dental appliances are even more expensive and not covered by insurance. Anecdata: I know that going over a certain weight triggers apnea and snoring for me so I try to stay under it - less expensive, less intrusive, better for the health overall. Research like this is both interesting and important to me. It is not about fat-shaming, it is about knowing the options. I understand that there are people for whom weight loss mai not be attainable or maintainable but it certainly will help to a great number of people.

rukittenme 7y ago

> for many people weight loss is neither practical nor maintainable Hard disagree. As for practicality, weight loss is a function of thermodynamics. Caloric deficit == weight reduction. Doesn't matter your physiology. As for maintainability, well that certainly depends on how a person is taught to diet. If you tell someone they need to eat less to lose weight (which is what almost every diet does) then, yes, it will be hard to maintain. If you tell someone to eat more (low calorie) food then weight loss is easy. Most obese, untrained people will very readily drop tons of fat weight with little stimulus. When I diet (whether the intention is gaining or losing weight) I'm probably eating 2x as much food as an obese person who is wondering to themselves "why is my metabolism so slow?". It's not. The foods I eat just contain less energy than the foods they're eating.

AnIdiotOnTheNet 7y ago
> Caloric deficit == weight reduction. Doesn't matter your physiology. True. This is the one piece of weight loss advice that multiple scientific disciplines agree on. However, being true does not make it easy.
- rukittenme 7y ago
  Did you miss the part where I describe how to make it easier? Did you miss the part where I criticize diet culture from preaching starvation as some sort of virtue. > If you tell someone they need to eat less to lose weight (which is what almost every diet does) then, yes, it will be hard to maintain.
  - AnIdiotOnTheNet 7y ago
    Yes. your advice is not significantly different than common advice on how to make it easy, and my personal experience with trying many, many things is that it is never actually easy.
    - rukittenme 7y ago
      I do it and have done it many times. You're not sacrificing anything by buying products with fewer calories in them. Just read the label.

spelunker 7y ago

Got a CPAP about a year ago, changed my life. Weight issues aside I also have a big neck which means I'll probably have OSA even if I achieve a normal BMI. Anyway, highly recommend a sleep study for anyone here who has symptoms like waking up feeling tired, dozing off in the afternoon, etc.

SubiculumCode 7y ago
amen is all I have to say to that. Don't hesitate or worry what your significant other will think, just get one. Best part: You can sleep with a cover over your face and still breathe fresh air.

grawprog 7y ago

>it is important to understand that for many people weight loss is neither practical nor maintainable People need to stop eating processed sugar. Losing and keeping off weight is easy. As soon as I stopped eating, candy, baked shit from coffee shops and crap, fast food, and stopped drinking pop, it became hard to gain weight. That shit's poison. It gives your body nothing. Cutting out nearly all processed sugary food is the easiest way to lose weight with basically no effort. I didn't change my lifestyle, I don't count calories or exercise to any regime. I sat for hours a day at my last job. I just stopped eating garbage and eating food that's actually food. I'm 5'8", I'd been over 200lbs for years and years. I can't get above 150lbs now and all I do is not eat sugar or processed crap. I eat tons of cheese and meat, I have at least one kind of grain and vegetable with each meal. If the main ingredients of something are chemicals and sugar. It's not food. Don't eat it. Your body will be healthy, you'll lose weight. It's a pretty simple concept. These things give your body nothing. Your body needs certain things to make new cells and perform biological functions, eat those things and you'll be healthy. Eat garbage and poison and you won't be. Eta: Sorry for the tone of my post. I've sat and watched a good friend of mine slipping in and out of a diabetic coma in a hospital brought on directly by the food he eats and to this day he still refuses to change his diet in anyway and I'm honestly worried it's going to kill him. This topic makes me a little more unreasonable than usual.

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lazyasciiart 7y ago
You have a friend who will probably die before he changes what he eats and you still call it "easy"?
- grawprog 7y ago
  He's in his 50's and doesn't believe the food causes problems and just doesn't care. It's not a matter of a lack of willpower or trying, in his case it's a lack of giving any kind of fucks.
mikedilger 7y ago

soperj 7y ago

> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable So you're saying that even though the obesity epidemic is an entirely new thing, that there's no way that these people can lose weight and keep it off? It might require a lifestyle change, but saying it's not possible because change is hard is bullshit.

viro 7y ago
what if your current life situation doesn't allow you time to go to the gym or spend any time at all meal planning??
- soperj 7y ago
  Change your life situation? I guess I've worked 77 hour weeks (11 hour days, 3 weeks on 3 days off). No kids at the time, but still had to make my lunches every day because otherwise you didn't eat (working in the field). Meal planning actually saves you time.
icebraining 7y ago
Maybe most can, which doesn't mean there aren't many who can't. Fat people aren't a new thing.
- soperj 7y ago
  The amount of them percentage wise is.

elric 7y ago

As someone with OSA - and a busted TMJ, so no mandibular advancement for me -, let me tell you: CPAP sucks. Sure, you die slower, you snore a hell of a lot less, and you feel more rested and energized. That's all (truly, no snark) great. But it sucks. Spontaneous sleepovers become impossible. Travel becomes a chore. Sleeping with bedfellows now comes with a noisy attachment. You have to rent or buy a relatively expensive machine. You have to get annual checkups, and you have to give up a fair amount of privacy to prove you are complying with the therapy... Not that much fun.

tdburn 7y ago
Have you looked into the portable CPAPs they are much smaller, Resmed has one. Still a pain but nice for travel. I’ve also seen online cpap companies that send you a at home test that qualifies for coverage.
chubot 7y ago
Have you tried the alternative dental appliance? Lots of people don't seem to know about it, but I'm using one and it works: https://news.ycombinator.com/item?id=22014204 https://news.ycombinator.com/item?id=22014204 I even heard on Joe Rogan that he has to use one. Not sure why more people don't know about it. I guess it depends on whether your doctor or dentist diagnoses it, but that shouldn't be the case. They should exchange more information!
RickS 7y ago
Agreed, sadly. I have a CPAP and it's just deeply unpleasant to use. It isn't worth it. Dismal compliance numbers say that many to most people who try CPAP feel similarly.

djsumdog 7y ago

Weight affects so much more though. It's not just sleep apnea, but heart disease and diabetes as well. Any type of surgery risk is greatly increased by obesity. Look at history. Even for people working desk jobs, Americans were much less obese than they are today. It's a systemic problem. Go into any gas station and try to grab a snack without sugar. It's difficult to impossible. We have more sugar and starch in our food today. I agree it's not necessarily a personal problem. It's a problem with the entire food industry and access to cheap sugar. It's starting to affect people in other western countries too and we are missing a lot of education about the dangers of starch and sugar.

at_a_remove 7y ago

Forgive my ignorance in this area -- these dental appliances, do they permanently reshape the jaw over time?

mikedilger 7y ago

Just adding another datapoint: With no particular dieting, I tend to hover around 95kg. I was able to get down to 80kg with smart dieting. But I was miserable at that weight.. I couldn't concentrate when programming, my brain kept interrupting me with hunger signals. I put the weight back on; I'd rather not live the rest of my life in hunger-misery. 20 years later and I'm still fine with that decision. I get plenty of exercise and eat lots of vegetables and take other steps to be healthy, but significant sustained weight loss with it's side effects is no longer desirable... until medicine comes up with a pill that removes the hunger itself w/o nasty side effects.

chubot 7y ago

Wow great to see a dentist here! I've had a lot of experience with sleep apnea in the last couple years, and it seems to be under control now after about 5 remedies, the most of important of which is a dental appliance. The other ones were sleep position, weight loss, and breathing habits, as you might imagine. What do you mean by "gold standard"? Is it because it's more effective for severe sleep apnea? From my perspective, the dental appliance is easier to use, and is better for traveling. I also tried a CPAP but couldn't get the hang of it. It's also super creepy that CPAPs all seem to have a cell modem that spies on you. (OK, that info also helps the doctor, but still.) I know a couple other people who are having problems with CPAP, and the doctor has not even made them aware of the dental appliance. They're surprised when I tell them there's an alternative. And one of these people is a doctor himself! I feel like sleep apnea is being treated very poorly given how common it is, probably for economic reasons. I know everyone wants to say this about their pet cause -- but it does seem like an "epidemic". The "epidemic" of weight gain seems to be an obvious reason for this. FWIW my BMI is now normal (less than 25, 166-169 at 5'9"), and I still need the dental appliance and to sleep on my side. Either one alone doesn't cut it. I've also been meaning to write a article about "Why AHI is wrong", which is basically because outliers determine outcomes and AHI doesn't measure outliers. It's a "count". It has a lot of the fallacies that Nassim Taleb talks about in his books. The AVERAGE minute of sleep doesn't matter; the WORST minute of sleep matters. The worst minute can ruin your whole night's sleep (or at least a REM's cycle worth of sleep), or it can cause you to have a heart attack and die. My AHI is 6 or 7, and most doctors have dismissed that as not important. However my sleep quality has improved greatly with all these remedies. Several minor health problems have cleared up all at once. The thing that motivated me to get treated was that I crushed a tooth in my sleep, which many doctors don't realize is related to sleep apnea (but my dentist did thankfully). But I think of all the people who did NOT happen to crush a tooth and are undiagnosed. I guess it's one of those things that kills you over 20 years and used to be called "getting old". But really it was amazing to me how many problems can have the same fundamental cause. FWIW I highly recommend this book about the "sleep breathing paradigm". It's written by an ENT who has observed a lot of these things in his practice. A key point is that he actually looks at your airway and sees if your tongue obstructs your airway when lying down. I went to 2 ENTs and neither of them did that. They don't understand the mechanism behind sleep apnea! It's geometry and gravity. This book is not popular, which is a shame. Don't judge a book by its cover :) It's a bit dense but that will be fine for HN readers. https://www.amazon.com/Sleep-Interrupted-physician-reveals-reason/dp/0980236738/ref=as_li_ss_tl?_encoding=UTF8&qid=1505313761&sr=8-1&linkCode=sl1&tag=doctorcom03-20&linkId=0fc71871ff1f9ad14df58ff8f1aa5c66 https://www.amazon.com/Sleep-Interrupted-physician-reveals-r...

nooron 7y ago

Hey, are you referring to the SUAD Device? I am thinking about getting one and curious if there is an alternative. I have heard mixed things about their quality. Thank you for sharing your knowledge with us.

kup0 7y ago

Proper and adequate sleep is also an important part of weight loss, so I find it naive to only attempt to fix the weight issue. It's a vicious catch-22 to not be able to breathe enough to sleep well enough to lose weight so that one can breathe in the first place.

romdev 7y ago

On topic: losing weight has a positive effect for sleep apnea. This is interesting, but something I had intuited from the small sampling of those I know with sleep apnea and weight problems. There are other factors that seem causal, like smoking, that would be interesting to hear about. Off topic: losing weight is hard to do for many people.