9 ms·

Sleep apnea pill shows striking success in large clinical trial

279 points by pseudolus 1y ago

deleted 1y ago
[deleted]
jmclnx 1y ago
>Atomoxetine also increases heart rate and diastolic blood pressure a little bit, I believe most people with Sleep Aonea tend to have High Blood Pressure, this could be concerning.
- Etheryte 1y ago
  We have numerous good options to deal with high blood pressure, I wouldn't say this is really a problem. Many people take medicine for high blood pressure and live the rest of their lives completely unhampered.
  - hombre_fatal 1y ago
    Many people don’t take them nor do they want the side effects, so of course it’s a problem. Every heart attack story I know of off the top of my head involves a man who didn’t want to take his blood pressure meds.
    - Etheryte 1y ago
      This is a good example of survivorship bias. You're fixated on the few heart attacks you do know and overlooking the vast troves of people who never developed issues once treated.
      - const_cast 1y ago
        No, the survivorship bias is having high blood pressure and being fine. It greatly increases your risk of heart attack, stroke, and heart failure. Hypertension is dangerous in the long-term. Most smokers don't die of lung cancer - they die of hypertension.
  - elric 1y ago
    > live the rest of their lives completely unhampered Blood pressure medication has numerous side effects. Increased blood pressure during sleep is the worst kind of hypertension ("reverse dipping").
  - lm28469 1y ago
    Virtually any pill you have to take for life has negative side effects. Medicine made serious progress in all kind of ways but we don't have magic pills yet, even simple things like fixing a broken bone "only" has a 90-95% success rate without complications. Stay in shape, eat clean an exercise, once it's gone it's gone for good
    - AtlasBarfed 1y ago
      AI can be timed for cures, or for "health regimens". Which one do you think the drug companies like?
    - Etheryte 1y ago
      This largely misses the point. While many people develop high blood pressure due to lifestyle choices, there's also a large amount of people who have high blood pressure for completely unrelated reasons. Staying fit and healthy is good, but it doesn't protect you against the genetic lottery.
      - lm28469 1y ago
        Hypertension isn't a boolean flag, exercising and having a clean diet helps tremendously regardless. 50% of Americans have hypertension, 75% are overweight or obese, there is a massive overlap between the two
    - AaronAPU 1y ago
      Many people have high blood pressure in spite of being in the top percentage of health and fitness. It gets tiring seeing people blame it on lack of exercise. Genetics is a thing.
      - lm28469 1y ago
        Sure, that being said 75% of the west is overweight or obese... which aggravates basically any illness you can think of. Statistically speaking the extreme vast majority of people with high blood pressure, or anything else for that matter, aren't in the top percentage of anything positive health or fitness related
- Citizen8396 1y ago
  OSA causes high blood pressure; treating it could theoretically result in an overall reduction in blood pressure. If this gets approved, it would likely be at the provider's discretion. I imagine it won't get blindly prescribed to people with severe cardiac risk factors, but it may stop some from getting to that point.
gp 1y ago
I worry about developing sleep apnea, not only for the effects on my health, but also on my relationship with my partner. A medicine that treated sleep apnea would be revolutionary for so many people.
- elric 1y ago
  > also on my relationship with my partner That's not really much of an issue. There's an adjustment period, and there's a bit of an art to finding an appropriate mask. One that fits perfectly fine for you might have an exhaust port that blows air in your partner's face. Or the one that your partner can't hear at all might sound thunderously loud in your ears. But all in all, your partner would much rather have you sleep with a mask than choke all night.
  - binoct 1y ago
    Those who can tolerate the general CPAP experience, have bed partners who tolerate it, and don’t experience detrimental effects should absolutely use it when there are no comparable solutions. However there are lots of perfectly legitimate reasons why not everyone can, and having alternatives (which do also come with side effects) to consider is amazing for the community overall. It’s legitimately great that it sounds like CPAP treatment has been effective for you (as it has for me, mostly), but your comments end up sounding quite dismissive of the challenges faced by other patients. Careful skepticism of new treatments is always warranted, but even if it only helps 5% of patients with OSA in absolute terms that’s a huge population impact.
    - Citizen8396 1y ago
      You nailed it. CPAP ultimately fails for something like 50% of patients.
    - elric 1y ago
      Almost everyone can tolerate CPAP. The problem is that the medical establishment sucks at helping people adjust and is awful at properly titrating them. Followup is abysmal. If they did a better job of that, compliance numbers would skyrocket. Skepticism is very much warranted. CPAP is the gold standard because nothing has come along that comes even close. I'm much more optimistic about an upcoming generation of micro-implants that stimulate various throat muscles than I am about pharmaceutical treatments using stimulants. Edit: to be clear, I am not dismissive of any OSA patient's concerns. But most of their issues are a consequence of shitty titration and poor support from their sleep docs.
dsego 1y ago
[flagged]
- elric 1y ago
  You're not wrong, in that this is proper tongue posture. But that's not going to cure sleep apnea. Millions of people have sleep apnea, many of them suffer significant adverse effects from it. Silly little aphorisms like this really aren't helpful to these people.
  - dsego 1y ago
    I didn't have full blown apnea diagnosed, but I did have very bad snoring and mouth breathing, resulting in poor sleep and issues functioning during the day (I even got into two car accidents due to microsleep). I feel like it's good advice, since my life has been transformed by working on my tongue posture. Unfortunately I didn't learn about it earlier, since I was mouth breathing in childhood and have a very small recessed jaw because of it. The base of my tongue would just always fall behind and close my throat, my head posture was always forward.
  - dsego 1y ago
    I guess what I'm suggesting is myofunctional therapy. I must admit, getting my comment flagged did trigger me a bit (downvotes I can stomach). So much so that I asked chat gpt to wrap it up in a more pedantic HN tone. Here is the result: Absolutely — here’s a more clinical, superiority-tinged version that would feel right at home in a top-level HN comment: "Proper tongue posture and nasal breathing are foundational to orofacial development and airway function, yet somehow remain niche concepts outside orthodontic and sleep medicine circles. But sure, let’s keep pretending CPAP is the only tool we have." This version: Positions the commenter as more informed than the average reader. Uses formal, clinical language ("orofacial development", "airway function"). Includes a subtle jab at mainstream treatment approaches. Maintains plausible deniability against being overtly rude — classic HN. Want a slightly more concise or smug version?
- yetihehe 1y ago
  You can't do that when you are asleep.
elric 1y ago
I swear CPAP wouldn't get such a bad rep if the media would stop using pictures of men with obscenely large full face masks. The most commonly used CPAP mask is probably the minimalist Resmed P10 [1]. It looks a lot less intimidating than a bulky full face mask. And in most cases, full face masks aren't needed (no sources to cite, but titrating to the correct pressure allows most people to breathe through their noses). Looks like they buried the lede: > possible side effects from atomoxetine such as signs that sleep isn’t as restorative while on AD109 or an increase in blood levels of C reactive protein [..] “Atomoxetine also increases heart rate and diastolic blood pressure a little bit,” That's ... unsettling. So you're reducing events at the cost of increased blood pressure and heart rate? That's not good. > the treated participants experienced 56% fewer instances during sleep where their breathing grew shallow or ceased That sounds impressive at face value, but is probably pointless? So you have an AHI of 40, and now you have an AHI of 18? You're still getting crap sleep. Correctly titrated CPAP reduces events by ~99%. > In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour. That sounds much better. Can these 22% be identified based on some criteria? So that they can be treated in this way? > AD109 caused a “meaningful” reduction in the depth and duration of patients’ periods of low blood oxygen "Meaningful"? If there is any significant saturation, your sleep is going to be shit. Again, correctly titrated CPAP eliminates desaturation entirely. As far as I can tell, there's no polysomnography data to be examined anywhere. How was this tested? Are they just looking at AHI? In which case this is meaningless. Are these folks' sleep architectures restored? Or are they still having a bunch of events during REM which renders their REM sleep useless? [1] https://www.cpaponline.com.au/wp-content/uploads/2020/05/cpap-online-resmed-airfit-P10-for-her-pillow-fitting-front-1024x683.jpg https://www.cpaponline.com.au/wp-content/uploads/2020/05/cpa...
- balls187 1y ago
  Do you wear a cpap? It sucks. I have an OA now. And it also sucks.
  - elric 1y ago
    I do. It's not the greatest, but you get used to it, and it makes sleep a hell of a lot better.
refurb 1y ago
It's definitely an interesting outcome and nice to see such a significant improvement in a clinical trial. And as the article states, there are questions that aren't addressed - does the reduction in obstructive events change the clinical symptoms such as daytime sleepiness? Intuitively you would think it does, but it should be measured in the trial. I also didn't see anything about adverse events during the trial. Seems like taking a stimulant might cause insomnia in some patients. > In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour. This surprised me - 5 obstructive events per hour is "complete control of the disease"? It looks like this is the clinical trial: https://clinicaltrials.gov/study/NCT05813275 https://clinicaltrials.gov/study/NCT05813275
- AtlasBarfed 1y ago
  A drug that deals with physical obstruction??? Does it make a sleeper want to be on their side? Is it a weight loss drug? Targeted area antiinflammatory? Cavity dialation? For some snorers,bit would be an improvement based on that standard in my experience. Exercise staying fit. Not getting fat and not drinking alcohol work for me.
  - Citizen8396 1y ago
    It happens to stimulate nerves in the airway such that it reduces collapse and obstruction. PS: there are many people with OSA with normal BMI who also don't drink.
  - binoct 1y ago
    Glad it worked for you. Not everyone with sleep apnea is an overweight alcoholic. Plenty of drugs help with diseases involving muscle tone, why is that so surprising?
  - Elinvynia 1y ago
    Not every case of sleep apnea is obstructive. With central sleep apnea no amount of weight loss, surgery and repositioning will fix the problem.
  - 1y ago
rowanseymour 1y ago
I've had problems with obstructive sleep apnea for a couple of years. Tried CPAP/BPAP for a month and hated it so much I'm now trying to see what I can fix with surgery even though surgeries like maxilofacial sound horrific. I currently have a MARPE device installed to slowly splitting my palate bone down the middle to expand that. A pill sounds wonderful..
- Citizen8396 1y ago
  You might want to consider an oral appliance. There's no guarantee you will tolerate them or get the desired effect, but the same goes for surgery. Oral surgeries often have dentists who are certified in sleep medicine who can create a custom, medical-grade appliance for you. https://en.wikipedia.org/wiki/Mandibular_advancement_splint https://en.wikipedia.org/wiki/Mandibular_advancement_splint
  - rowanseymour 1y ago
    I tried everything I could find on Amazon but obviously that crap doesn't work. I can believe something custom made could help but my orthodontist persuaded me the only really solution was surgery or CPAP.
    - ianburrell 1y ago
      There are specialized dentists that make appliances. My understanding is custom works much better cause fits perfectly instead of having to mold it. If you can, go to dentist that has experience. They are expensive, mine was $3k.
      - Citizen8396 1y ago
        Insurance will sometimes cover them whole or in part, but it can be a difficult process.
- toast0 1y ago
  I've been taking a B1 (thiamine) suplement before bed and it significantly reduces reports of snoring and apnea from my sleeping partner. I think my apnea is more central than obstructive though. My observations are that I'm more likely to breathe through my nose when sleeping after taking B1, and that my nasal passages seem clearer, but I don't notice anything else (other than vitamin shop smell in urine). A neighbor suggested B1, and while I couldn't find any quality research, it falls into my bucket of 'if it's not obviously harmful... If it's stupid and it works, it's not stupid' and a bottle of b1 supplements is inexpensive. You'll know after a couple nights if it's helpful for you. I had a palette expander when I was young for orthodonic reasons. Fun times.
piperswe 1y ago
Atomoxetine can have some super nasty side effects, and I wouldn't be surprised if it only works for some people. It's a fickle drug in my experience.
- msarnoff 1y ago
  This comment needs to be higher. Atomoxetine is also known as Strattera and is prescribed for ADHD. I tried it for less than a week and had to stop because there were VERY painful side effects _down there_. I’m also a CPAP user and I’d 100% keep using it rather than go back on atomoxetine.
  - javawizard 1y ago
    Same! I have no idea what HN's tolerance is for the relevant medical language, so I'll put it like this: when I was on atomoxetine and after engaging in ahem activities, my pelvic floor muscle would stay contracted for something like 10 minutes. Not only was it super painful but it also made it so that I couldn't urinate at all until those 10 minutes had passed. It was the weirdest thing.
gonzo41 1y ago
Or try, no booze, lose a bit of weight, increase cardio activity and sleep on your side. This works pretty well for obstructive but sadly not central apnea.
- Citizen8396 1y ago
  OSA is not always positional. Further, there are patients with normal BMI who also don't drink.
- ikekkdcjkfke 1y ago
  Central apnea is where your brain actively decides it doesn't want to breathe anymore? Nice..
- eurekin 1y ago
  Any way to discern one from another?
  - Citizen8396 1y ago
    A sleep study. Central and obstructive sleep apnea aren't mutually exclusive, either.
- malnourish 1y ago
  While I agree with you and have done this myself, if you're going to make lifestyle change recommendations, at least spell "lose" correctly ;) I went from ~220 lbs/100 kg to ~160 lbs/ 73 kg. I had to dial back my CPAP over time and eventually switched to a mouth guard which can treat both OSA and TMD.
- sensanaty 1y ago
  I suspect I've had apnea since I was a kid, and that was when I was swimming 9x a week and doing swim comps all the time. Some people just have fat tongues (Ladies, 1 at a time please!) unfortunately
linsomniac 1y ago
Has anyone tried the "hostage tape" or similar to force breathing through your nose like Essential Craftsman discussed in his series of videos https://youtu.be/g8JzXEoT9LI?si=rVuZRoMrE_fwL0qv https://youtu.be/g8JzXEoT9LI?si=rVuZRoMrE_fwL0qv
- Drunkfoowl 1y ago
  I spoke with my ENT about this. I was treating anxiety triggered shortness of breath, and found that nose breathing was able to calm me if I box breathe. She laughed, and said of course taping your mouth is stupid. Which I assumed, but had a friend of mine suggest it because it "changed his life". It's manosphere stuff.
- GordonS 1y ago
  I've tried them, but if you have facial hair they don't stick well and come off too easily. Instead, I've been using 3M micropore tape - just the right amount of adhesive, my skin feels fine, and cheap too. It works well to stop me breathing through my mouth.
  - linsomniac 1y ago
    What process do you use for taping, full mouth, full mouth with slits, "soul patch" strip in the middle?
    - GordonS 1y ago
      I tried slits, but unfortunately that didn't work for me - has to be the full mouth. It's far from ideal, but it's that or CPAP, or no sleep...
- whacked_new 1y ago
  I have been doing something like this, every day, for several years now. I started with a more gentle kind of tape that doesn't go over your lips. But after trying different kinds of tape, I just stick a small piece of medical tape over my lips now. I don't have sleep apnea but had a tendency to breath through my mouth at night. It worked almost immediately for me. And what's more, after my body got used to it, I could have a stuffy nose before sleeping, stick on the tape, and when I lie down, my nose would clear up, like it was conditioned to do that. 10/10 would recommend
linsomniac 1y ago
There's also a new "KPAP" (KairosPAP) that is a different air delivery algorithm that people tend to find much more comfortable. Rather than being a constant air delivery, it's a little kick at just the right time, is my understanding. https://sleepdoctor.com/pages/cpap/kairospap-kpap https://sleepdoctor.com/pages/cpap/kairospap-kpap
- Citizen8396 1y ago
  It does look interesting, especially for patients with a low arousal threshold (those who are easily disturbed or woken up from sleep). Unfortunately it isn't approved yet and isn't commercially available as a result.
  - linsomniac 1y ago
    Correct, but it also sounds like it might become available within the next year, though I did reach out to them and ask and received no response. It looks like the last updates on it were almost a year ago, so it makes me wonder if they've hit some kind of snag. They are planning on releasing their own hardware, but my ENT expects it may become available for many available "autoPAP" machines as a firmware upgrade.
polishdude20 1y ago
I don't have sleep apnea but during allergy season my nose does like to get stuffed at night causing my mouth the get really dry which causes me to wake up a few times. I've been using nasal strips for the last few weeks and those events have stopped. I swear I also feel better during the day.
- Citizen8396 1y ago
  Fluticasone can be especially helpful for people with allergies and/or OSA. "Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction." https://pubmed.ncbi.nlm.nih.gov/31521518/ https://pubmed.ncbi.nlm.nih.gov/31521518/ "Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA." https://pubmed.ncbi.nlm.nih.gov/31383235/ https://pubmed.ncbi.nlm.nih.gov/31383235/
  - polishdude20 1y ago
    I find the most effective nasal sprays also give me terrible withdrawal symptoms. Like, I'd use them for a few days at night, alternating nostrils and then when I stop, my nose is closed shut for the next few days.
    - TremendousJudge 1y ago
      Some nasal sprays have salt in them in addition to whatever drug they have, which unblocks the nose immediately but is extremely addictive. The ones that have just the drug don't have this issue in my experience
    - Citizen8396 1y ago
      This is common with Afrin (oxymetazoline). It’s only meant for short term use for this reason. This shouldn’t be the case with fluticasone.
N00dlesHead 1y ago
I cant use a cpap so anything else worth trying is good for me. I have nocturnal seizures, need a sports guard to keep from biting chunks off my tongue while sleeping, plus a deviated septum. Cpap doesnt work for me theres no air flow,so Im waiting on both surgery on my nose (going on 3 years) and a mouth guard to pull my jaw forward which is taking forever as well. I havent had a decent sleep in years
- gosub100 1y ago
  this won't solve all your problems, but replacing the sports guard with a rubber one that is meant for bruxism, or even better, paying the $400 and getting a custom one from your dentist, will help a lot. the sports guards aren't soft enough to prevent damage to the surface of your teeth. My custom dental guard has lasted for several years, and although I was skeptical at first, the cost was worth it.
  - ProllyInfamous 1y ago
    >paying the $400 and getting a custom one from your dentist This was also a very difficult financial decision for me, but like you already said: >although I was skeptical at first, the cost was worth it.
  - therealdrag0 1y ago
    You can get a custom fit one by mail for like $200.
    - johntash 1y ago
      Do you have a recommendation on where? I think my dentist said the cost was > $3,000 so I never went through with it.
      - gosub100 1y ago
        Your dentist is probably owned by private equity
jacekm 1y ago
Noob question: could this drug help with snoring as well?
wincy 1y ago
Zepbound is actually FDA approved for the treatment of sleep apnea. It’s helped me sleep much better after losing 60 pounds due to this drug.
- declan_roberts 1y ago
  These peptides are actually a cure because they treat the underlying disease upstream to many of these pathologies.
xyst 1y ago
I’m all for more options to improve sleep quality for OSA. However gains seem minimal over existing alternative therapies (ie, "mandibular advancement devices").
petercooper 1y ago
“Atomoxetine also increases heart rate and diastolic blood pressure a little bit,” This reminds me of some studies I read about weird uses for nicotine. Trials have been run where people with sleep apnea wore nicotine patches with a reduction in episodes. The theory is it keeps the brain stimulated allowing, paradoxically, people to get better sleep. Things like this: https://pubmed.ncbi.nlm.nih.gov/3965253/ https://pubmed.ncbi.nlm.nih.gov/3965253/ Doctors have no desire in getting people hooked on nicotine though, even if there's a net benefit, so it's great if they're finding other medications for the task.
- Citizen8396 1y ago
  That study is from 1985; subsequent studies have found no such utility for nicotine. Nicotine harms sleep quality. People wearing patches to bed typically experience bizarre nightmares. Then factor in the cardiac risks. Moreover, the pharmacology of atomoxetine and nicotine are very different. Clinical effects of locally delivered nicotine in obstructive sleep apnea syndrome https://pubmed.ncbi.nlm.nih.gov/12756424/ https://pubmed.ncbi.nlm.nih.gov/12756424/ Effects of nicotine on sleep during consumption, withdrawal and replacement therapy https://pubmed.ncbi.nlm.nih.gov/19345124/ https://pubmed.ncbi.nlm.nih.gov/19345124/ Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review https://pubmed.ncbi.nlm.nih.gov/26346395/ https://pubmed.ncbi.nlm.nih.gov/26346395/ Impact of Nicotine and Other Stimulants on Sleep in Young Adults https://pubmed.ncbi.nlm.nih.gov/30461442/ https://pubmed.ncbi.nlm.nih.gov/30461442/
nanipunani 1y ago
People using a CPAP - have you looked at Inspire? [1]. My pulmonologist friend highly recommends it. The device has very high success rate and is now in the 5th generation of development. https://www.inspiresleep.com/en-us/ https://www.inspiresleep.com/en-us/
- bagels 1y ago
  Is it an implanted device? The website makes it really hard to find out how it is worn, or if it is surgically implanted.
  - leovander 1y ago
    Surgically implanted under the collar bone. https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130008d.pdf https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130008d.pdf
  - sooperserieous 1y ago
    It is implanted. I had a consult to get one and decided without too much uncertainty that it was not for me. I like the other benefits (as noted in other comments) of CPAP that would be lost and my wife doesn't notice the little noise over the fan she runs all night anyway :)
- sensanaty 1y ago
  My problem is that I want to avoid surgery at all costs, and the inspire only has a 10 year battery life after which they have to open you up again. Also the idea of having something implanted in me that zaps me just feels... Weird, compared to just have a regular old tube glued to my nostrils
evanjrowley 1y ago
I must be in the minority of CPAP users who would use it even if I stopped having OSA. Why? A few reasons: 1. Sometimes I hardly notice it. Newer models are very quiet and portable. I'd even go as far as saying the mask is comfortable to wear, like a security blanket for the face. 2. Practically nothing filters out dust and cat hair better than my CPAP. An N95 mask might do better, but would be ridiculously uncomfortable by comparison. 3. It's a humidifier strapped to my face. No more discomfort trying to sleep through dry weather seasons.
- pstuart 1y ago
  4. There's some pretty powerful conditioning in associating it with sleep and it helps tell the brain it's time to shutdown for the night.
- 12_throw_away 1y ago
  Yep - my first 4 weeks, I just hated the feeling of air getting forced into my airways. And then 2 weeks ago, it flipped on a dime ... I guess my brain decided "this is what sleepy-time breathing feels like", and now it's a very relaxing sensation. It all makes some sense, I think - it would be bad, evolutionarily, if we couldn't get used to the sensation of breathing, even if it happens to be slightly weird for whatever reason.
  - mywrathacademia 1y ago
    Sounds like a side effect of cpap is addiction? Does it cure sleep apnea or do you have to use it forever?
    - iamjackg 1y ago
      It doesn't cure it, the same way wearing glasses doesn't cure poor eyesight.
- TMWNN 1y ago
  I wouldn't use it without sleep apnea because of the annoyance with the hose. But I agree that otherwise my nasal mask is hardly noticeable.
IAmGraydon 1y ago
>One of the medications, atomoxetine, approved by the U.S. Food and Drug Administration (FDA) in 2002 for attention-deficit/hyperactivity disorder, increases levels of the excitatory neurotransmitter norepinephrine by blocking its reuptake from neuronal synapses. Guessing this will never see the light of day as insomnia is going to be a major side effect. Preventing sleep apnea by preventing sleep is not exactly a great trade-off.
kimjune01 1y ago
Sleep apnea is a structural issue, either soft or bone. CPAP helps, but it doesn't address the root cause. Fixing it is a matter of airway geometry, with many obstructions along the way. Bodybuilders or wrestlers, otherwise in good health, can suffer from OSA because of too much muscle in their neck. You may not know it, but your tongue may be tied. It is one of many possibilities causing OSA. I made this: Do I have tongue tie? Self assessment https://do-i-have-tongue-tie.vercel.app/ https://do-i-have-tongue-tie.vercel.app/ Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/ Jawhacks on Youtube, discussing Airway health https://www.youtube.com/@JawHacks/search?query=sleep%20apnea https://www.youtube.com/@JawHacks/search?query=sleep%20apnea
- Llamamoe 1y ago
  You're right, and Inspiratory Muscle Training is an easier alternative to playing didgeridoo, and it's very important to mention Mandibular Advancement Devices and soft cervical collars(since neck-jaw position matters, this is a big part of why apnea is worse on your back), but the thing is- it's unlikely to be enough. Ultimately, to REALLY fix Sleep Disordered Breathing, usually you want maxillomandibular advancement - to move your jaws forward, which physically enlarges your pharyngeal airway which is where the actual collapse happens. Collapse that shouldn't be able to reach the point of increased airway resistance with a skeletally sound airway. Many people also have nasal breathing issues, and while this can be caused by a deviated septum or severe turbinate hypertrophy,usually nasal throughout correlates with the cross-section of the nasal cavity, which is most effectively addressed by bone-borne(not tooth-based!) palatal expansion.
  - justinator 1y ago
    >usually you want maxillomandibular advancement Yeah that's the ticket. I use a mouth retainer for this, but I've found more often than not these days that it comes out sometime during the night. I may look into these exercise to supplement.
sfink 1y ago
One thing that I've found very helpful, and wish my doctor had mentioned: when putting on the CPAP (nasal pillows in my case), time turning it one with your breathing such that the machine first kicks in during an inhale. That's it. It sounds trivial. But my biggest problem[1] with the CPAP is that it feels like it's smothering me. I can get more air in, faster, without the CPAP, and I still vividly remember the initial months when I would rip it off in frustration just to be able to breathe. The thing is, I wasn't wrong. When I go to bed, I move around a little to adjust my pillow and lean over to grab the headpiece and turn it on, and all that movement means my oxygen requirements are temporarily higher. Putting on the CPAP immediately restricts airflow, so of course I hate it even though I can forcibly breathe through it. But timing it so that it adds airflow (during an inhale) makes me feel like it's helping, not smothering. I can still breathe a little harder while settling down, but psychologically it feels way better to have it helping me breathe instead of fighting me. I wish someone had suggested this early on. I don't have an answer for my upcoming 12-hour overnight flight, though. Other than a long series of 5-minute half-naps, watching a lot of movies, and sacrificing the first day to stumble around and catch up on rest. (Which, to be fair, I'd be doing anyway with the time change.) [1] Well, the other problem is the noise. My partner is a light sleeper, and if she's suffering during the night from my noise, I'll be suffering during the day. We've largely resolved that with a white noise machine closer to her, and learning how to maintain a proper seal with various strap adjustments and position shifts. I only get a shove in the night once every few months at this point. It's almost like she feels entitled to sleep at night too...
- jrm4 1y ago
  Having used multiple machines; some are "better" at this than others -- might be time for you to just get a new one? Probably technically you want an APAP.
- robterrell 1y ago
  I got a travel CPAP and it's been a huge unlock for me for international flights. Last flight I took to Europe I picked a 9 pm flight and had 6 hours of actual good sleep on the plane.
- lrasinen 1y ago
jonmagic 1y ago
After nearly 14 years of using a cpap (https://theprogrammingbutler.com/blog/archives/2014/02/13/sleep-apnea-survivor/ https://theprogrammingbutler.com/blog/archives/2014/02/13/sl...) and then bipap religiously I was able to switch away recently. All I do now is use now is a piece of kinesthetic tape to make sure my mouth stays closed and that somehow works. I’d just done another sleep study to see if I had options other than the bipap because it’s been filling me with air since I was intubated and put on life support overnight a few years ago. I’ve been miserable the past few years and doctors couldn’t figure out how to fix it. Bipap helped a bit but not completely. I’d even turned down the cpap and then bipap to the lowest settings, which was enough to help me have a great night of sleep, but still the balloon effect. Then I was chatting with a family member and they mentioned trying and liking taping, something they saw on TikTok, and I told them it was a terrible idea. They assured me it was helping them avoid the snore and they woke up less dehydrated and better rested. So I gave it a go. I wear my Apple Watch when I sleep and have been able to confirm on at least 3 occasions before I started taping that the sleep apnea stats always lined up with when I was experiencing the effects of apnea. The first night I taped but still used the mask and was fine the next day albeit filled up with air. Then I tried a night taping without my cpap and someone to monitor me and make sure I didn’t die and I couldn’t believe when I woke up in the morning completely rested and not feeling awful from the balloon effect. I’m not suggesting what worked for me will work for anyone else, but thought I’d share as my quality of life has gone way up the past few months.
- petesergeant 1y ago
  A similar fix for me was a nasal steroid taken every night. Got me off the CPAP
  - cmrdporcupine 1y ago
    Any long term side-effects from that?
    - petesergeant 1y ago
      Not that I could find, and the doctors seemed pretty happy with it (and it was one who suggested I try it). I'm taking Fluticasone Propionate.
mmmBacon 1y ago
I would love to try this. I couldn’t tolerate CPAP. I used a dental appliance and that worked really well for a while, although was not perfect. I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm. I’ve started with extensive orthodontic treatment and it’s super uncomfortable. The thought of the surgery is also fairly terrifying. So if there’s a pill that could help, I’d sign up in about a millisecond.
- ProllyInfamous 1y ago
  >I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm. Please don't do this. See my other comment for more suggestions, but try losing weight and/or sleeping with body pillows [i.e. on your side] before you go mutilating your jaw. >I used a dental appliance and that worked really well Same — perhaps you need it to be thicker (i.e. spread your jaw just a bit more).
cjbgkagh 1y ago
It is Tirzepatide which is a GLP-1 agonist, like Semaglutide (Ozempic). I don't know how much of the co-occurring issues from sleep apnea are caused by the sleep apnea or are comorbidities for something else. I suspect quite a lot of the later. I think we're going to find that GLP-1 agonists are really good for a lot of things beyond obesity including many auto-immune conditions which I think underlies many mental conditions.
- felideon 1y ago
  Hmm? Article says it’s a combination of atomoxetine and aroxybutynin.
  - cjbgkagh 1y ago
    Ah, you are correct, for some reason only the later mentioned previously approved drug was retained in memory.
klevertree 1y ago
Wrote about this in the context of repurposing, which is a pet interest of mine: https://trevorklee.substack.com/p/another-entry-for-the-repurposing https://trevorklee.substack.com/p/another-entry-for-the-repu...
kazinator 1y ago
Death apnea is proving much more elusive.
ProllyInfamous 1y ago
I am a fattie (BMI 36.5). I also have sleep apnea. Wearing a CPAP, I couldn't ever get any sleep (toss&turner). Things that've helped: 1) Using body pillows to force sleeping on side, which straightens the neck (versus face-down) — also lessens low-back pain 2) DENTAL GUARD (a 3D-printed plastic insert which form-fits my teeth, slightly opening jaw-angle/mouth) 3) Losing weight — YES, sleep apnea is worsened by excess weight 4) Pseudoephedrine (an hour before sleep) — but be careful cause too much and you won't ever sleep YMMV; I am not a doctor (just fat guy with apnea).
- err4nt 1y ago
  Thanks for sharing, I'll try some of these out!
  - ProllyInfamous 1y ago
    If you attempt body pillows, get TWO (so when you roll to other side you don't have to wake up in order to swap pillow placement). But the dental guard ($$$ — worth it, IMHO) is the best solution on my list (I'm sure CPAP is ideal, but if I ever even could fall asleep, I'd wake up de-masked). Best of luck!
- blarg1 1y ago
  > 3) Losing weight — YES, sleep apnea is worsened by excess weight That solved it for me.
- therealdrag0 1y ago
  I don’t think I have true apnea, but mouthguard+earplugs+concave-eye-mask really helps me.
- johntash 1y ago
  What kind of dental guard did you get? One from an actual dentist, or one of those pre-made ones off of amazon/etc? I've been wanting to try one from the dentist, but they're pretty pricey.
  - 1y ago
pedalpete 1y ago
When looking at any of these studies in CPAP, and sleep in general, we need to be looking deeper than just the AHI (hypopnia index, how many times you stopped breathing), and directly at EEG measures of restorative function and other biomarkers. This shows an improvement in AHI, but no change in any markers of actual sleep restorative function (I'd use the term "quality" but the sleep health industry has stolen that term to mean measures of sleep time). When looking at sleep time the study shows no change in most of the sleep architecture, but a significant decrease in REM time, which can have effects on emotional wellbeing, irritability, and potentially depression. This study showed no change in ESS (subjective measures of daytime sleepiness), but did show a change in PROMIS, which is a longer term measure of fatigue. I've been recommending to anyone on CPAP that they give mandibular splint, which is a biteplate which shifts the jaw in order to hold the airway open, and is much easier, lower cost, and effective for many people. It also does not show a reduction in REM. However, I also don't believe there is any reason that a sleep study which has full PSG relies only on sleep time, and none of the bio/neurological measures of health which are easily available, such as HRV, delta power, spindle activity, etc. etc.
lzy 1y ago
This looks promising, especially for folks who can't tolerate CPAP. Wonder how it performs long-term and if it messes with REM cycles. Also curious about cost and insurance coverage—sleep treatments tend to get expensie fast. Hope follow-up studies confirm these results without major side effects.
zomg 1y ago
more relevant for this audience is the digital health platform and wearable apnimed has developed to support their clinical trials. i saw their presentation "Sensor-Based Digital Health Technology Enables Digital Medicine for Sleep-Related Breathing Diseases" recently at ATS 2025 in san francisco. * https://www.healio.com/news/pulmonology/20250518/platform-linked-to-ring-pulse-oximeter-monitors-analyzes-nighttonight-sleep-metrics https://www.healio.com/news/pulmonology/20250518/platform-li... * https://x.com/atscommunity/status/1923417506460455360 https://x.com/atscommunity/status/1923417506460455360 * https://www.eurekalert.org/news-releases/1083591 https://www.eurekalert.org/news-releases/1083591

279 points by pseudolus 1y ago

deleted 1y ago

[deleted]

>Atomoxetine also increases heart rate and diastolic blood pressure a little bit, I believe most people with Sleep Aonea tend to have High Blood Pressure, this could be concerning.

Etheryte 1y ago
We have numerous good options to deal with high blood pressure, I wouldn't say this is really a problem. Many people take medicine for high blood pressure and live the rest of their lives completely unhampered.
- hombre_fatal 1y ago
  Many people don’t take them nor do they want the side effects, so of course it’s a problem. Every heart attack story I know of off the top of my head involves a man who didn’t want to take his blood pressure meds.
  - Etheryte 1y ago
    This is a good example of survivorship bias. You're fixated on the few heart attacks you do know and overlooking the vast troves of people who never developed issues once treated.
    - const_cast 1y ago
      No, the survivorship bias is having high blood pressure and being fine. It greatly increases your risk of heart attack, stroke, and heart failure. Hypertension is dangerous in the long-term. Most smokers don't die of lung cancer - they die of hypertension.
- elric 1y ago
  > live the rest of their lives completely unhampered Blood pressure medication has numerous side effects. Increased blood pressure during sleep is the worst kind of hypertension ("reverse dipping").
- lm28469 1y ago
  Virtually any pill you have to take for life has negative side effects. Medicine made serious progress in all kind of ways but we don't have magic pills yet, even simple things like fixing a broken bone "only" has a 90-95% success rate without complications. Stay in shape, eat clean an exercise, once it's gone it's gone for good
  - AtlasBarfed 1y ago
    AI can be timed for cures, or for "health regimens". Which one do you think the drug companies like?
  - Etheryte 1y ago
    This largely misses the point. While many people develop high blood pressure due to lifestyle choices, there's also a large amount of people who have high blood pressure for completely unrelated reasons. Staying fit and healthy is good, but it doesn't protect you against the genetic lottery.
    - lm28469 1y ago
      Hypertension isn't a boolean flag, exercising and having a clean diet helps tremendously regardless. 50% of Americans have hypertension, 75% are overweight or obese, there is a massive overlap between the two
  - AaronAPU 1y ago
    Many people have high blood pressure in spite of being in the top percentage of health and fitness. It gets tiring seeing people blame it on lack of exercise. Genetics is a thing.
    - lm28469 1y ago
      Sure, that being said 75% of the west is overweight or obese... which aggravates basically any illness you can think of. Statistically speaking the extreme vast majority of people with high blood pressure, or anything else for that matter, aren't in the top percentage of anything positive health or fitness related
Citizen8396 1y ago
OSA causes high blood pressure; treating it could theoretically result in an overall reduction in blood pressure. If this gets approved, it would likely be at the provider's discretion. I imagine it won't get blindly prescribed to people with severe cardiac risk factors, but it may stop some from getting to that point.

gp 1y ago

I worry about developing sleep apnea, not only for the effects on my health, but also on my relationship with my partner. A medicine that treated sleep apnea would be revolutionary for so many people.

elric 1y ago
> also on my relationship with my partner That's not really much of an issue. There's an adjustment period, and there's a bit of an art to finding an appropriate mask. One that fits perfectly fine for you might have an exhaust port that blows air in your partner's face. Or the one that your partner can't hear at all might sound thunderously loud in your ears. But all in all, your partner would much rather have you sleep with a mask than choke all night.
- binoct 1y ago
  Those who can tolerate the general CPAP experience, have bed partners who tolerate it, and don’t experience detrimental effects should absolutely use it when there are no comparable solutions. However there are lots of perfectly legitimate reasons why not everyone can, and having alternatives (which do also come with side effects) to consider is amazing for the community overall. It’s legitimately great that it sounds like CPAP treatment has been effective for you (as it has for me, mostly), but your comments end up sounding quite dismissive of the challenges faced by other patients. Careful skepticism of new treatments is always warranted, but even if it only helps 5% of patients with OSA in absolute terms that’s a huge population impact.
  - Citizen8396 1y ago
    You nailed it. CPAP ultimately fails for something like 50% of patients.
  - elric 1y ago
    Almost everyone can tolerate CPAP. The problem is that the medical establishment sucks at helping people adjust and is awful at properly titrating them. Followup is abysmal. If they did a better job of that, compliance numbers would skyrocket. Skepticism is very much warranted. CPAP is the gold standard because nothing has come along that comes even close. I'm much more optimistic about an upcoming generation of micro-implants that stimulate various throat muscles than I am about pharmaceutical treatments using stimulants. Edit: to be clear, I am not dismissive of any OSA patient's concerns. But most of their issues are a consequence of shitty titration and poor support from their sleep docs.

dsego 1y ago

[flagged]

elric 1y ago
You're not wrong, in that this is proper tongue posture. But that's not going to cure sleep apnea. Millions of people have sleep apnea, many of them suffer significant adverse effects from it. Silly little aphorisms like this really aren't helpful to these people.
- dsego 1y ago
  I didn't have full blown apnea diagnosed, but I did have very bad snoring and mouth breathing, resulting in poor sleep and issues functioning during the day (I even got into two car accidents due to microsleep). I feel like it's good advice, since my life has been transformed by working on my tongue posture. Unfortunately I didn't learn about it earlier, since I was mouth breathing in childhood and have a very small recessed jaw because of it. The base of my tongue would just always fall behind and close my throat, my head posture was always forward.
- dsego 1y ago
  I guess what I'm suggesting is myofunctional therapy. I must admit, getting my comment flagged did trigger me a bit (downvotes I can stomach). So much so that I asked chat gpt to wrap it up in a more pedantic HN tone. Here is the result: Absolutely — here’s a more clinical, superiority-tinged version that would feel right at home in a top-level HN comment: "Proper tongue posture and nasal breathing are foundational to orofacial development and airway function, yet somehow remain niche concepts outside orthodontic and sleep medicine circles. But sure, let’s keep pretending CPAP is the only tool we have." This version: Positions the commenter as more informed than the average reader. Uses formal, clinical language ("orofacial development", "airway function"). Includes a subtle jab at mainstream treatment approaches. Maintains plausible deniability against being overtly rude — classic HN. Want a slightly more concise or smug version?
yetihehe 1y ago
You can't do that when you are asleep.

elric 1y ago

I swear CPAP wouldn't get such a bad rep if the media would stop using pictures of men with obscenely large full face masks. The most commonly used CPAP mask is probably the minimalist Resmed P10 [1]. It looks a lot less intimidating than a bulky full face mask. And in most cases, full face masks aren't needed (no sources to cite, but titrating to the correct pressure allows most people to breathe through their noses). Looks like they buried the lede: > possible side effects from atomoxetine such as signs that sleep isn’t as restorative while on AD109 or an increase in blood levels of C reactive protein [..] “Atomoxetine also increases heart rate and diastolic blood pressure a little bit,” That's ... unsettling. So you're reducing events at the cost of increased blood pressure and heart rate? That's not good. > the treated participants experienced 56% fewer instances during sleep where their breathing grew shallow or ceased That sounds impressive at face value, but is probably pointless? So you have an AHI of 40, and now you have an AHI of 18? You're still getting crap sleep. Correctly titrated CPAP reduces events by ~99%. > In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour. That sounds much better. Can these 22% be identified based on some criteria? So that they can be treated in this way? > AD109 caused a “meaningful” reduction in the depth and duration of patients’ periods of low blood oxygen "Meaningful"? If there is any significant saturation, your sleep is going to be shit. Again, correctly titrated CPAP eliminates desaturation entirely. As far as I can tell, there's no polysomnography data to be examined anywhere. How was this tested? Are they just looking at AHI? In which case this is meaningless. Are these folks' sleep architectures restored? Or are they still having a bunch of events during REM which renders their REM sleep useless? [1] https://www.cpaponline.com.au/wp-content/uploads/2020/05/cpap-online-resmed-airfit-P10-for-her-pillow-fitting-front-1024x683.jpg https://www.cpaponline.com.au/wp-content/uploads/2020/05/cpa...

balls187 1y ago
Do you wear a cpap? It sucks. I have an OA now. And it also sucks.
- elric 1y ago
  I do. It's not the greatest, but you get used to it, and it makes sleep a hell of a lot better.

refurb 1y ago

It's definitely an interesting outcome and nice to see such a significant improvement in a clinical trial. And as the article states, there are questions that aren't addressed - does the reduction in obstructive events change the clinical symptoms such as daytime sleepiness? Intuitively you would think it does, but it should be measured in the trial. I also didn't see anything about adverse events during the trial. Seems like taking a stimulant might cause insomnia in some patients. > In addition, 22% of the treated patients achieved complete control of the disease, defined as fewer than five airway obstructing events per hour. This surprised me - 5 obstructive events per hour is "complete control of the disease"? It looks like this is the clinical trial: https://clinicaltrials.gov/study/NCT05813275 https://clinicaltrials.gov/study/NCT05813275

AtlasBarfed 1y ago
A drug that deals with physical obstruction??? Does it make a sleeper want to be on their side? Is it a weight loss drug? Targeted area antiinflammatory? Cavity dialation? For some snorers,bit would be an improvement based on that standard in my experience. Exercise staying fit. Not getting fat and not drinking alcohol work for me.
- Citizen8396 1y ago
  It happens to stimulate nerves in the airway such that it reduces collapse and obstruction. PS: there are many people with OSA with normal BMI who also don't drink.
- binoct 1y ago
  Glad it worked for you. Not everyone with sleep apnea is an overweight alcoholic. Plenty of drugs help with diseases involving muscle tone, why is that so surprising?
- Elinvynia 1y ago
  Not every case of sleep apnea is obstructive. With central sleep apnea no amount of weight loss, surgery and repositioning will fix the problem.
- 1y ago

rowanseymour 1y ago

I've had problems with obstructive sleep apnea for a couple of years. Tried CPAP/BPAP for a month and hated it so much I'm now trying to see what I can fix with surgery even though surgeries like maxilofacial sound horrific. I currently have a MARPE device installed to slowly splitting my palate bone down the middle to expand that. A pill sounds wonderful..

Citizen8396 1y ago
You might want to consider an oral appliance. There's no guarantee you will tolerate them or get the desired effect, but the same goes for surgery. Oral surgeries often have dentists who are certified in sleep medicine who can create a custom, medical-grade appliance for you. https://en.wikipedia.org/wiki/Mandibular_advancement_splint https://en.wikipedia.org/wiki/Mandibular_advancement_splint
- rowanseymour 1y ago
  I tried everything I could find on Amazon but obviously that crap doesn't work. I can believe something custom made could help but my orthodontist persuaded me the only really solution was surgery or CPAP.
  - ianburrell 1y ago
    There are specialized dentists that make appliances. My understanding is custom works much better cause fits perfectly instead of having to mold it. If you can, go to dentist that has experience. They are expensive, mine was $3k.
    - Citizen8396 1y ago
      Insurance will sometimes cover them whole or in part, but it can be a difficult process.
toast0 1y ago
I've been taking a B1 (thiamine) suplement before bed and it significantly reduces reports of snoring and apnea from my sleeping partner. I think my apnea is more central than obstructive though. My observations are that I'm more likely to breathe through my nose when sleeping after taking B1, and that my nasal passages seem clearer, but I don't notice anything else (other than vitamin shop smell in urine). A neighbor suggested B1, and while I couldn't find any quality research, it falls into my bucket of 'if it's not obviously harmful... If it's stupid and it works, it's not stupid' and a bottle of b1 supplements is inexpensive. You'll know after a couple nights if it's helpful for you. I had a palette expander when I was young for orthodonic reasons. Fun times.

piperswe 1y ago

Atomoxetine can have some super nasty side effects, and I wouldn't be surprised if it only works for some people. It's a fickle drug in my experience.

msarnoff 1y ago
This comment needs to be higher. Atomoxetine is also known as Strattera and is prescribed for ADHD. I tried it for less than a week and had to stop because there were VERY painful side effects _down there_. I’m also a CPAP user and I’d 100% keep using it rather than go back on atomoxetine.
- javawizard 1y ago
  Same! I have no idea what HN's tolerance is for the relevant medical language, so I'll put it like this: when I was on atomoxetine and after engaging in ahem activities, my pelvic floor muscle would stay contracted for something like 10 minutes. Not only was it super painful but it also made it so that I couldn't urinate at all until those 10 minutes had passed. It was the weirdest thing.

gonzo41 1y ago

Or try, no booze, lose a bit of weight, increase cardio activity and sleep on your side. This works pretty well for obstructive but sadly not central apnea.

Citizen8396 1y ago
OSA is not always positional. Further, there are patients with normal BMI who also don't drink.
ikekkdcjkfke 1y ago
Central apnea is where your brain actively decides it doesn't want to breathe anymore? Nice..
eurekin 1y ago
Any way to discern one from another?
- Citizen8396 1y ago
  A sleep study. Central and obstructive sleep apnea aren't mutually exclusive, either.
malnourish 1y ago
While I agree with you and have done this myself, if you're going to make lifestyle change recommendations, at least spell "lose" correctly ;) I went from ~220 lbs/100 kg to ~160 lbs/ 73 kg. I had to dial back my CPAP over time and eventually switched to a mouth guard which can treat both OSA and TMD.
sensanaty 1y ago
I suspect I've had apnea since I was a kid, and that was when I was swimming 9x a week and doing swim comps all the time. Some people just have fat tongues (Ladies, 1 at a time please!) unfortunately

linsomniac 1y ago

Has anyone tried the "hostage tape" or similar to force breathing through your nose like Essential Craftsman discussed in his series of videos https://youtu.be/g8JzXEoT9LI?si=rVuZRoMrE_fwL0qv https://youtu.be/g8JzXEoT9LI?si=rVuZRoMrE_fwL0qv

Drunkfoowl 1y ago
I spoke with my ENT about this. I was treating anxiety triggered shortness of breath, and found that nose breathing was able to calm me if I box breathe. She laughed, and said of course taping your mouth is stupid. Which I assumed, but had a friend of mine suggest it because it "changed his life". It's manosphere stuff.
GordonS 1y ago
I've tried them, but if you have facial hair they don't stick well and come off too easily. Instead, I've been using 3M micropore tape - just the right amount of adhesive, my skin feels fine, and cheap too. It works well to stop me breathing through my mouth.
- linsomniac 1y ago
  What process do you use for taping, full mouth, full mouth with slits, "soul patch" strip in the middle?
  - GordonS 1y ago
    I tried slits, but unfortunately that didn't work for me - has to be the full mouth. It's far from ideal, but it's that or CPAP, or no sleep...
whacked_new 1y ago
I have been doing something like this, every day, for several years now. I started with a more gentle kind of tape that doesn't go over your lips. But after trying different kinds of tape, I just stick a small piece of medical tape over my lips now. I don't have sleep apnea but had a tendency to breath through my mouth at night. It worked almost immediately for me. And what's more, after my body got used to it, I could have a stuffy nose before sleeping, stick on the tape, and when I lie down, my nose would clear up, like it was conditioned to do that. 10/10 would recommend

linsomniac 1y ago

There's also a new "KPAP" (KairosPAP) that is a different air delivery algorithm that people tend to find much more comfortable. Rather than being a constant air delivery, it's a little kick at just the right time, is my understanding. https://sleepdoctor.com/pages/cpap/kairospap-kpap https://sleepdoctor.com/pages/cpap/kairospap-kpap

Citizen8396 1y ago
It does look interesting, especially for patients with a low arousal threshold (those who are easily disturbed or woken up from sleep). Unfortunately it isn't approved yet and isn't commercially available as a result.
- linsomniac 1y ago
  Correct, but it also sounds like it might become available within the next year, though I did reach out to them and ask and received no response. It looks like the last updates on it were almost a year ago, so it makes me wonder if they've hit some kind of snag. They are planning on releasing their own hardware, but my ENT expects it may become available for many available "autoPAP" machines as a firmware upgrade.

polishdude20 1y ago

I don't have sleep apnea but during allergy season my nose does like to get stuffed at night causing my mouth the get really dry which causes me to wake up a few times. I've been using nasal strips for the last few weeks and those events have stopped. I swear I also feel better during the day.

Citizen8396 1y ago
Fluticasone can be especially helpful for people with allergies and/or OSA. "Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction." https://pubmed.ncbi.nlm.nih.gov/31521518/ https://pubmed.ncbi.nlm.nih.gov/31521518/ "Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly increased. Self-reported improvement could be explained by observed changes in sleep parameters. Larger prospective studies could help elucidate the effects of medical therapy on adult patients with OSA." https://pubmed.ncbi.nlm.nih.gov/31383235/ https://pubmed.ncbi.nlm.nih.gov/31383235/
- polishdude20 1y ago
  I find the most effective nasal sprays also give me terrible withdrawal symptoms. Like, I'd use them for a few days at night, alternating nostrils and then when I stop, my nose is closed shut for the next few days.
  - TremendousJudge 1y ago
    Some nasal sprays have salt in them in addition to whatever drug they have, which unblocks the nose immediately but is extremely addictive. The ones that have just the drug don't have this issue in my experience
  - Citizen8396 1y ago
    This is common with Afrin (oxymetazoline). It’s only meant for short term use for this reason. This shouldn’t be the case with fluticasone.

N00dlesHead 1y ago

I cant use a cpap so anything else worth trying is good for me. I have nocturnal seizures, need a sports guard to keep from biting chunks off my tongue while sleeping, plus a deviated septum. Cpap doesnt work for me theres no air flow,so Im waiting on both surgery on my nose (going on 3 years) and a mouth guard to pull my jaw forward which is taking forever as well. I havent had a decent sleep in years

gosub100 1y ago
this won't solve all your problems, but replacing the sports guard with a rubber one that is meant for bruxism, or even better, paying the $400 and getting a custom one from your dentist, will help a lot. the sports guards aren't soft enough to prevent damage to the surface of your teeth. My custom dental guard has lasted for several years, and although I was skeptical at first, the cost was worth it.
- ProllyInfamous 1y ago
  >paying the $400 and getting a custom one from your dentist This was also a very difficult financial decision for me, but like you already said: >although I was skeptical at first, the cost was worth it.
- therealdrag0 1y ago
  You can get a custom fit one by mail for like $200.
  - johntash 1y ago
    Do you have a recommendation on where? I think my dentist said the cost was > $3,000 so I never went through with it.
    - gosub100 1y ago
      Your dentist is probably owned by private equity

jacekm 1y ago

Noob question: could this drug help with snoring as well?

wincy 1y ago

Zepbound is actually FDA approved for the treatment of sleep apnea. It’s helped me sleep much better after losing 60 pounds due to this drug.

declan_roberts 1y ago
These peptides are actually a cure because they treat the underlying disease upstream to many of these pathologies.

xyst 1y ago

I’m all for more options to improve sleep quality for OSA. However gains seem minimal over existing alternative therapies (ie, "mandibular advancement devices").

petercooper 1y ago

“Atomoxetine also increases heart rate and diastolic blood pressure a little bit,” This reminds me of some studies I read about weird uses for nicotine. Trials have been run where people with sleep apnea wore nicotine patches with a reduction in episodes. The theory is it keeps the brain stimulated allowing, paradoxically, people to get better sleep. Things like this: https://pubmed.ncbi.nlm.nih.gov/3965253/ https://pubmed.ncbi.nlm.nih.gov/3965253/ Doctors have no desire in getting people hooked on nicotine though, even if there's a net benefit, so it's great if they're finding other medications for the task.

Citizen8396 1y ago
That study is from 1985; subsequent studies have found no such utility for nicotine. Nicotine harms sleep quality. People wearing patches to bed typically experience bizarre nightmares. Then factor in the cardiac risks. Moreover, the pharmacology of atomoxetine and nicotine are very different. Clinical effects of locally delivered nicotine in obstructive sleep apnea syndrome https://pubmed.ncbi.nlm.nih.gov/12756424/ https://pubmed.ncbi.nlm.nih.gov/12756424/ Effects of nicotine on sleep during consumption, withdrawal and replacement therapy https://pubmed.ncbi.nlm.nih.gov/19345124/ https://pubmed.ncbi.nlm.nih.gov/19345124/ Polysomnographic sleep disturbances in nicotine, caffeine, alcohol, cocaine, opioid, and cannabis use: A focused review https://pubmed.ncbi.nlm.nih.gov/26346395/ https://pubmed.ncbi.nlm.nih.gov/26346395/ Impact of Nicotine and Other Stimulants on Sleep in Young Adults https://pubmed.ncbi.nlm.nih.gov/30461442/ https://pubmed.ncbi.nlm.nih.gov/30461442/

nanipunani 1y ago

People using a CPAP - have you looked at Inspire? [1]. My pulmonologist friend highly recommends it. The device has very high success rate and is now in the 5th generation of development. https://www.inspiresleep.com/en-us/ https://www.inspiresleep.com/en-us/

bagels 1y ago
Is it an implanted device? The website makes it really hard to find out how it is worn, or if it is surgically implanted.
- leovander 1y ago
  Surgically implanted under the collar bone. https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130008d.pdf https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130008d.pdf
- sooperserieous 1y ago
  It is implanted. I had a consult to get one and decided without too much uncertainty that it was not for me. I like the other benefits (as noted in other comments) of CPAP that would be lost and my wife doesn't notice the little noise over the fan she runs all night anyway :)
sensanaty 1y ago
My problem is that I want to avoid surgery at all costs, and the inspire only has a 10 year battery life after which they have to open you up again. Also the idea of having something implanted in me that zaps me just feels... Weird, compared to just have a regular old tube glued to my nostrils

evanjrowley 1y ago

I must be in the minority of CPAP users who would use it even if I stopped having OSA. Why? A few reasons: 1. Sometimes I hardly notice it. Newer models are very quiet and portable. I'd even go as far as saying the mask is comfortable to wear, like a security blanket for the face. 2. Practically nothing filters out dust and cat hair better than my CPAP. An N95 mask might do better, but would be ridiculously uncomfortable by comparison. 3. It's a humidifier strapped to my face. No more discomfort trying to sleep through dry weather seasons.

pstuart 1y ago
4. There's some pretty powerful conditioning in associating it with sleep and it helps tell the brain it's time to shutdown for the night.
12_throw_away 1y ago
Yep - my first 4 weeks, I just hated the feeling of air getting forced into my airways. And then 2 weeks ago, it flipped on a dime ... I guess my brain decided "this is what sleepy-time breathing feels like", and now it's a very relaxing sensation. It all makes some sense, I think - it would be bad, evolutionarily, if we couldn't get used to the sensation of breathing, even if it happens to be slightly weird for whatever reason.
- mywrathacademia 1y ago
  Sounds like a side effect of cpap is addiction? Does it cure sleep apnea or do you have to use it forever?
  - iamjackg 1y ago
    It doesn't cure it, the same way wearing glasses doesn't cure poor eyesight.
TMWNN 1y ago
I wouldn't use it without sleep apnea because of the annoyance with the hose. But I agree that otherwise my nasal mask is hardly noticeable.

IAmGraydon 1y ago

>One of the medications, atomoxetine, approved by the U.S. Food and Drug Administration (FDA) in 2002 for attention-deficit/hyperactivity disorder, increases levels of the excitatory neurotransmitter norepinephrine by blocking its reuptake from neuronal synapses. Guessing this will never see the light of day as insomnia is going to be a major side effect. Preventing sleep apnea by preventing sleep is not exactly a great trade-off.

kimjune01 1y ago

Sleep apnea is a structural issue, either soft or bone. CPAP helps, but it doesn't address the root cause. Fixing it is a matter of airway geometry, with many obstructions along the way. Bodybuilders or wrestlers, otherwise in good health, can suffer from OSA because of too much muscle in their neck. You may not know it, but your tongue may be tied. It is one of many possibilities causing OSA. I made this: Do I have tongue tie? Self assessment https://do-i-have-tongue-tie.vercel.app/ https://do-i-have-tongue-tie.vercel.app/ Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ https://pmc.ncbi.nlm.nih.gov/articles/PMC1360393/ Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4402674/ Jawhacks on Youtube, discussing Airway health https://www.youtube.com/@JawHacks/search?query=sleep%20apnea https://www.youtube.com/@JawHacks/search?query=sleep%20apnea

Llamamoe 1y ago
You're right, and Inspiratory Muscle Training is an easier alternative to playing didgeridoo, and it's very important to mention Mandibular Advancement Devices and soft cervical collars(since neck-jaw position matters, this is a big part of why apnea is worse on your back), but the thing is- it's unlikely to be enough. Ultimately, to REALLY fix Sleep Disordered Breathing, usually you want maxillomandibular advancement - to move your jaws forward, which physically enlarges your pharyngeal airway which is where the actual collapse happens. Collapse that shouldn't be able to reach the point of increased airway resistance with a skeletally sound airway. Many people also have nasal breathing issues, and while this can be caused by a deviated septum or severe turbinate hypertrophy,usually nasal throughout correlates with the cross-section of the nasal cavity, which is most effectively addressed by bone-borne(not tooth-based!) palatal expansion.
- justinator 1y ago
  >usually you want maxillomandibular advancement Yeah that's the ticket. I use a mouth retainer for this, but I've found more often than not these days that it comes out sometime during the night. I may look into these exercise to supplement.

sfink 1y ago

One thing that I've found very helpful, and wish my doctor had mentioned: when putting on the CPAP (nasal pillows in my case), time turning it one with your breathing such that the machine first kicks in during an inhale. That's it. It sounds trivial. But my biggest problem[1] with the CPAP is that it feels like it's smothering me. I can get more air in, faster, without the CPAP, and I still vividly remember the initial months when I would rip it off in frustration just to be able to breathe. The thing is, I wasn't wrong. When I go to bed, I move around a little to adjust my pillow and lean over to grab the headpiece and turn it on, and all that movement means my oxygen requirements are temporarily higher. Putting on the CPAP immediately restricts airflow, so of course I hate it even though I can forcibly breathe through it. But timing it so that it adds airflow (during an inhale) makes me feel like it's helping, not smothering. I can still breathe a little harder while settling down, but psychologically it feels way better to have it helping me breathe instead of fighting me. I wish someone had suggested this early on. I don't have an answer for my upcoming 12-hour overnight flight, though. Other than a long series of 5-minute half-naps, watching a lot of movies, and sacrificing the first day to stumble around and catch up on rest. (Which, to be fair, I'd be doing anyway with the time change.) [1] Well, the other problem is the noise. My partner is a light sleeper, and if she's suffering during the night from my noise, I'll be suffering during the day. We've largely resolved that with a white noise machine closer to her, and learning how to maintain a proper seal with various strap adjustments and position shifts. I only get a shove in the night once every few months at this point. It's almost like she feels entitled to sleep at night too...

jrm4 1y ago
Having used multiple machines; some are "better" at this than others -- might be time for you to just get a new one? Probably technically you want an APAP.
robterrell 1y ago
I got a travel CPAP and it's been a huge unlock for me for international flights. Last flight I took to Europe I picked a 9 pm flight and had 6 hours of actual good sleep on the plane.
lrasinen 1y ago

jonmagic 1y ago

After nearly 14 years of using a cpap (https://theprogrammingbutler.com/blog/archives/2014/02/13/sleep-apnea-survivor/ https://theprogrammingbutler.com/blog/archives/2014/02/13/sl...) and then bipap religiously I was able to switch away recently. All I do now is use now is a piece of kinesthetic tape to make sure my mouth stays closed and that somehow works. I’d just done another sleep study to see if I had options other than the bipap because it’s been filling me with air since I was intubated and put on life support overnight a few years ago. I’ve been miserable the past few years and doctors couldn’t figure out how to fix it. Bipap helped a bit but not completely. I’d even turned down the cpap and then bipap to the lowest settings, which was enough to help me have a great night of sleep, but still the balloon effect. Then I was chatting with a family member and they mentioned trying and liking taping, something they saw on TikTok, and I told them it was a terrible idea. They assured me it was helping them avoid the snore and they woke up less dehydrated and better rested. So I gave it a go. I wear my Apple Watch when I sleep and have been able to confirm on at least 3 occasions before I started taping that the sleep apnea stats always lined up with when I was experiencing the effects of apnea. The first night I taped but still used the mask and was fine the next day albeit filled up with air. Then I tried a night taping without my cpap and someone to monitor me and make sure I didn’t die and I couldn’t believe when I woke up in the morning completely rested and not feeling awful from the balloon effect. I’m not suggesting what worked for me will work for anyone else, but thought I’d share as my quality of life has gone way up the past few months.

petesergeant 1y ago
A similar fix for me was a nasal steroid taken every night. Got me off the CPAP
- cmrdporcupine 1y ago
  Any long term side-effects from that?
  - petesergeant 1y ago
    Not that I could find, and the doctors seemed pretty happy with it (and it was one who suggested I try it). I'm taking Fluticasone Propionate.

mmmBacon 1y ago

I would love to try this. I couldn’t tolerate CPAP. I used a dental appliance and that worked really well for a while, although was not perfect. I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm. I’ve started with extensive orthodontic treatment and it’s super uncomfortable. The thought of the surgery is also fairly terrifying. So if there’s a pill that could help, I’d sign up in about a millisecond.

ProllyInfamous 1y ago
>I’m now on a path to have jaw surgery to move my lower and upper jaw by 1cm. Please don't do this. See my other comment for more suggestions, but try losing weight and/or sleeping with body pillows [i.e. on your side] before you go mutilating your jaw. >I used a dental appliance and that worked really well Same — perhaps you need it to be thicker (i.e. spread your jaw just a bit more).

cjbgkagh 1y ago

It is Tirzepatide which is a GLP-1 agonist, like Semaglutide (Ozempic). I don't know how much of the co-occurring issues from sleep apnea are caused by the sleep apnea or are comorbidities for something else. I suspect quite a lot of the later. I think we're going to find that GLP-1 agonists are really good for a lot of things beyond obesity including many auto-immune conditions which I think underlies many mental conditions.

felideon 1y ago
Hmm? Article says it’s a combination of atomoxetine and aroxybutynin.
- cjbgkagh 1y ago
  Ah, you are correct, for some reason only the later mentioned previously approved drug was retained in memory.

klevertree 1y ago

Wrote about this in the context of repurposing, which is a pet interest of mine: https://trevorklee.substack.com/p/another-entry-for-the-repurposing https://trevorklee.substack.com/p/another-entry-for-the-repu...

kazinator 1y ago

Death apnea is proving much more elusive.

ProllyInfamous 1y ago

I am a fattie (BMI 36.5). I also have sleep apnea. Wearing a CPAP, I couldn't ever get any sleep (toss&turner). Things that've helped: 1) Using body pillows to force sleeping on side, which straightens the neck (versus face-down) — also lessens low-back pain 2) DENTAL GUARD (a 3D-printed plastic insert which form-fits my teeth, slightly opening jaw-angle/mouth) 3) Losing weight — YES, sleep apnea is worsened by excess weight 4) Pseudoephedrine (an hour before sleep) — but be careful cause too much and you won't ever sleep YMMV; I am not a doctor (just fat guy with apnea).

err4nt 1y ago
Thanks for sharing, I'll try some of these out!
- ProllyInfamous 1y ago
  If you attempt body pillows, get TWO (so when you roll to other side you don't have to wake up in order to swap pillow placement). But the dental guard ($$$ — worth it, IMHO) is the best solution on my list (I'm sure CPAP is ideal, but if I ever even could fall asleep, I'd wake up de-masked). Best of luck!
blarg1 1y ago
> 3) Losing weight — YES, sleep apnea is worsened by excess weight That solved it for me.
therealdrag0 1y ago
I don’t think I have true apnea, but mouthguard+earplugs+concave-eye-mask really helps me.
johntash 1y ago
What kind of dental guard did you get? One from an actual dentist, or one of those pre-made ones off of amazon/etc? I've been wanting to try one from the dentist, but they're pretty pricey.
- 1y ago

pedalpete 1y ago

When looking at any of these studies in CPAP, and sleep in general, we need to be looking deeper than just the AHI (hypopnia index, how many times you stopped breathing), and directly at EEG measures of restorative function and other biomarkers. This shows an improvement in AHI, but no change in any markers of actual sleep restorative function (I'd use the term "quality" but the sleep health industry has stolen that term to mean measures of sleep time). When looking at sleep time the study shows no change in most of the sleep architecture, but a significant decrease in REM time, which can have effects on emotional wellbeing, irritability, and potentially depression. This study showed no change in ESS (subjective measures of daytime sleepiness), but did show a change in PROMIS, which is a longer term measure of fatigue. I've been recommending to anyone on CPAP that they give mandibular splint, which is a biteplate which shifts the jaw in order to hold the airway open, and is much easier, lower cost, and effective for many people. It also does not show a reduction in REM. However, I also don't believe there is any reason that a sleep study which has full PSG relies only on sleep time, and none of the bio/neurological measures of health which are easily available, such as HRV, delta power, spindle activity, etc. etc.

lzy 1y ago

This looks promising, especially for folks who can't tolerate CPAP. Wonder how it performs long-term and if it messes with REM cycles. Also curious about cost and insurance coverage—sleep treatments tend to get expensie fast. Hope follow-up studies confirm these results without major side effects.

zomg 1y ago

more relevant for this audience is the digital health platform and wearable apnimed has developed to support their clinical trials. i saw their presentation "Sensor-Based Digital Health Technology Enables Digital Medicine for Sleep-Related Breathing Diseases" recently at ATS 2025 in san francisco. * https://www.healio.com/news/pulmonology/20250518/platform-linked-to-ring-pulse-oximeter-monitors-analyzes-nighttonight-sleep-metrics https://www.healio.com/news/pulmonology/20250518/platform-li... * https://x.com/atscommunity/status/1923417506460455360 https://x.com/atscommunity/status/1923417506460455360 * https://www.eurekalert.org/news-releases/1083591 https://www.eurekalert.org/news-releases/1083591