7 ms·

Sleep research led to a new sleep apnea drug

232 points by colinprince 5mo ago

gpt5 5mo ago
People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen. I've suggested 4 people over the last couple of years to get tested based on them casually mentioning some of these symptoms, and all 4 got diagnosed with moderate to severe sleep apnea (which is classified by the number of times you stopped breathing every hour - AHI, and the blood oxygen level). Getting tested is easy and cheap - you can find kits for under $100 which essentially are just a monitor you attach your finger + a few ECG stickers on your body which you use for a couple of nights. You can order them online without talking to a doctor, and you will get a prescription for CPAP if you are diagnosed as positive. Treatment with CPAP is highly effective in eliminating these symptoms, and also reversing the brain damage (although MRI scans shows that it takes around a year for the gray matter in your brain to restore itself). The other suggestion I'd make is that if you are overweight or obese, GLP-1 has proven to be also a miracle drug for sleep apnea. Unlike the study mentioned above, that essentially reduced the average AHI of participants by 4, which for almost everyone wouldn't cure them. Drugs like Zepbound have shown that over half are cured from sleep apnea after roughly a year of use. This is in addition to the other health benefits they provide with the weight reduction. Essentially. This unfortunately won't work for everyone, as weight is not the only cause of sleep apnea, but it is by far the most common one.
- anyfoo 5mo ago
  > People should be more aware of the symptoms of sleep apneas I'm always a bit puzzled that this needs to be pointed out? I don't have sleep apnea per se, at least not chronically, but I've definitely had bouts of it due to allergy, sickness, stuff like that. The symptoms are the same because the mechanism is the same: I didn't get enough oxygen in the night. It's always glaringly obvious to me the next day. I feel way more tired and exhausted than I normally would given the amount of sleep. I sometimes had instances of waking up gasping for air. I really don't need to be told in those instances that there was an issue during the night. My sleep didn't sleep, of course there's something wrong and needs to be looked at? Like, one time's a fluke, but if it happens a lot...
  - rattlesnakedave 5mo ago
    It’s typically something that sets in over time (often, but not always with weight gain and age), most people don’t notice because it’s gradual. Especially if they aren’t in normal risk groups. OSA symptoms are easy for an individual (and clinicians) to misatribute
    - anyfoo 5mo ago
      Yeah, but I've met people who think it's "normal" to wake up tired and exhausted even after multiple (or even many) nights of sufficient sleep, time-wise. I remember one person who thought waking up tired is just part of being an adult? The original comment said "multiple folds higher chances to be depressed, unemployed", for me that's a bit like saying that being on fire has a very high chance to make you depressed and unemployed. Yeah, of course that's true, but the effect on performance and well-being after a sleep apnea night is so obvious to me, I don't have to look for the proximate cause... EDIT: Through the other answer came to me that maybe in other cases, it's not so directly obvious just after waking up.
      - tayo42 5mo ago
        Waking up tired could be caffeine addiction too, which I think most adults are addicted to
        jurgenburgen 5mo ago
        I’m addicted to caffeine and don’t wake up tired. Maybe you have sleep apnea.
  - devmor 5mo ago
    I think it’s important to know your personal context levels. You noticed it because it’s happened to you occasionally. What about people who’ve been experiencing it most of their lives? To them, they are just tired all the time and don’t know why. It could be any number of things. To someone who’s never experienced it, how could they understand? My wife has bad sleep apnea and has to use a CPAP - neither of us noticed or understood the issue until she did a sleep study to deal with her bad snoring. We knew she was tired all the time, but attributed it to factors like work stress or maybe diet. The average person’s understanding of sleep apnea is probably around the level of “it exists and they have to wear a device at night” and not much more.
- patrickdavey 5mo ago
  I've tried a CPAP machine for 6 weeks and felt no different and gave up. I think I was a 6 on the scale. I wish it had worked though! Currently I've just given up and embracing feeling relatively tired all the time. I've tried side sleeping devices (woody knows backpack) mandibular advancement splints etc. So hard to tell (I find anyway) to get to a definitive answer
  - cortesoft 5mo ago
    For some people it takes months to feel any different. For some people, they don't feel any better but it improves their health. Did you examine your numbers at all in something like OSCAR? You could get a good idea of how many events you were having at night, and if the CPAP was improving it. Even if you aren't feeling any better (yet) it could still be helping. You could also have multiple things that are causing you fatigue issues, and maybe fixing only one of them wasn't enough... that doesn't mean that one wasn't also important, though.
  - stingraycharles 5mo ago
    I didn’t have apnea but I had UARS, which works differently. It’s more difficult to diagnose, primarily because it’s more rare.
  - galactus 5mo ago
    exactly the same for me (but I gave after 5 weeks, because I didnt felt any different and hated everything about sleeping with the cpap)
  - petesergeant 5mo ago
    Three more things to try if you haven’t, on a “can’t hurt” basis: nightly Avamys spray (might need a scrip depending on where you are), magnesium glycinate before bed, little bits of plastic that go inside the nostril and hold them open.
    - toast0 5mo ago
      Also worth a try... B1 (thiamine) seems to help for me. I don't have objective numbers, but I disturb my spouse with my snoring and breathing troubles far less. I believe I have (undiagnosed) central sleep apnea rathee than OSA though, it's been a long time since I had a sleep study, but I had only one event over a few recorded nights... But some nights it's pretty bad.
- calvinmorrison 5mo ago
  #1 symptom - fat necks! if you are like me and had a 17" neck at 185 in high school and now boast a 18.5".... you have it!
  - dnnddidiej 5mo ago
    Why is that?
    - thfuran 5mo ago
      Sleep apnea can indirectly cause weight gain, but obesity—particularly excess fat on the neck—is the main controllable risk factor for obstructive sleep apnea, so it’s primarily the other way around.
- shermantanktop 5mo ago
  Having been down this path, it’s evident to me that the US has built up a sizable medical equipment industry around CPAP machines and their supplies. The sleep doctors who prescribe them don’t have many alternatives, so it’s the normal treatment they hand out. So it’s not a surprise that a casual mention of sleep quality ended with a CPAP machine rented by the month. It’s kind of what happened to me.
  - Shadowmist 5mo ago
    Better to outright buy the machine online, then open it up and disable the modem.
    - antisthenes 5mo ago
      Why in the world does a CPAP machine need a modem?
      - f17428d27584 5mo ago
        Most have a cf slot to store the sleep data, it’s how the doctor / clinician can see if it’s working, make adjustments to pressure etc. but for convenience they can just upload the data directly. They also do OTA updates. However they also can perform an enforcement function: compliance. Insurers will penalize users of the device for not using it enough. This isn’t something I know much about just have seen it discussed, I don’t think all jurisdictions allow insurers to access this data for enforcement but it does seem to happen in USA. I think what happens is the insurers agree to pay for the device in installments. But they will cancel those payments if the person isn’t using it. But disabling the modem won’t fix that problem, you’d still get caught by the cf recorded data, or failing to provide it.
      - kotaKat 5mo ago
        Many patients starting out CPAP therapy go noncompliant because they have various issues or concerns with the machine, mask comfort, etc. Insurance companies are tired of paying thousands of dollars in machines and supplies that don't go used, so they instead 'rent' the machines from medical equipment suppliers, and use the machine's usage data to determine that you are still using it (and thus continue to pay for treatment). Typically after a year or so of usage they get 'paid for' but there's still ongoing compliance monitoring to get insurance to pay for supplies. The sleep lab and sleep doctors can also remotely review the usage and make adjustments as needed. One example is using the humidity sensors in ResMed units to adjust the humidification settings remotely. I was with a doctor that showed usage logs together and noted the bedroom was severely dry and thus we needed to adjust the humidifier to run hotter to compensate.
- syntaxing 5mo ago
  Any brand of test kit you recommend?
- Aurornis 5mo ago
  This is worth pursuing for anyone with the symptoms. However please do it with a reputable doctor, preferably associated with an established institution. Watch out for some of the specialty clinics and independent practice doctors who treat apnea like a cash cow. Sleep study scoring is theoretically set by strict rules, but in practice there can be differences between operators and clinics. Some clinics use this to their advantage to push more treatments and equipment and they’ll do it in ways that are most profitable for themselves. If they can’t get you scored high enough on the first sleep study they’ll pressure you to keep coming back for more studies or in some cases to start paying out of pocket after your insurance company starts refusing so many repeat studies with negative results. The better clinics are not afraid to tell someone they don’t have apnea or that they likely won’t benefit from PAP machine. They also aren’t shy about telling someone that weight management can be the best long term solution for weight-related cases, whereas some clinics won’t mention it because they want you coming back to them for never ending management.
  - JSR_FDED 5mo ago
    A friend went to one of those clinics. “The diagnosis is sleep apnea. What are your symptoms?”
  - aaron695 5mo ago
    [dead]
  - nemo44x 5mo ago
    Get 2 opinions. And yes about weight - some people won’t have Apnea if they get their BMI to like 25 or whatever. Saying that I have a CPAP machine and love it.
    - gushogg-blake 5mo ago
      Multiple opinions won't necessarily help unless you research first. I'm not sure about other disciplines but in orthodontics for example there is a very definite split between whether they are "airway focused" or mainstream. I saw 6 or 7 different doctors, dentists and orthos in the UK over a period of about 10 years and none of them saw anything wrong with my jaws. Saw an airway focused ortho and a surgeon specialising in maxillo-mandibular advancement surgery and they recommended aggressive surgery. I agree with them, mainstream medicine is ignoring an epidemic of jaw underdevelopment because it challenges current practices in orthodontics.
- petesergeant 5mo ago
  > Treatment with CPAP is highly effective in eliminating these symptoms … for those who tolerate it. Numbers are all over the place, but roughly people who start it are only 50% likely to still be using it properly after a year.
  - nemo44x 5mo ago
    I don’t know but I wonder if people that have insomnia or similar difficulty falling asleep (anxiety, etc) struggle with a CPAP. I am fortunate to fall asleep very easily, usually within 3-5 minutes or even faster. And I use a CPAP (nose saddles not a full mask), and prefer it to not using one while sleeping. The way it just opens all passageways is relaxing and I think helps fall asleep even more quickly.
  - jrm4 5mo ago
    That seems -- quite high actually?
- thibaut_barrere 5mo ago
  Would you had precise kits references to share? It is quite hard to figure out what has cheap electronic versus what works. Thanks!
- gniv 5mo ago
  I bought a connected oxymeter (viatom). I wore it overnight on my finger with the phone nearby. The graph on the app shows exact values through the night so you can see how many time oxygen drops and for how long. It's not quite as good as the real thing but should give you an idea, and it's cheap.
- radial_symmetry 5mo ago
  100% agree. I can cleanly divide my life into before and after treatment for sleep apnea, I didn't realize I wasn't supposed to feel awful and tired all the time.
- xivzgrev 5mo ago
  Yes the lead is buried in the article. The drug reduces AHI by 4. It could only cure very mild sleep apnea. Otherwise it seems most useful as an additional treatment with CPAP. It could also help raise awareness of sleep apnea - try the drug first. Don't see any changes? Ok now try CPAP.
EdwardDiego 5mo ago
I don't have sleep apnea, as in, my severe snoring doesn't cause significant drops in blood oxygen levels, but it's still severely impacted my life - when my wife and I married, I spent the first night of our honeymoon awake so that she could sleep. Oh and it's so loud that I'm at risk of damaging my own hearing. And I bounced off CPAP hard, no matter what I tried, I would eventually remove the mask in my sleep, it was heartbreaking, I was so excited to finally be able to fall asleep beside my wife. I also tried the mouth guards and would wake up panicking and gagging. So my only other option currently is self-funding expensive surgery (our public system doesn't fund treatment for severe snoring unless it causes apnoea, and my private health insurance excludes the most expensive portions shrug), which like all surgery, carries no guarantees of success, and also carries the risk that any general anaesthesia application does. So this is awesome! I just hope it continues proving efficacious and safe.
- Insanity 5mo ago
  You snor so loud it damages your own hearing? Can you wear ear plugs to sleep?
  - EdwardDiego 5mo ago
    Not yet it hasn't, but another 10 years of exposure to it will - and I do. :) I phrased it like that to try to convey the impact my snoring has on anyone near me. When I got hunting or tramping, and intend to stay at a backcountry hut, I always carry my bivvy bag in case there's other people staying at the hut, if there are, I go sleep in my bivvy bag about 50m away from the hut. Nothing like waking up and 20 other people all want to beat you.
- swe123456 5mo ago
  I found a way to stop removing the mask through smarthome magic: flash my lights if I take off the mask. Parts: 1. Smarthome coordinator - HomeAssistant/AppDaemon (runs on my desktop) 2. Prescense sensor - e.g. Aqara FP2 3. Smart light - e.g. Phillips Hue 4. Smart Plug/Power Meter - e.g. Kasa ESP25P4 5. Claude Code to write the logic ..... The alarm goes off if all of the following are true: 1. it's in sleep period (11pm-6am) 2. i am in bed 3. i have been in the bed for at least 3 minutes 4. i have worn the cpap (wattage > 10w for 3 minutes during sleep period) .... I can't get around this system at all without walking across the house to my desktop, at which point I'd be too awake to be stupid enough to remove the mask. Bonus CPAP nerdery: Wireless data collection into homeassistant using a Toshiba W04 SD Card/Wifi Transmitter.
xamuel 5mo ago
The drug is called AD109, but the title seems misleading as the drug is apparently still under trial, though it has shown good results there so far
ElijahLynn 5mo ago
It only reduces by 4 events per hour. That seems like it might be helpful for someone with mild sleep apnea. But not with moderate or severe sleep apnea. Adult AHI Severity Levels Normal: Less than (5) events per hour. Mild Sleep Apnea: (5) to (14.9) events per hour (frequent minor interruptions). Moderate Sleep Apnea: (15) to (29.9) events per hour.Severe Sleep Apnea: (30) or more events per hour. "By mapping the neural circuits that lead to this common condition, work from the Horner lab laid the foundation for AD109, a new treatment developed by researchers in Boston to specifically target the two pathways that contribute to sleep apnea. The daily oral medication contains two drugs: one that increases noradrenaline levels and another that blocks muscarinic receptors. In a recently published phase 3 randomized clinical trial, people with mild to severe sleep apnea who received AD109 had less airway obstruction and higher oxygen levels than those who received a placebo. On average, per hour of sleep, participants on AD109 had four fewer events where they stopped breathing or had very shallow breathing."
- Waterluvian 5mo ago
  My AHI was 151 when measured. The CPAP has changed my life but I do look forward to any possible way to not need it anymore.
  - UncleOxidant 5mo ago
    Mine was in the 50s when they measured, which seemed bad enough. CPAP takes it down to about 2 to 3.
  - folkrav 5mo ago
    Oof, and here I thought my AHI of 69 was bad (which it kind of is regardless). My condolences. Glad the CPAP helped, it completely and utterly changed my life too.
    - LooseMarmoset 5mo ago
      256 here :( the cpap is a wonder, I can't sleep without it. I only wish I'd gotten one 10 years sooner. I have whole years of my life missing from my memory - REM sleep is very important to long-term memory formation. Using my CPAP now nets me about 1.5 AHI. if your doctor tells you to get one, get one.
rattlesnakedave 5mo ago
Great. Something like 60% of OSA cases are linked to obesity. GLP-1 drugs could probably lead to resolution for a lot of them if the Lilly SURMOUNT-OSA trial tells us anything.
- crazydoggers 5mo ago
  Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all. The preconception that it is mostly obesity related is a dangerous stigma since it prevents a lot of people understanding what is happening and getting treatment. I started with sleep apnea in my 20s when I was in amazing physical condition. I would jolt awake, heart racing, almost panic attack levels. No idea what was happening.. took me another 15 years to do a sleep study and get diagnosed, and CPAP treatment literally overnight cured the condition. I went from 20-30 events per night to less than 1 on average. If anyone has any sleep issues at all, or suspects any.. go get a sleep study. It’s not as scary as it sounds and there’s no downside to having one done.
  - cortesoft 5mo ago
    > Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all. I mean, the person you replied to literally said "60% of cases are linked to obesity" Which obviously implies that 40% of cases are NOT linked to obesity. You are saying the exact same thing the person you replied to is saying, just without the numbers. I feel like the person you replied to's comment was not stigmatizing obesity at all, in fact learning that 40% of sleep apnea cases are unrelated to obesity entirely probably educated some people that it was less tied to weight than they believed before.
piou 5mo ago
I highly recommend BongoRX (https://bongorx.com/ https://bongorx.com/) if you have sleep apnea and can't deal with CPAP. The mechanism: it makes it a little harder to breathe out, which keeps your airways more open when you breathe in next. The pictures on the website are a little misleading: it comes with a strap to keep the device in your nostrils, so they don't just fall out in the middle of the night. FDA-approved, and does require a prescription...
- FlamingMoe 5mo ago
  I might have to try this. Their bland website with last year’s copyright would never have sold me by itself, but a HN comment could
georgemcbay 5mo ago
Surprisingly the most effective treatment I've found for my own apnea is just wearing an inexpensive soft cervical collar to sleep, but there are lots of different things that can contribute to sleep apnea, so YMMV. After dealing with unexplained ectopic heartbeats (sometimes PVCs, sometimes PACs) I saw a chain of doctors and that included both getting a sleep study done and seeing a cardiologist. I was diagnosed with mild apnea (AHI just above 10), but despite the apnea being mild on the AHI scale, my Sp02 blood oxygen percentage was dropping into the low 80%s for extended periods per night down from a normal 95-99% most of the time. I weigh 180 lbs at 6 foot 2, being overweight was a non-factor in my apnea. Got a CPAP machine, it helped but even after dialing in my personally optimal pressure settings using the CPAP data with OSCAR my AHI was still kind of all over the place, from under 1 to as much as 6 seemingly randomly per night with no mechanical issues like mask leaks showing up. Had heard (on reddit /r/CPAP) about some people using soft cervical collars to help with their apnea and I gave it a try and when wearing one my AHI drops down to 0.0 - 0.4 per night. The collar alone helps more consistently in my case than the CPAP machine does. Basically my sleep apnea is almost entirely due to the fact that when I'm sleeping (even on my side, but worse on my back) I seem to naturally tuck my chin in toward my neck in a way that constricts my upper airway and the collar stops this from happening. This is very much YMMV, there are lots of different causes of apnea.
- gdudeman 5mo ago
  Curious how you tested this - did you do repeated home tests to figure this out?
  - georgemcbay 5mo ago
    Most CPAP machines including the one I have record a lot of data that can be analyzed via software like OSCAR: https://www.sleepfiles.com/OSCAR/ https://www.sleepfiles.com/OSCAR/ On the machine I have (ResMed AirSense 10) the data gets written to an SD card I can pull out and import into OSCAR to see what the machine detected about my sleep apnea events. I also (not always, but when I'm testing changes) use a continuous pulse oximeter to test my SpO2 blood oxygen % over the entire night. The data from this can either be combined with the data from the CPAP machine, or used on its own to test things like how I do with the collar and no CPAP machine, since the SpO2 drops are the dangerous thing I'm trying to avoid by eliminating the apnea events. I use the Wellue SleepU for SpO2 monitoring but there are a lot of similar devices (the kind with finger tip sensors are generally more accurate than the wristwatch based solutions).
tickerticker 5mo ago
The difference maker for me was an app, Snore Lab. that my son told me to try. It said that my snoring was EPIC. That led to my current CPAP use, for which the benefits [no daytime sleepiness, more energy, no food cravings] exceed the hassle [mask wearing, cleaning routine, supplies reordering.] Four events per hour AHI improvement would not be a meaningful change for my therapy, but this is the beginning of better treatment options in the future. The best benefit of CPAP is that it thwarts heart arrhythmias which arise from depriving the brain of oxygen.
adamtulinius 5mo ago
I wake up without my cpap mask after a few hours every night. In total I might get 6 hours with it after putting it on multiple times. Doctors think I’m doing fine due to total amount of hours used, and my resmed cpap claims I’m at below 1 event/hour. I’m not doing fine and I think the numbers are lying to me. I snore a million, my mouth gets dry, and my nose tightens up, so my nasal mask isn’t always that nice to use. Other masks also annoy me. What do? I haven’t sleep a solid 8 hours for 3-4 years :(
- wincy 5mo ago
  Obviously I don’t know you or your specific situation, but I lost 120 pounds taking Zepbound and my apnea is gone. I make sure to take fluticasone in each nostril before I sleep, but getting to a healthy weight eliminated my apnea. If you aren’t overweight, this might not help, but hopefully it’ll help someone!
  - adamtulinius 5mo ago
    I’m 130 kg and know it’s way too much. Hard to gather the energy for loosing weight. Can you take fluticasone permanently? Sometimes it’s like I just lie down and my nasal congestion gets worse instantly
    - retrac 5mo ago
      > Can you take fluticasone permanently? This is a surprisingly controversial question. I've known more than one person who claims something to the effect of becoming addicted to Flonase. Like now they have to take it only to feel like how they felt before they started taking it. Rebound inflammation when stopping use is a real effect with long-term use of corticosteroids and can, at least briefly, be worse than the initial symptoms were. As someone with multiple mild inflammatory disorders I've always been afraid to use steroids consistently lest I have nothing effective when things are worst.
    - 0xack 5mo ago
      This is suppose to be a tell tale sign of deviated septum (lying down and losing airflow).
RobotToaster 5mo ago
It's aroxybutynin 2.5 mg/atomoxetine 75 mg. They don't actually say in the article but the development code "AD109" leads to that
- iammjm 5mo ago
  So basically a non-stimulant medication for ADHD? Very interesting
kiddz 5mo ago
I have severe obstructive sleep apnea -- am 6ft and 210. I wear a CPAP and now swear by it. A couple things to help those who try: 1) Make sure you have a CPAP machine with a water tank so the forced air is moist. For me, if the water runs out, that's when I wake up bc my nose dries. 2) Get a spray saline solution for your nose -- not Afrin or drugs (habit inducing) -- just simple and cheap Arm & Hammer Simply Saline. 3) Wear a shirt when you're in bed and put the hose under your shirt so it's hard to roll off. 4) Bonus -- sleep elevated. Those are my best tips. If you can do the CPAP and suffer the awkwardness, you'll really feel so much better. First time it stuck, I woke up at 4:45 am fully rested and felt as if a heavy weight was lifted off me. Best luck :)
- chasebank 5mo ago
  Have you tried losing weight and if so, did that help?
  - al_borland 5mo ago
    My dad used a CPAP for many years and was quite the evangelist for them due to how significantly it improved his quality of life. At one point, when trying to nudge him toward weight loss and diet changes for type 2 diabetes, I mentioned it may also help with his sleep apnea. He was adamant that the type of sleep apnea he had would exist no matter what and weight loss wouldn't help... apparently his doctor told him this. Fast forward 5 years, he ends up in a program for his diabetes that put him on a pretty extreme elimination diet which led to him losing a pretty significant amount of weight. During that time he kept having to turn the pressure on the CPAP down, until eventually even the lowest setting was too strong and he was able to get off the CPAP completely. For over a decade he talked about how happy that CPAP made him, he almost seemed proud of it. However, he got pretty emotional when he found out he was able to get off of it. As much as it may help, it is still a burden to need a machine to sleep. I know it's an N of one, but it shows it can help and is worth a shot. Even if it doesn't completely resolve the sleep apnea, there are so many other additional benefits. After an alert from my Apple Watch and a few extremely rough nights of sleep when my weight hit an all time high, I scheduled a sleep study for myself. It's 2-3 months out still, so I plan to lose what I can while I wait to see how much it can help. Even the first 10 lbs was a significant help and stopped the truly awful sleep I had for a week or two.
pmcg 5mo ago
I had bad sleep apnea until last year, sleeping 8-9 hours a night and usually feeling tired in the morning. As of the last 12 months it seems to be heald, after I used mouth tape and a nasal dilator consistently for 30 nights in a row. I highly recommend trying this, it was quite cheap (~$20) and the change seems to have been permanent. I used 3m micro-pore tape that doesn't tear the facial hair, and the nasal dilator I used was called "woody knows", though there are many brands that may work just as well. I barely snore anymore where I used to be a raging snorer according to those in the know and my own audio recordings of myself. Most importantly, I only need about 7 to 7.5 hours of sleep now and I will wake up feeling well rested most days. I can also breathe exclusively through my nose now where before I could not. I can take very big breaths through just the nose and do this now when exercising. I don't think it's all perfect though as I still often breathe through my mouth. I'm starting to wear the mouth tape at night again as an experiment - it really isn't that annoying. Relatedly, I recently started looking into "mewing" after a breath-work teacher I took classes with recommended it to me as she has been doing it with good results (improved breathing). It seems related to this as Mew recommends keeping the mouth shut all the time. I intend to try the mewing exercises and see if that helps my breathing further.
an0malous 5mo ago
I went through the whole process of seeing an ENT, using the machine for the at-home sleep study so insurance would give me a CPAP, then not being able to sleep with a CPAP, and over the course of a couple years I fixed my sleep apnea by fixing my posture and breathing. If you have forward head posture or are not used to breathing through your nose, you might also benefit from this. I think it’s kind of crazy that we do surgeries and take medicine that modifies your brain chemistry for what I believe in many cases is a structural issue. If you’re curious to try this, read James Nestor’s book Breath, do yoga with breathing exercises, or see a physical therapist. It takes time to fix these structural issues, but you can literally change the shape of your nose, palate, and jaw from just practice. Here’s a quick exercise you could try. Sit up, relax your body, breathe in through your nose, and feel the breath move up your nose, down to the base of your skull, down your neck, and then as far down your spine as you can. The air isn’t literally moving through these areas, but you should feel a current of sensations moving roughly along that path. As you breathe out, follow the current in the opposite direction. As you tune into this current, your neck and back will naturally straighten a bit, it should feel very natural and even pleasant. Keep your body relaxed and allow your neck and back to align with this current. If you keep doing this regularly it should help improve your posture and breathing. This is basically a pranayama / yoga breathing exercise. If it feels painful, definitely stop and try physical therapy or working with a hatha yoga instructor who can give you more guided instruction. I used to snore so badly it sounded like, without much exaggeration, a dying elephant. I only did this exercise for a couple years and it slowly improved over that time, and now I sleep quietly.
- pmcg 5mo ago
  I had a similar experience, with a slightly different approach (mouth tape and a nose dilator) but seemingly similar outcome. I like that you did it just through exercises with no mechanical intervention. Inspiring.
  - an0malous 5mo ago
    Thank you! I saw you mentioned mewing in your comment, they teach you that in some pranayama exercises as well and I agree it’s a great addition. It feels unnatural at first but when you get used to it, it’s almost like bracing your palate with your tongue allows you to pull air in through your nose more smoothly and with more power. I’ve found this is all really worth learning, even if you don’t have sleep apnea. I feel more clear headed and energized when I can breath through my nose now.
Bender 5mo ago
I was never diagnosed with sleep apnea but I had an O2 saturation alert when I would sleep side sleeper so I bought a cervical pillow and found a quiet CPAP machine. I add saline and a few drops of very diluted I+KI to the water just to keep anything from growing in it despite changing it daily. I love it. My sleep has never been better. I often forget I have the little nose mask thing. The cervical pillow is awesome, never goes flat. My biggest improvements were from that little cervical pillow.
milchek 5mo ago
I see CPAP rightly getting mentioned a lot here. What worked for me was a MJS (Mandible Jaw Splint), it’s basically a mouthguard you sleep with that moves your lower jaw forward and thus brings your tongue forward so it doesn’t obstruct your airways. Best bet is to get this custom made. Here in Australia there are specialist dentists that do this for you. It’s far easier than CPAP and works just as well for many like myself. Often folks will use CPAP at home and these mouth guards when travelling.
dimgl 5mo ago
I think sleep apnea would have killed me had I not gotten the sleep study. I was having 100+ events in the span of a few hours. Anyhow, I use the CPAP everyday. I don't snore anymore and I have maybe 1 event a night. Incredible machine.
luxuryballs 5mo ago
I always thought as a stomach sleeper why not get one of those massage table head rest things, face down symmetrical and wouldn’t gravity help keep things open then? Just have to build it into a cozy bed, not sure if that would be comfortable though.
- tickerticker 5mo ago
  I also thought of this idea and wanted to try it. Gemini said not to do it bc when we sleep, we naturally want to change positions. Thus, maintaining one position all night would cause muscle cramps?
  - luxuryballs 5mo ago
    yeah true, maybe it could be good for a power nap “table” if we can make it comfy enough, I did see a massage table head/face cushion adapter that hooks into a normal bed so might be inexpensive to try it out
moojacob 5mo ago
If you wake up every day feeling like you got hit by a train and also have anxiety, depression, chronic heartburn, or exhaustion (not sleepiness, like a wired but tired) I would highly recommend looking into Upper Airway Respiratory Syndrome (UARS). UARS was coined by Dr. Christian Guilleminault who was on the team that coined sleep apnea. Over his career he slowly widened his definition of sleep disordered breathing from choking (sleep apnea) to any nasal resistance that causes wake ups. You be young and perfectly healthy but due to bad anatomy have micro arousals throughout the night. Becuase your young, your body fights through it (cuasing exhuastion) and will wake up up to readjust your airway. You won't remeber any of the wakeups, but many suffer from insomnia from it. The two big issues is large tongue in underdeveloped jaw that falls back and constricts your airway (you can test this with a mallamapati test) or a small nasal passage way.
Traubenfuchs 5mo ago
You can‘t get AD109, but unless you live in a shithole country you can order some ambroxol today. https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0860514.pdf https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0... I once wrote a summary here: https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a_well_known_side_effect_free_cheap_over/ https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a...
KnuthIsGod 5mo ago
STOP-BANG Score for Obstructive Sleep Apnea: https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive...
m0nit0r 5mo ago
If it spares a respirator this is huge win. Even if might be used before severtiy leads to the unavoidable NIV-respirator with overnight CPAP.
deleted 5mo ago
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petercooper 5mo ago
There are some older studies that showed nicotine (not via smoking, which makes sleep apnea worse) had a positive effect on sleep apnea as well due to the stimulation increasing muscular activity in the airways. Obviously lots of downsides too so it never caught on, but this seems to have a similar mechanism.
huzaifasinan 5mo ago
[flagged]
fluxist 5mo ago
One of the drugs in this treatment, oxybutynin (Ditropan), is associated with cognitive impairment[1]. [1]https://www.sciencedirect.com/science/article/pii/S0090429524000062 https://www.sciencedirect.com/science/article/pii/S009042952...
euroderf 5mo ago
For me the CPAP was too damn invasive. Fail. So as an alternative they made me a dental appliance. I put it in at bedtime and it kept my lower jaw jutted out just enough to maintain airflow. It worked :)
- DrAwdeOccarim 5mo ago
  Yes! I had a mandibular advancement device for many years, but after about 10, my lower jaw stopped resetting all the way in the morning. I forced myself to find the right CPAP (nasal pillows with fabric elastic chin strap to keep my mouth closed). It's been about 5 years and my jaw finally is >95% back to normal (YMMV). But by far the most critical part of getting CPAP to work was using an open source program to review the SD card raw data every morning, learning the interplay between max/min pressure, temperature, humidity, and ramp. Gaining access to the admin controls on my AirSense and fiddling it myself over weeks to find the right settings--this was the only way I made it work. The idea of waiting 6 months to make a change to the pressure was bonkers to me. Especially, for some reason, my brain is shit the next morning if I over oxygenate with too high max pressure overnight, worse than not wearing it at all! But once you dial in the settings. It's magic.
jrm4 5mo ago
I often get (perhaps reasonable) pushback for this, but the level to which CPAP equipment and supplies are gatekept by the industry is absurd. They're a fan tube, a mild heating element, and a sensor, and I'm nearly certain that it would be pretty difficult to harm yourself using one "wrong" -- especially as opposed to other medical items and drugs available OTC. Also, yes, they're pretty cool. I don't love that I seem to need mine right now, but at least I know a guy. :)
crazyfingers 5mo ago
“CPAP treatment is extremely effective, but Horner notes that many people have a hard time sticking with CPAP because they find it uncomfortable and cumbersome.” The sleep medicine industry uses compliant long term cpap patients as the denominator in order to conclude it’s “extremely effective”. If you stop cpap therapy after a year (or even years!) of it not working, they will blame patient compliance not the machine. The machine manufacturers (who incidentally happen to fund most sleep research) have made a variety of machines and settings, and thus there is always another setting to adjust or device to try before concluding cpap won’t help. The assumption is that it’s “extremely effective” and thus, all failures are attributed to compliance. “You just need to find a better doctor to help with the titration”, or “you need a different type of mask”, or “turn off the autoset and up the pressure”, or “it can takes years to adapt to the machine and see improvement”, or my favorite “you may feel much worse and get very little sleep but the science says you need cpap, even if it’s not helping the apnea and maybe even making it worse.” Indeed, the research literature show cpap is potentially iatrogenic, inducing or increasing (central) sleep apnea in some patients. The solution the industry has marketed, a different type of cpap device for CSA called asv, about twice the cost of a regular cpap, actually increased mortality in a major trial iirc. So yeah, if you don’t give up after years and dozens of machines and doctors and weekly titration appointments and none of that helping at all and maybe even making the apnea worse or even killing you (if you have HF, the main cause of CSA, then yes, cpap is “extremely effective” or there wouldn’t be a multibillion dollar business behind it propped up by insurers who can presumably use cpap patient non-compliance to deny future insurance claims related to the cardiovascular system or metabolic dysfunction.
gushogg-blake 5mo ago
Article says sleep apnea is caused by muscles collapsing in the upper airway, but an overlooked cause is structural deficiency in the bones of the midface. https://news.stanford.edu/stories/2020/07/toll-shrinking-jaws-human-health https://news.stanford.edu/stories/2020/07/toll-shrinking-jaw... I realised I was affected by this in 2023 and have been researching it and trying to spread the word about it since.
frankohn 5mo ago
Just to share my experience. I think I was beginning to develop sleep apnea: I was waking up suddenly with an awful feeling of something terrible happening for no reason. The most terrible experience was waking up in the middle of the night with a sensation of dread I couldn't explain, and it took me half an hour to calm down. More generally, since I was young, I always slept part of the night with my mouth open and woke up in the morning with a terribly dry mouth. Now I have solved my problem with two simple things, without any medication: during the day, I am always careful to breathe only through my nose (except during intense physical effort), and at night, I just use mouth tape to keep my mouth closed all night long. Since I started using the tape on my mouth, I sleep well and I no longer experience nighttime panic (due to apnea?). At the beginning, I was scared of having the tape keep my mouth closed, but I very quickly got used to it and now I barely notice it.
- binary132 5mo ago
  FWIW, I started experiencing the “night panics” (for lack of a better term) probably 10 years before I was diagnosed with sleep apnea, and once I began treatment they went away completely. So I am inclined to believe it’s definitely related.

232 points by colinprince 5mo ago

gpt5 5mo ago

People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen. I've suggested 4 people over the last couple of years to get tested based on them casually mentioning some of these symptoms, and all 4 got diagnosed with moderate to severe sleep apnea (which is classified by the number of times you stopped breathing every hour - AHI, and the blood oxygen level). Getting tested is easy and cheap - you can find kits for under $100 which essentially are just a monitor you attach your finger + a few ECG stickers on your body which you use for a couple of nights. You can order them online without talking to a doctor, and you will get a prescription for CPAP if you are diagnosed as positive. Treatment with CPAP is highly effective in eliminating these symptoms, and also reversing the brain damage (although MRI scans shows that it takes around a year for the gray matter in your brain to restore itself). The other suggestion I'd make is that if you are overweight or obese, GLP-1 has proven to be also a miracle drug for sleep apnea. Unlike the study mentioned above, that essentially reduced the average AHI of participants by 4, which for almost everyone wouldn't cure them. Drugs like Zepbound have shown that over half are cured from sleep apnea after roughly a year of use. This is in addition to the other health benefits they provide with the weight reduction. Essentially. This unfortunately won't work for everyone, as weight is not the only cause of sleep apnea, but it is by far the most common one.

anyfoo 5mo ago
> People should be more aware of the symptoms of sleep apneas I'm always a bit puzzled that this needs to be pointed out? I don't have sleep apnea per se, at least not chronically, but I've definitely had bouts of it due to allergy, sickness, stuff like that. The symptoms are the same because the mechanism is the same: I didn't get enough oxygen in the night. It's always glaringly obvious to me the next day. I feel way more tired and exhausted than I normally would given the amount of sleep. I sometimes had instances of waking up gasping for air. I really don't need to be told in those instances that there was an issue during the night. My sleep didn't sleep, of course there's something wrong and needs to be looked at? Like, one time's a fluke, but if it happens a lot...
- rattlesnakedave 5mo ago
  It’s typically something that sets in over time (often, but not always with weight gain and age), most people don’t notice because it’s gradual. Especially if they aren’t in normal risk groups. OSA symptoms are easy for an individual (and clinicians) to misatribute
  - anyfoo 5mo ago
    Yeah, but I've met people who think it's "normal" to wake up tired and exhausted even after multiple (or even many) nights of sufficient sleep, time-wise. I remember one person who thought waking up tired is just part of being an adult? The original comment said "multiple folds higher chances to be depressed, unemployed", for me that's a bit like saying that being on fire has a very high chance to make you depressed and unemployed. Yeah, of course that's true, but the effect on performance and well-being after a sleep apnea night is so obvious to me, I don't have to look for the proximate cause... EDIT: Through the other answer came to me that maybe in other cases, it's not so directly obvious just after waking up.
    - tayo42 5mo ago
      Waking up tired could be caffeine addiction too, which I think most adults are addicted to
      - jurgenburgen 5mo ago
        I’m addicted to caffeine and don’t wake up tired. Maybe you have sleep apnea.
- devmor 5mo ago
  I think it’s important to know your personal context levels. You noticed it because it’s happened to you occasionally. What about people who’ve been experiencing it most of their lives? To them, they are just tired all the time and don’t know why. It could be any number of things. To someone who’s never experienced it, how could they understand? My wife has bad sleep apnea and has to use a CPAP - neither of us noticed or understood the issue until she did a sleep study to deal with her bad snoring. We knew she was tired all the time, but attributed it to factors like work stress or maybe diet. The average person’s understanding of sleep apnea is probably around the level of “it exists and they have to wear a device at night” and not much more.
patrickdavey 5mo ago
I've tried a CPAP machine for 6 weeks and felt no different and gave up. I think I was a 6 on the scale. I wish it had worked though! Currently I've just given up and embracing feeling relatively tired all the time. I've tried side sleeping devices (woody knows backpack) mandibular advancement splints etc. So hard to tell (I find anyway) to get to a definitive answer
- cortesoft 5mo ago
  For some people it takes months to feel any different. For some people, they don't feel any better but it improves their health. Did you examine your numbers at all in something like OSCAR? You could get a good idea of how many events you were having at night, and if the CPAP was improving it. Even if you aren't feeling any better (yet) it could still be helping. You could also have multiple things that are causing you fatigue issues, and maybe fixing only one of them wasn't enough... that doesn't mean that one wasn't also important, though.
- stingraycharles 5mo ago
  I didn’t have apnea but I had UARS, which works differently. It’s more difficult to diagnose, primarily because it’s more rare.
- galactus 5mo ago
  exactly the same for me (but I gave after 5 weeks, because I didnt felt any different and hated everything about sleeping with the cpap)
- petesergeant 5mo ago
  Three more things to try if you haven’t, on a “can’t hurt” basis: nightly Avamys spray (might need a scrip depending on where you are), magnesium glycinate before bed, little bits of plastic that go inside the nostril and hold them open.
  - toast0 5mo ago
    Also worth a try... B1 (thiamine) seems to help for me. I don't have objective numbers, but I disturb my spouse with my snoring and breathing troubles far less. I believe I have (undiagnosed) central sleep apnea rathee than OSA though, it's been a long time since I had a sleep study, but I had only one event over a few recorded nights... But some nights it's pretty bad.
calvinmorrison 5mo ago
#1 symptom - fat necks! if you are like me and had a 17" neck at 185 in high school and now boast a 18.5".... you have it!
- dnnddidiej 5mo ago
  Why is that?
  - thfuran 5mo ago
    Sleep apnea can indirectly cause weight gain, but obesity—particularly excess fat on the neck—is the main controllable risk factor for obstructive sleep apnea, so it’s primarily the other way around.
shermantanktop 5mo ago
Having been down this path, it’s evident to me that the US has built up a sizable medical equipment industry around CPAP machines and their supplies. The sleep doctors who prescribe them don’t have many alternatives, so it’s the normal treatment they hand out. So it’s not a surprise that a casual mention of sleep quality ended with a CPAP machine rented by the month. It’s kind of what happened to me.
- Shadowmist 5mo ago
  Better to outright buy the machine online, then open it up and disable the modem.
  - antisthenes 5mo ago
    Why in the world does a CPAP machine need a modem?
    - f17428d27584 5mo ago
      Most have a cf slot to store the sleep data, it’s how the doctor / clinician can see if it’s working, make adjustments to pressure etc. but for convenience they can just upload the data directly. They also do OTA updates. However they also can perform an enforcement function: compliance. Insurers will penalize users of the device for not using it enough. This isn’t something I know much about just have seen it discussed, I don’t think all jurisdictions allow insurers to access this data for enforcement but it does seem to happen in USA. I think what happens is the insurers agree to pay for the device in installments. But they will cancel those payments if the person isn’t using it. But disabling the modem won’t fix that problem, you’d still get caught by the cf recorded data, or failing to provide it.
    - kotaKat 5mo ago
      Many patients starting out CPAP therapy go noncompliant because they have various issues or concerns with the machine, mask comfort, etc. Insurance companies are tired of paying thousands of dollars in machines and supplies that don't go used, so they instead 'rent' the machines from medical equipment suppliers, and use the machine's usage data to determine that you are still using it (and thus continue to pay for treatment). Typically after a year or so of usage they get 'paid for' but there's still ongoing compliance monitoring to get insurance to pay for supplies. The sleep lab and sleep doctors can also remotely review the usage and make adjustments as needed. One example is using the humidity sensors in ResMed units to adjust the humidification settings remotely. I was with a doctor that showed usage logs together and noted the bedroom was severely dry and thus we needed to adjust the humidifier to run hotter to compensate.
syntaxing 5mo ago
Any brand of test kit you recommend?
Aurornis 5mo ago
This is worth pursuing for anyone with the symptoms. However please do it with a reputable doctor, preferably associated with an established institution. Watch out for some of the specialty clinics and independent practice doctors who treat apnea like a cash cow. Sleep study scoring is theoretically set by strict rules, but in practice there can be differences between operators and clinics. Some clinics use this to their advantage to push more treatments and equipment and they’ll do it in ways that are most profitable for themselves. If they can’t get you scored high enough on the first sleep study they’ll pressure you to keep coming back for more studies or in some cases to start paying out of pocket after your insurance company starts refusing so many repeat studies with negative results. The better clinics are not afraid to tell someone they don’t have apnea or that they likely won’t benefit from PAP machine. They also aren’t shy about telling someone that weight management can be the best long term solution for weight-related cases, whereas some clinics won’t mention it because they want you coming back to them for never ending management.
- JSR_FDED 5mo ago
  A friend went to one of those clinics. “The diagnosis is sleep apnea. What are your symptoms?”
- aaron695 5mo ago
  [dead]
- nemo44x 5mo ago
  Get 2 opinions. And yes about weight - some people won’t have Apnea if they get their BMI to like 25 or whatever. Saying that I have a CPAP machine and love it.
  - gushogg-blake 5mo ago
    Multiple opinions won't necessarily help unless you research first. I'm not sure about other disciplines but in orthodontics for example there is a very definite split between whether they are "airway focused" or mainstream. I saw 6 or 7 different doctors, dentists and orthos in the UK over a period of about 10 years and none of them saw anything wrong with my jaws. Saw an airway focused ortho and a surgeon specialising in maxillo-mandibular advancement surgery and they recommended aggressive surgery. I agree with them, mainstream medicine is ignoring an epidemic of jaw underdevelopment because it challenges current practices in orthodontics.
petesergeant 5mo ago
> Treatment with CPAP is highly effective in eliminating these symptoms … for those who tolerate it. Numbers are all over the place, but roughly people who start it are only 50% likely to still be using it properly after a year.
- nemo44x 5mo ago
  I don’t know but I wonder if people that have insomnia or similar difficulty falling asleep (anxiety, etc) struggle with a CPAP. I am fortunate to fall asleep very easily, usually within 3-5 minutes or even faster. And I use a CPAP (nose saddles not a full mask), and prefer it to not using one while sleeping. The way it just opens all passageways is relaxing and I think helps fall asleep even more quickly.
- jrm4 5mo ago
  That seems -- quite high actually?
thibaut_barrere 5mo ago
Would you had precise kits references to share? It is quite hard to figure out what has cheap electronic versus what works. Thanks!
gniv 5mo ago
I bought a connected oxymeter (viatom). I wore it overnight on my finger with the phone nearby. The graph on the app shows exact values through the night so you can see how many time oxygen drops and for how long. It's not quite as good as the real thing but should give you an idea, and it's cheap.
radial_symmetry 5mo ago
100% agree. I can cleanly divide my life into before and after treatment for sleep apnea, I didn't realize I wasn't supposed to feel awful and tired all the time.
xivzgrev 5mo ago
Yes the lead is buried in the article. The drug reduces AHI by 4. It could only cure very mild sleep apnea. Otherwise it seems most useful as an additional treatment with CPAP. It could also help raise awareness of sleep apnea - try the drug first. Don't see any changes? Ok now try CPAP.

EdwardDiego 5mo ago

I don't have sleep apnea, as in, my severe snoring doesn't cause significant drops in blood oxygen levels, but it's still severely impacted my life - when my wife and I married, I spent the first night of our honeymoon awake so that she could sleep. Oh and it's so loud that I'm at risk of damaging my own hearing. And I bounced off CPAP hard, no matter what I tried, I would eventually remove the mask in my sleep, it was heartbreaking, I was so excited to finally be able to fall asleep beside my wife. I also tried the mouth guards and would wake up panicking and gagging. So my only other option currently is self-funding expensive surgery (our public system doesn't fund treatment for severe snoring unless it causes apnoea, and my private health insurance excludes the most expensive portions shrug), which like all surgery, carries no guarantees of success, and also carries the risk that any general anaesthesia application does. So this is awesome! I just hope it continues proving efficacious and safe.

Insanity 5mo ago
You snor so loud it damages your own hearing? Can you wear ear plugs to sleep?
- EdwardDiego 5mo ago
  Not yet it hasn't, but another 10 years of exposure to it will - and I do. :) I phrased it like that to try to convey the impact my snoring has on anyone near me. When I got hunting or tramping, and intend to stay at a backcountry hut, I always carry my bivvy bag in case there's other people staying at the hut, if there are, I go sleep in my bivvy bag about 50m away from the hut. Nothing like waking up and 20 other people all want to beat you.
swe123456 5mo ago
I found a way to stop removing the mask through smarthome magic: flash my lights if I take off the mask. Parts: 1. Smarthome coordinator - HomeAssistant/AppDaemon (runs on my desktop) 2. Prescense sensor - e.g. Aqara FP2 3. Smart light - e.g. Phillips Hue 4. Smart Plug/Power Meter - e.g. Kasa ESP25P4 5. Claude Code to write the logic ..... The alarm goes off if all of the following are true: 1. it's in sleep period (11pm-6am) 2. i am in bed 3. i have been in the bed for at least 3 minutes 4. i have worn the cpap (wattage > 10w for 3 minutes during sleep period) .... I can't get around this system at all without walking across the house to my desktop, at which point I'd be too awake to be stupid enough to remove the mask. Bonus CPAP nerdery: Wireless data collection into homeassistant using a Toshiba W04 SD Card/Wifi Transmitter.

xamuel 5mo ago

The drug is called AD109, but the title seems misleading as the drug is apparently still under trial, though it has shown good results there so far

ElijahLynn 5mo ago

It only reduces by 4 events per hour. That seems like it might be helpful for someone with mild sleep apnea. But not with moderate or severe sleep apnea. Adult AHI Severity Levels Normal: Less than (5) events per hour. Mild Sleep Apnea: (5) to (14.9) events per hour (frequent minor interruptions). Moderate Sleep Apnea: (15) to (29.9) events per hour.Severe Sleep Apnea: (30) or more events per hour. "By mapping the neural circuits that lead to this common condition, work from the Horner lab laid the foundation for AD109, a new treatment developed by researchers in Boston to specifically target the two pathways that contribute to sleep apnea. The daily oral medication contains two drugs: one that increases noradrenaline levels and another that blocks muscarinic receptors. In a recently published phase 3 randomized clinical trial, people with mild to severe sleep apnea who received AD109 had less airway obstruction and higher oxygen levels than those who received a placebo. On average, per hour of sleep, participants on AD109 had four fewer events where they stopped breathing or had very shallow breathing."

Waterluvian 5mo ago
My AHI was 151 when measured. The CPAP has changed my life but I do look forward to any possible way to not need it anymore.
- UncleOxidant 5mo ago
  Mine was in the 50s when they measured, which seemed bad enough. CPAP takes it down to about 2 to 3.
- folkrav 5mo ago
  Oof, and here I thought my AHI of 69 was bad (which it kind of is regardless). My condolences. Glad the CPAP helped, it completely and utterly changed my life too.
  - LooseMarmoset 5mo ago
    256 here :( the cpap is a wonder, I can't sleep without it. I only wish I'd gotten one 10 years sooner. I have whole years of my life missing from my memory - REM sleep is very important to long-term memory formation. Using my CPAP now nets me about 1.5 AHI. if your doctor tells you to get one, get one.

rattlesnakedave 5mo ago

Great. Something like 60% of OSA cases are linked to obesity. GLP-1 drugs could probably lead to resolution for a lot of them if the Lilly SURMOUNT-OSA trial tells us anything.

crazydoggers 5mo ago
Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all. The preconception that it is mostly obesity related is a dangerous stigma since it prevents a lot of people understanding what is happening and getting treatment. I started with sleep apnea in my 20s when I was in amazing physical condition. I would jolt awake, heart racing, almost panic attack levels. No idea what was happening.. took me another 15 years to do a sleep study and get diagnosed, and CPAP treatment literally overnight cured the condition. I went from 20-30 events per night to less than 1 on average. If anyone has any sleep issues at all, or suspects any.. go get a sleep study. It’s not as scary as it sounds and there’s no downside to having one done.
- cortesoft 5mo ago
  > Although there is a link in many cases, there are a lot of cases where there’s no obesity link at all. I mean, the person you replied to literally said "60% of cases are linked to obesity" Which obviously implies that 40% of cases are NOT linked to obesity. You are saying the exact same thing the person you replied to is saying, just without the numbers. I feel like the person you replied to's comment was not stigmatizing obesity at all, in fact learning that 40% of sleep apnea cases are unrelated to obesity entirely probably educated some people that it was less tied to weight than they believed before.

piou 5mo ago

I highly recommend BongoRX (https://bongorx.com/ https://bongorx.com/) if you have sleep apnea and can't deal with CPAP. The mechanism: it makes it a little harder to breathe out, which keeps your airways more open when you breathe in next. The pictures on the website are a little misleading: it comes with a strap to keep the device in your nostrils, so they don't just fall out in the middle of the night. FDA-approved, and does require a prescription...

FlamingMoe 5mo ago
I might have to try this. Their bland website with last year’s copyright would never have sold me by itself, but a HN comment could

georgemcbay 5mo ago

Surprisingly the most effective treatment I've found for my own apnea is just wearing an inexpensive soft cervical collar to sleep, but there are lots of different things that can contribute to sleep apnea, so YMMV. After dealing with unexplained ectopic heartbeats (sometimes PVCs, sometimes PACs) I saw a chain of doctors and that included both getting a sleep study done and seeing a cardiologist. I was diagnosed with mild apnea (AHI just above 10), but despite the apnea being mild on the AHI scale, my Sp02 blood oxygen percentage was dropping into the low 80%s for extended periods per night down from a normal 95-99% most of the time. I weigh 180 lbs at 6 foot 2, being overweight was a non-factor in my apnea. Got a CPAP machine, it helped but even after dialing in my personally optimal pressure settings using the CPAP data with OSCAR my AHI was still kind of all over the place, from under 1 to as much as 6 seemingly randomly per night with no mechanical issues like mask leaks showing up. Had heard (on reddit /r/CPAP) about some people using soft cervical collars to help with their apnea and I gave it a try and when wearing one my AHI drops down to 0.0 - 0.4 per night. The collar alone helps more consistently in my case than the CPAP machine does. Basically my sleep apnea is almost entirely due to the fact that when I'm sleeping (even on my side, but worse on my back) I seem to naturally tuck my chin in toward my neck in a way that constricts my upper airway and the collar stops this from happening. This is very much YMMV, there are lots of different causes of apnea.

gdudeman 5mo ago
Curious how you tested this - did you do repeated home tests to figure this out?
- georgemcbay 5mo ago
  Most CPAP machines including the one I have record a lot of data that can be analyzed via software like OSCAR: https://www.sleepfiles.com/OSCAR/ https://www.sleepfiles.com/OSCAR/ On the machine I have (ResMed AirSense 10) the data gets written to an SD card I can pull out and import into OSCAR to see what the machine detected about my sleep apnea events. I also (not always, but when I'm testing changes) use a continuous pulse oximeter to test my SpO2 blood oxygen % over the entire night. The data from this can either be combined with the data from the CPAP machine, or used on its own to test things like how I do with the collar and no CPAP machine, since the SpO2 drops are the dangerous thing I'm trying to avoid by eliminating the apnea events. I use the Wellue SleepU for SpO2 monitoring but there are a lot of similar devices (the kind with finger tip sensors are generally more accurate than the wristwatch based solutions).

tickerticker 5mo ago

The difference maker for me was an app, Snore Lab. that my son told me to try. It said that my snoring was EPIC. That led to my current CPAP use, for which the benefits [no daytime sleepiness, more energy, no food cravings] exceed the hassle [mask wearing, cleaning routine, supplies reordering.] Four events per hour AHI improvement would not be a meaningful change for my therapy, but this is the beginning of better treatment options in the future. The best benefit of CPAP is that it thwarts heart arrhythmias which arise from depriving the brain of oxygen.

adamtulinius 5mo ago

I wake up without my cpap mask after a few hours every night. In total I might get 6 hours with it after putting it on multiple times. Doctors think I’m doing fine due to total amount of hours used, and my resmed cpap claims I’m at below 1 event/hour. I’m not doing fine and I think the numbers are lying to me. I snore a million, my mouth gets dry, and my nose tightens up, so my nasal mask isn’t always that nice to use. Other masks also annoy me. What do? I haven’t sleep a solid 8 hours for 3-4 years :(

wincy 5mo ago
Obviously I don’t know you or your specific situation, but I lost 120 pounds taking Zepbound and my apnea is gone. I make sure to take fluticasone in each nostril before I sleep, but getting to a healthy weight eliminated my apnea. If you aren’t overweight, this might not help, but hopefully it’ll help someone!
- adamtulinius 5mo ago
  I’m 130 kg and know it’s way too much. Hard to gather the energy for loosing weight. Can you take fluticasone permanently? Sometimes it’s like I just lie down and my nasal congestion gets worse instantly
  - retrac 5mo ago
    > Can you take fluticasone permanently? This is a surprisingly controversial question. I've known more than one person who claims something to the effect of becoming addicted to Flonase. Like now they have to take it only to feel like how they felt before they started taking it. Rebound inflammation when stopping use is a real effect with long-term use of corticosteroids and can, at least briefly, be worse than the initial symptoms were. As someone with multiple mild inflammatory disorders I've always been afraid to use steroids consistently lest I have nothing effective when things are worst.
  - 0xack 5mo ago
    This is suppose to be a tell tale sign of deviated septum (lying down and losing airflow).

RobotToaster 5mo ago

It's aroxybutynin 2.5 mg/atomoxetine 75 mg. They don't actually say in the article but the development code "AD109" leads to that

iammjm 5mo ago
So basically a non-stimulant medication for ADHD? Very interesting

kiddz 5mo ago

I have severe obstructive sleep apnea -- am 6ft and 210. I wear a CPAP and now swear by it. A couple things to help those who try: 1) Make sure you have a CPAP machine with a water tank so the forced air is moist. For me, if the water runs out, that's when I wake up bc my nose dries. 2) Get a spray saline solution for your nose -- not Afrin or drugs (habit inducing) -- just simple and cheap Arm & Hammer Simply Saline. 3) Wear a shirt when you're in bed and put the hose under your shirt so it's hard to roll off. 4) Bonus -- sleep elevated. Those are my best tips. If you can do the CPAP and suffer the awkwardness, you'll really feel so much better. First time it stuck, I woke up at 4:45 am fully rested and felt as if a heavy weight was lifted off me. Best luck :)

chasebank 5mo ago
Have you tried losing weight and if so, did that help?
- al_borland 5mo ago
  My dad used a CPAP for many years and was quite the evangelist for them due to how significantly it improved his quality of life. At one point, when trying to nudge him toward weight loss and diet changes for type 2 diabetes, I mentioned it may also help with his sleep apnea. He was adamant that the type of sleep apnea he had would exist no matter what and weight loss wouldn't help... apparently his doctor told him this. Fast forward 5 years, he ends up in a program for his diabetes that put him on a pretty extreme elimination diet which led to him losing a pretty significant amount of weight. During that time he kept having to turn the pressure on the CPAP down, until eventually even the lowest setting was too strong and he was able to get off the CPAP completely. For over a decade he talked about how happy that CPAP made him, he almost seemed proud of it. However, he got pretty emotional when he found out he was able to get off of it. As much as it may help, it is still a burden to need a machine to sleep. I know it's an N of one, but it shows it can help and is worth a shot. Even if it doesn't completely resolve the sleep apnea, there are so many other additional benefits. After an alert from my Apple Watch and a few extremely rough nights of sleep when my weight hit an all time high, I scheduled a sleep study for myself. It's 2-3 months out still, so I plan to lose what I can while I wait to see how much it can help. Even the first 10 lbs was a significant help and stopped the truly awful sleep I had for a week or two.

pmcg 5mo ago

I had bad sleep apnea until last year, sleeping 8-9 hours a night and usually feeling tired in the morning. As of the last 12 months it seems to be heald, after I used mouth tape and a nasal dilator consistently for 30 nights in a row. I highly recommend trying this, it was quite cheap (~$20) and the change seems to have been permanent. I used 3m micro-pore tape that doesn't tear the facial hair, and the nasal dilator I used was called "woody knows", though there are many brands that may work just as well. I barely snore anymore where I used to be a raging snorer according to those in the know and my own audio recordings of myself. Most importantly, I only need about 7 to 7.5 hours of sleep now and I will wake up feeling well rested most days. I can also breathe exclusively through my nose now where before I could not. I can take very big breaths through just the nose and do this now when exercising. I don't think it's all perfect though as I still often breathe through my mouth. I'm starting to wear the mouth tape at night again as an experiment - it really isn't that annoying. Relatedly, I recently started looking into "mewing" after a breath-work teacher I took classes with recommended it to me as she has been doing it with good results (improved breathing). It seems related to this as Mew recommends keeping the mouth shut all the time. I intend to try the mewing exercises and see if that helps my breathing further.

an0malous 5mo ago

I went through the whole process of seeing an ENT, using the machine for the at-home sleep study so insurance would give me a CPAP, then not being able to sleep with a CPAP, and over the course of a couple years I fixed my sleep apnea by fixing my posture and breathing. If you have forward head posture or are not used to breathing through your nose, you might also benefit from this. I think it’s kind of crazy that we do surgeries and take medicine that modifies your brain chemistry for what I believe in many cases is a structural issue. If you’re curious to try this, read James Nestor’s book Breath, do yoga with breathing exercises, or see a physical therapist. It takes time to fix these structural issues, but you can literally change the shape of your nose, palate, and jaw from just practice. Here’s a quick exercise you could try. Sit up, relax your body, breathe in through your nose, and feel the breath move up your nose, down to the base of your skull, down your neck, and then as far down your spine as you can. The air isn’t literally moving through these areas, but you should feel a current of sensations moving roughly along that path. As you breathe out, follow the current in the opposite direction. As you tune into this current, your neck and back will naturally straighten a bit, it should feel very natural and even pleasant. Keep your body relaxed and allow your neck and back to align with this current. If you keep doing this regularly it should help improve your posture and breathing. This is basically a pranayama / yoga breathing exercise. If it feels painful, definitely stop and try physical therapy or working with a hatha yoga instructor who can give you more guided instruction. I used to snore so badly it sounded like, without much exaggeration, a dying elephant. I only did this exercise for a couple years and it slowly improved over that time, and now I sleep quietly.

pmcg 5mo ago
I had a similar experience, with a slightly different approach (mouth tape and a nose dilator) but seemingly similar outcome. I like that you did it just through exercises with no mechanical intervention. Inspiring.
- an0malous 5mo ago
  Thank you! I saw you mentioned mewing in your comment, they teach you that in some pranayama exercises as well and I agree it’s a great addition. It feels unnatural at first but when you get used to it, it’s almost like bracing your palate with your tongue allows you to pull air in through your nose more smoothly and with more power. I’ve found this is all really worth learning, even if you don’t have sleep apnea. I feel more clear headed and energized when I can breath through my nose now.

Bender 5mo ago

I was never diagnosed with sleep apnea but I had an O2 saturation alert when I would sleep side sleeper so I bought a cervical pillow and found a quiet CPAP machine. I add saline and a few drops of very diluted I+KI to the water just to keep anything from growing in it despite changing it daily. I love it. My sleep has never been better. I often forget I have the little nose mask thing. The cervical pillow is awesome, never goes flat. My biggest improvements were from that little cervical pillow.

milchek 5mo ago

I see CPAP rightly getting mentioned a lot here. What worked for me was a MJS (Mandible Jaw Splint), it’s basically a mouthguard you sleep with that moves your lower jaw forward and thus brings your tongue forward so it doesn’t obstruct your airways. Best bet is to get this custom made. Here in Australia there are specialist dentists that do this for you. It’s far easier than CPAP and works just as well for many like myself. Often folks will use CPAP at home and these mouth guards when travelling.

dimgl 5mo ago

I think sleep apnea would have killed me had I not gotten the sleep study. I was having 100+ events in the span of a few hours. Anyhow, I use the CPAP everyday. I don't snore anymore and I have maybe 1 event a night. Incredible machine.

luxuryballs 5mo ago

I always thought as a stomach sleeper why not get one of those massage table head rest things, face down symmetrical and wouldn’t gravity help keep things open then? Just have to build it into a cozy bed, not sure if that would be comfortable though.

tickerticker 5mo ago
I also thought of this idea and wanted to try it. Gemini said not to do it bc when we sleep, we naturally want to change positions. Thus, maintaining one position all night would cause muscle cramps?
- luxuryballs 5mo ago
  yeah true, maybe it could be good for a power nap “table” if we can make it comfy enough, I did see a massage table head/face cushion adapter that hooks into a normal bed so might be inexpensive to try it out

moojacob 5mo ago

If you wake up every day feeling like you got hit by a train and also have anxiety, depression, chronic heartburn, or exhaustion (not sleepiness, like a wired but tired) I would highly recommend looking into Upper Airway Respiratory Syndrome (UARS). UARS was coined by Dr. Christian Guilleminault who was on the team that coined sleep apnea. Over his career he slowly widened his definition of sleep disordered breathing from choking (sleep apnea) to any nasal resistance that causes wake ups. You be young and perfectly healthy but due to bad anatomy have micro arousals throughout the night. Becuase your young, your body fights through it (cuasing exhuastion) and will wake up up to readjust your airway. You won't remeber any of the wakeups, but many suffer from insomnia from it. The two big issues is large tongue in underdeveloped jaw that falls back and constricts your airway (you can test this with a mallamapati test) or a small nasal passage way.

Traubenfuchs 5mo ago

You can‘t get AD109, but unless you live in a shithole country you can order some ambroxol today. https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0860514.pdf https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0... I once wrote a summary here: https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a_well_known_side_effect_free_cheap_over/ https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a...

KnuthIsGod 5mo ago

STOP-BANG Score for Obstructive Sleep Apnea: https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive...

m0nit0r 5mo ago

If it spares a respirator this is huge win. Even if might be used before severtiy leads to the unavoidable NIV-respirator with overnight CPAP.

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petercooper 5mo ago

There are some older studies that showed nicotine (not via smoking, which makes sleep apnea worse) had a positive effect on sleep apnea as well due to the stimulation increasing muscular activity in the airways. Obviously lots of downsides too so it never caught on, but this seems to have a similar mechanism.

huzaifasinan 5mo ago

[flagged]

fluxist 5mo ago

One of the drugs in this treatment, oxybutynin (Ditropan), is associated with cognitive impairment[1]. [1]https://www.sciencedirect.com/science/article/pii/S0090429524000062 https://www.sciencedirect.com/science/article/pii/S009042952...

euroderf 5mo ago

For me the CPAP was too damn invasive. Fail. So as an alternative they made me a dental appliance. I put it in at bedtime and it kept my lower jaw jutted out just enough to maintain airflow. It worked :)

DrAwdeOccarim 5mo ago
Yes! I had a mandibular advancement device for many years, but after about 10, my lower jaw stopped resetting all the way in the morning. I forced myself to find the right CPAP (nasal pillows with fabric elastic chin strap to keep my mouth closed). It's been about 5 years and my jaw finally is >95% back to normal (YMMV). But by far the most critical part of getting CPAP to work was using an open source program to review the SD card raw data every morning, learning the interplay between max/min pressure, temperature, humidity, and ramp. Gaining access to the admin controls on my AirSense and fiddling it myself over weeks to find the right settings--this was the only way I made it work. The idea of waiting 6 months to make a change to the pressure was bonkers to me. Especially, for some reason, my brain is shit the next morning if I over oxygenate with too high max pressure overnight, worse than not wearing it at all! But once you dial in the settings. It's magic.

jrm4 5mo ago

I often get (perhaps reasonable) pushback for this, but the level to which CPAP equipment and supplies are gatekept by the industry is absurd. They're a fan tube, a mild heating element, and a sensor, and I'm nearly certain that it would be pretty difficult to harm yourself using one "wrong" -- especially as opposed to other medical items and drugs available OTC. Also, yes, they're pretty cool. I don't love that I seem to need mine right now, but at least I know a guy. :)

crazyfingers 5mo ago

“CPAP treatment is extremely effective, but Horner notes that many people have a hard time sticking with CPAP because they find it uncomfortable and cumbersome.” The sleep medicine industry uses compliant long term cpap patients as the denominator in order to conclude it’s “extremely effective”. If you stop cpap therapy after a year (or even years!) of it not working, they will blame patient compliance not the machine. The machine manufacturers (who incidentally happen to fund most sleep research) have made a variety of machines and settings, and thus there is always another setting to adjust or device to try before concluding cpap won’t help. The assumption is that it’s “extremely effective” and thus, all failures are attributed to compliance. “You just need to find a better doctor to help with the titration”, or “you need a different type of mask”, or “turn off the autoset and up the pressure”, or “it can takes years to adapt to the machine and see improvement”, or my favorite “you may feel much worse and get very little sleep but the science says you need cpap, even if it’s not helping the apnea and maybe even making it worse.” Indeed, the research literature show cpap is potentially iatrogenic, inducing or increasing (central) sleep apnea in some patients. The solution the industry has marketed, a different type of cpap device for CSA called asv, about twice the cost of a regular cpap, actually increased mortality in a major trial iirc. So yeah, if you don’t give up after years and dozens of machines and doctors and weekly titration appointments and none of that helping at all and maybe even making the apnea worse or even killing you (if you have HF, the main cause of CSA, then yes, cpap is “extremely effective” or there wouldn’t be a multibillion dollar business behind it propped up by insurers who can presumably use cpap patient non-compliance to deny future insurance claims related to the cardiovascular system or metabolic dysfunction.

gushogg-blake 5mo ago

Article says sleep apnea is caused by muscles collapsing in the upper airway, but an overlooked cause is structural deficiency in the bones of the midface. https://news.stanford.edu/stories/2020/07/toll-shrinking-jaws-human-health https://news.stanford.edu/stories/2020/07/toll-shrinking-jaw... I realised I was affected by this in 2023 and have been researching it and trying to spread the word about it since.

frankohn 5mo ago

Just to share my experience. I think I was beginning to develop sleep apnea: I was waking up suddenly with an awful feeling of something terrible happening for no reason. The most terrible experience was waking up in the middle of the night with a sensation of dread I couldn't explain, and it took me half an hour to calm down. More generally, since I was young, I always slept part of the night with my mouth open and woke up in the morning with a terribly dry mouth. Now I have solved my problem with two simple things, without any medication: during the day, I am always careful to breathe only through my nose (except during intense physical effort), and at night, I just use mouth tape to keep my mouth closed all night long. Since I started using the tape on my mouth, I sleep well and I no longer experience nighttime panic (due to apnea?). At the beginning, I was scared of having the tape keep my mouth closed, but I very quickly got used to it and now I barely notice it.

binary132 5mo ago
FWIW, I started experiencing the “night panics” (for lack of a better term) probably 10 years before I was diagnosed with sleep apnea, and once I began treatment they went away completely. So I am inclined to believe it’s definitely related.