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Someone really needs to properly do the science on this I (presumably like the majority) assumed that sleep apnea was at least partially caused by weight gain,

Someone really needs to properly do the science on this I (presumably like the majority) assumed that sleep apnea was at least partially caused by weight gain, but if there is weight gain caused by sleep apnea it’s going to give doctors some new tools

david-gpu 5mo ago
I had textbook symptoms of sleep apnea with a BMI of 19, before I was diagnosed. The sleep tech told me bluntly that plenty of slim people, even children, develop sleep apnea. Obesity increases the chance of developing sleep apnea, yes. But sleep apnea also increases the chance of becoming obese. It is not just a simple unidirectional cause and effect.
elric 5mo ago
There is plenty of proper science on this. Weight gain does not cause obstructive sleep apnea until you get into extremes (e.g. huge necked bodybuilders or people with so much fat on their chest that they physically struggle to move it to breathe). Sleep apnea makes it harder to lose weight and easier to gain weight. Having sleep apnea and being heavier can make sleep apnea worse. Losing weight quickly can make sleep apnea worse when you lose muscle mass along side fat (e.g. on ozempic). There are plenty of tools for doctors to treat sleep apnea. The problem is that they refuse to use them. Many people on CPAP would benefit greatly from being on BiPAP instead, but doctors commonly refuse to prescribe it. Some cases of sleep apnea can be treated using positional therapy (typically side sleeping), but there's no prescription for that. Some cases can be solved by exercising throat muscles (with or without a didgeridoo), but there's no prescription for that either, and there are virtually zero speech/physical therapists who focus on that. There are some surgeries that can really benefit some patients, but most sleep labs and ENTs refuse to even to even perform a proper sleep endoscopy.
- s5300 5mo ago
  [dead]
- elric 5mo ago
  Not sure why the other reply got downvoted to death. Commenter is right. The same motor seems to power resmed CPAP and resmed BiPAP. Haven't tried jailbreaking my own yet, but maybe I should give that a go.
  - s5300 5mo ago
    [dead]
- bobthepanda 5mo ago
  At least in the US my understanding is insurers don't generally support BiPAP because it's more expensive. Surgery costs more, has extended recovery time, is more risky, and is less effective at the broader population level; if it works, it may not work forever. For a lot of people, CPAP is good enough, and so it's currently the standard.
  - elric 5mo ago
    BiPAP is only more expensive for artificial reasons. It's the same hardware just with a different algorithm. CPAP machines are around €/$500, BiPAP can be more than twice as much. But if you take into account that they last 5-10 years, and that my local hospital charges my insurance €90/month for leasing a CPAP device, it quickly becomes apparent how much of a cash grab that is. Patient care should be at the top of the list, especially for something as important as sleep. But saving a few bucks in the short term seems to be more important. But people with improperly treated sleep apnea still suffer many of the same effects of people who aren't treated at all.
    - bobthepanda 5mo ago
      For BiPAP i could buy that. For surgery, it turns out there are higher rates of it being the improper treatment and partial or full failure, and you still might need CPAP anyways. And that’s on top of the fairly standard and obvious preference for non invasive treatments in general. I will say a fairly non invasive surgery that is much easier to consider is fixing a deviated septum; it probably won’t fix your apnea, but it being deviated is probably not helping.
      - elric 5mo ago
        I share your concerns about surgery. The way I understand it, the difficulty lies in choosing the right surgery (or surgeries) for the right patient. The supposed gold-standard diagnostic approach is a drug induced sleep endoscopy, where an ENT looks at your airway while you sleep. The problem is that being sedated is not the same as being asleep. It's possible to do this "right", but that is much more time consuming than just shooting people up with propofol and scoping them while they're knocked out. One thing to keep in mind is that surgery might still be useful even if it doesn't get you off CPAP: being able to use lower CPAP pressures could increase comfort and adherence. I've been putting off my own septoplasty because it all sounds extremely unpleasant, so yeah.
kjs3 5mo ago
The idea people aren't doing 'proper science' on this is a spectacular level of oblivious. There's nothing in here that I haven't at some point had a discussion about with my sleep doc in the last 20 years (well, not specifically a didgeridoo, but circular breathing and other types of breath exercises, including 'straw breathing'). Yes, some people do loose weight when they get their apnea under control, among other health benefits. That also is not new, and it's not some sort of miracle insight that noone has considered.

david-gpu 5mo ago

I had textbook symptoms of sleep apnea with a BMI of 19, before I was diagnosed. The sleep tech told me bluntly that plenty of slim people, even children, develop sleep apnea. Obesity increases the chance of developing sleep apnea, yes. But sleep apnea also increases the chance of becoming obese. It is not just a simple unidirectional cause and effect.

elric 5mo ago

There is plenty of proper science on this. Weight gain does not cause obstructive sleep apnea until you get into extremes (e.g. huge necked bodybuilders or people with so much fat on their chest that they physically struggle to move it to breathe). Sleep apnea makes it harder to lose weight and easier to gain weight. Having sleep apnea and being heavier can make sleep apnea worse. Losing weight quickly can make sleep apnea worse when you lose muscle mass along side fat (e.g. on ozempic). There are plenty of tools for doctors to treat sleep apnea. The problem is that they refuse to use them. Many people on CPAP would benefit greatly from being on BiPAP instead, but doctors commonly refuse to prescribe it. Some cases of sleep apnea can be treated using positional therapy (typically side sleeping), but there's no prescription for that. Some cases can be solved by exercising throat muscles (with or without a didgeridoo), but there's no prescription for that either, and there are virtually zero speech/physical therapists who focus on that. There are some surgeries that can really benefit some patients, but most sleep labs and ENTs refuse to even to even perform a proper sleep endoscopy.

s5300 5mo ago
[dead]
elric 5mo ago
Not sure why the other reply got downvoted to death. Commenter is right. The same motor seems to power resmed CPAP and resmed BiPAP. Haven't tried jailbreaking my own yet, but maybe I should give that a go.
- s5300 5mo ago
  [dead]
bobthepanda 5mo ago
At least in the US my understanding is insurers don't generally support BiPAP because it's more expensive. Surgery costs more, has extended recovery time, is more risky, and is less effective at the broader population level; if it works, it may not work forever. For a lot of people, CPAP is good enough, and so it's currently the standard.
- elric 5mo ago
  BiPAP is only more expensive for artificial reasons. It's the same hardware just with a different algorithm. CPAP machines are around €/$500, BiPAP can be more than twice as much. But if you take into account that they last 5-10 years, and that my local hospital charges my insurance €90/month for leasing a CPAP device, it quickly becomes apparent how much of a cash grab that is. Patient care should be at the top of the list, especially for something as important as sleep. But saving a few bucks in the short term seems to be more important. But people with improperly treated sleep apnea still suffer many of the same effects of people who aren't treated at all.
  - bobthepanda 5mo ago
    For BiPAP i could buy that. For surgery, it turns out there are higher rates of it being the improper treatment and partial or full failure, and you still might need CPAP anyways. And that’s on top of the fairly standard and obvious preference for non invasive treatments in general. I will say a fairly non invasive surgery that is much easier to consider is fixing a deviated septum; it probably won’t fix your apnea, but it being deviated is probably not helping.
    - elric 5mo ago
      I share your concerns about surgery. The way I understand it, the difficulty lies in choosing the right surgery (or surgeries) for the right patient. The supposed gold-standard diagnostic approach is a drug induced sleep endoscopy, where an ENT looks at your airway while you sleep. The problem is that being sedated is not the same as being asleep. It's possible to do this "right", but that is much more time consuming than just shooting people up with propofol and scoping them while they're knocked out. One thing to keep in mind is that surgery might still be useful even if it doesn't get you off CPAP: being able to use lower CPAP pressures could increase comfort and adherence. I've been putting off my own septoplasty because it all sounds extremely unpleasant, so yeah.

kjs3 5mo ago

The idea people aren't doing 'proper science' on this is a spectacular level of oblivious. There's nothing in here that I haven't at some point had a discussion about with my sleep doc in the last 20 years (well, not specifically a didgeridoo, but circular breathing and other types of breath exercises, including 'straw breathing'). Yes, some people do loose weight when they get their apnea under control, among other health benefits. That also is not new, and it's not some sort of miracle insight that noone has considered.