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How I figured out I have sleep apnea

I was always super tired every morning and about every two weeks I’d have a situation where I’d wake up gasping for air. I never really paid attention to it, because I figured that this was pretty normal. 

Thanks to a random Facebook advertisement, I decided to take the Lofta sleep test, which revealed that I have sleep apnea with an AHI of 18 and RDI of 26.

I followed up with an ENT to take a look at my throat. Viewed through an endoscope, it was obvious that my tongue was too far back, close to obstructing my airway. I’ve attached the video below.

I figured that while CPAP is a decent solution, it’d be a good idea to test some less annoying ways of fixing my sleep apnea. The masks are rizzless, see below

A quick aside though – CPAP is the gold standard therapy for sleep apnea and if my exploration doesn’t work I’ll very likely begin using one. It’s just that my sleep apnea is relatively moderate, I’m young, and I’m highly motivated. Don’t use this article as an excuse to not treat your sleep apnea!

Measurement

In order to properly measure the impact of interventions, I’d have to measure my sleep somehow. There aren’t a lot of options unfortunately.

Oura Ring – it measures sleep quality in a general sense, not specifically sleep apnea. It does have a blood oxygen measurement feature, but it’s not very sensitive. I decided to buy one mostly on the theory that improved sleep apnea would likely correlate with better sleep in general.

Wellue O2 ring – I’m not sure why continuous pulse oximeters are so hard to find (glares at FDA?), but this one does the job. It measures my sleep apnea decently well. The only issues I have with it is that 1. if I toss and turn too much I get bad readings 2. The rubber ring has started to wear out, which I counteract by putting on progressively larger fingers.

Lofta sleep test – This is the test I used to get a formal diagnosis. It’s usually somewhere around $189 for the test. Lofta ships you a pulse ox which is connected to a single EKG lead that you attach to your chest. You connect it via an app, measure for one night, then discard the hardware (!!!). Someone please hack this thing so it’s not such a horrible waste. You then get a call from a doctor who discusses the test results with you and tries to sell you a CPAP from Lofta.

Sunrise sleep test – I haven’t tried this but it looks really cool. It measures sleep apnea with a sensor placed on your chin. The idea is that your jaw moves forward to counteract a collapsed airway, so by measuring jaw movement you can determine respiratory effort.

Lifestyle interventions (listed from least woo to most)

Sleep position – this is by far the best effort to results item on this list. If you currently sleep on your back, try sleeping on your side. There are countless ways to achieve this, so I won’t bother listing them all, but suffice to say they usually work by mechanically forcing you to sleep on your side. (Un?)Fortunately for me, I’m a lifelong side sleeper. Interestingly though, the O2 ring and Oura helped me discover a position issue during sleep. I usually sleep hugging a pillow, but for a short period during a move I slept without one. My sleep and oxygen scores were significantly worse! It turns out that hugging the pillow were helping my breathing by preventing me from flopping onto my stomach. The conclusion for you should be to experiment with various position interventions.

I started with the wedge pillow, since it was the easiest of the interventions. Unfortunately, it was a total failure, with my sleep apnea appearing to only get worse. You can also try tilting your bed.

Nasal breathing! Mouth taping

Nasal strips, as previously mentioned, can be a lifesaver. I don’t even have nasal based sleep apnea but just having an open nose is super helpful in having better sleep quality.

Nasal dilators are an alternative to nasal strips where rather than pulling open your nose through an adhesive on the outside, they push it open from the inside with a plastic bit. Haven’t tried, so can’t say how useful they are.

Weight loss can help a LOT with sleep apnea. If you have less fat in your airway, you’ll have less to collapse. Sleep apnea tends to cause weight gain, so treating sleep apnea can actually help you lose weight as well. I’m at a normal weight, so not much relevant here for me.

Exercise can help a lot, but I already exercise. If you don’t, you really should, and not just because of the sleep apnea.

I next tried Flonase. I heard from Vik Veers that only 6% of patients exclusively have a tongue issue. On hearing that, I thought I’d try Flonase to have a bit easier time breathing through my nose, hoping that it’d have an effect on my sleep apnea. Unfortunately, while I did subjectively feel that it improved my sleep quality, it didn’t affect my Oura or O2 scores. Note – you can use Flonase continuously for up to 6 months, which should cover you for allergy season.

Azelastine is an alternative mentioned by my doctor for allergies. It’s an antihistamine that you can spray directly into your nose, which means it works significantly better for opening up nasal passages. Do note that there’s a specific spraying technique you should use to avoid getting it into your throat since apparently it tastes terrible. I ended up not trying azelastine since Flonase didn’t improve my symptoms and allergy season ended.

There’s some evidence that mouth exercises can help with sleep apnea. Below are some links to research papers and Reddit posts about success with various exercise techniques. Since my apnea is mostly tongue related I’ve been doing this set from Vik Veers. So far I haven’t seen much in terms of effects, but it takes a while to build up muscle tone. If you want exercises in a nice app format, check out Airway Gym.

Have you wanted to learn an instrument? No? Me neither, but here we are. There’s some (sketchy) evidence that playing specifically either a double reed instrument, which is the oboe, or a didgeridoo can be protective against sleep apnea. The suspected mechanism in the didgeridoo appears to be the circular breathing, which doesn’t make sense because many woodwind instruments require circular breathing. The oboe may be useful since you need to generate high pressure in the mouth and also move your tongue to play music. In any case, it’s worth trying, but don’t hold your breath (hah).

Buteyko breathing is a technique by which you work to increase your CO2 tolerance. In theory this should help with sleep apnea symptoms since you’ll have a lower reaction to holding your breath (which in this case is choking on esophagus). Buteyko does seem to work for freediving, so maybe it works for sleep apnea, someone please try and report back.

Myofunctional therapy

Mewing

People on Reddit say Wim Hof breathing helped, but frankly I’m not certain by what mechanism it would help with sleep apnea. Let me know if it worked for you?

Medical treatments

CPAP

REM catchup

Poor sleep regardless

Mask fitting + settings

iNAP

Bongo RX

Note: I’ll use the word “shock” to describe what the next few devices are doing, but it’s less of an electrocution and more of a gentle pulse. Nobody’s looking like this —

Inspire is a bit hardcore for my tastes, but it does appear to be super helpful for people. It involves surgically implanting the equivalent of a pacemaker that then shocks your esophageal muscles every time you take a breath. This ensures that your airway has the same level of openness as it does when you’re awake and your muscles are tense. Downside is that it requires surgery.

Zeus is basically Inspire but without the surgical implantation step. You attach it to the bottom of your chin and it shocks the tongue & jaw muscles through the skin.

ExciteOSA is a fascinating product — exercise in a device! If you don’t have the executive function to stick with the tongue exercises, you can try using this instead. You put the device in your mouth and it shocks your muscles to exercise them. You use it for 20 minutes per day for 6 weeks.

Oral appliances are generally anything that manipulates your mouth physically to prevent sleep apnea. They fall into two main categories, mandibular advancement devices and tongue retention devices. Mandibular advancement devices shove your jaw forward, which should open your esophagus more. Tongue retention devices grip your tongue and thus prevent it from falling back and choking you. I can’t use the jaw advancer since I have TMJ, but you should feel free to try! Tongue retention devices are notoriously uncomfortable since they’re usually grabbing your tongue.

Surgery is an option, but I don’t know much about it. I’d be careful if I were you.

Sleep apnea

Sleep apnea is where your breathing stops and then restarts during sleep. This can be either due to airway collapse or because your brain forgets to send a signal to your body to breathe. Your brain forgetting to breathe is pretty rare and called central sleep apnea. Most treatments here will have no effect on central sleep apnea — if you do have it you should go on a CPAP since you’re literally forgetting to breathe.

Obstructive sleep apnea, where your airway collapses, is generally because your airway muscles relax during sleep. Since you now can’t breathe, your body attempts to counteract this by increasing heart rate (to deliver oxygen more effectively) and releasing adrenaline (since you can’t breathe). This makes you do a mini-wake-up, where you wake up just enough to bring back some muscle tension to your airway. Your AHI is the number of times you stopped breathing per hour, your RDI is AHI + the amount of respiratory effort–related wake-ups you had per hour.

Why do people get it now?

What are the effects?

Why get treatment

Ensemble effect?

Honorable mention to chilisleep

Breathe by James Nestor