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Sleep apnea pill shows striking success in large clinical trial

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Re: Sleep apnea pill shows striking success in large clinical trial

#151

Post by elric »

VectorLock wrote: post #149
elric wrote: post #109

Earlier quoted context omitted.

I will keep beating this horse to death, but the vast majority of those who cannot tolerate CPAP are improperly titrated and/or have a mask that isn't right for them and/or are having leaks. Often all of the above. That 4 hours is just another symptom of a medical establishment that's not interested in treating patients, but is only interested in numbers. If you want maximum benefits from CPAP, you have to wear it al…

I don't know why you're so insistent that anybody who can't tolerate CPAP its a titration or fitment issue. I've talked to people who have loads of interaction with sleep doctors, mask fitment specialists, trying different CPAP/AutoPAP/BiPAP/auto-titration settings and I'm one of them. I'm glad medical science is pursuing other treatments that can help the 40% who can't tolerate CPAP and maybe help some of those who…

Because it usually is an issue of titration or mask fit.

There are some cases of people have complex sleep apnea, or having awfully non-compliant airways that require uncomfortably high pressures. But the vast majority of people can tolerate PAP just fine.

There are certainly improvements to be made. And thankfully some of them are being worked on (e.g. VCOM or KPAP). And some people could benefit from bilevel or even ASV, and it's a shame that those are often way harder to get. But even if we're being generous, the article's suggestion of 22% of patients who can get by on just the drugs is incredibly underwhelming compared to PAP.

Re: Sleep apnea pill shows striking success in large clinical trial

#152

Post by hombre_fatal »

diggan wrote: post #42
elric wrote: post #7

I swear CPAP wouldn't get such a bad rep if the media would stop using pictures of men with obscenely large full face masks. The most commonly used CPAP mask is probably the minimalist Resmed P10 [1]. It looks a lot less intimidating than a bulky full face mask. And in most cases, full face masks aren't needed (no sources to cite, but titrating to the correct pressure allows most people to breathe through their noses…

> That's ... unsettling. So you're reducing events at the cost of increased blood pressure and heart rate? That's not good. Ultimately, the question becomes "is higher quality of sleep with some tradeoffs more or less healthy overall, than not getting enough sleep at all?", as research keeps showing how important sleep is. So even if this increases heart rate and diastolic blood pressure, does it raise it more than a…

Yeah, apnea already tends to come with cardiovascular risks. If this pill can give you a full night's rest with 90% of apnea's BP increase, it still seems like a bargain.

Re: Sleep apnea pill shows striking success in large clinical trial

#153

Post by Citizen8396 »

ianburrell wrote: post #120
rowanseymour wrote: post #64

Earlier quoted context omitted.

I tried everything I could find on Amazon but obviously that crap doesn't work. I can believe something custom made could help but my orthodontist persuaded me the only really solution was surgery or CPAP.

There are specialized dentists that make appliances. My understanding is custom works much better cause fits perfectly instead of having to mold it. If you can, go to dentist that has experience. They are expensive, mine was $3k.

Insurance will sometimes cover them whole or in part, but it can be a difficult process.

Re: Sleep apnea pill shows striking success in large clinical trial

#154

Post by Citizen8396 »

polishdude20 wrote: post #110
Citizen8396 wrote: post #56

Earlier quoted context omitted.

Fluticasone can be especially helpful for people with allergies and/or OSA. "Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction." https://pubmed.ncbi.nlm.nih.gov/31521518/ "Intranasal steroids and montelukast did not decrease AHI; however, total sleep time and percent of stage R sleep significantly i…

I find the most effective nasal sprays also give me terrible withdrawal symptoms. Like, I'd use them for a few days at night, alternating nostrils and then when I stop, my nose is closed shut for the next few days.

This is common with Afrin (oxymetazoline). It’s only meant for short term use for this reason. This shouldn’t be the case with fluticasone.

Re: Sleep apnea pill shows striking success in large clinical trial

#155

Post by TMWNN »

Diti wrote: post #25
balls187 wrote: post #10

Earlier quoted context omitted.

Do you wear a cpap? It sucks. I have an OA now. And it also sucks.

I do, a ResMed AirSense 11 with a ResMed Mirage FX. Wonderful sleep, wonderful comfort, and no need for the water supplement.

Yes, I don't think a lot of people realize that it's possible to run the AirSense 11 (I don't know about other models/brands) without distilled water. Resmed even sells "ResMed AirSense & AirCurve 11 Side Cover", which takes the place of the water tank.

Re: Sleep apnea pill shows striking success in large clinical trial

#156

Post by TMWNN »

evanjrowley wrote: post #82

I must be in the minority of CPAP users who would use it even if I stopped having OSA. Why? A few reasons: 1. Sometimes I hardly notice it. Newer models are very quiet and portable. I'd even go as far as saying the mask is comfortable to wear, like a security blanket for the face. 2. Practically nothing filters out dust and cat hair better than my CPAP. An N95 mask might do better, but would be ridiculously uncomfort…

I wouldn't use it without sleep apnea because of the annoyance with the hose. But I agree that otherwise my nasal mask is hardly noticeable.

Re: Sleep apnea pill shows striking success in large clinical trial

#157

Post by pedalpete »

When looking at any of these studies in CPAP, and sleep in general, we need to be looking deeper than just the AHI (hypopnia index, how many times you stopped breathing), and directly at EEG measures of restorative function and other biomarkers.

This shows an improvement in AHI, but no change in any markers of actual sleep restorative function (I'd use the term "quality" but the sleep health industry has stolen that term to mean measures of sleep time).

When looking at sleep time the study shows no change in most of the sleep architecture, but a significant decrease in REM time, which can have effects on emotional wellbeing, irritability, and potentially depression.

This study showed no change in ESS (subjective measures of daytime sleepiness), but did show a change in PROMIS, which is a longer term measure of fatigue.

I've been recommending to anyone on CPAP that they give mandibular splint, which is a biteplate which shifts the jaw in order to hold the airway open, and is much easier, lower cost, and effective for many people. It also does not show a reduction in REM.

However, I also don't believe there is any reason that a sleep study which has full PSG relies only on sleep time, and none of the bio/neurological measures of health which are easily available, such as HRV, delta power, spindle activity, etc. etc.

Re: Sleep apnea pill shows striking success in large clinical trial

#158

Post by schwartzworld »

Llamamoe wrote: post #98
elric wrote: post #7

I swear CPAP wouldn't get such a bad rep if the media would stop using pictures of men with obscenely large full face masks. The most commonly used CPAP mask is probably the minimalist Resmed P10 [1]. It looks a lot less intimidating than a bulky full face mask. And in most cases, full face masks aren't needed (no sources to cite, but titrating to the correct pressure allows most people to breathe through their noses…

The problem with CPAP is that 40% of patients don't tolerate it even for the 4h/night defined as treatment compliance, while most of the rest use it less than the full duration of the night, with studies demonstrating that treatment compliance depends on efficacy. And this is for traditional OSA in men - people with Upper Airway Resistance Syndrome(mostly identical mechanism as OSA, less oxygen desaturation, more aro…

> 40% of patients don't tolerate it

Tough to know how much of this is patients not being able to tolerate vs doctors giving people barely calibrated machines and next to no support or training. It’s very common to be given your cpap at the default pressure range (4-20). When I told my doctor I still wasn’t sleeping, she offered to refer me to a shrink.

Re: Sleep apnea pill shows striking success in large clinical trial

#159

Post by therealdrag0 »

ProllyInfamous wrote: post #125

I am a fattie (BMI 36.5). I also have sleep apnea. Wearing a CPAP, I couldn't ever get any sleep (toss&turner). Things that've helped: 1) Using body pillows to force sleeping on side, which straightens the neck (versus face-down) — also lessens low-back pain 2) DENTAL GUARD (a 3D-printed plastic insert which form-fits my teeth, slightly opening jaw-angle/mouth) 3) Losing weight — YES, sleep apnea is worsened by exces…

I don’t think I have true apnea, but mouthguard+earplugs+concave-eye-mask really helps me.

Re: Sleep apnea pill shows striking success in large clinical trial

#160

Post by therealdrag0 »

gosub100 wrote: post #114
N00dlesHead wrote: post #68

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

this won't solve all your problems, but replacing the sports guard with a rubber one that is meant for bruxism, or even better, paying the $400 and getting a custom one from your dentist, will help a lot. the sports guards aren't soft enough to prevent damage to the surface of your teeth. My custom dental guard has lasted for several years, and although I was skeptical at first, the cost was worth it.

You can get a custom fit one by mail for like $200.
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