Insufficient Sleep Is a Public Health Epidemic
cdc.gov
cdc.gov
1. Go to your GP and have them refer you to a sleep specialist.
2. Make an appointment with the sleep specialist (one major clinic here in the Bay Area is booked out weeks in advance). Do that office visit where you get the prescription for an overnight sleep study.
3. Wait 2-3 more weeks for your sleep study date, where you get wired up like you're joining the Matrix, and then told to go to sleep at 9:30pm. Riiight.
4. Have a follow up visit at the office in step 2. Go over results. Possibly get prescribed a CPAP machine.
5. Find an in-network provider to buy the CPAP from, and make an appointment with them. This is not an off the shelf thing, expect to spend 2-3 hours in the office/store. Wait time: a couple days to a couple weeks.
6. (optional, if the study from step 3 wasn't split-phase) Return for another sleep study with your new machine so they can calibrate it.
7. Make another follow up appointment to have the doc look at the report from step 6 and actually perform the calibration.
Dude, WHO HAS TIME FOR THIS? Ironically, this whole process is a bit of a nightmare.
On the other hand, recently I started looking at ways to get rid of dreams... they're just too much if they happen every night.
That said, while the quitting process has been quite difficult for her (irritability's through the roof- almost as bad as when I've tried to quit smoking cigarettes), she says she started feeling "better" almost immediately. Probably the best part (for both of us, haha) is that her natural appetite is coming back- and in fact, she's reporting that she's developing a taste for a lot of foods she previously didn't like because the flavor was too intense or the texture was too unusual. The only real explanation we can figure out is that the cannabis intensified culinary experiences to the point where she couldn't handle it, and so she just ended up avoiding a lot of types of food.
The brain is an interesting organ.
CPAP just barely creates enough benefit for me to keep me using it.
It is very common for a CPAP to be misconfigured or not to be the right size in the first place. You may want to ask a sleep tech for help. There is documentation online as well.
I have already had the pressure dropped once. My main problem may be that I can't get enough air through my nose, so I have to breathe through my mouth. Using a chinstrap makes me feel like I am suffocating.
I felt like superman after the first time I used it.
It's been a few years, and I haven't slept a single night without CPAP.
Looking back, I am amazed at how well I was able to function at all.
I think not only is my quality of life improved, but I think it's also extended my life. I know that chronic sleep deprivation leads to a variety of illnesses (heart disease, high blood pressure, diabetes..etc...).
That issue aside, they're readily available used on craigslist, and you can buy "kits" online to replace the parts that wear or touch "gross parts" of the prior user, so if you don't care about the prescription issue, CL is probably better than traveling overseas to get one.
Fortunately my ENT wrote a prescription for a sleep study but told me to try Breathe Right strips first. He told me honestly the surgery is painful and the strips had cut his surgical load in half.
He was right. I've never slept better and my wife is no longer contemplating my early demise by pillow smothering.
And before anyone acuses me of being a shill I switched to knock offs long ago. The cheap Chinese ones on ebay have weaker glue but if they work for you they are far cheaper.
I've tried several doctors (I snore and stuff), they think I have nasal polyps - one wanted to try surgery and the other wanted to try some ultrasound stuff.
Most people with sleep apnoea are not helpless victims to an incurable disease. Losing weight doesn't appear to be easy, but it's certainly achievable for most overweight people.
EDIT: Here's the CDC page listing obesity as a cause for apnea http://www.cdc.gov/healthyweight/effects/index.html
I’m quite certain that people with sleep apnoea for whom weight is a relevant component are quite aware of that. Yours is just a pointless diversion in this context – because what exactly is the your angle here?
Should it be hard for people with sleep apnoea to get treatment? I mean, what are you arguing here for exactly?
All that stuff is true. All that stuff is avoided by losing weight.
Your comment appears to be overly sensitive to a calm, non-judgemental bit of information.
EDIT: Here's the link to the CDC page which lists overweight as a cause of sleep apnea: http://www.cdc.gov/healthyweight/effects/index.html
It's really easy for people, especially men, to hit a BMI of 30 and not realise that they are obese. Especially in obesogenic societies where very many people are obese, morbidly obese or even super obese. This carries a range of health risks, most of which are helped by losing weight.
It's weird the source article doesn't mention weight, since it is caused by lack of sleep (especially in children and young people) and causes lack of sleep (in adults).
http://www.cdc.gov/sleep/about_sleep/chronic_disease.htm
> Laboratory research has found that short sleep duration results in metabolic changes that may be linked to obesity. Epidemiologic studies conducted in the community have also revealed an association between short sleep duration and excess body weight. This association has been reported in all age groups—but has been particularly pronounced in children. It is believed that sleep in childhood and adolescence is particularly important for brain development and that insufficient sleep in youngsters may adversely affect the function of a region of the brain known as the hypothalamus, which regulates appetite and the expenditure of energy
I strongly disagree on the point of time. It is important to realize how slow actual weight loss is. By my naive googling, losing 1kg of fat per week will require quite a lot of calorie restriction, and it is not achievable easily. If you are say 20kg overweight, you will need at least 20 weeks to lose that weight, likely more as nobody is perfect and stress factors here as well.
I am stressing this point as I would like to encourage anyone who suffers from sleep apnea to start both treatment and losing weight. Telling yourself "I don't have to seek treatment, I'll just lose weight" may lead you into several weeks of diminished productivity (as a PhD student with apnea, when not getting enough sleep my scientific productivity is close to zero).
I am not claiming any of the original commenters suggest this, but still: "I'll just suffer until I lose enough weight" is a terrible decision.
That's a good point.
> I am not claiming any of the original commenters suggest this, but still: "I'll just suffer until I lose enough weight" is a terrible decision.
Well, yes, but treatment will change as weight changes. Why go through risky surgery if weight loss might help? Why go through the hassle of sleep studies and waiting for machine fitting if weightloss will help? The alternative to weightloss is not "instant cure", there's still time delays built in.
/working on it
Losing weight is not hard. Change your diet and start walking (just walking) 30-60 minutes a day.
I agree with your other points, but I'd say that getting a CPAP is probably a good idea, but that losing weight could make that unnecessary down the road and there are a myriad of other benefits.
2. The metabolism and appetite changes drastically. Instead of getting a break and waking up in the morning after a good night of sleep not needing food, you are constantly sugar crazy 24/7. You never get a break from the appetite and blood sugar mayhem. This makes it really difficult to change eating behavior.
The best solution is to get as many people as possible a CPAP machine so they can feel well rested and reset their system, and then they will have a much better starting point for losing weight. And yeah, you can be skinny as hell and still have sleep apnea, a bunch of people do.
And for the past several years, I felt the exact same symptoms - falling asleep behind the wheel (or on the subway); craving for food; episodes of sleep paralysis (thankfully not too frequent).
STRONGLY disagree. My doctor says that IN MY CASE, losing weight should be enough. We're talking 10kg (~22 pounds) from the ideal weight.
Is this true for the general population? No idea. There are several other possible causes. And that includes central sleep apnea, or problems in the airways.
We are in agreement that losing weight should be the first thing one should try. But one would think that doctors would point that out too (as they did with me).
> All that stuff is true. All that stuff is avoided by losing weight.
As that is not true in 100% of cases of sleep apnea as you implied, you are being an asshole and misleading, fyi.
http://www.mayoclinic.org/diseases-conditions/sleep-apnea/ba...
> Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop this disorder, too.
But even if no-one were obese, obstructive sleep apnea would still exist. Anyone who snores could have it. The person may have a deviate septum. They might have swollen tonsils or adenoids. They might have a congenitally narrow airway. Maybe even a particularly long uvula.
And then there are the non-obstructive (worse) sleep apneas, such as those caused by defects in the nervous system, where the brain is unable to tell the diaphragm to move.
Being thin is not a perfect defense against sleep apnea. Nevertheless, it appears that the vast majority of apneas are worsened by obesity, and obesity is worsened by sleep deprivation. That is a vicious cycle.
With my foil hat on, I suspect that safe and effective treatments for reducing body fat in obese individuals are not being researched for public health reasons (esp. as preventative measures against heart disease and diabetes), because an non-curing treatment for fatness would make ten times more money than boner pills, especially in the US. And this is why you get people doing DIY fecal transplants from thin friends in their own kitchens, or buying and injecting barely-tested research peptides (like cyclized CKGGRAKDC-GG-D(KLAKLAK)2 HCl salt) from Chinese synthesis labs. The health care system wants all the money, and the people who need the treatments most just don't have enough of it. When the flow of cash takes priority over patient well-being, people start to do crazy things out of desperation, and a sense that the doctors are acting as drug pushers instead of trying to help them get well.
> All that stuff is true. All that stuff is avoided by losing weight.
No, its not.
For one thing, because if you are overweight and have OSA, "losing weight" can be more difficult if you don't get the OSA treated.
For another thing, healthy weight loss of an amount that is likely will significantly OSA is a longer process than getting treatment for OSA, even with all the problems that can involve.
I slowly gained about 30kg (66lb) in my early twenties (I went from about 75kg to 105kg at peak over about four years). When I started having trouble breathing at night I knew there was a problem (and figured the weight might be the cause), but I didn't hear of sleep apnea until a few years after I had lost the weight (the breathing difficulty disappeared with it).
I know all about this. That is why this condescending behavior is so awful.
(I could also stand to lose several stone.)
- They are both self imposed, chronic problems
- They both induce a myriad of known health issues
- They both are readily solvable using known methods and by building healthy habits over time
It is really imperative that obese people lose weight, in the same way that it's important that smokers stop smoking. You would never say someone is being "smoker shamed" by being told to stop smoking, that they are being "smoker shamed" by being told that their smoking is causing health problems, or that they are being "smoker shamed" by being told that smoking is not that attractive. Why should it be different for obesity?
This difference makes me think that people view obesity as some inherent characteristic of themselves like race or sex. This simply does not have to be the case. I think if people knew how straight forward it was to lose weight by applying validated diet methods over time, there wouldn't be all this nonsense and controversy about "fat shaming".
I was pretty slim until about 23, so my identity was always firmly rooted in a healthy weight range. I never felt defensive over being overweight; sensitive, certainly, but I was also my biggest critic (no pun intended).
Then again, maybe it's something entirely different!
A person who is overweight isn't inherently a "fat person", they're a person that hasn't discovered and applied the methods and systems to be at a normal weight; A person who has no strength isn't inherently a "weak person", they're a person that hasn't discovered and applied the methods to be strong etc.
Once a problem is framed like that, solving it is simply a matter of research and applying known methods. You don't need to change your identity, you just need to change your systems.
I think that goes for you too. If you don't feel that the comment addressed you personally why over-react like this? It was simply a bit of information presented in good faith.
It’s also the typical shitty response overweight people tend to often get – people who are perfectly aware of their weight.
That does not stop it being true!
When a doctor tells someone to lose weight to help some health problem s/he's not dismissing the health problem. S/he's giving very good, useful, achievable, advice. In England the doctor may also give a prescription to 12 weeks free on a weight loss course, such as "Slimming World".
You seem to think this is some kind of /r/fatpeoplehate or /r/fatlogic thing, but it isn't. Your dismissal of this calmly presented, good faith, evidence based bit of advice is odd.
I have no issues with doctors giving someone advice – but that’s really not the point here.
In the UK positive pressure machines are only recommended after lifestyle interventions have been tried.
http://www.nice.org.uk/guidance/ta139/chapter/1-guidance
> 1.1 Continuous positive airway pressure (CPAP) is recommended as a treatment option for adults with moderate or severe symptomatic obstructive sleep apnoea/hypopnoea syndrome (OSAHS).
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
> they have symptoms that affect their quality of life and ability to go about their daily activities, and
> lifestyle advice and any other relevant treatment options have been unsuccessful or are considered inappropriate.
http://www.nice.org.uk/guidance/ta139/chapter/2-Clinical-nee...
> 2.4 Major risk factors for developing OSAHS are increasing age, obesity and being male. OSAHS is also associated with certain specific craniofacial characteristics (such as retrognathia), enlarged tonsils and enlarged tongue. Use of alcohol or sedatives can also increase the risk or severity of the condition. OSAHS has been reported to affect up to 4% of middle-aged men and 2% of middle-aged women in the UK. It is estimated that 1% of men in the UK may have severe OSAHS.
> 2.5 Treatments aim to reduce daytime sleepiness by reducing the number of episodes of apnoea/hypopnoea experienced during sleep. The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. Surgery involves resection of the uvula and redundant retrolingual soft tissue. However, there is a lack of evidence of clinical effectiveness, and surgery is not routinely used in clinical practice.
Talking about weight loss in a thread about lack of sleep is not a derailment; it is not condescending. Lack of sleep is one cause of obesity. Obesity plays a major role in lack of sleep.
I also think that this is a much better comment than your first one. I really think one should be very careful when dragging victim terminology into this discussion or, in fact, any discussion about weight. I have been unable to lose weight for years (all the time being extremely aware of how shitty I felt all the time and the negative impact on my health) and now after I did I’m still not sure how I actually did it.
Point is, it’s not as simple as telling people to just lose weight. Because just losing weight is extremely hard and it’s time we acknowledge that. And I’m not talking about the raw mechanics of losing weight here – those are easy and work with mathematical precision (well, ok, I myself may be generalizing too much here, but for me they did: if calories out minus calories in are equal to roughly 7000 I had lost 1kg, maybe ±.3kg, though that’s probably mostly due to the inherent uncertainties of estimating calories).
It’s about psychology and accusing people of playing the victim or trying to insult them to lose weight is just not a workable strategy. It just doesn’t work. Or it may even work for some people, but I don’t think it’s in general a wise strategy because it’s plain dehumanizing.
The medical opinion in the US is that CPAP is the first-line treatment to be done in parallel with any necessary lifestyle adjustments in all cases of OSA.
http://annals.org/article.aspx?articleid=1742606
> Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)
> Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)
Though not explicitly stated in the paper, the general consensus I have heard from physicians here (and others in this sub-thread have stated) is that lifestyle intervention is much more likely to fail if CPAP is not initiated in parallel.
> 1.2 CPAP is only recommended as a treatment option for adults with mild OSAHS if:
I can't see the definitions of mild and severe, but clearly this is not recommending CPAP only "after lifestyle interventions have been tried" for the entire population.
This is the typical exchange in the US:
MD: Losing 20kg of body fat would reduce your other symptoms tremendously.
Pt: Great. Can you help me do that?
MD: No.
Pt: But I just gave you a $30 co-pay on a $300 office visit.
MD: I can prescribe pills to treat your symptoms for as long as you continue to take
them, and order additional tests. You won't know how much the tests will cost until
after you take them, and your insurance denies the claim to stick you with the entire
bill.
Pt: Could you prescribe exercise? Would that let me use my insurance to get a bench and
barbell or exercise bike or elliptical machine or something?
MD: No. Your insurance won't cover a preventative treatment that would very
inexpensively reduce your risk for literally dozens of horribly expensive diseases.
The assumption is that you won't exercise, even if you own all the necessary
equipment in your home.
Pt: What about a prescription diet? Could I go on Atkins or some other ketogenic diet?
MD: I can't recommend any diet in particular, because I don't want to get sued, or
censured and persecuted by the AMA. But yes, changes to your diet may or may not
help you achieve a goal of fat loss, depending on what the available research may
indicate.
Pt: What research? Can I read it?
MD: Are you a student or professor?
Pt: No.
MD: Then you probably don't want to pay Elsevier $100 a pop just to read articles with
ambiguous results.
Pt: What about liposuction?
MD: That's a cosmetic procedure. You can't afford it, and your insurance won't pay a
dime.
Pt: Fat loss drugs?
MD: None approved by the FDA that won't make your heart explode.
Pt: Why am I here?
MD: Because you want to help pay for my daughter's orthodontic treatment?You don't need any equipment. All you need to do is walk. Nothing else. Walk for two hours every day or two.
It's also enjoyable and relaxing and mentally stimulating.
It's win, win, win and it costs zero dollars.
They will, however, give you some cash or premium discounts if you enroll in their health nagging/spying program. You self-report a sackfull of valuable risk factor information, and they, in turn, frequently call you and read from a script at you. There is no material support or genuine incentive for positive lifestyle change.
As regular walking has such great, demonstrable health benefits, you would think that a health insurance company might do something like send you a free new pair of walking shoes if you send them your old pair, with the soles worn out from walking.
I can't exactly agree with the part about being enjoyable, relaxing, and mentally stimulating, though. That's largely dependent on your route and companions. Someone walking through a sprawl of suburban McMansions with an unrelenting babbler is not going to keep at it as easily as someone who can enjoy a hiking trail at a scenic park with someone who knows how to just shut up and enjoy nature in companionable silence. (~Any resemblance to actual walking experiences is purely coincidental.~)
The number one reason I have for keeping exercise equipment in my home is because I think you shouldn't have to get in a car and drive somewhere in order to have a positive exercising experience, and walking around my neighborhood is not one.
Of course they don't. It's tautological. Insurance companies by definition do not insure against regular, predictable expenses.
A car insurance company will never insure you for new tires and a health insurance company will never insure you for regular, recurring wellness checkups. Because math.
Yes, sometimes they say they will, and sometimes such a reimbursement actually occurs, but make no mistake - that is never a claim payment and basically amounts to fee for service. You will not receive claim payment for items like this - they are not underwriteable.
Alternatively, you could view the physical exam as a genuine insurance claim because not all insured parties actually take advantage of all the preventative services that they're theoretically entitled to under their policies. I've had years where I didn't get a physical exam or dental exam that my policies would have allowed me to, and so have many other people (but the carriers still got paid the premiums for those years!). If the carrier makes actuarial estimates of the likelihood of people not using those services, it's pretty solidly back in insurance territory!
Well, except for the long list of preventive measures they must pay for, as a result of state and federal regulations [1].
And, except for the fact that some insurers paid for non-mandated preventive services previously (and cover non-mandated preventive measures now), but only to the extent that their experience bore out that those services reduced their downstream expected costs.
[1] e.g., https://www.healthcare.gov/preventive-care-benefits/
However, in this case, it's hugely beneficial that common sense wins the day, most of the time. Most obese people can lose a huge chunk of their fat by cutting out sugar, replacing it with fibre and healthy fats. Throw in a few walks a week and that's the first 100 pounds.
A lifestyle intervention would include exercise (perhaps on prescription - cheaper gym membership) and a few months free access to a slimming club.
Whether the comment is addressed to you or not seems irrelevant to me. Example: somebody says somebody racist, but you're not a member of the discriminated group. Should you be all "i'm not going to say anything, because it doesn't address me personally?" I should hope not.
i'm pretty sure he's arguing for people to treat their own apnea by losing weight instead of dealing with clinics and the treatment "racket"
This is why losing weight is one of the most important steps. The CPAP should make it easier to do so.
Here are two distinct facts:
1. I do have eyes and I can see a trend.
* I do not recall seeing less fat people as a child, but I do recall seeing more thin people now.
* I also notice that the fat people I see now seems on average younger than the fat people I recall from my childhood.
* I also notice that the fattest ones - those grossly obese instead of merely overweight - are both larger and more common now than what I recall from childhood (and I was practically raised by an aunt that used to be at the very top of the scale back then, but somehow found herself surpassed in the last 20 years or so).
2. We are told by the media that there are statistics that show an epidemic of overweight. The study pointed out claims that physicians consider overweight as one cause (not the cause) of sleep apnea. We are now told that there is also an epidemic of sleep apnea.
* If A causes B, and we observe an increase of both A and B. It is only logic that the "increase of A" is at least partially responsible for the "increase of B".
* It would make an interesting scientific study to figure out the degrees of correlation between "increase of A" and "increase of B". It would be even better if such study could conclude if such correlation is strong enough to justify calling "increase of A" a driving factor in the "increase of B" or not.
* On the other hand, it is a logical fallacy to claim that no conclusion can be reached regarding the causation/correlation between increases of A and B without "backing it up with facts". I will even claim that it is AntiScientific. If you start with that kind of attitude, you will never be able to form falsifiable hypothesis and therefore will be going through the motions of the scientific method without getting down to the substance.
The observable results are somewhat consistent with a contagious disease. Adenovirus 36 has been shown to cause long-term obesity in lab animals. Gut microbiome comparative studies have shown a marked difference between the intestinal flora of fat people and skinny people.
Additional environmental factors are in play. Car culture in the US reduces the necessity for daily exercise in comparison to walkable city infrastructure elsewhere in the world. The US uses a lot of chemically altered corn syrup in prepared foods in lieu of other sugars. Agricultural practices differ between the US and other nations, particularly with respect to allowable herbicides and pesticides. Real inflation-adjusted disposable income has been declining in the US since about 1970, and poorer people have less healthy diets. Parenting culture has changed since 1970, such that children left to play outside (aka exercise) without direct adult supervision may actually get a parent arrested. People have increased their consumption of sedentary entertainments, and reduced the time that they typically sleep.
The only way to really figure out which factors contribute most to increases in obesity is by objective analysis of unbiased data. That will lead to actual, testable hypotheses, which will in turn lead to solutions that actually work to reduce the public health risks represented by excess adiposity.
Telling every fat person "hey fatty, go lose some fat" may seem like a simple and easy solution on its face, but it really is a lot more complex and difficult than that.
No one is denying that fat people would be healtier if they were skinnier, or that they do want to be less fat. Very few fat people actually want to be fat, and most do take active measures to try to become less fat. But no one apparently knows with certainty why those measures--often the exact same measures employed by skinny people to avoid becoming fat--do not always work.
When people dismiss those discrepancies as "not trying hard enough" rather than "potential research opportunity", that does not advance the human knowledge in this domain that would allow us to better address obesity on a worldwide scale rather than piecemeal.
That in combination with stopping drinking, eliminating pop and just adding some mild walking has made a huge impact. I don't worry about portion size, counting calories etc.
If you are like me, you might want to check paleo out.
Whatever works for you is great, but I just hear so many people raving about diet X, when at the same time they started it, they also cut out candy/soda/booze and starting hitting the gym...
It is a matter for some debate among paleo advocates as to whether exercising in a gym is an adequate simulation of hunter-gatherer activity. And that's about when I start tuning out. Then I get to the part about donating blood to account for recoverable injuries, and I switch off. It's a diet/lifestyle, not a cosplay.
The success is driven by having a plan and maintaining the individual motivation to carry it out.
I agree that there's a bunch of gut flora / genetic / etc stuff going on, and that society makes weight loss really hard.
What I get pissed off at, is the insistence on some people around here that if you cannot quote scientific articles from memory, then you must be lying and your opinion should be disregarded.
There's lots we don't know about human biology. It does not mean we should go find somewhere to roll and die of whatever ill is affecting us. Somehow we need to make decisions and take actions under incomplete and inaccurate information.
Maybe my grandchildren will benefit from the enhanced understanding you talk about, and I will be grateful for it. But this does not change the fact that I need to address my own problem today.
I posted links to government advice from two differnet countries showing links between obesity and sleep problems.
Basically, in order to (possibly) cure your apnea via weight loss, you have to treat it first, so you can get some uninterrupted sleep. And then, you still might have a constricted or obstructed airway, even with 5% body fat. An ENT specialist might be able to drill it out or laser it off, but that's still technically a surgery, with all the attendant risks, and obesity and apnea are both added risk factors for surgery and general anaesthesia. Better to have just one than both.
So you will still have to go through the rigmarole which seems designed to maximize the number of insurance co-pays the patient has to make. It is possible to send the patients home with a black box, have them attach the two sensors themselves before sleeping as is usual for them, in their own beds. Then you can diagnose apnea from the black box data, and send a tech out to their home to adjust the fit of a new CPAP or BiPAP, to be titrated by an automated black box program. Afterward, the black box can be returned in person or mailed back.
But there's the critical problem with US health care. There are strong anti-incentives to reducing costs in that manner. Reducing the costs causes the providers to lose money. Failing to do all the expensive CYA tests exposes the provider to malpractice complaints.
The standard operating procedure is not structured around what is best for the patients. There is definitely an element of racket in it, especially if you are forced by your insurer to rent the CPAP machine.
Sure, once you've tried lifestyle interventions and they don't work CPAP and surgery are options.
Why reach for those risky options when a lifestyle intervention - and that's not telling fatties to go lose some weight - is much safer and carries so many other health benefits?
I can easily imagine how, in nations with less sadistic health care systems, an actual human might show up in person, to do things like take the fatty on an instructional trip to their local grocery store, followed by example preparations of salubrious meals. Or the person might demonstrate beginner exercises that require minimal equipment. There might be an organized support group of individuals with similar goals available at no additional cost.
The actual situation in the US is that if you have a problem that some weight loss might help to fix, you get a pamphlet or printout entitled (paraphrased) "Hey Fatty, Being Fat Is Bad For You!" There will probably be a deprecated recommendation to start a low-fat, reduced-sodium diet. There might even be a true factoid on it that you didn't already know. But no actual, material support is provided, whatsoever. If you need to lose 100 lbs., you are completely on your own, to not only figure out how, but to stick to your plan for the next two years.
...Unless you have enough money. In that case, you can rent a personal trainer and nutrition consultant, at your own expense. Weight loss (and other types of lifestyle change) is a for-profit business in the US. And the business is horribly inefficient. Americans spend millions on it, and are only getting fatter. A very large part of the business is fueled by ignorance and disinformation.
So perhaps you can explain to me why lifestyle interventions are not seriously attempted in the US as part of medical treatment. What you say is true. It is safer. It provides other benefits to the patient. But few people can accomplish it without some form of external assistance or support. And in the US, that often comes at a price.
By the time someone in the US actually goes to endure the gauntlet of getting some responsive treatment for OSA, they may have already been trying for several years to lose weight, without success. They may be falling asleep at work (in meetings, even!) or while driving. They need relief now, not in six months. That's why sleep docs in the US go straight for CPAP. It's a quicker response to treatment and a surer path to profitability.
[1] http://www.niddk.nih.gov/health-information/health-statistic...
At 6' and 155lbs I fall in to the "NIH normal," but far below the "US normal."
Were you referring to the NIH normal, or the US normal?
While obesity is a risk factor for OSA, untreated OSA makes it harder to lose weight (or do lots of other things; it has a variety of physical and cognitive impacts.)
If you have OSA and you want to lose weight to deal with OSA, that's great, but its not really an alternative to getting immediate treatment for OSA, rather, its an addition reason to get the OSA treated.
You might not need continued treatment for the OSA once the obesity is resolved, sure, but that's a longer-term concern.
You're also forgetting the confound that being chronically fatigued and having a screwed up cortisol, blood oxygenation and glycemic index (all due to lack of sleep), makes losing weight extremely difficult.
3 minutes of Googling and quick change to the settings enabled the automatic function. I found the APAP much easier to sleep with than the pretty harsh blasting of the CPAP setup.
I should add, I'm a slim/skinny guy, been so all my life, so it's not about weight.
There is surgery to treat snoring. It's not great.
http://www.sleepapnea.org/treat/treatment-options/oral-appli...
Surgery is not very effective. Anecdotally, my dad who is not overweight had it done and it didn't help him at all.
Note: I am not a doctor, so please consult one, etc. :)
2. They are all booked everywhere, it seems
3. Or, even worse, they might hit delays and not put you to bed until way after midnight, as was with me. I could barely sleep. They still can't explain the 5h it took for me to reach deeps leep.
4. This is where I left off. Not enough obstructive sleep events to warrant a treatment, according to the clinic(perhaps because I was half awake?). My doctor did not fully agree with them.
Do I have sleep apnea? Only Cthulhu knows. I wonder if I'll ever try the sleep study again. The Heisenberg Uncertainty Principle does seem to apply here. How are they supposed to diagnose your sleep issues, if you are so uncomfortable that sleeping at your work desk feels fantastic in comparison?
I ventured to craigslist and bought a used one for $100. I bought new gear off amazon. Google search led to the keystrokes to change the pressure myself. Few tweaks and I wake well rested rather than sleepy. Previously, I could sleep for 12 hours and still feel tired.
Friend is still waiting for their appointment to receive their machine two months later.
Personally, I did steps 2-4 above, got an APAP prescription valid until the end of time, and bought a new machine online. (Maybe insurance would reimburse? I didn't even bother; time is money too.)
Trying to get a CPAP covered by insurance is a pain, but if you have a prescription you can get one online and pay for it yourself - the same is true for supplies.
Also, there's tons of interesting data you can get off the machine, if you get one that's data capable (you really, really want one that. Take a look at the program sleepyhead:
http://www.sleepfiles.com/SH2/
Monitoring things yourself with your own data is really the way to go. It makes the sleep data you get from a jawbone/fitbit/etc look extremely minimal.
I was pissed when I found out the cash price for my machine at cpap.com was less than the insurance co-pay I made for it. Insurance is not always worth the crap you have to go through.
Look at your O2 levels and see how low the percentage goes, if you get some serious dips then you quite possibly have a serious apnoea problem and need to get it properly checked ASAP. I think you should be in the 90-100% range, go below 80% and you're really heading towards trouble.
When you stop breathing your O2 falls.
(Usual disclaimer, I'm not a doctor etc)
2. Find some bed or recliner that maintains your back at a 45 degree position relative to the floor. The zero gravity chair helps a lot.
like this: https://www.dealbeds.com/serta-motion-essentials-ii-adjustab...
Sleeping at a reclining angle doesn't completely eliminate the gravity but it lessens the gravitational pull. Depending on each individual case, the decrease in gravitational pull could be enough to stop the flesh from blocking your airway. You should just sleep on some lazy boy couch or something to see if it works before buying.
Step 1 and 2 should be the same thing: have your GP send you directly to a sleep study.
Step 3 should include an order from your GP to titrate for CPAP immediately if N apneations occur/hour. That kills steps 4,5,6 and turns step 7 into "durable medical equipment vendor shows up at your house to set up the CPAP and figure out what mask will work for you".
Sorry it was a rough experience for you.
Also note: every CPAP I've met can be calibrated to your Rx by a simple procedure involving reading the manual... that they probably don't provide to you. It will be available as a PDF online from the manufacturer.
That's what happens when you've got Complex Sleep Apnea (combo of obstructive and central).
There's too much competition within society. Keeping up with the Joneses, unreasonable standards of "work ethic" - we've become far too individualistic, and the consequences are starting to show.
Perhaps it is time to recalibrate the whole paradigm, and investigate more ways to rely on each other and the group - the way human beings have operated since the beginning of time.
But I can tell you that getting one, if you have serious sleep apnea, is life-changing. Here are the differences in my life 5 years later: Income has doubled. Layoffs are nonexistent (I used to get laid off every 2-4 years, like clockwork). Lost weight. Testosterone went up. I am no longer late to appointments (my "time estimation" seems to have improved!) I have dreams again AND remember them!! Been YEARS since that! Actually have energy in the morning, how the hell did I live 30 years of my life without knowing what everyone else enjoys?? So I can actually exercise (because I have the energy), leading to even more fitness. Leading to better... dating experiences (ahem), and pretty much better everything!
My one recommendation with CPAP is DO NOT let the doc prescribe you the over-the-nose mask... You want the ResMed Swift FX Nasal Pillow mask (google it). MUCH MUCH more comfortable/less "claustrophobic".
A couple of years ago, I wanted to look into getting a machine, and we had (and still have) Kaiser Permanente, in Northern California.
The first appointment was to pickup a take-home testing machine. It was just a 'come get it' process. I took it home, followed the instructions, and slept with it. It had a variety of connections to me, so it wasn't easy to sleep. The next day, I took that machine back. The day after that, they invited me to another appointment.
In that appointment, there were about 50 people. We each sat at an assigned place at a table, with our new CPAP machine in front of us. They talked us through it, and invited us to come up and talk to one of two of three doctors, one at a time, at the end.
Overall, it took maybe a week and cost maybe a hundred bucks.
Health care is getting better in some areas, at least!
Screw steps 5-7.
Get your prescription and go to cpap.com (or another place) and buy an Auto CPAP (APAP) using your prescription. Use cpaptalk.com to get more answers and help with picking out a machine and other stuff.
Then you can "calibrate" it yourself. APAPs let you specify a range of pressures. Use the pressure you should have been told from the sleep study to pick a range around that pressure and just use that for a week. Look at the information yourself which any good machine lets you do so on your own.
The machine will show you how much time was spent at various pressure levels so if its hanging low or high in the range adjust the range to fit that value in the middle.
Rinse and repeat, its easy if a bit time consuming. Just don't look at the data after 1 night and make decisions.
And Auto CPAPs are generally FAR better than regular CPAPs. You can try to get one covered by insurance but that depends on the equipment providers and insurance company.
I'm a diagnosed narcoleptic and have obstructive sleep apnea, which is a lot better now after having a tonsillectomy about 2-3 years go. I too am a patient at the same clinic you go to (Stanford) and have been a patient at two other clinics, one in Raleigh, NC and one in São Paulo, Brazil. I don't even remember how many sleep studies I've done. I think 8. Five in Raleigh (One for diagnosis and for as part of the clinical study that approved sodium oxybate for general narcolepsy and not just cataplexy). I did another two in SP IIRC and I did one at Stanford, but should do another one since my surgery.
First thing I recommend is drop your HMO in favor of a PPO. Having to see a GP first is the biggest waste of time and you know your symptoms well enough to at least figure out what specialist to see.
When booking an appointment with the clinic, you can be seen sooner by not picking who will see you. The main doctor at Stanford is Dr. Mignot. He's amazing and bar none the best of the sleep doctors I've seen. The reason that clinic is booked out forever is because he and his clinic are that much better. Booking in the summer months is particularly bad because there are lots of younger patients from elsewhere in the country that will visit Stanford due to its reputation. You're not just competing with local patients but people everywhere in the US. Also let the receptionist know that you're a local patient and that you would be happy to be on the waitlist to be called in case of a cancellation. You'll be seen much sooner this way.
If you actually have sleep problems, all those wires, as inconvenient as they are, are unlikely to impact the results much. In every sleep study I've done, I've been in REM sleep in about ~2 minutes of laying my head on the pillow after the lights have been turned out. All the numbers they use for diagnosis are based on the same methodology with that equipment. If the inconvenience impacts the results than that is already accounted for.
I highly recommend looking into the surgery option (tonsillectomy and lingual reduction) if your ENT doctor (mine is Dr. Capassso) thinks you're a candidate for it. My nighttime breathing was night and day better and I don't snore as much. That said, it's one of the most painful surgeries you can get as an adult. I didn't eat food for more than two weeks and didn't even miss it because it hurt to even think about it. The results were worth it.
Yeah, the whole process sucks at times, but it's not trivial stuff to figure out and if you need this, it will make such a huge improvement in your life that you'll be asking yourself who has time to not go through all that song and dance.
Or, to put it another way, for me, it was 1, 2, 3, and a not-as-long-as-you-describe 5.
I used to have a serious acne problem. Cutting down on meat and dairy really helped, but I was still getting a few small pimples now and then after that. It was only when I stopped using my computer or TV late in the evening that I got 100% clear skin.
What made me suspect sleep was a few studies showing that a lack of sleep has a negative effect on various hormones:
http://www.ncbi.nlm.nih.gov/pubmed/22844441
http://www.ncbi.nlm.nih.gov/pubmed/22787499
http://www.ncbi.nlm.nih.gov/pubmed/19955752
http://www.ncbi.nlm.nih.gov/pubmed/10543671
http://www.ncbi.nlm.nih.gov/pubmed/23078578
I found a couple studies on acne that mentions lack of sleep:
https://www.ncbi.nlm.nih.gov/pubmed/11763987
https://www.ncbi.nlm.nih.gov/pubmed/14962066
https://www.ncbi.nlm.nih.gov/pubmed/20463367
https://www.ncbi.nlm.nih.gov/pubmed/22850476
[0] - https://justgetflux.com/
1. Don't look at a screen for an hour before going to bed.
2. Wear a sleep mask. If you can open your eyes and see any sliver of light or a distinguishable shape, you need something different.
The effect is complete lack of visual stimulus making it really easy to start hallucinating (an overly strong word) which is an easy ramp into deeper sleep. The lack of bright blue light beforehand does something something melatonin, and you'll feel significantly more tired before bed (the lack of stimulus will also help).
source: http://www.amazon.com/gp/product/B000CCI4YU?psc=1&redirect=t...
Make sure your doctor leaves orders to titrate for a CPAP, APAP or biPAP setting if you show more than N apneations/hour. That will save you another sleep study and get you set up faster.
But couldn't this cause the opposite problem? In the morning, the rising sun levels tell your body to start waking up. I'm not an expert, but I would guess that this also stimulates (or de-stimulates) certain chemicals or hormones in the body needed for normal waking. So without your eyes seeing the sunlight increasing as a cue to wake up, doesn't that just cause a different problem?
Between work and kids, the uninterrupted time required to get sufficient sleep is a luxury. It just doesn't happen regularly.
And that's a comfortably-living first worlder's perspective. I'm not trying to compare myself to people who do need to work 2 jobs just to get by.
I never got help from anyone but myself and my huge trust fund.
Everybody knows you should get 8-9 hours of sleep per night, and most people are at least vaguely familiar with studies that say lack of sleep can reduce life expectancy. Yet people still choose to sleep less than the optimal amount. That's a choice. There is a tradeoff of time now, vs time at age 70+. If time now is more valuable, then it could be rational to sacrifice time at 70+ by sleeping less now. People make this choice every day, subconsciously or not.
Of course, the choice of how much sleep to get is often not an easy one. We have to go to school or work. We have obligations. Perhaps the easiest win from a public health perspective would be changing the start time of public high schools. Why are we forcing kids to wake up at 6am to go to school? That's just stupid, and flies in the face of all sorts of research.
I'm with you on health choices and quality of sleep, but I've never needed more than 6-7 hours in the rack.
> The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need 9-105 hours, and adults need 7-8 hours.
According to the article 7-8 for adults is normal.
Sounds about right...
This would only be bad if the sleep start time didn't allow for enough rest. And the sleep start time should be determined by the time one needs to wake up.
Therefore wake up "time" is irrelevant. It is the parents' responsibility to have their children sleep enough, doesn't matter the wake up time.
Also, study after study proves that daylight time is by far the best time to be awake when it comes to treating depression and therefore sleep hygiene. 6am is a good indicator in most places that we're close to sunrise.
Numerous studies have been conducted, to the point where the topic submarines monthly on HN, that controlled for sleep duration, high school students perform much better when start times are later in the morning. The cause that researchers commonly attribute to this is that people in that age group have an optimal sleep schedule that's later than young children and adults.
> That's just stupid, and flies in the face of all sorts of research.
Private schools are for grooming the children of the elite to inherit their class power. Public schools are for training the children of the public to obey rules, listen to authority, and be minimally capable of participating in the wringer of wage labor.
This comment belongs on reddit, not hackernews. There is no evidence to back this up.
What evidence would convince you anyway? Video footage of the school board twisting their moustaches and laughing as they toast their cleverness?
None of the people involved are doing it deliberately (many of my teachers were obviously mad, even us kids could see it.) Everyone is (more or less) trying to do their best.
I went to Montessori schools at first and then public schools after eight. The difference in educational styles was shocking. Compared to my personal experiences at the former the later were like prison camps. When the class stood up and recited the "times tables" (multiplication) by rote in unison the only thing I could relate it to was the military displays I'd seen on TV! I already knew how multiplication worked from playing with the math blocks (in fact I knew more than simple multiplication) but I didn't realize it until much later. This was just simple parroting, rote training, no insight was transferred to or evoked in the students and, indeed, no one tried.
And the bells! I had never had to do anything routine according to bells in my whole lil life.
That right there should be evidence for you, no? The regimented scurrying from class to class at the bell has no educational purpose and actually harms concentration and learning. The best you can say about it is that it conditions the children to being able to stop and change gears at the sound of a bell. The schools are training machinery, not raising people.
Education is perhaps the single most important human activity (Parenting, Gardening, Mathematics, that's my list.) So it behooves (a word I learned in public school, it wasn't all bad..) us to do the best we can at it. Public schools, at least the ones I attended, were pathetic.
EDIT:
Public school teachers (et. al.) are freaking heroes and deserve so much more than we give them! One good, dedicated person can have a massive positive effect, even in an otherwise poor situation. I want to make that clear. :-)
>Public school teachers are in much the same position as prison wardens. Wardens' main concern is to keep the prisoners on the premises. They also need to keep them fed, and as far as possible prevent them from killing one another. Beyond that, they want to have as little to do with the prisoners as possible, so they leave them to create whatever social organization they want. From what I've read, the society that the prisoners create is warped, savage, and pervasive, and it is no fun to be at the bottom of it.
>In outline, it was the same at the schools I went to. The most important thing was to stay on the premises. While there, the authorities fed you, prevented overt violence, and made some effort to teach you something. But beyond that they didn't want to have too much to do with the kids. Like prison wardens, the teachers mostly left us to ourselves. And, like prisoners, the culture we created was barbaric.
-Paul Graham
[1]: https://exist.io
Back in Lan Party days pounding red bull after red bull I was still easily the first one to bed by far (which is never a good thing to be asleep around a bunch of wired up young immature males late at night...)
...of course, sometimes I will get up early, do some stuff around the house, drive to the shops, drive back to the house, put everything away, cycle to work, and I still won't feel like I've woken up properly until I've drunk my coffee and read my email.
For me, it's all about the ritual of drinking the coffee rather than the caffeine content. I'm quite sure that if someone were to replace it with decaf and not tell me, it'd work just as well.
Everyone's different.
The effects can also be different from what's expected. I've tried to stay awake one night, as I had a deadline, by drinking to cans of redbull in quick succession. Didn't seem to work, I fell asleep half an hour later.
Thing is, a fly landing on the other side of the room would startle and wake me up. I couldn't sleep indeed, not by not falling asleep, but by waking up all the time from random city noises.
I drink afternoon coffee all the time and am usually fine. I tried it 2 days ago and couldn't sleep at all. My unscientific speculation is that eating a light dinner that night combined with the coffee was too much.
Can I train to sleep (a little bit) less?
I can usually get by with less sleep (7 hours) and function somewhat normally if I go to bed and wake up at the same time every day, but I feel much better if I get a couple of hours more.
That should lead you to something like this: "a sudden, widespread occurrence of a particular undesirable phenomenon."
Also look up Epidemiology, which studies all manner of health based topics, sleep being one of them.
If your proposed RF interference model has a factor of ~10^-19 in it, then a competing social interaction model that has a factor of 1 in it would have a much stronger effect, even if social interaction has only changed to the power of 10^0.1.
So the point there is that the magnitude of the change in the environment is not sufficient information to do a comparison, you also need some sort of explanatory model.
I'm also not making a no mechanism claim.
I'm pointing out that the magnitude you stated is insufficient information to draw any sort of conclusion. You (apparently) want people to be alarmed at a large number. A large number is not a good reason to be alarmed. A large number coupled with an explanatory model as to the effects that the large number can have might be a reason to be alarmed, but the number itself just has a lot of zeros.
It would be something like:
sleep deprivation=(x*RF intensity)+A Constant.
So I'm not demanding a theory demonstrating that RF can influence biology, just pointing out that the magnitude of the change in RF is insufficient information to draw a conclusion from.