Hacker News Reader

Comment by Aloha | Hacker News Reader

I think the risk of death is probably overstated, as these people have often gone decades without a CPAP, and lived just fine.

View on HN

Just to be clear, sleep apnea causes organ damage. I had oxygen levels dipping to 71% in my sleep study. It was enough to dramatically affect my cognitive abilities and took months of CPAP therapy to recover from. I'm 43, relatively fit, and don't have a history of snoring. If you have excessive daytime sleepiness, confusion, and difficulty thinking, get checked ASAP. Fortunately you can reverse the damage:

https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-i...

Sleep apnea is not a joke. My dad has a pacemaker because of the stress placed on his heart from years of untreated apnea.

> If you have excessive daytime sleepiness, confusion, and difficulty thinking

Ive always wondered and never found data: do you have an idea of how many people with these symptoms get prescribed mental disorder medicines from not knowing the real root cause? I can picture this stuff being misdiagnosed pretty hard by some practitioners.

I don't know what the statistics are, but they definitely tried this with me. Aside from the usual sleepiness and confusion, sleep apnea can also cause anxiety. (No wonder, you're basically running on cortisol by the time it gets bad enough to notice.)

I don't fit the standard profile for someone with sleep apnea, so they pushed anxiety meds pretty hard on me. Had to insist on a sleep apnea test.

Yeah, that's what Im scared of.

I personally have a lot of the symptoms. I have extremely low attention span, awful memory, I wake up 5 times a night, weird dreams, can't focus at work, can't keep track of anything for more than a few minutes...

Talking to my doctor and going through my health history, he immediately ruled out sleep apnea and started suspecting ADHD and such. While it definitely could be that, for the first half of my life I was the opposite... extremely focused, top of my class, photographic long term memory, you name it. I need to convince someone to let me do a sleep study

That sounds a LOT like sleep apnea. I'm not sure how your doctor could _possibly_ rule it out without a sleep study (it's pretty much impossible -- he would have to confirm any potential normalcy by watching you sleep and breathe).

Good question. I think the sea change will come when there are cheap and widely available sleep monitors which include continuous pulse oximetry. We're close, but not quite there yet.

That's not entirely true. If you mess up you can end up rebreathing your own air in the tube.

It has small holes that are supposed to allow fresh air to mix in even if the machine is not providing any. But they are small.

If you are a normal sleeper you would normally wake up and remove the mask if you feel suffocated. (For example a power outage.)

If you are with someone who uses such a machine you can test it - unplug the machine, and see how long it takes them to do something (wake up, or remove the mask in their sleep).

I've slept long into a power outage and woken up with a headache and significant disorientation and my mask still on. Really upsetting.

And with an AHI off the charts, I may very well die without one.

Might be worth investing in an Uninterruptible Power Supply for it if you haven't already.

If you get a UPS, make sure you test it at least once per month or so.

I discovered that my 2 year old UPS failed when the power went out and I got a mere 3 seconds of power to my computer. If it had been being used for what is effectively life support, I'd be dead.

Such an obvious answer that eluded me for some reason... Thanks for the suggestion.

This is a good idea, also many machines have batteries you can charge.

That said I should get a UPS for my machine, I literally cannot sleep without it!

As a bonus, these usually beep loudly when power to them is interrupted.

And/or a power failure alarm.

There are CPAP batteries.

> It has small holes that are supposed to allow fresh air to mix in even if the machine is not providing any. But they are small.

Oh for god's sake.

You are not going to die if the machine switches off, even with a full face mask. It is not hermetically sealed.

If you don't use a full face mask, but instead a nasal mask or pillows, this is what you'll do: you'll open your mouth and start breathing that way. Simple.

In my experience, if the power goes out you wake up immediately due to the change in respiratory effort, way, way before you'd suffocate. Even if you could, which would be hard given that you can breathe through the mask when the machine is off.

Also, many masks are nose only for those who sleep with their mouth closed (or learn to.)

> unplug the machine,

The only machine I've had experience with (a parent) had an alarm for power loss. Is that somehow not standard/a requirement?

Edit: As I think about it, there was an associated oxygen machine, and that was the device with an alarm for power loss. Nevertheless, it seems like an audible alarm on a CPAP would be a really good idea.

Nope. My machine is plugged in where my bed hits the wall, every now and then the bed moves a little in the night and unplugs the machine and I wake up because I am having trouble breathing. But my guess is that this is only a serious hazard for people with very serious health problem, or the elderly. If you are one of those, don't F around.

Edited my original, it was probably that way on the one I mentioned too.

I am a little surprised to find that CPAP use is considered non-serious though. (Being halfway to a BiPAP? Holy moly.)

High RDIs/AHIs are directly linked to orders of magnitude higher risk of heart attack (and I think also strokes).

Epidemiologically speaking, sleep apnea is deadly, if untreated.

I have an AHI of 79. Sleeping without a CPAP is like rolling the dice on death.

It's also something I can't change through diet. I'm a very in shape individual. My anatomy just isn't right.

I'd say 'lived fine' is probably not accurate. OSA is under diagnosed and one unfortunate outcome of OSA is high blood pressure, and that left untreated can cause and early death.

Not to mention the loss of productivity due to not getting healthy sleep.

Maybe a badly configured CPAP machine is worse than nothing at all?

The article says the data they collect include something called "mask leak rates". That means the machine has an airtight mask and could in principle suffocate you if it malfunctions.

That means the machine has an airtight mask and could in principle suffocate you if it malfunctions.

Ummm... no. If the CPAP machine fails, you'll just start sucking air in the holes that are normally used to expel your exhalations. (When you exhale, the air goes out through these vents, not back into the machine.)

It's significantly less airflow, and will cause you to wake up, but it's not going to suffocate you.

But isn't the point of sleep apnea that the lack of air does not wake you up?

Only until your brain reaches a threshold where it says "OOOOK, we definitely need to start breathing now. Time to wake up". When you reach that threshold, you wake up on a very low, subconscious level that disrupts your sleep pattern, which in combination with the lower level of oxygen, is what causes the damage to your system.

The difference with a malfunctioning machine is that you still cant get air even after that threshold has been hit (or at least it's very difficult to do so). At that point, your brain kicks you totally out of a sleep state and you awake completely.

No, the point is that your brain initiates an "emergency procedure", so to speak, when oxygen levels in the blood get too low. This results in a few very quick, gasping breaths and lots and lots of physiological stress, including heightened blood pressure.

If lack of air not making you wake up was the problem, patients would die long before seeing a doctor.

That means the machine has an airtight mask and could in principle suffocate you if it malfunctions.

One of the most popular masks is the ResMed Airfit P10.[1] This is a "nasal pillows mask". It is airtight, but only on your nose.

If the mask malfunctions or your nose clogs up, then instead of suffocating, you can open your mouth to breathe.

A full-face mask can presumably malfunction, even though it has a "failsafe" feature to let you breathe.

[1] https://www.resmed.com/us/en/consumer/products/masks/airfit-...

Peter Farrell (ResMed founder) has an oft-repeated quote to the effect of “The only way a CPAP machine can harm you is if someone hits you over the head with it.”

I'd be surprised. You can breathe fine even with the machine powered off. Power failures would be pretty exciting if not.

They are airtight in as much as they can effectively deliver the prescribed pressure without leaking air. Not truly airtight. The system HAS to have a safeguard against malfunctions, as power loss is always a possibility. They generally have a passive airflow built into the line somewhere.

Not sure what exactly "mask leak rate" means, but I know you want the device to form an airtight seal with your face so it's not blowing out the sides of the mask. The mask as a whole has small ventilation holes, however.

That would be a terrible device design regardless of if the approved software is being used on it or not. I suspect it's not nearly that risky.

Reply on news.ycombinator.com