Comment by DrAwdeOccarim | Hacker News Reader

Comment by DrAwdeOccarim | Hacker News Reader

Totally agree. My journey started with TMJ disorder. Turns out bruxism (teeth grinding) is common in sleep apnea patients; I assume because it forces the lower jaw forward. I started with a mandibular advancement device and it was amazing. It completely relived my debilitating TMJ jaw pain and fixed my sleep apnea. I couldn’t believe how amazing I fet every morning. Unfortunately, and which was clearly communicated to me by my sleep dentist, after about 8 years my lower jaw stopped resetting back to a normal bite during the day. So I switched to CPAP. I love my nasal pillows plus chin strap CPAP, the sleep quality is unbeatable and my light-sleeping partner would have left to sleep in another room permanently if not for it. Along the way I have tried many other ideas—a tongue suction pull forward thing, a rear tongue electro stimulation device, prone sleeping, wedge sleeping, just the chin strap, and I looked into the pace maker thing and participating in an oral small molecule trial but didn’t follow through with it (also, I’m already thin, just a weak jaw line). Nothing compares to CPAP at high humidity and medium temperature. What has made a major impact was seeing an ENT, and the discovery of sinus blockages, so I recently had major sinus surgery and it’s improved my sleep apnea about 75%! Turns out “negative pressure” is a major cause of airway collapse. So I’m going to try some of the non-CPAP stuff again to see if my partner is able to deal with at most some loud breathing.

Sorry for the long post, but my advice to all is see an ENT if you need a CPAP and are already thin.

I want to emphasize the importance of seeming an ENT. I also saw an ENT, but very early in my journey. I also had sinus surgery. After recovery was the first time in my life I could breathe fully through my nose. I had no idea - it was like being blind and being able to see for the first time, except I had no inkling others could see. That actually opened up a realization that the sinus issues they fixed had led to chronic infections, which upon over a year of various treatments I finally cured, leading to an incredible uptick in life quality. Turns out some non trivial percent of people have chronic sinus infections due to poor nasal air flow, and having an infection next to your brain doesn’t make you feel very good. But they’re also very hard to diagnose.

The ultimate treatment that worked was daily sinus irrigation plus a treatment of sinus irrigation with a specific type of topical antibiotic that can break down biofilms. I would mix the antibiotic with saline and topically irrigate the sinuses. The benefit was it wasn’t a systemic antibiotic so it didn’t screw up my entire system. I eventually read this book:

Harvard Medical School Guide to Healing Your Sinuses (Harvard Medical School Guides) https://a.co/d/dpDZwba

And they had a brief section on topical antibiotics. I asked my ENT and he said it’s a vastly superior treatment but most people refuse to do sinus irrigation so he just gives pills - which he said are usually partially effective, and thus temporary, due to the presence of biofilms.

Anyways long story - I recommend everyone assume they have a sinus infection and visit an ENT for a check up, and to take up the practice of sinus irrigation as a preventative measure especially during and after an upper respiratory infection. Apparently when baths were the common way of cleaning (especially before modern plumbing, using rivers and lakes), sinus irrigation was generally part of the routine by just dunking the head and filling the sinuses then expelling the water and other stuff. There’s a now lost English word for it that I can’t recall any more, but with showers and modern Victorian hygiene that dispensed with a lot of traditional hygiene, we’ve lost the practice.

What’s the antibiotic?

https://en.m.wikipedia.org/wiki/Mupirocin

Have you had any experience with nitroxoline?

It's worth knowing that, according to some recent research, taking a topical antibiotic like this might have permanent impacts on microbiome in your nose (and lead to drug resistance.)

Yes, but systemic antibiotics are substantially worse in this regard as they change your entire systemic micro biome, and a chronic sinus infection is a permanent highly negative micro biome in your nose. Sometimes it’s better to hit the reset button than endure misery for the rest of your life :-)

Just to add this, my ENT prescribed a nasal probiotic prior to my surgery due to staph risk. I used it for 6 months prior to the surgery and now I continue to use it because, either it's a placebo or something special, it seems to improve the airflow in my nose beyond what I'd expect from just squirting some buffered water up my nose. Additionally, I seem to have fewer head-colds that also seem to resolve more rapidly (I have two small children, so my house is literally an incubator for infections). This is the product: https://liviaone.com/collections/probiotics/products/probiot... in case you were curious.

Now I’m curious what the lost English word is.

it's important to point out that sinus irrigation is said to be able to cause a brain infection itself.

hence the need to sterilise your water by heating it first.

i have been doing sinus irrigation with a syringe filled with water straight from the tap for years; i was horrified when a friend pointed this out to me.

Yea, this is why I just pay for the sterile sensimist nasal saline spray: https://www.amazon.com/Simply-Saline-Adult-Nasal-Original/dp...

>What has made a major impact was seeing an ENT [...] Turns out “negative pressure” is a major cause of airway collapse.

The cause of snoring & apnea, from my own searching online and seeing various anecdata, is that there are several common causes but it can vary wildly.

I've also tried many similar treatments to yours, short of CPAP, and including trying tongue & jaw exercises and mewing to try and get my default sleeping jaw & tongue position to be the same as when I'm awake (never had success after months). I had my deviated septum corrected and a turbinectomy alongside it, and it made absolutely no difference to my snoring (but I do breathe better in more humid climates now).

The only other main factor I've noticed is weight, or rather visceral fat. Being overweight often comes with lots of visceral fat, and this includes near the airways, thus constricting the space your airways have to operate with. Perhaps that contributes to this whole negative pressure thing.

A side benefit of having your partner sleep separately is that there is far less sleep disturbance, even the kinds you wouldn't notice. My sleep quality has gone up.

Is "mewing" a typo? This sounds incredibly cute.

“ Mewing is a technique in which the tongue is placed on the roof of the mouth in an effort to make the jaw bigger and more square. This may be done for aesthetic reasons and/or to correct orthodontic, breathing, and facial structural issues.”

> I love my nasal pillows plus chin strap CPAP

Speaking of chin straps - I could never get one to work, but “Caldera Releaf Neck rest” collar worked a treat.

Totally agree! I went through tons of them. The one that finally worked for me was this one: https://www.amazon.com/PRIMADA-Premium-White-Support-Industr...

It's basically a 4 inch wide soft elastic band with velcro on the ends.

Omg, I purchased one of the Caldera neck rest collars and slept with it on last night instead of my chin strap. Wow is all I can say. Normally my AHI is around 2, it was 0.2 last night. What is this black magic!? Thanks so much internet stranger!

You’re welcome.

Can you elaborate on “oral small molecule”? Googles failed me.

https://apnimed.com/

https://journals.lww.com/neurotodayonline/Fulltext/2022/0407...

Thanks.

“AD109 targets two neurochemical pathways which control the upper airway musculature during sleep via a dual mechanism of action”

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