TL:DR: Go to bed, quit touching yourself infront of the nice sleep technician lady at the sleep centre, and here’s a bunch of useful sleep apnoea industry tips!

So I’ve been working in sleep medicine for some time and after reading a few of the posts on the board I thought I’d reveal a bit of “behind the scenes” thinking and opinions your specialist might be having.

First off every week I’m reading about new oddball treatments and diagnostic tools. It’s very important to be aware that sleep medicine is only recently getting much attention, which means…the marketers are moving in. They spied a gap in the market and boy oh boy everyone is trying to reinvent the wheel and sell it to you with infographics and bad science.

You read any marketing or entrepreneur blog right now and they’re all gushing about how healthcare is the growth industry right now. Ugh. They crave your dollars sleepy friend.

To elaborate on the diagnostic tools for sleep apnoea I’ll go over the most fundamental testing kit we use. The pulse oximeter. Little doodad that goes on your finger for a night or too. Measures your pulse rate and blood oxygen level and gives us an “ODI” oxygen desaturation index. This is a bargain basement stand in for AHI or RERA, all those good numbers that follow the 5-15-30 mild-moderate-severe limits of severity for sleep apnea.

Being an actual centre for sleep medicine we of course use the most accurate kit around. And after the test comes back to us…

It’s still innacurate for a whole bunch of our patients.

That is untill we correct the recording to account for artefacts, basically where you moved slightly or had the device fitted wrongly by too many degrees, or your skin tone is darker, or you had fake or painted nails, or any one of a bucket of other reasons.

Alot of the time when I see someone post about a catastrophically low minimum oxygen saturation reported on thier study the first thing that pops into my head is that lab might not be bothering to correct thier own sleep studies properly.

Fun fact, because sleep medicine is so newly expanded but now in such high demand, some centers don’t even analyse their studies by hand! Takes time, the consultant doesn’t appreciate good scoring (they assume the software does a decent enough job…I’m not a fan), and mo patients rushed through means mo money. They are the minority fortunately.

So when I hear about the newest bestest sleep tracking tool evar I’m always instantly sceptical because if it was really that good, reproducably good, and validated vs our best tools…guys we would be using it. It’s not like we hate diagnosing you correctly.

The number of phone apps I keep getting shown telling us how much sleep by stages you guys are getting is nuts. Does your phone come with a set of EEG leads? Mine didn’t even come with earbuds.

I’ve also read on this sub a few times that upper airways resistance syndrome is the subject of some big cover up. Like…what? We don’t like the name of that specific condition so we’ve decided we don’t want anyone to have it?

The real answer is again, sleep medicine is only just getting the attention it deserves. Your consultant might genuinely not be up on the latest research. Some of these guys trained 20 years ago after all, some of them aren’t even solely sleep specialists.

We also might be triaging you. If by our questionaires you aren’t very tired, and your sleep study is on the mild side, and my clinic is pressed for time, then sorry bud but I’m spending my time on the dudes with 80+ AHI and a failing marriage over you. Personally I will still let you know about your other options.

Treatment wise stick with what works. What works isn’t always expensive either. I recently saw a thinly veiled ad for a water bottle that forces you to exercise your throat muscles so you snore less.

Were I a more world curious fellow I might be thinking “wow I wonder if that really does solve the problem of lost muscle tone during REM sleep sufficiently to reduce arousals”

Really I’m thinking “Wow that’s fucking dumb I wonder how many people are gonna buy that before they have a single large scale study to back thier shit up. Seriously buy any proven device that costs a fraction of the price”

So here’s my patented scale of “Cheap Bastard to I Want My Sleep Apnoea/Snoring Treated Now Goddamn It”. I’m leaving out the wierd sprays and clips and whatever because I’ve never been shown any paper convincing me they’re worth a damn. I could be wrong though, no specialist is ever omnicient.

(Cheap bastard end, other than the obvious weight loss this end kinda sucks for treating any serious sleep apnoea though)

  • Eat less (actually SAVE money! Yea ok I’m not making light though for real this is hard, but much easier with a good nights sleep first, so the rest of this list is more for you)
  • Sleep on your side (sorry ladies this does make wrinkles fractionally worse, but so does bad sleep sooo)
  • Sew a tennis ball into a shirt on the back to make you sleep on your side
  • Tape up that mouth
  • Strap that mouth closed (this one and the tape are particularly rubbish but kinda work especially in combination with other stuff)
  • Buy a cervical or anti snoring pillow that tilts your head back to open up your airways (you could also just stick something under your neck/pillow to do this too. I heard traditional korean roll pillows are good here)
  • Buy a wedge pillow to tilt the upper body up to open up the airway

—Now it gets good!—

  • Buy a simple “boil and bite” mandibular advancement device
  • Go to a dentist and get fitted with a proper mandibular advancement device
  • Go get yourself a second hand CPAP machine (a few sites for this) but this is very tricky because you’ll need to know the pressure you need with any specific mask to actually fix your sleep apnoea. I hate to say I can’t reccomend this all that much but I don’t have much experience here.
  • Go get yourself your own CPAP machine and well fitted mask (Gold standard!)

(This is the best end for actual treatment but pricier. At the end of the day though skimping out of proper sleep apnoea treatment is false economy. The money you’ll loose on your health cratering generally from lack of sleep, poor work productivity, mental health, loss of life opportunity, yea go get treated my dude).

I left out surgery because there are just so many procedures and how effective it would be would depend hugely on your unique anatomy and the skills of the centre you choose. I would personally consider surgery a very last resort if CPAP mask use doesn’t work for you. And even then I would try multiple centres before you really think CPAP isn’t for you, some places just work with you better to get a comfortable fit.

That’s all skipping the most important piece of advice I love to give my patients…

GO TO BED. Don’t come to me telling me you’re tired when you voluntarily go to bed at 1AM, just after a few rounds of Call of Duty, to wake up at 7AM. Sometimes with a cup of deliciously caffeinated tea beforehand to relax. Do you have sleep apnea? I dunno, maybe, I have a suspicion no CPAP machine in the world will fully fix your problem though. Work with me here.

Oh and quit harrassing the nice lady who fits your sleep study machine for your inpatient overnight stay ya pervs. She’s heard the jokes. Yes. All the jokes. And she turns the camera away when you start touching yourself because noone wants to watch that, now or later. You think undiagnosed sleep disorders are the most potent aphrodesiac known to mankind or something? That is the only explanation I have managed to come up with.

This has been a potentially useful information dump/clinicians rant, sleep well y’all.

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