It's a firm spring mattress with a relatively thick and soft mattress topper.
But it's a bit of a compromise. My girlfriend hates foam mattresses even though I thought they felt great. This set-up lets me get a somewhat similar feel of sinking into the bed while being well supported.
She's also much lighter than I am and wants a soft mattress, so her side of the bed is softer.
I would call it the no booze hangover. Sometimes the symptoms would be like a mild hangover. You wake up with a headache, still tired, and a little bit of a “what happened last night?” vibe.
Except that “what happened last night” was drink plenty of water and go to bed at a reasonable hour.
A wide variety of non-specific things. The most frightening of which was palpitations and skipped beats. Then panic attacks. Occasional ice pick headaches. Brain fog. Strangely, daytime sleepiness was not a symptom for me.
The problem is compounded by (in the USA) middle class requiring 2 working parents increasingly in most places. We aren't built as humans to function like this.
I'd be willing to buy a nice one, but it's probably one of the most annoying things to shop for. I don't know what I want, and mattress vendors all seem like crooks. The rise of the internet foam mattress startup has made it worse.
I purchased four different mattresses until I settled on one. Most major brands have very easy return policies so shop around and try out a few before settling.
Any advice in overcoming insomnia? I’ve tried everything I can think of. Melatonin, various vitamin supplements, exercise, dietary changes of a wide variety, nothing seems to help. Always waking up in the middle of the night and can’t get back to sleep.
Exercising. More specifically aerobic exercising. High and low intensity both work, but you have to do enough to properly exhaust yourself, just 15 minutes of walking is not enough. And not doing anything too exciting or demanding 2-3 hours before going to sleep. Maybe you just haven't done enough or not consistently enough.
I picked up meditating daily in an attempt to address one of my mental disorders.
Falling asleep is much easier for me now, whereas I used to struggle with it a lot.
My thoughts used to feel unstoppable and the moment I would wake up in the middle of the night, they started going and I was wide awake and no longer sleepy within seconds.
Now it’s like I’m observing them, but no longer get excited. I still have bad days, it’s not a 100% consistent solution, but it’s helped me massively.
What has worked for me, but with only one month experience: An apparatus that pulls my lower teeth forward, prescribed by a doctor, that keeps me from snoring. Then suddenly, I slept so soundly that I didn’t wake up at odd times during the night. I used to wake up at 2am and stay awake until 6am, only to sleep between 6 and 8 and be late at work.
In French it’s an “orthèse mandibulaire”. It holds teeth together (with a hinge), its role is to push the lower mandibula forwards to get 0.5cm farther from the throat so that air can pass unencumbered.
Sleep hygiene was #1 for me. If I'm not sleeping or having sex, I get out of the bed.
I never go to bed if I'm not tired and if it takes too long for me to fall asleep I get back up, trying to force sleep will just cause physical pain. I usually have a ~30 minute nonsense trivia podcast playing for me to fall asleep to. If I can hear it ending, I get up and do something else.
#2 was switching to a job that's less stressful. If my day-job requires me to juggle 20 things at the same time, it's impossible for me to wind down enough to sleep - or at least I couldn't figure out a way. For a co-worker journaling worked, basically they offloaded their brain to a physical notebook and that gave enough peace of mind to relax and fall asleep.
I struggled with the same. I tried all sorts of practices, "sleep hygiene", supplements and devices. What I eventually learned is that frequently what's need is changing your relationship with sleep. I couldn't find a CBT-I[1] psychologist in my area. So I ended up taking the sleepio.com[2] coaching class as a trial candidate. It walked me through the steps of CBT-I and got my sleep back on track. The recent book Hello Sleep[3] by Dr Jade Wu also does a good job re-framing your perspective on sleep and walking your through CBT-I. You do need to commit to the CBT-I process. It could take several months to complete and one of the initial sleeps often leads to sleep deprivation, so it may feel worse before getting better. But after following the process my sleep improved dramatically. I still keep in mind what I learned when I have the occasional bad night of sleep.
I agree with you so much. That's an aspect that stood out in The Expanse series. Holden was from Earth and was brought up with many "fathers and mothers" I'm assuming through a time where it was difficult to have children
Looking at today it feels we'd alleviate a ton of parental pressure if we had households like that and not depend on the traditional couple.
I understand that in the novel series that sort of setup was encouraged by institutions (there is a vague mention of taxes), and in The United States this is setup is disincentivized by institutions. However if greater than two parent households was a genuinely preferable way to live I would expect more people to choose that lifestyle now.
Research and summaries of research will rarely hand out advice. In recent years, there has been an explosion of content that provides practical advice on getting better sleep. Most of this advice involves habit changes, and many of these habit changes are hard (e.g. avoiding screen time for ~2 hours before bed is tough if you always watch Netflix in the evenings).
I added links as a response to the sibling comment with some practical resources, and I think it's important to recognize that work focusing on the impact of sleep or the lack thereof is not necessarily in the same category as work that seeks to provide remedies / improve sleep.
Thankfully, as we continue to learn just how important sleep is, we also continue to learn about ways to improve it.
This is probably a clear metric for our annoying friends who complain that they don’t get high enough quality sleep, but go to bed at 2 and have an alarm set for 7 every day. Sure you may have worked best on 5 hours sleep in college (though probably not), but if you aren’t "feeling well rested after waking up at least five days a week", you might try more sleep.
Some people need this advice, and a clear metric to hit. I’ve known them, and although I failed to make a dent, eventually something did. Maybe it was an article like this.
Convincing people that sleep is a problem worth caring about is half the battle.
There are many resources available that get into the practical/tactical aspect of improving sleep. But if you don't believe sleep is a problem yet, you won't seek those out.
The Huberman Lab has put out a number of good resources for this [0] including a podcast episode speaking with Matt Walker, PhD, sleep researcher and author of Why we Sleep [1] (also a good read).
I've been a night owl for most of my life, and only more recently did I fully realize how connected this behavior was to traumatic situations growing up. When I started going down the rabbit hole on how to improve sleep, it was encouraging to find the emergence of a ton of practical non-pharmaceutical resources (I did try sleep aids for awhile, but couldn't deal with the side effects).
The hard part is that it does require willingness to implement real changes. They're not pleasant at first, but I went from an average 3AM-10AM sleep cycle to 10PM-6AM, and I've realized that all the things I told myself over the years about needing to be up all night were simply untrue.
I started this journey by setting a goal for myself to see/photograph a sunrise. I now regularly take pre-dawn walks and have seen more sunrises in the past few weeks than I had during the prior 30+ years of my life.
Huberman and Walker cover some of this in the linked materials, but “The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology” [0] is a pretty interesting review of the literature on this.
In short, we’re becoming increasingly aware of the impact of light throughout the day on the body’s circadian rhythm. Bottom line: natural selection didn’t design to be up throughout the night.
As for the benefits I’ve personally noticed:
- I’m significantly clearer in the head throughout the day and feel more able to make better choices during the day (about food, time spent, etc)
- My mental/emotional state has improved, and I have more capacity to deal with challenging emotions
- Increasingly (this has been shifting steadily) I start each day ready to tackle the hard stuff and I don’t have to use as much willpower
- This is the other side of the “mental/emotional” item but I generally feel happier, or have more capacity to experience happy feelings
- There is also a body of research about getting morning sunlight in your eyes, and I’ve found that on days that I do, I sleep much better. Sleep tracking confirms this. Having a science-backed reason to witness/enjoy the sunrise is nice on mornings when my body just wants to stay in bed.
More generally, such a question is starting to look like similar to questions about a healthy/balanced diet: some of the benefits can be experienced now, but prevention of long term issues is just as important. The links between lack of healthy sleep and degenerative brain issues later in life (dementia, Alzheimer’s, etc) seem to be getting stronger based on recent research.
> but I went from an average 3AM-10AM sleep cycle to 10PM-6AM, and I've realized that all the things I told myself over the years about needing to be up all night were simply untrue.
You also seem to sleep an hour more, so some changes you experienced might be due to that.
Prior to implementing bigger changes, I tried many things to make my late nights “work”, including trying to sleep more.
Sleeping longer while going to bed later didn’t help much with quality (deep and REM phases were poor/short), and was also difficult to achieve for practical reasons.
I took about 3 months to fully shift the schedule, and I was tracking stats along the way. I started to notice improvements once my average bedtime was closer to midnight.
Once I hit that point, I kept shifting earlier because I wanted the benefit of the morning solitude that comes with getting up earlier. But sleep quality kept improving as well.
How did you get it treated? I've heard of the machines for this, but its not a very appealing option. I've also heard of exercises for neck/throat/jaw region, but do they work?
In regards to your last question, Yes, the exercises can/do work with helping to strengthen your throat area. Tying your jaw shut at night with a scarf, or taping your mouth shut, works as well. Another thing I learned, through a comment found here on HN, is how to force your sinuses to open up. Even if you are congested, close your mouth and try to breath through your nose. Eventually (usually not long) your body's need for oxygen will take over and open up your sinuses. Hope this helps but remember that I am not a doctor.
With a CPAP machine, a lot of patience, OSCAR [1], and the help of the kind people over at Apnea Board [2].
I was given the machine, which was titrated to the wrong pressure settings, with the cheapest mask that was too small for my big nostrils. If it hadn't been for the fact that I had a friend whose life was greatly improved by CPAP, I probably would have thrown in the towel on the first night. But I stuck with it, asked for help on Apnea Board, tried to learn as much about apnea and PAP-therapy as I could, and eventually got to a point where I'm pretty happy with it.
This is a huge problem! If they are in the US most insurers allow you to go straight to a specialist. Unsure if that helps them but for anyone reading this, if you can, go straight to a sleep specialist. My treatment was delayed for 3 years because I didn’t snore (another common reason for rejection of a sleep study).
As a former chronic couch sleeper, this one hit close to home. You're describing my sleeping patterns over the past few decades pretty well.
After I encountered the book "Why we Sleep" and heard some podcast interviews with the author, I was convinced that I needed to change my habits and started taking this seriously. Here's what I did:
1. If I slept on the couch, I'd stay there. My first priority was to start getting full nights of sleep. This involved "giving in" to my couch sleeping, and stocking the couch with sheets/blankets so I could set myself up for success. I found that once I was no longer "oh shit, I did it again", I could actually sleep through the night.
2. I started a morning mindfulness habit. Over time, this helped me notice more clearly each morning how I was feeling, and how my choices the night before improved or degraded my day. If I passed out while watching something, I would always wake up less rested.
3. After getting some regularity in my schedule, I started feeling more rested, and my meditation habit seemed to be providing even more clarity. One day, I started internally questioning why I was sleeping on the couch when my bed was far more comfortable.
So I went to bed on time. And then I kept doing it. For the first time in over 30 years, I feel like my relationship with sleep and going to bed has fundamentally changed.
I realized that my poor sleep was more about bad habits I'd been clinging to since I was a kid, and the more I improved my sleep, the more clearly I could see this.
YMMV, but figured I'd share how this went for me.
> if I'm out late with friends and stay up till 3am, I'm still up at 7am.
This was a hard pill to swallow, but as I dug more into the sleep research, it became clear that the body is not well suited for the occasional (or regular) 3AM morning. The body seems to be optimized for regularity/consistency, and adding a 3AM night is never without cost.
This doesn't mean I never stay up late, but I now do so knowing exactly what to expect.
I'm not so sure, my experience tells me differently..
I am a thin guy with very low body fat. As soon as I told my doctor that I had woken up 2-3 times with my soft pallet dry & semi-collapsed, also that I would wake up regularly with a dry mouth, he immediately sent me for a sleep test. I went and did the test and the results were that I had mild sleep apnea. The sleep doctor told me that they were ordering a CPAP machine for me. I asked why I needed it for mild apnea and also told them I wouldn't use it. They ordered it anyway and told me to take the issue up with my doctor.
While all this was going on I was in the process of reducing the amount of meds I took (bad accident in 2010). I also started reading up on & studying sleep apnea. One of the first things I learned, and that worked, was keeping my mouth shut during sleep (many ways to accomplish that). The other thing I learned is that Big Pharma/FDA does a horrible job of listing medication side effects. I say that because "causes sleep apnea" was not on the list of side effects for carbamazeine (used for my peripheral neuropathy). As soon as I stopped the carbamazepine the apnea symptoms vanished. I have no need for a CPAP, it was ordered and I've received many calls about it, but there it sits at the sleep doctor's office..
Sleep study was a complete joke - I slept in a creepy hotel like room in a clinic for maybe 3h total. Uncomfortable and totally different sleep then at home.
AHI of 5, given CPAP with no follow up. It really felt like this sleep Doctor got paid to hand out machines.
Hacked the settings, used it for 8months then quit cold turkey as a test. Felt the same.
My sleep improved more from:
Drastically reducing alcohol, smoking, weed. Septum correction and tonsil removal. Sleep alone in bed in complete darkness in a cool room.
> The other thing I learned is that Big Pharma/FDA does a horrible job of listing medication side effects. I say that because "causes sleep apnea" was not on the list of side effects for carbamazeine
Having designed and run clinical trials, I think your assertion based on a single experience is unreasonable.
Companies are very interested in unexpected events, particularly bad ones (called “adverse events” in the jargon). Viagra was “discovered” because of an unanticipated side effect of a drug being tested for a heart disorder.
That long list of side effect warnings? The companies love that list because it reduces legal risk (and marketing risk: doctors will tell patients what to look for and/or will avoid giving it to patients at risk of effect X).
While it seems plausible to me that sleep apnea could be a side effect of a drug like carbamazepine (though it’s not a benzo) it was not reported to any statistically significant extent.
since you have to report all AEs, the FDA will, in some cases, zero in on one that was reported at a minor level for additional study, because someone in the review panel thought worthy of investigation due to some scientific issue in their specialty. Drug companies hate that of course, but that’s one reason why there’s a review panel rather than a single reviewer.
While I respect your expertise in the field, I disagree.
>Companies are very interested in unexpected events, particularly bad ones (called “adverse events” in the jargon). Viagra was “discovered” because of an unanticipated side effect of a drug being tested for a heart disorder.
Tell that to Moderna and Pfizer. They, nor the FDA, have shown any interest in adverse events reported by both patients and doctors to VAERS [1], unless whatever hypothetical minimum number of people report it. I've had, as well as Dr. Greg Poland [2], a pretty severe adverse reaction to the mRNA vaccines but our problems remain unaddressed because not enough people have reported it, science knows little about our reaction, or it doesn't monetarily benefit anyone (liability or profit). As for the Viagra discovery, it was a monetary benefit.
Scientists and researchers in the medical field need to realize everyone is different and we have different reactions to various drugs. I guarantee you that carbamazepine was causing my apnea problems. It also caused two other adverse reactions that are not listed as side effects.
Now that I think about it, your entire comment screams pharmaceutical marketing to me.
> Scientists and researchers in the medical field need to realize everyone is different and we have different reactions to various drugs.
You really think that they do not realize this? The whole reason for phase 3 trials is to have a candidate drug tested on a sufficiently large and diverse population that represents the treatment population in order to look for these very variations.
If there is anyone who doesn’t want to recognize this, it would be the actuaries at the insurance companies.
> I guarantee you that carbamazepine was causing my apnea problems.
I never suggested otherwise. I merely said that a statistically significant number of such cases did not show up in trials so it wasn’t listed as a side effect for doctors to look out for.
Your comment about vaers doesn’t make much sense either. Vaccines have absolute insurance coverage provided by the government so that companies will make them at all. Vaers is a postmarket surveillance system for the government. Both Moderna and Pfizer’s Covid vaccines have been through the full phase 1,2,3->NDA process (i.e. no longer under emergency use authorization) including ae surveillance.
I followed your route. Got the machine, hated it, didn't accept it.
I ended up getting a "boil-and-bite" mouthguard thing that kept my lower jaw from slipping backwards when I sleep.
That helped for about 6 months, but eventually I would wake up throwing up in my mouth. What happens is that you fall asleep, your throat collapses, you go to take a breath and since you can't bring in air through your mouth, instead you try to bring the stomach acid from your stomach up into your lungs.
eventually went through the hassle of getting a machine, found the nasal pillows mask was *much* better than the default mask, and have been good.
My wife got a foam topper and an 'under mattress inflatable thing' for my bed about 10 years ago - it was like sleeping on a new bed. I think it was around $150 at the time. Possibly getting a new bed this year, but those gave new life for a long time.
that isn’t true. i’ve never received nutritional advice from a doctor, and if i did i doubt it would be much more than “eat fruits and veggies and exercise”
the “official” food pyramid put out by the government still tells people to eat mostly refined grains and carbs.
Your statement is not at odds with my claim, not to mention eating more fruits and veggies is an improvement for 85%+ of Americans so yea that's actually solid advice. I don't know why you think it isn't
Most Americans are also sedentary and don't exercise at all so again, even just walking more is an improvement for most people.
All that being said, I also have not had a doctor who didn't first ask me what my diet and exercise are like before making suggestions
Eating fruits and vegetables is not typically good medical advice when we’re talking about acute issues.
Advice for a healthier lifestyle, more energy, longevity, etc? Yes of course. Advice for sleep apnea that’s already set in and affecting a patient nightly? Not at all.
I am not a doctor so it’s entirely possible I am misusing a term here. But afaik chronic is something that cannot be cured. This is not the case with sleep apnea. It just can’t be cured with vegetables.
A condition is described as acute when the onset is sudden and duration is short, a condition is chronic when it persists over a long period of time. It has nothing to do with curability
One of the major causes of sleep apnea is being overweight, so it can definitely be helped with a change in activity levels a diet modification
> the “official” food pyramid put out by the government still tells people to eat mostly refined grains and carbs.
Apparently this isn't true anymore. The Food Pyramid was replaced with the current "MyPlate" model in 2011 [1]. That said, grains still feature prominently on the plate and the details say up to half of those can be refined [2], which still seems high.
Maybe in part. But it’s also because medical practices are for profit enterprises and don’t make any money by telling patients to stop drinking alcohol, but make a bunch of money charging out CPAP machines to insurance companies.
Doctors “have given up” implies there was a time when doctors would dish this stuff out as a treatment plan. At least in the US, I don’t know if that’s ever been true.
Believe it or not, most doctors don't own their own practice and don't make more money for giving out treatments. Most of them did get into the field because they want to help people and it's a pretty small minority that profits off handing out treatments
Believe it or not, I am not blaming doctors. I respect doctors, and go to them frequently. But it's useful to go in with open eyes.
Even doctors that do not own their own practice are incentivized by the people who do own the practice. In the same way that a store clerk is incentivized to sell high margin items over low margin items. Or a Facebook engineer is incentivized to get users to engage in unhealthy social media addiction. There's nothing wrong with the individuals, its the incentive system that they are operating within.
My claim is as simple as the claim that for-profit enterprises are incentivized by profit and will prioritize profit-making activities over not-profit-making activities. If you have even a passing belief in capitalism then you have all the evidence necessary.
Every single doctor (in the US) profits off of handing out treatments. It's a pivotal part of how the economics of medicine works in this country. The entire thing would, quite literally, fall apart if doctors/practices did not profit from handing out treatments.
Note that I am not claiming that doctors are out there prescribing medicine they shouldn't be prescribing just to line their pockets or whatever...you seem to be convinced that I have some sort of negative view of doctors and I don't. What I am saying is that they operate within a system that literally requires them to prescribe medicine in order to stay in business. So given the option of "prescribe medicine, bill insurance, and see the next patient in line" or "suggest a lifestyle change and work with the patient over the course of months and years to monitor those changes"...they all choose the former. AND THAT IS FINE. But to be blind to it is simple ignorance.
Hell, it's what most patients want. Most people go to a doctor for medicine, not lifestyle advice.
> generally they're pressured to see as many patients as possible
That is because this is what maximizes profit for the parent company. It is a business like any other.
Yes and engineers only get paid for writing code. The money just appears from the employer. I honestly can’t tell if you’re just being purposefully obtuse.
Bit rude of you to assume that I'm apparently an alcoholic or a smoker.
Nice illustration of my point that public awareness on sleep apnea is lacking.
Good luck figuring out the root cause of sleep apnea. Years of research hasn't turned one up. There's a wide variety of contributing factors (including weight, alcohol, asthma/COPD). But there's also plenty of fat asthmatic drunks who don't have sleep apnea. It's obviously not as simple as you're making it out to be.
Do you have trouble breathing through your nose only? Other issue is people breathe through their mouth instead of nose. Get some nose strips and tape mouth shut and train yourself to breathe through your nose.
No one cares specifically about _your_ diagnosis, obviously we don't know you. You put yourself up for discussion when you posted your stance. You yourself called it a soapbox. Now people are using you as the obvious example and satisfying their curiosity.
According to your initial post, you should be glad for the questions so that you can combat misconceptions.
> Good luck figuring out the root cause of sleep apnea.
Inadequate jaw development. We're so used to people having recessed jaws that we're just used to considering several mm of recession as a normal, non-recessed face, and we don't even think about the fact that most kids have jaws so tiny that their teeth don't fit properly and they need braces.
This causes both narrow, collapse-prone airways, and tiny nasal cavities that have high airflow resistance and deviated septums.
Both age and obesity largely just convert people from waking up out of airway collapse to overt apneas.
Even a lot of the more specific habits that do sometimes get recommended ("sleep hygiene") are:
1) Potentially expensive/disruptive (control of the sleep environment may imply moving house or installing soundproofing materials, air conditioning, etc.)
2) Contradictory (get out of bed if you don't fall asleep in 15 minutes, but also don't look at the clock)
3) Not individually tested or validated
4) Based more on old-school behaviorism than on anything specific to the processes of sleep.
EDIT: forgot an important one
5) Only addressed at difficulty falling asleep initially, not staying asleep or improving sleep architecture.
Drop caffeine after noon, quite alcohol/cig/weed/screens anywhere close to bed time, keep evening meals small and low in carbs/sugar to avoid an insulin spike, wait at least 3 hours before hitting bed after a meal, more is better. Go to bed at roughly the same time every day, make sure your room is as dark as can be, make sure it's not warmer than 20c, exercise so that you're physically tired at the end of the day, only use your bedroom for sleep
Yes, I've been following similar recipes and my sleep improved noticeably (after initial ~2 weeks or misery, when my body was getting accustomed to the new sleep schedule)
isn't sleep apnea usually related to another problem, like diet (most of the time), or smoking/drinking, another is the position of your jaw (the teeth shouldn't touch)
It's a blanket term that describes a condition where your airway collapses while you sleep, but there are lots of causes. Smoking, drinking and other substances can cause your muscles to relax and bring on apnea, as can being overweight. Lots of body builders suffer from it as their necks become developed.
The biggest "cause" once you remove factors like alcohol is heredity. You get the shape of your face from your parents, why not the anatomy of your airway as well?
112 comments
[ 2.9 ms ] story [ 182 ms ] threadBut it's a bit of a compromise. My girlfriend hates foam mattresses even though I thought they felt great. This set-up lets me get a somewhat similar feel of sinking into the bed while being well supported.
She's also much lighter than I am and wants a soft mattress, so her side of the bed is softer.
I would call it the no booze hangover. Sometimes the symptoms would be like a mild hangover. You wake up with a headache, still tired, and a little bit of a “what happened last night?” vibe.
Except that “what happened last night” was drink plenty of water and go to bed at a reasonable hour.
Though fasting is a thing, and when well performed has health benefits (self reporting here).
And I've -- probably for good reasons -- never heard of oxygen of sleep fasting :)
Caffeine is an absolute killer that we don't talk about nearly enough when it comes to sleep.
Falling asleep is much easier for me now, whereas I used to struggle with it a lot.
My thoughts used to feel unstoppable and the moment I would wake up in the middle of the night, they started going and I was wide awake and no longer sleepy within seconds.
Now it’s like I’m observing them, but no longer get excited. I still have bad days, it’s not a 100% consistent solution, but it’s helped me massively.
I never go to bed if I'm not tired and if it takes too long for me to fall asleep I get back up, trying to force sleep will just cause physical pain. I usually have a ~30 minute nonsense trivia podcast playing for me to fall asleep to. If I can hear it ending, I get up and do something else.
#2 was switching to a job that's less stressful. If my day-job requires me to juggle 20 things at the same time, it's impossible for me to wind down enough to sleep - or at least I couldn't figure out a way. For a co-worker journaling worked, basically they offloaded their brain to a physical notebook and that gave enough peace of mind to relax and fall asleep.
1: https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_f...
2: https://onboarding.sleepio.com/sleepio/onboarding-sleep-test...
3: https://drjadewu.com/
Looking at today it feels we'd alleviate a ton of parental pressure if we had households like that and not depend on the traditional couple.
Point 5: "feeling well rested after waking up at least five days a week"
But of course! I'll fix my sleep by ensuring I wake up well rested.
I added links as a response to the sibling comment with some practical resources, and I think it's important to recognize that work focusing on the impact of sleep or the lack thereof is not necessarily in the same category as work that seeks to provide remedies / improve sleep.
Thankfully, as we continue to learn just how important sleep is, we also continue to learn about ways to improve it.
Some people need this advice, and a clear metric to hit. I’ve known them, and although I failed to make a dent, eventually something did. Maybe it was an article like this.
There are many resources available that get into the practical/tactical aspect of improving sleep. But if you don't believe sleep is a problem yet, you won't seek those out.
The Huberman Lab has put out a number of good resources for this [0] including a podcast episode speaking with Matt Walker, PhD, sleep researcher and author of Why we Sleep [1] (also a good read).
I've been a night owl for most of my life, and only more recently did I fully realize how connected this behavior was to traumatic situations growing up. When I started going down the rabbit hole on how to improve sleep, it was encouraging to find the emergence of a ton of practical non-pharmaceutical resources (I did try sleep aids for awhile, but couldn't deal with the side effects).
The hard part is that it does require willingness to implement real changes. They're not pleasant at first, but I went from an average 3AM-10AM sleep cycle to 10PM-6AM, and I've realized that all the things I told myself over the years about needing to be up all night were simply untrue.
I started this journey by setting a goal for myself to see/photograph a sunrise. I now regularly take pre-dawn walks and have seen more sunrises in the past few weeks than I had during the prior 30+ years of my life.
It's worth the effort.
- [0] https://hubermanlab.com/toolkit-for-sleep/
- [1] https://www.goodreads.com/book/show/34466963-why-we-sleep
In short, we’re becoming increasingly aware of the impact of light throughout the day on the body’s circadian rhythm. Bottom line: natural selection didn’t design to be up throughout the night.
As for the benefits I’ve personally noticed:
- I’m significantly clearer in the head throughout the day and feel more able to make better choices during the day (about food, time spent, etc)
- My mental/emotional state has improved, and I have more capacity to deal with challenging emotions
- Increasingly (this has been shifting steadily) I start each day ready to tackle the hard stuff and I don’t have to use as much willpower
- This is the other side of the “mental/emotional” item but I generally feel happier, or have more capacity to experience happy feelings
- There is also a body of research about getting morning sunlight in your eyes, and I’ve found that on days that I do, I sleep much better. Sleep tracking confirms this. Having a science-backed reason to witness/enjoy the sunrise is nice on mornings when my body just wants to stay in bed.
More generally, such a question is starting to look like similar to questions about a healthy/balanced diet: some of the benefits can be experienced now, but prevention of long term issues is just as important. The links between lack of healthy sleep and degenerative brain issues later in life (dementia, Alzheimer’s, etc) seem to be getting stronger based on recent research.
- [0] https://www.frontiersin.org/articles/10.3389/fnetp.2021.8303...
You also seem to sleep an hour more, so some changes you experienced might be due to that.
Sleeping longer while going to bed later didn’t help much with quality (deep and REM phases were poor/short), and was also difficult to achieve for practical reasons.
I took about 3 months to fully shift the schedule, and I was tracking stats along the way. I started to notice improvements once my average bedtime was closer to midnight.
Once I hit that point, I kept shifting earlier because I wanted the benefit of the morning solitude that comes with getting up earlier. But sleep quality kept improving as well.
I was given the machine, which was titrated to the wrong pressure settings, with the cheapest mask that was too small for my big nostrils. If it hadn't been for the fact that I had a friend whose life was greatly improved by CPAP, I probably would have thrown in the towel on the first night. But I stuck with it, asked for help on Apnea Board, tried to learn as much about apnea and PAP-therapy as I could, and eventually got to a point where I'm pretty happy with it.
[1] https://www.sleepfiles.com/OSCAR/ [2] http://www.apneaboard.com/forums/
1. Dim house lights 1-2 hours before going to bed.
2. Earplugs + blackout curtains.
3. Doing some sort of physical activity during the day.
After I encountered the book "Why we Sleep" and heard some podcast interviews with the author, I was convinced that I needed to change my habits and started taking this seriously. Here's what I did:
1. If I slept on the couch, I'd stay there. My first priority was to start getting full nights of sleep. This involved "giving in" to my couch sleeping, and stocking the couch with sheets/blankets so I could set myself up for success. I found that once I was no longer "oh shit, I did it again", I could actually sleep through the night.
2. I started a morning mindfulness habit. Over time, this helped me notice more clearly each morning how I was feeling, and how my choices the night before improved or degraded my day. If I passed out while watching something, I would always wake up less rested.
3. After getting some regularity in my schedule, I started feeling more rested, and my meditation habit seemed to be providing even more clarity. One day, I started internally questioning why I was sleeping on the couch when my bed was far more comfortable.
So I went to bed on time. And then I kept doing it. For the first time in over 30 years, I feel like my relationship with sleep and going to bed has fundamentally changed.
I realized that my poor sleep was more about bad habits I'd been clinging to since I was a kid, and the more I improved my sleep, the more clearly I could see this.
YMMV, but figured I'd share how this went for me.
> if I'm out late with friends and stay up till 3am, I'm still up at 7am.
This was a hard pill to swallow, but as I dug more into the sleep research, it became clear that the body is not well suited for the occasional (or regular) 3AM morning. The body seems to be optimized for regularity/consistency, and adding a 3AM night is never without cost.
This doesn't mean I never stay up late, but I now do so knowing exactly what to expect.
I am a thin guy with very low body fat. As soon as I told my doctor that I had woken up 2-3 times with my soft pallet dry & semi-collapsed, also that I would wake up regularly with a dry mouth, he immediately sent me for a sleep test. I went and did the test and the results were that I had mild sleep apnea. The sleep doctor told me that they were ordering a CPAP machine for me. I asked why I needed it for mild apnea and also told them I wouldn't use it. They ordered it anyway and told me to take the issue up with my doctor.
While all this was going on I was in the process of reducing the amount of meds I took (bad accident in 2010). I also started reading up on & studying sleep apnea. One of the first things I learned, and that worked, was keeping my mouth shut during sleep (many ways to accomplish that). The other thing I learned is that Big Pharma/FDA does a horrible job of listing medication side effects. I say that because "causes sleep apnea" was not on the list of side effects for carbamazeine (used for my peripheral neuropathy). As soon as I stopped the carbamazepine the apnea symptoms vanished. I have no need for a CPAP, it was ordered and I've received many calls about it, but there it sits at the sleep doctor's office..
In that they diagnose you with apnea, throw a CPAP machine at you, and then do no follow up.
I’m curious what part of this you are saying is not aligning with OP?
Sleep study was a complete joke - I slept in a creepy hotel like room in a clinic for maybe 3h total. Uncomfortable and totally different sleep then at home.
AHI of 5, given CPAP with no follow up. It really felt like this sleep Doctor got paid to hand out machines.
Hacked the settings, used it for 8months then quit cold turkey as a test. Felt the same.
My sleep improved more from:
Drastically reducing alcohol, smoking, weed. Septum correction and tonsil removal. Sleep alone in bed in complete darkness in a cool room.
Having designed and run clinical trials, I think your assertion based on a single experience is unreasonable.
Companies are very interested in unexpected events, particularly bad ones (called “adverse events” in the jargon). Viagra was “discovered” because of an unanticipated side effect of a drug being tested for a heart disorder.
That long list of side effect warnings? The companies love that list because it reduces legal risk (and marketing risk: doctors will tell patients what to look for and/or will avoid giving it to patients at risk of effect X).
While it seems plausible to me that sleep apnea could be a side effect of a drug like carbamazepine (though it’s not a benzo) it was not reported to any statistically significant extent.
since you have to report all AEs, the FDA will, in some cases, zero in on one that was reported at a minor level for additional study, because someone in the review panel thought worthy of investigation due to some scientific issue in their specialty. Drug companies hate that of course, but that’s one reason why there’s a review panel rather than a single reviewer.
>Companies are very interested in unexpected events, particularly bad ones (called “adverse events” in the jargon). Viagra was “discovered” because of an unanticipated side effect of a drug being tested for a heart disorder.
Tell that to Moderna and Pfizer. They, nor the FDA, have shown any interest in adverse events reported by both patients and doctors to VAERS [1], unless whatever hypothetical minimum number of people report it. I've had, as well as Dr. Greg Poland [2], a pretty severe adverse reaction to the mRNA vaccines but our problems remain unaddressed because not enough people have reported it, science knows little about our reaction, or it doesn't monetarily benefit anyone (liability or profit). As for the Viagra discovery, it was a monetary benefit.
Scientists and researchers in the medical field need to realize everyone is different and we have different reactions to various drugs. I guarantee you that carbamazepine was causing my apnea problems. It also caused two other adverse reactions that are not listed as side effects.
Now that I think about it, your entire comment screams pharmaceutical marketing to me.
[1] https://vaers.hhs.gov/ [2] https://www.mayo.edu/research/faculty/poland-gregory-a-m-d/b...
edit: mRNA
You really think that they do not realize this? The whole reason for phase 3 trials is to have a candidate drug tested on a sufficiently large and diverse population that represents the treatment population in order to look for these very variations.
If there is anyone who doesn’t want to recognize this, it would be the actuaries at the insurance companies.
> I guarantee you that carbamazepine was causing my apnea problems.
I never suggested otherwise. I merely said that a statistically significant number of such cases did not show up in trials so it wasn’t listed as a side effect for doctors to look out for.
Your comment about vaers doesn’t make much sense either. Vaccines have absolute insurance coverage provided by the government so that companies will make them at all. Vaers is a postmarket surveillance system for the government. Both Moderna and Pfizer’s Covid vaccines have been through the full phase 1,2,3->NDA process (i.e. no longer under emergency use authorization) including ae surveillance.
I ended up getting a "boil-and-bite" mouthguard thing that kept my lower jaw from slipping backwards when I sleep.
That helped for about 6 months, but eventually I would wake up throwing up in my mouth. What happens is that you fall asleep, your throat collapses, you go to take a breath and since you can't bring in air through your mouth, instead you try to bring the stomach acid from your stomach up into your lungs.
eventually went through the hassle of getting a machine, found the nasal pillows mask was *much* better than the default mask, and have been good.
My wife got a foam topper and an 'under mattress inflatable thing' for my bed about 10 years ago - it was like sleeping on a new bed. I think it was around $150 at the time. Possibly getting a new bed this year, but those gave new life for a long time.
if you’re not fat and have sleep apnea, the other major cause is alcohol consumption/smoking.
seems odd to treat the symptom eg sleep apnea and not try to cut out alcohol and smoking and then reevaluate.
the “official” food pyramid put out by the government still tells people to eat mostly refined grains and carbs.
Most Americans are also sedentary and don't exercise at all so again, even just walking more is an improvement for most people.
All that being said, I also have not had a doctor who didn't first ask me what my diet and exercise are like before making suggestions
you don’t take nutrition in medical school. doctors wouldn’t be able to prescribe a more personalized nutritional plan even if they wanted to
whether or not they say this or don’t won’t change anyone’s life
Advice for a healthier lifestyle, more energy, longevity, etc? Yes of course. Advice for sleep apnea that’s already set in and affecting a patient nightly? Not at all.
One of the major causes of sleep apnea is being overweight, so it can definitely be helped with a change in activity levels a diet modification
https://medlineplus.gov/ency/imagepages/18126.htm
Apparently this isn't true anymore. The Food Pyramid was replaced with the current "MyPlate" model in 2011 [1]. That said, grains still feature prominently on the plate and the details say up to half of those can be refined [2], which still seems high.
[1] https://www.health.harvard.edu/blog/crumbling-confusing-food...
[2] https://www.myplate.gov/eat-healthy/grains
Doctors “have given up” implies there was a time when doctors would dish this stuff out as a treatment plan. At least in the US, I don’t know if that’s ever been true.
Even doctors that do not own their own practice are incentivized by the people who do own the practice. In the same way that a store clerk is incentivized to sell high margin items over low margin items. Or a Facebook engineer is incentivized to get users to engage in unhealthy social media addiction. There's nothing wrong with the individuals, its the incentive system that they are operating within.
When a physician works for someone else's practice or hospital, generally they're pressured to see as many patients as possible
Every single doctor (in the US) profits off of handing out treatments. It's a pivotal part of how the economics of medicine works in this country. The entire thing would, quite literally, fall apart if doctors/practices did not profit from handing out treatments.
Note that I am not claiming that doctors are out there prescribing medicine they shouldn't be prescribing just to line their pockets or whatever...you seem to be convinced that I have some sort of negative view of doctors and I don't. What I am saying is that they operate within a system that literally requires them to prescribe medicine in order to stay in business. So given the option of "prescribe medicine, bill insurance, and see the next patient in line" or "suggest a lifestyle change and work with the patient over the course of months and years to monitor those changes"...they all choose the former. AND THAT IS FINE. But to be blind to it is simple ignorance.
Hell, it's what most patients want. Most people go to a doctor for medicine, not lifestyle advice.
> generally they're pressured to see as many patients as possible
That is because this is what maximizes profit for the parent company. It is a business like any other.
Nice illustration of my point that public awareness on sleep apnea is lacking.
Good luck figuring out the root cause of sleep apnea. Years of research hasn't turned one up. There's a wide variety of contributing factors (including weight, alcohol, asthma/COPD). But there's also plenty of fat asthmatic drunks who don't have sleep apnea. It's obviously not as simple as you're making it out to be.
According to your initial post, you should be glad for the questions so that you can combat misconceptions.
Unless you're a doctor, you should probably stop giving unsolicited medical advice on the internet.
Inadequate jaw development. We're so used to people having recessed jaws that we're just used to considering several mm of recession as a normal, non-recessed face, and we don't even think about the fact that most kids have jaws so tiny that their teeth don't fit properly and they need braces.
This causes both narrow, collapse-prone airways, and tiny nasal cavities that have high airflow resistance and deviated septums.
Both age and obesity largely just convert people from waking up out of airway collapse to overt apneas.
1) Potentially expensive/disruptive (control of the sleep environment may imply moving house or installing soundproofing materials, air conditioning, etc.)
2) Contradictory (get out of bed if you don't fall asleep in 15 minutes, but also don't look at the clock)
3) Not individually tested or validated
4) Based more on old-school behaviorism than on anything specific to the processes of sleep.
EDIT: forgot an important one
5) Only addressed at difficulty falling asleep initially, not staying asleep or improving sleep architecture.
Do you have a reference for this? 20 C is freaking cold. I wake up because of cold below 23 C.
The biggest "cause" once you remove factors like alcohol is heredity. You get the shape of your face from your parents, why not the anatomy of your airway as well?