Sleep research led to a new sleep apnea drug

People should be more aware of the symptoms of sleep apneas - the lack of energy during the day, feeling tired, waking up throughout the night, waking up tired/exhausted, etc. People with untreated sleep apnea have multiple folds higher chances to be depressed, unemployed, and have trouble with basic life functions, in addition to the long term health consequences of depriving your brain from Oxygen.

I've suggested 4 people over the last couple of years to get tested based on them casually mentioning some of these symptoms, and all 4 got diagnosed with moderate to severe sleep apnea (which is classified by the number of times you stopped breathing every hour - AHI, and the blood oxygen level). Getting tested is easy and cheap - you can find kits for under $100 which essentially are just a monitor you attach your finger + a few ECG stickers on your body which you use for a couple of nights. You can order them online without talking to a doctor, and you will get a prescription for CPAP if you are diagnosed as positive.

Treatment with CPAP is highly effective in eliminating these symptoms, and also reversing the brain damage (although MRI scans shows that it takes around a year for the gray matter in your brain to restore itself).

The other suggestion I'd make is that if you are overweight or obese, GLP-1 has proven to be also a miracle drug for sleep apnea. Unlike the study mentioned above, that essentially reduced the average AHI of participants by 4, which for almost everyone wouldn't cure them. Drugs like Zepbound have shown that over half are cured from sleep apnea after roughly a year of use. This is in addition to the other health benefits they provide with the weight reduction. Essentially. This unfortunately won't work for everyone, as weight is not the only cause of sleep apnea, but it is by far the most common one.

Just to share my experience. I think I was beginning to develop sleep apnea: I was waking up suddenly with an awful feeling of something terrible happening for no reason. The most terrible experience was waking up in the middle of the night with a sensation of dread I couldn't explain, and it took me half an hour to calm down.

More generally, since I was young, I always slept part of the night with my mouth open and woke up in the morning with a terribly dry mouth.

Now I have solved my problem with two simple things, without any medication: during the day, I am always careful to breathe only through my nose (except during intense physical effort), and at night, I just use mouth tape to keep my mouth closed all night long.

Since I started using the tape on my mouth, I sleep well and I no longer experience nighttime panic (due to apnea?). At the beginning, I was scared of having the tape keep my mouth closed, but I very quickly got used to it and now I barely notice it.

I have severe obstructive sleep apnea -- am 6ft and 210. I wear a CPAP and now swear by it. A couple things to help those who try:

1) Make sure you have a CPAP machine with a water tank so the forced air is moist. For me, if the water runs out, that's when I wake up bc my nose dries.

2) Get a spray saline solution for your nose -- not Afrin or drugs (habit inducing) -- just simple and cheap Arm & Hammer Simply Saline.

3) Wear a shirt when you're in bed and put the hose under your shirt so it's hard to roll off.

4) Bonus -- sleep elevated.

Those are my best tips. If you can do the CPAP and suffer the awkwardness, you'll really feel so much better. First time it stuck, I woke up at 4:45 am fully rested and felt as if a heavy weight was lifted off me.

Best luck :)

I went through the whole process of seeing an ENT, using the machine for the at-home sleep study so insurance would give me a CPAP, then not being able to sleep with a CPAP, and over the course of a couple years I fixed my sleep apnea by fixing my posture and breathing. If you have forward head posture or are not used to breathing through your nose, you might also benefit from this. I think it’s kind of crazy that we do surgeries and take medicine that modifies your brain chemistry for what I believe in many cases is a structural issue.

If you’re curious to try this, read James Nestor’s book Breath, do yoga with breathing exercises, or see a physical therapist. It takes time to fix these structural issues, but you can literally change the shape of your nose, palate, and jaw from just practice.

Here’s a quick exercise you could try. Sit up, relax your body, breathe in through your nose, and feel the breath move up your nose, down to the base of your skull, down your neck, and then as far down your spine as you can. The air isn’t literally moving through these areas, but you should feel a current of sensations moving roughly along that path. As you breathe out, follow the current in the opposite direction. As you tune into this current, your neck and back will naturally straighten a bit, it should feel very natural and even pleasant. Keep your body relaxed and allow your neck and back to align with this current. If you keep doing this regularly it should help improve your posture and breathing. This is basically a pranayama / yoga breathing exercise. If it feels painful, definitely stop and try physical therapy or working with a hatha yoga instructor who can give you more guided instruction.

I used to snore so badly it sounded like, without much exaggeration, a dying elephant. I only did this exercise for a couple years and it slowly improved over that time, and now I sleep quietly.

It only reduces by 4 events per hour. That seems like it might be helpful for someone with mild sleep apnea. But not with moderate or severe sleep apnea.

Adult AHI Severity Levels

Normal: Less than (5) events per hour.

Mild Sleep Apnea: (5) to (14.9) events per hour (frequent minor interruptions).

Moderate Sleep Apnea: (15) to (29.9) events per hour.Severe Sleep Apnea: (30) or more events per hour.

"By mapping the neural circuits that lead to this common condition, work from the Horner lab laid the foundation for AD109, a new treatment developed by researchers in Boston to specifically target the two pathways that contribute to sleep apnea. The daily oral medication contains two drugs: one that increases noradrenaline levels and another that blocks muscarinic receptors.

In a recently published phase 3 randomized clinical trial, people with mild to severe sleep apnea who received AD109 had less airway obstruction and higher oxygen levels than those who received a placebo. On average, per hour of sleep, participants on AD109 had four fewer events where they stopped breathing or had very shallow breathing."

I don't have sleep apnea, as in, my severe snoring doesn't cause significant drops in blood oxygen levels, but it's still severely impacted my life - when my wife and I married, I spent the first night of our honeymoon awake so that she could sleep.

Oh and it's so loud that I'm at risk of damaging my own hearing.

And I bounced off CPAP hard, no matter what I tried, I would eventually remove the mask in my sleep, it was heartbreaking, I was so excited to finally be able to fall asleep beside my wife.

I also tried the mouth guards and would wake up panicking and gagging.

So my only other option currently is self-funding expensive surgery (our public system doesn't fund treatment for severe snoring unless it causes apnoea, and my private health insurance excludes the most expensive portions shrug), which like all surgery, carries no guarantees of success, and also carries the risk that any general anaesthesia application does.

So this is awesome! I just hope it continues proving efficacious and safe.

If you wake up every day feeling like you got hit by a train and also have anxiety, depression, chronic heartburn, or exhaustion (not sleepiness, like a wired but tired) I would highly recommend looking into Upper Airway Respiratory Syndrome (UARS).

UARS was coined by Dr. Christian Guilleminault who was on the team that coined sleep apnea. Over his career he slowly widened his definition of sleep disordered breathing from choking (sleep apnea) to any nasal resistance that causes wake ups.

You be young and perfectly healthy but due to bad anatomy have micro arousals throughout the night. Becuase your young, your body fights through it (cuasing exhuastion) and will wake up up to readjust your airway. You won't remeber any of the wakeups, but many suffer from insomnia from it. The two big issues is large tongue in underdeveloped jaw that falls back and constricts your airway (you can test this with a mallamapati test) or a small nasal passage way.

I had bad sleep apnea until last year, sleeping 8-9 hours a night and usually feeling tired in the morning.

As of the last 12 months it seems to be heald, after I used mouth tape and a nasal dilator consistently for 30 nights in a row. I highly recommend trying this, it was quite cheap (~$20) and the change seems to have been permanent. I used 3m micro-pore tape that doesn't tear the facial hair, and the nasal dilator I used was called "woody knows", though there are many brands that may work just as well. I barely snore anymore where I used to be a raging snorer according to those in the know and my own audio recordings of myself. Most importantly, I only need about 7 to 7.5 hours of sleep now and I will wake up feeling well rested most days. I can also breathe exclusively through my nose now where before I could not. I can take very big breaths through just the nose and do this now when exercising.

I don't think it's all perfect though as I still often breathe through my mouth. I'm starting to wear the mouth tape at night again as an experiment - it really isn't that annoying.

Relatedly, I recently started looking into "mewing" after a breath-work teacher I took classes with recommended it to me as she has been doing it with good results (improved breathing). It seems related to this as Mew recommends keeping the mouth shut all the time. I intend to try the mewing exercises and see if that helps my breathing further.

“CPAP treatment is extremely effective, but Horner notes that many people have a hard time sticking with CPAP because they find it uncomfortable and cumbersome.”

The sleep medicine industry uses compliant long term cpap patients as the denominator in order to conclude it’s “extremely effective”. If you stop cpap therapy after a year (or even years!) of it not working, they will blame patient compliance not the machine. The machine manufacturers (who incidentally happen to fund most sleep research) have made a variety of machines and settings, and thus there is always another setting to adjust or device to try before concluding cpap won’t help. The assumption is that it’s “extremely effective” and thus, all failures are attributed to compliance. “You just need to find a better doctor to help with the titration”, or “you need a different type of mask”, or “turn off the autoset and up the pressure”, or “it can takes years to adapt to the machine and see improvement”, or my favorite “you may feel much worse and get very little sleep but the science says you need cpap, even if it’s not helping the apnea and maybe even making it worse.” Indeed, the research literature show cpap is potentially iatrogenic, inducing or increasing (central) sleep apnea in some patients. The solution the industry has marketed, a different type of cpap device for CSA called asv, about twice the cost of a regular cpap, actually increased mortality in a major trial iirc. So yeah, if you don’t give up after years and dozens of machines and doctors and weekly titration appointments and none of that helping at all and maybe even making the apnea worse or even killing you (if you have HF, the main cause of CSA, then yes, cpap is “extremely effective” or there wouldn’t be a multibillion dollar business behind it propped up by insurers who can presumably use cpap patient non-compliance to deny future insurance claims related to the cardiovascular system or metabolic dysfunction.

Article says sleep apnea is caused by muscles collapsing in the upper airway, but an overlooked cause is structural deficiency in the bones of the midface.

https://news.stanford.edu/stories/2020/07/toll-shrinking-jaw...

I realised I was affected by this in 2023 and have been researching it and trying to spread the word about it since.

I see CPAP rightly getting mentioned a lot here. What worked for me was a MJS (Mandible Jaw Splint), it’s basically a mouthguard you sleep with that moves your lower jaw forward and thus brings your tongue forward so it doesn’t obstruct your airways.

Best bet is to get this custom made. Here in Australia there are specialist dentists that do this for you. It’s far easier than CPAP and works just as well for many like myself.

Often folks will use CPAP at home and these mouth guards when travelling.

I think sleep apnea would have killed me had I not gotten the sleep study. I was having 100+ events in the span of a few hours. Anyhow, I use the CPAP everyday. I don't snore anymore and I have maybe 1 event a night. Incredible machine.

One of the drugs in this treatment, oxybutynin (Ditropan), is associated with cognitive impairment[1].

[1]https://www.sciencedirect.com/science/article/pii/S009042952...

For me the CPAP was too damn invasive. Fail. So as an alternative they made me a dental appliance. I put it in at bedtime and it kept my lower jaw jutted out just enough to maintain airflow. It worked :)

The difference maker for me was an app, Snore Lab. that my son told me to try. It said that my snoring was EPIC. That led to my current CPAP use, for which the benefits [no daytime sleepiness, more energy, no food cravings] exceed the hassle [mask wearing, cleaning routine, supplies reordering.]

Four events per hour AHI improvement would not be a meaningful change for my therapy, but this is the beginning of better treatment options in the future.

The best benefit of CPAP is that it thwarts heart arrhythmias which arise from depriving the brain of oxygen.

It's aroxybutynin 2.5 mg/atomoxetine 75 mg. They don't actually say in the article but the development code "AD109" leads to that

STOP-BANG Score for Obstructive Sleep Apnea:

https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive...

There are some older studies that showed nicotine (not via smoking, which makes sleep apnea worse) had a positive effect on sleep apnea as well due to the stimulation increasing muscular activity in the airways. Obviously lots of downsides too so it never caught on, but this seems to have a similar mechanism.

I was never diagnosed with sleep apnea but I had an O2 saturation alert when I would sleep side sleeper so I bought a cervical pillow and found a quiet CPAP machine. I add saline and a few drops of very diluted I+KI to the water just to keep anything from growing in it despite changing it daily. I love it. My sleep has never been better. I often forget I have the little nose mask thing. The cervical pillow is awesome, never goes flat. My biggest improvements were from that little cervical pillow.

I highly recommend BongoRX (https://bongorx.com/) if you have sleep apnea and can't deal with CPAP. The mechanism: it makes it a little harder to breathe out, which keeps your airways more open when you breathe in next.

The pictures on the website are a little misleading: it comes with a strap to keep the device in your nostrils, so they don't just fall out in the middle of the night.

FDA-approved, and does require a prescription...

The drug is called AD109, but the title seems misleading as the drug is apparently still under trial, though it has shown good results there so far

Surprisingly the most effective treatment I've found for my own apnea is just wearing an inexpensive soft cervical collar to sleep, but there are lots of different things that can contribute to sleep apnea, so YMMV.

After dealing with unexplained ectopic heartbeats (sometimes PVCs, sometimes PACs) I saw a chain of doctors and that included both getting a sleep study done and seeing a cardiologist.

I was diagnosed with mild apnea (AHI just above 10), but despite the apnea being mild on the AHI scale, my Sp02 blood oxygen percentage was dropping into the low 80%s for extended periods per night down from a normal 95-99% most of the time.

I weigh 180 lbs at 6 foot 2, being overweight was a non-factor in my apnea.

Got a CPAP machine, it helped but even after dialing in my personally optimal pressure settings using the CPAP data with OSCAR my AHI was still kind of all over the place, from under 1 to as much as 6 seemingly randomly per night with no mechanical issues like mask leaks showing up.

Had heard (on reddit /r/CPAP) about some people using soft cervical collars to help with their apnea and I gave it a try and when wearing one my AHI drops down to 0.0 - 0.4 per night. The collar alone helps more consistently in my case than the CPAP machine does.

Basically my sleep apnea is almost entirely due to the fact that when I'm sleeping (even on my side, but worse on my back) I seem to naturally tuck my chin in toward my neck in a way that constricts my upper airway and the collar stops this from happening. This is very much YMMV, there are lots of different causes of apnea.

If it spares a respirator this is huge win. Even if might be used before severtiy leads to the unavoidable NIV-respirator with overnight CPAP.

Great. Something like 60% of OSA cases are linked to obesity. GLP-1 drugs could probably lead to resolution for a lot of them if the Lilly SURMOUNT-OSA trial tells us anything.

I wake up without my cpap mask after a few hours every night. In total I might get 6 hours with it after putting it on multiple times.

Doctors think I’m doing fine due to total amount of hours used, and my resmed cpap claims I’m at below 1 event/hour. I’m not doing fine and I think the numbers are lying to me.

I snore a million, my mouth gets dry, and my nose tightens up, so my nasal mask isn’t always that nice to use. Other masks also annoy me.

What do? I haven’t sleep a solid 8 hours for 3-4 years :(

I often get (perhaps reasonable) pushback for this, but the level to which CPAP equipment and supplies are gatekept by the industry is absurd. They're a fan tube, a mild heating element, and a sensor, and I'm nearly certain that it would be pretty difficult to harm yourself using one "wrong" -- especially as opposed to other medical items and drugs available OTC.

Also, yes, they're pretty cool. I don't love that I seem to need mine right now, but at least I know a guy. :)

You can‘t get AD109, but unless you live in a shithole country you can order some ambroxol today.

https://www.iosrjournals.org/iosr-jpbs/papers/Vol8-issue6/B0...

I once wrote a summary here:

https://www.reddit.com/r/snoring/comments/1kn4dzr/there_is_a...

I always thought as a stomach sleeper why not get one of those massage table head rest things, face down symmetrical and wouldn’t gravity help keep things open then? Just have to build it into a cozy bed, not sure if that would be comfortable though.

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