All extremely good advice, but the whole process of getting a CPAP machine drives me bonkers (at least in the US).

A CPAP machine is a couple hundred dollars [1] (certainly less than a thousand) and everyone I've ever spoken to about one has either instantly, the first night of using one had a tremendous dramatic improvement in their sleep or it was sort of 'meh'.

Given the costs and extremely minor risks (we're talking about a small fan that blows air into your mouth) you would think the diagnostic process would be to just give you a CPAP machine and see if it helped.

However you HAVE to go through a sleep study to get one, and you have to get a prescription to even buy one online. All of which means thousands and thousands of dollars of extra health care expense with very little to show for it.

1 - http://www.cpap.com/customize.php?PNum=2507&PAID=0

Agree with most everything, but when I bought a CPAP machine many years ago, I don't recall needing a prescription (I could be forgetting). I was deemed "borderline" by my sleep study, so my insurance wouldn't pay for it. I went ahead and bought a portable one online for a couple hundred, and it worked like a charm. Funny thing is the place I bought it from sent me the "nurse's manual" with instructions on setting pressure and "under no circumstances let the patient see this manual" :) I've since lost some weight and had septoplasty (to treat chronic sinus infections) and don't need it, so I donated it to my brother-in-law. If your doctor won't prescribe it, you might need to find a new one. Sleep really is one of those three pillars of health.

I managed to luck out in finding the "full" manual for my device through some googling. Basically you hold down some unrelated buttons and voila, you can adjust pressure yourself. As I've lost weight I've periodically lowered it.

You used to be able to buy them online without a prescription, but it's changed now. You can easily buy them through craigslist, though.

This is a really good criticism of the current system. I know someone who attempted to get a sleep study done but insurance denied it. The doctor's response was basically "oh well, looks like there's nothing we can do".

It's been a while, but I'm pretty sure that the first HMO I got treated at used an auto-titrating CPAP initially, just to see if I was a candidate for a sleep study. The machine can sense when you stop breathing, and adjust the pressure accordingly.

It's not always as easy as just strapping on a CPAP and seeing if it works. There are at least two major kinds of sleep apnea: Obstructive (which is the most common) and Central (where your nervous system "forgets" to breathe). Using a CPAP with central sleep apnea can cause serious problems.

There are several different things that can cause poor sleep. So just giving them a machine may miss some important things.

Also, CPAP machines can really screw with your blood chemistry.

I used a CPAP for a three or four years. Overall I had better quality sleep, but there were lots of difficulties and some very long stretches where I think I was much worse off for using the machine.

Depending on the type of sleep apnea a CPAP can make it worse.

Oh, you can sometimes find CPAP machines at swap meets and craigslist, if you look around. I've ended up with three of them, and should probably sell one or two. I know it's still a pain to get a mask, though.

Yes! This has been a huge win for me.

I'd typically fall asleep at my desk around 3pm, or be fighting micro-sleep episodes. In any case, sitting there felt like torture. Never mind the effect on coding and debugging. Been doing that for decades. Tried ADHD remedies, etc. etc.

I started using a machine on a Friday, and noticed that although I was still a bit tired, I didn't take my usual 2-hour afternoon naps on the weekend. With the initial settings, I would still get a bit tired by mid-afternoon on a work-day, but it was an improvement.

After a second sleep-study and further calibration, I don't get tired at all in the afternoon. This is going to bed at 11:30 to 12:00 and waking up at 6:30 to 7:30.

It's hard to describe the practical effects of sleep-deprivation on programming effectiveness. It's like every programming problem just got a bit easier, and every tool just works a bit better. The difference between being slightly too dumb to do the job well, and being a monster is a small one.

Unanticipated benefits are that colds are not really tiring, and my alcohol tolerance is back to University levels (not sure if that's a win). On the flip side, I'm less inclined to drink alcohol, because I don't want to mess with my new mental powers.

Good stuff. My dad had apnea so bad he had to have his nose and sinuses redrilled. I'm looking forward to the study.

Not saying this is a cure-all for everyone, but it's a good first thing to try:

My dad was diagnosed with sleep apnea. He was tired during the day and got bad migraines. They recommended a fancy apparatus but he instead sewed a golf ball into a small pocket on the back of his pjs. Like most folks, he only snored and suffocated himself when asleep on his back. So this way when he rolled from his side onto his back he woke up slightly and went back to his side. 100% cured him, no migraines since.

I did basically the same thing, but took three tennis balls, put them in a tube sock, and safety-pinned it to the back of a T-shirt. I found loose T-shirts didn't work quite as well as one that's a little tight.

lol! going to try this

Wow! That's unfortunate.

The message I've been getting from my ENT is that he'd only advocate surgery if the patient wasn't tolerating the CPAP. I.e. at higher pressure settings it might be uncomfortable, and reshaping the airways could help with that.

For me, I just pretend I'm Prometheus in an interstellar cold-sleep casket. I love the mask -- badass!

The other crazy thing is that his face now looks very different than it did when I was a kid. Old pictures don't look like the same person, doesn't fit my memory, &c. Perhaps he died and was replaced with a deep-cover Soviet spy?

It was also 20 years ago, so intervention strategies have likely improved.

A pulse oximeter can also be worn overnight to check for oxygen desaturation during the night from pauses in breathing.

Polysomnography (sleep test) is the gold standard, but O2 saturation is a good indicator as well.

An oximeter isn't a bad thing to own and can be had cheaply from Amazon. Sleep apnea can emerge with as little as 10% weight gain, acid reflux or allergies. If you really care about your sleep, heart and brain it doesn't hurt to check once in a while.

This is great advice, thanks. On that subject, I use CPAP since 2008 but I occasionally did not use it for intervals up to a week (for example, when I traveled I would not bring the CPAP with me). It turns out I had an episode of atrial fibrilation (the heart beats with a weird rhythm) due to a few factors together, but the major one being the lack of CPAP usage. It was scary and I spent the night at the hospital. The doctor explained me that this condition can be caused by low levels of O2 while sleeping, which is caused by apnea.

I think people need to be more proactive about this sort of thing. If you're uncomfortable, don't assume it's normal! See if there is something to it.

I used to have a lot of trouble breathing at night. I would sleep, but be exhausted in the morning. After college, I got surgery for a deviated septum. Then I started using a humidifier and Breathe-Right strips religiously at night. Now, I've got a baby that doesn't sleep through the night and I still wake up every morning quite refreshed. :)

Thanks. I've got #3 on your list, and working in front of a screen is unbearable most days. I've thought about doing a sleep study, this just reinforces it.

I wish you all the best.

If I got diagnosed with sleep apnea, it would be the best news I've gotten in years - it would be like winning the lottery, as I could put a name to the root of the problem, and take steps to deal with it.

I want to do my own startup, and solving my sleep issues could easily be the difference between doing it and not.

So thanks again, it means a lot.

I can absolutely relate to that. True names are power and all that jazz.

I have high-grade apnea and I use a CPAP for years (and yes, it changed my life for the better!). Just last week I started an acupuncture treatment in which the doctor applies very small electric shocks to a muscle that pulls the tongue a little, for 30 minutes. I was explained this is a bit like physiotherapy, but for the tongue and mouth. I did my first session last week and I already felt some improvement. I have 4 more sessions to go.

I cannot stop using the CPAP because my apnea index is pretty high, but it might work for someone with a mild level.

Note that even though I mentioned acupuncture, this is not a "new age" or alternative-style treatment. In my country (Brazil) acupuncture is actually regulated by the Health Ministry, and this treatment is accepted by the local medical community.

Another important thing to consider if you always feel tired, anemia. My wife was chronically anemic for years and no matter how much sleep she would get always felt tired. Started taking iron supplements and a week later felt perfectly fine.

I was having many of these problems but not too severe, a sleeping nasal clip has turned me around. It's just a little piece of plastic that slips up into the nose when I sleep that seems to keep my air passage open better.

my wife also says that I snore a lot less

(before that I was also sleeping on my side with my mouth open to get air resulting in lots of night drooling which was...messy)

Another good remedy is an oral appliance for sleep apnea. I use one to position my lower jaw forward while I sleep so I can breathe more easily. The appliance is also a lot easier to maintain than the CPAP (an occasional brushing will do it good). The downside is that it can cost a lot more than the CPAP, as in several thousand dollars.

Edit: I used to use CPAP, but I found fitting it on my face to get a good airtight seal was finicky. It was only after using the CPAP that my insurance let me consider the oral appliance.

Me too! I started using a CPAP machine about 2 years ago. It felt as though I instantly gained 10 IQ points overnight. I could focus deeply for longer. I felt better. And I didn't need to nap anymore. All for a few hundred bucks.

Could you summarize exactly what a sleep study involves?

Basically you sleep in a hotel-like room but with a bunch of wiring hooked-up to your head and body. It's painless, except for the discomfort of sleeping with all those wires. The "output" of the test is an index called AHI, which indicates your level of apnea. AHI > 5 means you might need a CPAP or some other kind of apnea treatment.

Thanks!