This page can drastically change your life for the better if you have Obstructive Sleep Apnea (OSA).
Many people suffer from OSA for many years, but do not even know that such an illness exists!

WHAT IS THAT?

If you have never heard about obstructive sleep apnea, the information, provided below, can shock you. But I let you know in advance, that the problem can be solved quickly and easily - you will read about that on this page, in the "HOW TO GET RID OF OSA?" section.

Your muscles are more relaxed in sleep compared to wakefulness. When you drop asleep, the muscles, which keep the internal tissues of your mouth near your upper airway, relax, so the tissues move down and the airway becomes narrowed (which causes snoring). After your brain goes into the deep sleep phase, it loses control over these muscles at all. They collapse under their own weight and completely block the airway:

Your brain is not aware of that blockage since it is deeply sleeping, so the suffocation can last as long as 1-2 minutes, and even more! The blood oxygen level is keeping dropping. The heart kicks into high gear trying to compensate for that oxygen getting low (that puts severe strain on the cardiovascular system and causes arterial hypertension), but with null results, of course. When the blood oxygen saturation decreases critically (that causes heart conditions), the brain, bombed with SOS signals, slightly wakes up and takes emergency measures to save the situation (among other things, injecting a large dose of adrenaline), and raises the collapsed tissues. Since pauses in breathing cause oxygen deprivation and accumulation of CO2 in the bloodstream, breathing often restarts with a deep and awakening gasp similar to a sharp grunt. Air passage is restored. After a while, oxygen level in the blood returns to its normal level. The brain falls back into a deep sleep, and... the story repeats itself over and over again:

During the whole night you're having these ups and downs: a very-very low oxygen, and then a big gasp when you're trying to compensate anoxaemia and get more oxygen into your lungs. The brain is very unhappy when its environment changes in very drastic ways!

BTW, OCA can be connected with type 2 diabetes and cancer.

"I AM 100% SURE I DON'T HAVE SLEEP APNEA..." ©

People spend half a night not breathing - in heavy asphyxia. Or even more - for example, my own sleep study revealed 5 hours of suffocation of the total 8 hours! But they are unaware that they stop breathing while asleep. After waking up in the morning, they remember nothing having no idea why they are suffering many years from sleepiness, fatigue, obesity, heart diseases, hypertension and many other problems.

The reason Sleep Apnea is so unheard of and I dub it "the silent killer" is because you may have no clue that you are suffering from it. This is because if you sleep by yourself, you will have nobody there to notice you are choking or intermittently ceasing to breathe in your sleep. And even if you sleep with someone beside you, they may sleep through your apneas, or just assume you're a bad snorer and write it off as something normal.

Sleep Apnea - The Real Reason Why So Many Bodybuilders Are Dying

Unfortunately, the majority of people who have sleep apnea don't know it. A study by the American Academy of Sleep Medicine found that while approximately 30 million American adults have obstructive sleep apnea only about 6 million, or 20%, have been properly diagnosed and treated. The reason sleep apnea goes unrecognized so often is simply that it happens when people are asleep. In many, many cases the individual isn't conscious of what’s happening in their sleep. It's frequently a bed partner or other member of a household whose sleep is disrupted by the other person's snoring or gasping that brings it to their attention.

Slumber disruptions caused by sleep apnea can take a toll on health

Some have breathing stops so long, and with a frequency so high, that the bed partners fear for their lives. Fortunately, for those who do not sleep alone, a partner witnessing interrupted breathing provides powerful evidence of a problem and good reason to seek professional help.

HOW TO KNOW WHETHER OR NOT I HAVE OCA?

The official diagnosis can only be established by a polysomnography (sleep study) - the details will be provided soon, keep reading. That can take weeks, but there is something you can do this night, so you have a chance to know the answer tomorrow morning: record a video of your sleep using your smartphone (Struggling to Breathe? Film Yourself Sleeping). That requires some light in your bedroom. If it's a problem, then only record the sound using a voice recorder app. If you discover the pattern "snore - snore - snore - silence when snore is expected - sharp, loud gasp - rapid breathing" (watch the first 30 sec of this video), then you definitely have OCA. If you cannot hear that pattern, that is not a guarantee that you don't have OCA in a mild form (that's why I wrote "you have a chance to know the answer tomorrow morning" rather than "you will know").

TYPICAL SIGNS AND SYMPTOMS:

Over time, these repeated disruptions of sleep and oxygen supply can produce effects far worse than next-day fatigue. Sleep apnea is a known cause of high blood pressure, is associated with heart failure, atrial fibrillation, stroke and other diseases and can worsen respiratory disorders such as asthma. If they're happening hour by hour, night by night, month by month, year by year, a patient's body will change as a result of these ongoing 'insults' that occur during sleep.

Slumber disruptions caused by sleep apnea can take a toll on health

Snoring and cessation of breathing. Ask your bed partner if he or she notices that you snore heavily, choke, gasp, or stop breathing during sleep.

Waking up in the morning still not rested, with "heavy" head - even if you have slept for many hours, and woke up very late in weekend. A frequent complaint of patients with OSA is: "I sleep throughout the night but I wake up as tired as I was when I went to bed". The reason is obvious: the sleep has been disrupted and lacks its normal restorative qualities. The more hours you were sleeping, the more time you were suffocating!

Excessive daytime sleepiness which may be so severe that one unintentionally nods off to sleep. Impaired alertness and fighting falling asleep while driving, sitting in business meetings or watching TV. The brain do not rest at night. And, trying to take its own, the brain tries to fall asleep during the day to somehow compensate for its nightly losses.

A decline in performance on the job or in school, "brain fog", difficulty with concentration, decreased attention, memory loss.

Chronic tiredness, fatigue, lassitude, lack of energy.

Morning headaches, caused by an all-night oxygen roller-coaster, which usually dissipate within a few hours.

Psychological problems: bad mood, anxiety, irritability and depression (Obstructive Sleep Apnea May Be One Reason Depression Treatment Doesn't Work).

Nightly panic attacks, waking in a state of horror, with palpitation. You do not understand what is happening and think that you have a mental disorder, but you simply wake up right at the moment when your brain is suffering of suffocation!

High blood pressure (hypertension). The repeated episodes of disrupted breathing during sleep leads to sharp spikes in the heart rate (which can lead to a heart attack or stroke), and increased blood pressure. When the brain discovers lack of oxygen, it firstly instructs the heart to pump blood harder in order to transport more oxygen from the lungs to the brain. The heart does its best, so blood pressure dramatically increases. Of course, that cannot solve the problem - the transport is working fine, but it has nothing to bring: the molecules of oxygen are not even reaching the lungs, being blocked by the collapsed tissues of the upper airway. The resulting inflammation affects the whole body. When a man requires blood pressure medications and still cannot keep his hypertension under control, there is a 96% chance that he has sleep apnea! Unfortunately, many doctors prescribe blood pressure pills to their patients and do not inform them about sleep apnea in order to maintain a constant cash flow to the pharmaceutical industry. If you know somebody with hypertension, advise them to go to a sleep disorder specialist NOW - sleep apnea should be investigated as a potential cause with a sleep study!!!

Heart diseases. Not only because the heart works itself to death through the whole night as described above, but also because it begins to suffer and be damaged from lack of oxygen quicker than many other organs including the brain.

Stroke.

Type 2 diabetes. Insulin is a hormone released by your pancreas (a gland in your abdomen behind your stomach that plays a role in hormone production and digestion) to help you store and use the sugar and fat from the food you eat. When your body is deprived of oxygen during sleep apnea events, your fat cells become resistant to insulin and your glucose levels rise. This is referred to as insulin resistance and glucose intolerance. When this happens, your body may not respond to insulin. For more details, read this article.

Sweating at night even when it is not hot. Turning the wet pillow over with the dry side up in the middle of the night. Understand why? When the airway is blocked, the chest is repeatedly, but unsuccessfully, trying to breathe. So, the body is working very hard physically throughout the whole night!

Visits to washroom (to urinate) at least once per night (sometimes more frequently).

RISK FACTORS:

Obesity. Excess body weight is the king of the risk factors!

Recessed chin, or retrognathia, i.e. the lower jaw placed too close to the neck - like in picture A (picture B shows the norm):

Check right now with your forefinger: the lower and upper teeth should be coplanar. If the lower teeth are behind the upper ones, and you need to move your chin to the front to make them coplanar, it's a "red light"! Why? The soft tissues, which can collapse, are attached to the lower jaw. If it leans forward, then the airway stays large enough even when the muscles are absolutely relaxed. But if the jaw is close to the neck, the soft tissues must travel much less distance to block airway! As simple as that! The left X-ray shows that shorter distance; the right X-ray shows the norm:

Other craniofacial abnormalities like nasal septum deviation, narrow nasal passages and / or pharynx.

Large tongue, uvula or tonsils. There are cases when patients with the most severe form of obstructive apnea became healthy after tonsillectomy - an elementary surgery to remove adenoids. The left photo shows how it was before the surgery, and the right one - as it became 2 weeks after the surgery (from an Instagram post of professor Roman Buzunov):

Increased neck circumference (collar size), especially with fat folds on the back of the head:

The fat behind the neck arches the backbone forward. This narrows the airway - like in the right X-ray:

Drinking alcohol, sedatives, tranquilizers, sleeping pills and narcotic pain medications (especially in the second half of the day). They all contribute to obstruction events by relaxing the upper airway muscles and making them more prone to collapse, so the tissues tend to block the airway quicker and more frequently. After the collapse, they increase the reaction time of the brain when it gets the SOS signals about low level of oxygen in the blood, so suffocation lasts longer and is more dangerous (the lower blood saturation - the more chances to die).

Bodybuilding. Sleep Apnea - The Real Reason Why So Many Bodybuilders Are Dying.

Tallness. Previously, this risk factor didn't exist in the list. I knew four slim, but really tall guys with severe sleep apnea, but I didn't jump to conclusions - four people were not a representative sample. One day, I found the topic How many of you tall guys/girls snore or have sleep apnea? on Reddit and decided to add this bullet even though I don't see any logical link between height and OSA.

OSA CAN KILL. LITERALLY!

Have you ever heard the phrase that someone died in a dream, although he/she seemed to be healthy? Chances are great that it happened because of sleep apnea. I mean death not from diseases that are the consequences of apnea (like blood pressure, heart attack or oncology). I'm talking about death directly from the sleep apnea itself. People are just strangled while sleeping.

The normal level of saturation (oxygen concentration in the arterial blood) is 95-98%. The reduction to 93% is considered clinically insignificant. If the level drops to 90%, it is considered as hypoxemia, and it can lead to hypoxia. The level of oxygen in the blood below 80% can disrupt the functioning of the brain and heart. 70% can lead to cardiac arrest. A decrease in saturation of less than 50% within 2 minutes leads to the onset of necrosis (death) of neurons in the cerebral cortex.

A catastrophic decrease in saturation is clearly seen on a fragment of a cardiorespiratory monitoring recording during sleep in a patient with obstructive sleep apnea:

The following video shows how OCA leads to a drop in the oxygen level in the blood to 53%. The brain at the last moment woke up and saved the situation, but not everyone was so lucky:

Yes, you can die from sleep apnea. Carrie Fisher did.

OBESITY CAUSES OSA...

Please get familiar with the statistics of OSA prevalence in groups of people with different body mass index (source):

BMI 35-39.9 - 71%
BMI 40-49.9 - 74%
BMI 50-59.9 - 77%
BMI 60 or more - 95%

How exactly does obesity cause apnea? There are 3 factors:

When most people gain weight, they gain it everywhere - including their neck and intraoral organs ("visceral fat"). Fatty tissues in this area can narrow your airway when you lie down. Compare the throats of a slim and a fat person:
The visceral fat makes the internal tissues, joined with the tongue and lower jaw, heavier and, therefore, more prone to collapse under the action of the terrestrial gravitation.
As is was explained earlier, the fat behind the neck arches the backbone forward, which narrows the airway as well.

While the weight is increasing, the clearance between the collapsing internal tissues and the neck continues to decrease, and one night the airway is completely blocked...

...AND OSA CAUSES OBESITY!

How exactly? There are 7 (!) factors:

When the sleeping brain finally discovers that the level of oxygen in the blood has fallen to a critical level, it switches to an "emergency mode" and throws into the blood an extra dose of adrenaline and other special biochemistry to save the situation and raise the fallen nasopharyngeal organs. In such an emergency, the body (thanks to evolution!) prepares the body for the worst case scenario (perhaps, prolonged hunger) and launches the mechanism for storing fat as a reserve (to survive the hungry period).
Intermittent sleep in apnea causes a disruption in the production of growth hormone (testosterone) responsible for transforming fat stores to energy, necessary for the normal functioning of the body. As you could read in the page HOW TO START, growth hormone "plays an important role in weight loss - it "opens the fat depot" i.e. enables the use of fat deposits as a source of energy". The sleep of a healthy person consists of two alternating stages: shallow ("fast sleep", or "fast eye movement" phase) and deep ("slow sleep"). Growth hormone is produced mostly in the deep stages of sleep. But as soon as the brain enter deep sleep and loses control on the muscles, an obstruction occurs and the brain returns to the shallow stage ("the brain, bombed with SOS signals, slightly wakes up and takes emergency measures to save the situation" - remember?). The lack of growth hormone causes the body to require more and more food to get energy from it, since the stored fat is "locked". The mechanism of stored fat burning is out of order, but the mechanism of new fat depositing keeps working fine!
Sleep apnea causes us to over produce ghrelin. The job of that hormone is to tell us when we need to eat - it stimulates food intake by making us physically feel hunger. So, the link between increased secretion of ghrelin and wight gain is very straightforward. In patients with obesity, after eating, the level of ghrelin does not decrease, for this reason there is no feeling of satiety after eating. Interesting fact: ghrelin is produced in the area of ??the stomach, which is removed with most bariatric surgeries - this is one of the mechanisms of action (but not the main) of these surgeries, which turn obese into slim. While bariatric surgeries almost stops the production of ghrelin, obstructive sleep apnea - on the contrary, greatly increases.
Sleep apnea causes us to under produce leptin, and reduces sensitivity to it. Leptin is the hormone which regulates appetite (it tells us to stop eating). Because of the developed resistance to leptin, the body thinks that a person is hungry, even when in fact there is no physical need for food at the moment. That causes two effects: more frequent meals, and overeating during one meal.
Sleep apnea reduces the production of serotonin. Serotonin is a natural suppressant of appetite: that hormone suppresses the feeling of hunger and gives a feeling of saturation, even if the stomach is not full. Thanks to serotonin, the amount of food consumed decreases, and as a consequence, the weight decreases.
Sleep apnea reduces sensitivity to insulin. High levels of insulin (hyperinsulinemia), which are caused by insulin resistance, are associated with central obesity (a massive accumulation of fat in the abdomen): the person can look not very fat in front, but have a large, overhanging belly.
Chronic and pronounced lack of oxygen at night (the total duration of respiratory arrest during the night can be a few hours) leads to an overall slowdown in the body's metabolism.

As you see, Obstructive Sleep Apnea causes fat to be stored MORE, then necessarily, and consumed (utilized for energy production) LESS, then necessarily, so nor diets (even the best ones in the world!) nor Intermittent Fasting will help to lose weight seriously and constantly because the fat storage mechanism of OCA has nothing to do with WHAT, HOW MUCH and HOW OFTEN you eat. People can think that you are a lazy glutton who don't want to do sport, but it's not your fault that you are obese - you have a problem (which, fortunately, can be quickly and easily solved - keep reading!).

So, all the just listed reasons cause further weight gain and make weight loss unrealistic. Because the person gets fatter, the degree of apnea becomes even stronger, which leads to an even greater weight gain... and so on, and so on - we have a vicious circle:

Detailed explanation of how OCA prevents weight loss can be found in these videos:

A "CHICKEN AND EGG" ISSUE

You've just read that OBESITY CAUSES OSA... ...AND OSA CAUSES OBESITY. But which of them is the very first reason which launches that vicious circle? They both can be the initial trigger.

SCENARIO 1: a slim person has no problems with the anatomic shape (and, hence, has no sleep apnea), but gains weight by any reason (for example, eats too much carbohydrates), and that causes OCA. In this case, losing the excess weight can make the sleep apnea disappear.

SCENARIO 2: the anatomic shape (like recessed lower jaw) firstly causes OCA, which, in turn, initiates gaining weight. That is my case: even though I have lost a lot of fat, my sleep apnea is still severe, so I will sleep with a mask for the rest of my life. Which mask, you ask? Ooops, sorry, I have not told you how to get rid of OCA yet... OK, now it's the time to do that:

HOW TO GET RID OF OSA

The treatment is very quick and easy - CPAP (continuous positive airway pressure) device, or "sleeping machine". It's a compact computerized device with a compressor that supplies air under pressure through a face mask, connected with a hose. During the whole night, the air pressure mechanically keeps the tissues from collapsing and closing the airway, so you never stop breathing in your sleep:

I have been using a CPAP machine religiously now for 4 years and it has literally been a night and day difference in my quality of life. Now a full 8 hours of sleep actually equates to 8 hours of real rest, and I can function like a human being again! And also even more importantly, I don't have to worry about my heart going to war every single night now and having my cardiovascular system undergo vicious levels of stress and damage each and every day. I'm not exaggerating when I say that this machine literally saved my life, and I highly suggest you invest in one if you have been diagnosed with Sleep Apnea (source).

...in 1981 Colin Sullivan and his colleagues introduced their invention of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea. In my opinion, the only possible rival for a single product that would produce such an upturn in life expectation and quality of life for humanity was the introduction of penicillin (Brochure about the history of CPAP therapy).

ELECTRONIC BRAIN GIVES OXYGEN TO HUMAN BRAIN

A modern high-tech Automatic CPAP (aka APAP) has a smart algorithm which tries to keep the pressure as low as possible for your convenience, but increases it in real time when detects airflow limitation in order to prevent airway blockage. If an airway blockage does happen anyway, the device immediately detects that and starts to increase pressure until the collapsed tissues are raised and the breath resumes. So, the problem is always resolved just in a few seconds - well before the blood saturation starts dropping.

The pressure will adjust itself while you are asleep as well if it recognizes that you need more oxygen, or if you don't need as much as it is pushing out, and then re-calibrates itself to push the exact amount of oxygen you need into your airway (source).

The upper graph shows how pressure is being increased when flow limitation (the lower graph) is detected, and drops when flow limitation has been successfully removed (i.e. the internal tissues are not collapsing anymore). The flow limitation range is from 0 (airway absolutely open) to 1 (completely blocked). As you see, the worst case scenario is an about 50% blockage for a very short period of time, so no blood oxygen drop occurs:

AFTER HOW MUCH TIME TO EXPECT IMPROVEMENT?

CPAP-therapy removes sleep apnea (but not its reason) IMMEDIATELY, not after a few months or even days. So, you will start feeling much-much-much better (I would say, begin your new life) next morning after the first night of the therapy. In fact, it will be your first night with good sleep and no suffocation for many years! The next day will be your first day without sleepiness, lassitude and depression for, maybe, decades! It's like a fairy tale, but there are no miracles - physics only: is it was already told, the air pressure, produced by the "sleeping machine", mechanically keeps the tissues from collapsing and closing the airway. Voilà - no suffocation and its terrible effects anymore! Of course, it takes time to get used to the face mask (for example, I stopped feeling discomfort after 1.5 weeks, and stopped paying attention at all after 1.5 months), and you will not lose weight after just a few nights with CPAP, but the obstacle, which didn't allow you to lose weight, is removed literally immediately!

In the following two videos, people share their impressions in the first day after beginning CPAP therapy:

Finding Out I Had Sleep Apnea Was The Best Thing That Ever Happened To Me. Sometimes a diagnosis isn't the end of the world. It's just the beginning of a better one.

CPAP THERAPY CAUSES WEIGHT LOSS

Do you know how I was diagnosed with OSA? I went through preparation to a bariatric (weight loss) surgery. Sleep test is one of the important pre-surgical steps. If OSA is found, then the patient must go through half a year CPAP therapy to lose some weight before the surgery. That will decrease the amount of the internal fat and facilitate the work of the surgeon, who needs access to the organs to be cut. Fortunately, I cancelled my surgery before it was too late (since I found a much better way to lose weight - intermittent fasting + LCHF), but I am writing about that here to practically demonstrate, that OCA prevents weight loss, and CPAP therapy - oppositely, causes it.

DREAM MACHINE: VIVID DREAMS IN, NIGHTMARES OUT

Sometimes a CPAP is called a "dream machine". You might think that this is a beautiful figurative expression. But this is not so - CPAP changes your dreams in the full sense of the word.

Dreams happen most often during REM (rapid eye movement) sleep, which is the deepest stage of sleep. This stage makes up about 20 to 25 percent of adult sleep and occurs in intervals that can last anywhere from a few minutes to 30 minutes. You cycle through REM sleep a number of times during the night, and if you happen to wake up in the morning during that stage of sleep, a dream may seem fresher in your mind.

But, as said earlier, as soon as the brain enter deep sleep and loses control on the muscles, an obstruction occurs and the brain returns to the shallow stage. Since dreams occur during REM sleep, which is the deepest stage of sleep, people with untreated OSA may not have as many dreams, and their dreams are not vivid.

When CPAP therapy begins to work, most people begin to dream again, or their dreams become vivid and emotional, often - less violent (due to the fact that they experience a more restful sleep with the brain not tortured by suffocation): their often-intense nightmares are gone from the first night of CPAP therapy.

When you’re suffering from sleep apnea, your brain is waking you hundreds of times a night begging for you to start breathing again. We know these microarousals are a lifesaving measure which prevent you from succumbing to a complete lack of oxygen, but they’re exhausting. These frequent wakings impact your sleep in every way, right down to the way that you dream.

Whether you’re dreams are less frequent than ever or just too intense and terrifying, your untreated sleep apnea might be responsible.

Is My CPAP Machine Making Me Dream More?

Quite frequently, people with untreated sleep apnea have no clue that their dreams have been affected. It’s not until after they’ve started continuous positive airway pressure therapy that they’re having wild dreams. Some CPAP users describes episodes of climbing mountain or eating huge delicious meals. It’s easy to blame these sudden apparitions on your CPAP therapy, but the truth is, you’re dreams are one-hundred percent normal. Before you began treating your sleep apnea, not only were you at risk for developing all sorts of serious illnesses like diabetes and kidney disease, but you’re constant need to breathe was keeping you from staying in the REM, or rapid eye movement, stage of sleep. The REM stage brings about your exciting nighttime visions but also sorts your unconscious mind. Without it, you’re likely to feel exhausted and simply out of sorts.

Nightmares and Sleep Apnea

If you’re one of the unfortunate sleep apnea sufferers who experiences nightmares, you’ll be pleased to know that there is an end in sight. A controlled study found that regular use of a CPAP machine put a complete stop to those nightmares and intensely anxious dreams. Although you’re probably going to have more active dreams of a happier nature for a while, their lucidity will decrease as you get used to your CPAP. The same study found that a decrease in dream recollection was a good sign that a person’s treatment had normalized.

Vivid Dreams and CPAP Therapy

WHAT SHOULD YOU DO TO BE DIAGNOSED?

Ask your family doctor to write a referral to a sleep disorder specialist ("sleep doctor"). That specialist will send you to a sleep study (polysomnography), which may require an overnight stay at a sleep clinic (or, alternatively, you will get a device, connected to which you will sleep at home). The sleep study monitors a variety of functions during sleep including brain activity, heart rate, respiratory effort, airflow, and blood oxygen levels. This test is used both to diagnose sleep apnea and to determine its severity.

If the diagnosis of OSA is made, the sleep doctor will prescribe a CPAP. In many places it's covered by insurance. For example, private insurance ("benefits") of Canadian workers covers 90-100% of the CPAP-related costs (including supplies - masks, hoses, humidifiers). If you live in Ontario and have no benefits: Assistive Devices Program covers 75% of the cost for equipment and supplies. If you are not from Ontario, Google a similar program in your province/state/country.

IF YOU ARE SURE THAT YOU HAVE SEVERE SLEEP APNEA...

...BUT YOU WILL SEE A SLEEP DISORDER SPECIALIST (AND HAVE A CPAP) ONLY AFTER A WHILE, YOU CAN PERFORM SOME STEPS RIGHT NOW TO PARTIALLY SAVE THE SITUATION:

Do not drink alcohol and do not take sedatives or sleeping pills, especially in the second half of the day!

Try sleep sitting up in an armchair. This can be a real life saver for those suffering from a severe form of obstructive apnea until they buy a CPAP machine. If the backrest is low, put your pillow ON it. Use an airplane neck pillow (buy it in a tourism/travelling store or department).

The principle of this method is clear to anyone who knows what obstructive apnea is (we simply turn the vector of gravity by 90 degrees, and the nasopharynx is no longer touches the back of the airway, which previously led to blockage, but in a completely different direction, so that blockage now does not occur or occurs much less frequently). Sleeping up will not absolutely remove moderate or severe OSA, but can improve the situation. However, in the case of a mild or medium degree, the problem can be eliminated altogether or reduced noticeably. Maybe, you will even say in the morning: "It was my best sleep in years!" - even though sleeping in an armchair is not very comfortable.

Long time ago, when I had terrible apnea, but all the doctors kept quiet about it, I had to sleep sitting in the car. I woke up a different person! Many years have passed, but when I remember these sensations, I simply "live" that refreshing thrill anew!

If you fail to sleep sitting up, buy a bed wedge. By elevating the person's upper body, the position helps keep the upper airway open and prevent weak tongue muscles from collapsing to block the airway, hence promotes better air-flow and prevents snoring as well as mild sleep apnea:

Buy a wedge with height at least 9 inch (that info always appears on the product or in the description if you buy online). Also, watch this video (it's an ad, but explains the principle).

Try the anti-snore/anti-apnea oral device (a.k.a. sleep apnea mouth guard). It slightly moves your lower jaw ahead, thus opening the airway (and prevents it from falling down while sleeping). You can buy it in any pharmacy. Usually, it's useless at all with severe apnea when you are sleeping in your bed on a normal pillow, but it may help in combination with sleeping up in an armchair, or with a bed wedge.

Stop smoking.

MIRACLES DO HAPPEN!

People answer the question "How much of a difference does using a cpap make for you?" in Reddit (just to remind: I don't sell cpap devices or anything else, related to health; the quotes are provided for those who are unsure whether or not they will be able to sleep with mask):

My business and personal and social life turned 180 degrees. Feeling fresher, younger and happier :)

Huge difference. I can sleep at night and my wife doesn't hear anything at all. I actually have no problem sleeping with my CPAP and keep it on all night.

I'm a year into BiPAP and it's made a huge difference! I sleep less and wake up feeling better. I used to wake up after sleeping 10-11 hours and literally say "I need a nap.". Now it's 7-8 hours a night and I have a little spring in my step. I don't think I'll ever be a morning person but that's just me. Cognition and mental status has by far been the biggest improvement. I feel like I'm firing on all 8 cylinders rather than driving a Cadillac with a 4 cylinder engine. I feel like I have a lot more willpower than I ever had. It has helped me loose some weight and will help me finally quit smoking. What made me talk to my doctor was having to fight sleep really hard while driving at night. It started to happen almost every time I drove at night. Regardless how much I slept or how much caffeine I consumed. This was right around the time a couple of train derailments were in the news and tentatively attributed to sleep apnea. That scared the crap out of me. I talked to my (then new to me) PCP about it. He looked at me and said you have sleep apnea as if it were a plain as day fact. TBH, it sounded a little arrogant without any testing. I was concerned it could be something worse. After the specialist referral and testing it turned out he was spot on. Good catch doc! Despite being slightly claustrophobic, ex: I cannot drive in a car with all the windows closed, I had very little trouble adjusting to the mask. After the titration study where I'd only slept 4.5 hours I noticed a little spring in my step walking out of the sleep lab. That 4.5 hours during the study felt like the best sleep I had in years. I knew I'd *have to* adjust to the mask and did so without much issue.

Amazing difference for me, the first 2 weeks were a tough adjustment period, but after that my sleep has been so much more restful, I never want to go back to sleep without it. I had no idea how tired I was before (and that it wasn't normal!).

My CPAP has changed my life. When I was first tested and prescribed a machine it took me almost 3 months to sleep through the night with it. I had severe anxiety when wearing it which was the reason it took so long. When I was first tested my AHI was 85, I was waking up to go to the washroom 4-5 times a night not to mention the countless times I would wake up. I fell asleep in meetings and pretty well any time I sat down on the couch. Now after being on the machine or a solid 10 months I sleep through the night and only wake up if one of my kids needs me. I usually fall asleep within 5 minutes of putting the mask on and I have also not even had a nap in almost as many months. My anxiety is gone, my energy level is way better and the mental cloudiness is gone as well. I know the results are different for everyone but my experience has been extremely positive.

I can focus so much better. When playing the piano I can follow the music better. I can hear and play both hands more meaningfully.

I no longer fall asleep standing. I'm still tired but not death tired.

I wake up every day not needing caffeine and can actually make it through a work day without worrying about falling asleep. Driving is much safer considering I can finally stay awake. Quality of life in general is greatly improved once you get used to wearing the mask. I feel like I can think straight again without the mind-cloudiness every day. Keep trying, and try other types of masks if you feel the one you have isn't for you. It is more than worth it to get rid of the brain fog and tiredness through the day.

It's made a huge difference for me. I used to sleep through the night, almost fall asleep driving and at work, and took long naps on the weekend. I was always tired. After using the cpap for a few nights I was able to stay awake during all those times and cut out the weekend naps. I normally sleep about 8 hours or so per night now and I also have a lot more energy. It was difficult getting used to the full face mask but I was very motivated. Now it doesn't even bother me.

USEFUL TIPS FOR A BEGINNER CPAP USER:

• Buy only an automatic device (aka APAP, or Auto CPAP). I use and recommend ResMed AirSense 10 Autoset. Its main competitor, Philips Respironics DreamStation Auto, seems to be excellent too.

• Buy only a device with a memory card. Analyze your nights using the OSCAR program which can be downloaded for free here.

• Depending on a person and on a mask, it can be comfortable to go to sleep with the minimum pressure (4), or with a higher pressure. EXPERIMENT to find the pressure you feel comfortable with! If you decide to go with a number, which is lower than your minimum prescribed pressure (for example, your prescribed range is 9-14 but you like 4), don't worry: when needed, the APAP will increase the pressure, depending on the conditions in the real time. That will happen when you will already be sleeping, so you will not notice that.

• Don't use ramp (even auto) - you can feel that the pressure jumps up before you are 100% sleeping, and that will wake you up.

• Use the exhalation relief feature (make exhalation pressure 3 cm less than inhalation pressure - that is the maximum relief in most models).

• Avoid caffeine in the second half of the day (for at least 5-6 hours before sleeping). Or even don't drink coffee and tea at all in the day just before your "wedding night" with CPAP, so you will get to bed even more sleepy and tired than usually, which will help you fall asleep with the mask easier and quicker.

• In the first few days, BEFORE you go to sleep (i.e. in the day time), put on the mask (without connecting the tube) and watch interesting and exciting films, or surf the Internet, wearing it. That will help you get accustomed to feeling the mask on your face. Also, you will make sure that it's definitely possible not to pay attention to it.

• In the first few days, when you go to sleep, wear the mask, lie on bed, but DON'T CONNECT THE HOSE IMMEDIATELY. Maybe, you have an easy shortness of breath which you do not notice (because of physical activity just before going to bed, superexcitation or excess weight). Allow 2-3 minutes to shortness of breath to disappear, and only after that connect the hose.

• If you feel like you can't breath under pressure, then try slow breathing just after putting the mask on, i.e. sloooooow inhale and sloooooow exhale - after a few cycles, you will realize that everything is going fine!

• If you suddenly feel that there is not enough air, then take the deepest breath that you can. Whatever the pressure is, it's ALWAYS possible! When you know this fact, you know that you are not in the danger of suffocation, i.e. a certain psychological problem disappears.

• Peg pressure as your friend. Many beginners think: "How is it possible to breath under pressure?"... Believe me: it's even easier, than without pressure since the compressor HELPS your lungs. For beginners, it's all about psychology, not physics!

• Are you afraid that you will not be able to get used to the mask? I was afraid of that too. But after 1.5 weeks I was feeling absolutely comfortable with the mask, after 1.5. months stopped paying any attention, and after a few months, I had a strange feeling if I lay in bed without a mask - I am missing something! Trust me: you will slowly grow to love your CPAP machine. You may very well hate it at first, but each day should get a little bit easier. Like any major lifestyle change, it can take some time to fully adjust. Inconvenience in the beginning is nothing compared to the benefits that will dramatically improve the quality of your life. Soon, you will be ready to kill everybody who will suggest you to stop using CPAP!

• If you wake up at night and feel that you cannot breath, you are probably under high pressure at that moment. Maybe, you are going through a RERA event (Respiratory Effort Related Arousal - usually you don't realize that you wake up, but sometimes do) which requires much higher pressure to be treated than a full blockage. The natural reaction of a beginner in that situation is urgent removal of the mask. But if you wake up because of the high pressure (BTW, that sometimes happens to me even after years of cpap experience and feeling very comfortable with the mask), then turn off and turn on the device (i.e. simply double-click the "On/Off" button) - that will reset the pressure to the starting (minimum) level, so you can keep sleeping comfortably.

• Many people ask: what if there will be an electricity blackout in the night, when you are sleeping with a CPAP? OK, you will suffocate and die. Do you really think, that the engineers of a device as high-tech as a CPAP, didn't think about that? In fact, it's easy to check what will happen... When you are wearing a mask, unplug your device from electricity. You will see, that you keep on breathing without any problem. Of course, the effect will disappear if the device will stop working, but you will not become its victim for sure!

• Use CPAP mask leak sealer gel (buyable in the Internet - I bough this). You will forget how masks leak.

• If the mask hurts your skin, buy the mask named "Resmed AirTouch F20". It has a very soft memory foam rather than silicon (video) - you will hardly feet it. Mask leak sealer gel cannot be used with it (and there is no need because air doesn't leak from under AirTouch F20). That model has become my favorite mask after trying a few others, I buy only it each 6 months!

• Use humidifier! In good modern CPAP models, it is built in, but if your device doesn't have it, buy an external humidifier. The CPAP ventilation is drying on the airways. The airways are meant to be moist since it is line with mucus membranes. When it dried out, you got tiny wounds in your airways, opening you up for infection. The mucus production was your body doing its best to protect you from drying out.

• If you experience condensation in the mask, or if you use masks of different KINDS, then switch humidity level to "auto" (rather than setting an exact temperature each time you change mask KIND or the room temperature and humidity change). The "auto" setting works perfectly in my ResMed AirSense 10 Autoset! You will see, that with a nasal mask much less water is consumed that with a full face mask. If you want to get as high humidification as you can without getting condensation, then use a heated hose (ResMed AirSense 10 Autoset has it by default) or an insulating cover for your tube - that helps to prevent condensation.

• Use a CPAP hose stand (buy in Amazon or Ebay, or ask your CPAP provider) to hang your hose above your head. Firstly, it's more convenient, especially when you are turning from side to side (a holder can help reduce the amount of times the tube bangs against your bed/bed-board and it can also prevent entanglements). Secondly, a fragment of the hose will be running uphill, so the moisture, collected within the tubing, will run back down the hose to the humidifier, rather than into your mask, dousing you in the face in the middle of the night. If you don't have a hose holder, put the CPAP machine in a lower position than where you are lying in bed (below your mattress level - even on the floor) to ensure the hose goes from the bottom upwards.

• If you will be staying in a hospital (e.g. as an inpatient or observation patient), make sure to tell the clinical staff that you require a CPAP machine. Whenever possible, try to bring your CPAP machine with you so that you don't have to use the hospital's model which probably has settings different than your machine has, and a mask different from yours.

• Before you go under anesthesia, ensure that the clinical staff are aware that you have sleep apnea.

• Use your CPAP machine to sleep each and every night. Take it with you to vacations and use in hotels (CPAPs work without vacations!). Most people suffer dearly even when they skip a single night. Also use the CPAP machine for any naps that you take during the day.

• When you sleep in an airplane and don't want to use a CPAP, don't decline the seat (keep it as vertical as possible), and use an oral anti-snoring device. Consider booking a business class seat where you will have enough room to use the CPAP conveniently.

• Trim your beard. Long facial hair can result in CPAP mask leakage. I have no issues when my beard is short . But when it grows, I usually have air leakage.

• If your nose is not absolutely clean, and you want to use a nasal mask, then, just before going to sleep, use salt water nasal rinse (you can buy it in any pharmacy).

• Don't buy a "compact" traveler's machine. It is only a little bit smaller, but the same room will be occupied by accessories, so you will save very little room overall. With that, it will not be as good as a regular one. It is slightly lighter in weight, but that gives you no advantage travelling by an airplane: any kind of cpap does not count towards your carry on bag total since it is medical equipment. In fact, lighter weight is a disadvantage: a compact machine is not stable on the bed-side table. Cases reported when user pulled the hose while turning to a side, and the device fell down to the floor. In fact, any regular device is portable and easy to travel and comes with a bag - simply travel with the device you are so familiar with.

And now - some nice, glamour selfies!

In the sleep clinic, just before my sleep test (I am smiling because I don't know what a nightmare is happening to me!):

polysomnography, sleep test