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Sleep habits may have long-term benefits (acc.org)
158 points by giuliomagnifico 11 days ago | hide | past | favorite | 146 comments

I'll keep saying it: sleep apnea is vastly underdiagnosed and undertreated. I had so many weird symptoms for so long, which all gradually started to disappear as I started to get my sleep apnea treated.

Unless you're fat, doctors will rarely even consider the possibility. And once you do get a polysomnogram, the usualy course of action is to throw a CPAP machine at you and send you on your way, without much followup. This, predictably, leads to abysmal compliance and the perception that PAP-therapy is awful or innefective.

And while I'm on my soap box, I really wish the PAP-manufacturers would dislodge their collective head from their collective arse. Trying to lock down machines and preventing patients from accessing their data (and settings) is plain evil. And maybe put some money into R&D for better machines? There's literally hundreds of millions of people with sleep apnea, there's bound to be a market for better devices ...

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..

> 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.

[1] https://vaers.hhs.gov/ [2] https://www.mayo.edu/research/faculty/poland-gregory-a-m-d/b...

edit: mRNA

> 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 had the same experience.

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.

This seems to jive exactly with what OP was saying.

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?

I'm not fat. I was immediately diagnosed and rushed to a sleep doctor.

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.

Two relatives in my family who are highly symptomatic were turned down by their primary care when they asked for a sleep study. One for being too skinny and the other for being "too cheerful".

If you want to criticize the pap manufacturers, there's a lot more than just that too. There's a shortage of machines because of the negligence of the Philips company. Documents have shown that they knew their machines were causing problems for years before finally doing a recall.

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).

I recently did a sleep test because i was really sleepy and tired during the say an my apple watch is telling me i have too many wake ups. My AHI score is 33 which is quite bad. I immediately got A CPAP (auto) and after a week of using my AHI is now 1.3. And my brain has become so clear and alert. I can't imagine how I lived before once i got the taste of normal brain.

What symptoms did you have, if one may ask?

(Not OP)

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.

>Trying to lock down machines and preventing patients from accessing their data (and settings) is plain evil.

Which means it's profitable and they will double down on it

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?

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.

[1] https://www.sleepfiles.com/OSCAR/ [2] http://www.apneaboard.com/forums/

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.

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?

oh shape right, like for bulldogs (artificially created by humans)

...the teeth absolutely should touch, and besides, that's guided by tooth contact points and not habit/lifestyle factor. Sheesh.

why treat “sleep apnea” and not the actual root cause?

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.

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.

> 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.

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.

Please stop trying to diagnose me on HN without any context or background information. It's not helpful, and it's extremely condescending.

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.

Did it ever occur to you that sometimes the structure of people's face makes it harder or easier to breathe through the nose exclusively?

Unless you're a doctor, you should probably stop giving unsolicited medical advice on the internet.

no that is not why “millions” of people have undiagnosed sleep apnea

This sounds quite dangerous if someone has apnea.

Doctors aren’t typically incentivized to treat things with lifestyle changes. For better or worse, that’s something you need to self advocate for.

That's because nobody listens, doctors have more or less given up. People want meds, they always want a quick fix not to exercise and eat better

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.

What is the evidence for your claim? As far as I'm aware, insurance shoots down as much as possible

When a physician works for someone else's practice or hospital, generally they're pressured to see as many patients as possible

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.

Doctors get paid for seeing patients, not specifically for giving out treatments and I'm not sure where you got that idea from

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.

Engineers get instructed to implement features, doctors do not get instructed to hand out treatments

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

a doctor giving generic “eat fruits and vegetables” doesn’t mean anything. it’s just generic words an 8 year old could tell you

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

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 wasn't aware that sleep apnea is an acute issue, I could have sworn that's chronic

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.

[1] https://www.health.harvard.edu/blog/crumbling-confusing-food...

[2] https://www.myplate.gov/eat-healthy/grains

I really wanted there to be controllable habits listed in this article, but instead it was about sleep characteristics.

Telling me that "having trouble falling asleep," or "having trouble staying asleep," or "not feeling alert upon waking" are working against me is useless to me. These aren't "habits." I'm not choosing to do them until they become routine. They just happen to me.

Tell me how to FIX those things. Tell me what habits would help me fall asleep, stay asleep, and feel rested.

As-is, this isn't actionable. It's just, "Hey, people who don't sleep well don't live as long."

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.

It's worth the effort.

- [0] https://hubermanlab.com/toolkit-for-sleep/

- [1] https://www.goodreads.com/book/show/34466963-why-we-sleep

> 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.

What benefit do you derive from changing which hours you are awake?

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.

- [0] https://www.frontiersin.org/articles/10.3389/fnetp.2021.8303...

This annoyed the hell out of me as well. I thought, oh cool, some advice to improve my sleep.

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.

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.

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.

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

> make sure it's not warmer than 20c

Do you have a reference for this? 20 C is freaking cold. I wake up because of cold below 23 C.

I sleep at 16c, but I'd say it's more a personal preference. As long as you feel cool while sleeping and after waking up then you should be okay.

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)

Pretty much this. It isn't rocket science. Unfortunately, easier said than done for most people.

Ok, then what?

To be fair, it's a press release about a scientific study, not a self-help blog post, but you raise a good point when you say that poor sleep patterns "just happen to me." I've always valued sleep, but often in my life, my sleep has been disrupted because of stress, anxiety, and depression. The article says the researchers controlled for "other factors that may have heightened the risk of dying, including lower socioeconomic status, smoking and alcohol consumption and other medical conditions," but did they control for stress?

The author quoted in the press release seems quite confident that we can eliminate these bad mortality outcomes by teaching people to sleep better, but another way to interpret the result is that any factor that increases stress will damage health and also disrupt sleep.

I also wonder where the author gets his confidence that "good sleep hygiene" can have such a great impact. How does he assume that "sleep hygiene" will overcome the factors causing poor sleep? Does he really believe that they've controlled for every other factor and isolated "sleep hygiene" as the root cause? My personal experience says that what he calls "sleep hygiene" helps a little bit, but it doesn't overcome the effects of stress or poor life management due to depression, and those factors have to be managed directly.

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.

Get a sleep study that scored UARS in addition to OSAS.

As a tangent, I got a new bed couple of weeks ago. My old one had been around for ages and was well past it's expiration date.

It cost a small fortune but Jesus Herbert Christ on a tandem bicycle has it made a difference on how I feel during the day. I fall a sleep faster, wake up more well rested.

First few mornings I was just sort of confused by the feeling of waking up profoundly physically relaxed. Felt very weird and unusual. I don't think I've been that relaxed for years.

How did you chose your new mattress? I've had a hard time knowing from the short impressions in a mattress store if that mattress is really what I want or just feels nice for 5 minutes in a store

We've had good luck buying basic spring mattresses with almost no extra features and then experimenting with toppers. You can throw 2 or 3 inches of latex or memory foam on it and it gives you that instant comfort.

Cheap spring mattresses seem to be getting harder to find online. I believe the margins are much higher on memory foam products.

Was looking for this type of comment.

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.

Went to several stores and tried a whole bunch of mattresses. Tried several dozen beds and got input from a bunch of different salespeople. Was like a 2-3 week vetting process before I found something great.

A bit of a hassle, but well worth it though.

What kind of mattress was it in the end? Springs? Memory foam? And how hard?

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.

Not OP but I’ve had a very good experience just buying thick foam toppers for super cheap. Can’t link but you can buy 12’ foam pads straight from the factory in mattress size for a few hundred dollars. It’s essentially like buying a foam mattress.

Buy from a place that has a good reputation for no-hassle returns.

I recently had a similar experience with a new pillow. For as long as I could remember, I couldn't find a comfortable pillow. It got to the point where I just ditched them and slept without one. The closest to something suitable had been foam knee pillows, or sometimes a blanket rolled up in a weird position. A couple of months ago I saw a sale on Tempur pillows and walked into the store on a whim. Decided to give one of them a try and got one. Luckily, this one seemed to do the trick! I was surprised at how big a difference it made both with falling asleep and staying asleep better throughout the night.

I’m always baffled that so many people don’t make new or comfortable beds, sheets, pillows, etc. a critical priority. Generally speaking, a third of your life will be spent there, invest in the best you can afford.

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.

Is there anything special about your new bed that’s causing your better sleep or just the fact that it’s new and not saggy?

Nothing special. Like it's modern mattress technology and all, which has apparently improved quite a lot sine back when I bought my old bed.

But overall it's just much better suited to my body. I'm pretty tall so I need a relatively firm mattress to avoid sinking into it and sleeping all banana-shaped, but with this bed the core is firm but the top layer is soft. Hard to explain, but it's amazing.

Everyone is different, I found that I sleep the best on a firm futon combined with a 2cm thick memory foam mattress from Ikea.

If the bed is too soft, it might be comfy for a few nights but then my back and neck start hurting.

memory foam mattress of 2cm?

According to Google Translate "Mattress topper" is the correct term I was looking for =)

Basically a thing you put on top of a mattress for extra comfort and it makes making the bed a bit easier and cleaner.

I've been going through another episode of sleeplessness lately. Just like it had before, it has serious detrimental effects on my overall wellbeing. I'm less trusting of others, more inclined to shirk social situations, more sensitive to antisocial behaviors in others. I struggle with telling cause from effect, because these things literally stress me out even more, exacerbating the sleep problem. I just _feel_ the sleep deprivation eating away at my general health.

I'm getting the best possible treatment (standard of care) which is cognitive behavioral therapy, but man, is it a slow process to recovery.

Have you considered talking to your dr about a little sleeping pill or mirtazipine?

I had a serious episode of ptsd after a natural catastrophe and I couldn't shut both eyes for months. Meds became a life saver.

Sleep. It's underrated.

Can you sleep without the pills now? That’s my worry

Mirtazapine ended up giving me blurred vision

I've wondered if my kids will literally kill me through sleep deprivation.

Sleep deprivation prevents memories from forming, that's my theory on why people have more than one kid. They actually don't form memories for most of the first year or so. The only memories they have are the pictures they took of the happy moments.

Nobody takes a video of their kid screaming their lungs out at 3am with snot running from every orifice because their favourite toy fell off the bed or the pillow is the wrong colour.

I only have one kid. Having to wake up and calm her down (or, "fuck it, no sense falling asleep since she's gonna wake me up AGAIN in 30 minutes") is probably the one thing I remember very distinctly in the last three years. COVID-19 kinda smooshed everything else together and made it bleak. My sleep deprivation stands out.

I want to forget, but can't.

Haha, it's a funny theory even if not true!

It actually has some science behind it:

https://www.theguardian.com/science/blog/2010/dec/17/sleep-p... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170365/

Basically by not getting REM sleep after a traumatic event your brain doesn't get the time to actually form and store the memories of the event.

Having more than two people in the house who can act as parents is a game changer. Definitely one place where modern society has slipped up, though there's some change in that with families like mine.

Do you care to elaborate?

I've been thinking about this a LOT over the years. I feel like children were meant to be able to roam around and find different adults to glom onto until they're too annoyed and then move on to the next, all the while learning different specialized skills and niches to find one they fit in with.

I can't help but feel that more-than-2-adult households would have a huge advantage in this era.

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.

There's 5 of of us. Me, wife, wife's girlfriend, my girlfriend, and my girlfriend's boyfriend. To my kids me and my wife are mom and dad and responsible for primary parenting duties, but we're all one big family and help each other out. Not unlike cultures where it's normal to have many extended family members under one roof.

People lose their minds when I tell them I have three kids and that my wife and I have rarely ever had less than six hours of sleep.

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.

"It takes a village to raise a child" [0] sums it up nicely.

Teenagers and adults also need a "third place" [1].

It's all about community. Current individualistic trends and cost of living undermine this.

[0] https://en.wikipedia.org/wiki/It_takes_a_village

[1] https://en.wikipedia.org/wiki/Third_place

I utterly despise nuclear families now. Not the families of course (I'm in one!) but the arrangement. It's horrible. For all involved.

It gets better, soon you won't be able to drag them out of bed! Hang in there. Sleep when you can.

You'll live, but the toll is harsh. Hire help if you can so that you can get some rest.

Hoping to move somewhere I can shove them out the door (nicely) and tell them to play in the neighbourhood.

I've been there, brother. Hang in there.

At least I'll get some rest when I'm dead!

Blamed 4 kids for sleep problems. Turned out I picked up sleep apnea somewhere when raising the littles. CPAP changed my life.

Lol, always a bright side!

Couldn't a poor sleep pattern just be a symptom of an illness?

Also, say sleeping well adds 6 months to your life, then not sleeping well "killed" you 6 months earlier.

If you sleep for 20 extra minutes every day, that's a full extra year sleeping over a 72 year span. (If you exclude 1/3 of the time as sleep, that's a year and a half of extra awake time.)

If you gain 1.5 years of extra time awake but lose 0.5 years of life, did you win or lose time?

Well but there's a lot more to sleep than time. I know waking up 20 minutes earlier then my bodies decided wake time creates much more than 20 minutes of grogginess. Waking up n minutes before sleep Cycle end might be okay for some people but in the times I've had to set my alarm a little earlier, the time of waking makes a difference all day.

Now, if you're already not sleeping enough for your body and get woken up groggy and tired by an alarm every morning, that 20 minutes probably won't kill you faster than the lessened sleep you already get.

Yeah possibly! I wasn't making that point. More the lies, damn lies, statistics point.

Yes it’s like “Was the chicken or the egg born first?” anyway if you sleep bad maybe you don’t know your issue, and if you just sleep bad you will have more chance to die prematurely. This research just want to say this i think.


But you might just work retail, do shiftwork at a factory, or work in any number of places that require weird hours. Healthcare, plowing snow, train conductor, and anywhere that you wind up on-call just to name a few.

Many sleep-deprived are overweight with all the consequences thereof.

Illness is just coding

I'm a pretty bad sleeper, but some habits I find helpful:

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.

4. sunlight

I've seen enough mental issues in people (depression, schizophrenia, etc...) that seem to have a high correlation to poor sleep and/or lack of sleep to make sure I stay on top of getting enough sleep.

Depriving your body of food, water, oxygen or sleep is no joke.

Most people I know with anxiety also: heavily abuse caffeine and sleep poorly.

Caffeine is an absolute killer that we don't talk about nearly enough when it comes to sleep.

I’m bipolar and my sleep problems are because of my mental issues. For example, when I’m depressed, I can’t sleep. The part of my brain that makes sleep happen doesn’t work.

Lack of good sleep hygiene is unlikely to give you a highly genetic mental disorder.

> Depriving your body of food, water, oxygen or sleep is no joke.

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 :)

Yeah, I'm not talking about self-directed fasting here.

I recommend the book "Why we Sleep" by Matthew Walker [0]. It helped me to fix sleep schedule and better understand why good sleep is important

[0] https://www.goodreads.com/book/show/34466963-why-we-sleep

I've currently got two issues with my sleep: I'm a chronic couch sleeper and I am incapable of sleeping in. The first problem is most nights, about half my night, from 11-3am usually, I sleep on the couch before getting up and going to bed, I don't feel tired the morning after but I know there's an impact. The second issue is that I just can't sleep in, if I go to bed at 11pm, I wake up at 7am, if I'm out late with friends and stay up till 3am, I'm still up at 7am. For me it's like at 7am my brain just starts working, I was laying in my bed at 6:50am this morning and my brain is already going "alright we gotta work on that new database, oh how should I design it, yada, yada, yada", after a while of staring at the ceiling I always just go "fuck it might as well get to work".

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'd guess a good solution could be to get rid of your TV

For me the number one issue in the industry for sleep health has been PagerDuty and chronic short staffing.

As a founder I’ve slept irregularly for 15 years. My solution that kinda works is if I’m tired after a night’s sleep, I sleep a few more hours later in the day.

My cofounder in one venture you never know when he is awake or asleep as he refuses to set an alarm.

So if I wake up in the middle of the night for two hours every day for 60 years, I can still technically live more years than those having a good night sleep. Unless we count the time we spend sleeping as living.

Well, if it doesn't take a lot of years off your life.

Defragmenting thoughts

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.

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.

1: https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_f...

2: https://onboarding.sleepio.com/sleepio/onboarding-sleep-test...

3: https://drjadewu.com/

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 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.

Can you share more about this apparatus, or what made your doctor think you needed this? Were you investigating sleep issues or dental issues or what.

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.

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.

Sleep has been my biggest issue for the last 10 years and I don't know what to do about it. Even after this time, I still have not much of an idea regarding the cause. I'm in my thirties.

Falling asleep or staying asleep is not an issue, with rare exceptions. However, how I wake up is a whole other story. I hardly remember the last time I woke up truly relaxed, that happens maybe 10 times a year. It's a huge spectrum, most of the time it is somewhere between okay-ish (feeling exhausted after waking up, but it gets much better within 1-2 hours) and super exhausted (like the biggest hangover in my younger years. Can't concentrate at all, minimal effort activities like going up a small staircase become demanding, strained cardiovascular system in general, not hungry.. in short, a lost day). How I wake up is not predictable, there is no obvious pattern or causality.

I am closer to being underweight than overweight. Even on a mediocre day, I can be cheerful. Doctors therefore do not necessarily take me seriously and things happen slowly. Personal "experiments" with an oxygen and pulse tracker clearly show ups and downs when sleeping, but not to a degree to alert doctors with. Over the course of the last 10 years, I actually did 5-6 polysomnograms at a diagnostic center, but every time it was difficult for me to get any sleep there, so the results are close to being worthless. For the 45-60 minutes of sleep that I got per night, the graphs actually did show small irregularities. Which was enough to end up with a CPAP device that I rarely use because I don't feel any better with it.

Although I'm quite sure poor sleep is the immediate reason for my exhaustion, I do not rule out that the root cause is not somatic. There is this other problem of mine, a skin disease which makes me very susceptible to sunlight, which has a severe impact on the way I life and do things. I mainly stay indoors. Doing sports, running errands etc. usually happen after sunset. Bad weather is my friend. I really like my job and colleagues and get well along with everyone, but my personal social circle is small and most of the (spare-)time, I'm alone. Although I don't feel depressed and can be cheerful on most of the days, I talked to someone in therapy for a few months, but it didn't help much. As a software engineer, rational und deterministic thinking makes me wanna try antidepressants, just for the sake of trial and error. But it didn't come to that.

By the way, the last time I went to polysomnograpy, they also did two other tests regarding daytime fatigue. I failed miserably on the first test (basically my ability to keep my pupils focused on something), but succeded in the 99.5 percentile on the second test (reaction time), which is unusual. They came to the conclusion that I have become so accustomed to the situation that my body compensates very well for it. Which coincides with my impressions and helps me in my job and daily life. But doesn't help much when it comes to overall quality of life, or... potential conseqential damages to my cardiovascular system. Over the years, I got used to this whole situation, even with all the time I lost feeling miserable. Sometimes, I'm trying to ignore it and get on with my life, there are some good days after all. But lately, there is this emerging fear of said potential damages. Being in my 30s or 40s and tied to a bed for the rest of my life due to a stroke or something similar is a thought that makes me shudder. Much more than not surviving it.

Maybe it's just plain old sleep apnea with a wrongly adjusted or otherwise not helpful CPAP device (I was at the diagnostic center for trying an ajdustment, but guess what... I just can't sleep at that place). Or maybe the root cause purely psychogenic. Or it's something in between. Which is my current guess, but would be even worse, since it requires some interdisciplinary work and thinking from doctors, which, from my experience, they don't do that much.

I have no clue what to do.

I'm really sorry to hear that you're struggling so much. I've been dealing with sleep issues for the last ~7 years, but it's not as bad as what you are having.

I do relate to that state of barely getting any sleep and then having a lost day. 2022 Dec was my worst month so far when it comes to sleep. I had a few weeks when I'd sleep for 1-5 hours for many consecutive days and then I couldn't function on those days at all. My performance at work really dropped. I took a sabbatical with the main goal of improving my sleep.

In January I went for 1 week to Morocco (I'm originally from Northern/Eastern Europe) to visit a friend, and my sleep was dramatically better there. I did take my sleep medication on a few nights, but still the quality of sleep was very different. It might have been a combination of psychological (foreign place, less stress) and physical (sun, movement/walking) factors, but the main lesson for me was that improvement is possible.

After going back to my home country my sleep returned to baseline (terrible), but over the last several weeks it's been improving. It'd take a lot of text to describe all the things I've tried during all those years.

One of my recent discoveries was that I probably wasn't consuming enough protein (I'm fairly physically active) and consuming too much fat. Changing that improved my sleep ~15%. Just being on a sabbatical and having no work related thoughts/stress improved my sleep maybe 20%. I'm also currently experimenting with Magnesium L-Threonate and Apigenin (I only started those, but I do seem to notice that I feel better the next day).

Your situation might be very different, but with this comment I wanted to say that your solution might be somewhere out there. Just don't lose hope.

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