IamA Stanford trained sleep doctor, treated sleep conditions like apnea, insomnia, exploding head syndrome, restless legs syndrome, narcolepsy. AMA!

Since you've listed it in your title, I'm very curious about this "exploding head syndrome". Can you share your experience with it?

Also, could you share your opinion on polyphasic sleep patterns? I've never really tried it, but I'm interested if it can be as effective as just one long sleep phase.

I've had a few patients with exploding head syndrome. At first, I didn't believe it could be a real diagnosis, because it is such a dramatic title. It happens when at sleep onset, the moment of transitioning from wake to sleep, there is a loud bang heard in your head (usually painless). It usually is pretty scary and makes people afraid to go to sleep at night. The good news is that it is treatable with medication. Polyphasic sleep is super interesting, but almost no one has been able to do it for several years at a time.

Wow, TIL. This used to happen to me. I'd hear a door slam, or window break right when I was falling asleep...EVERY night! Doctor prescribed some RLS medication unrelated to that symptom, and those noises stopped. I've since stopped the medication, and it no longer happens.

I'm glad that your sleep improved!

So exploding head syndrome is in the hypnic jerk 'family' of sleep medicine. Have you ever kicked your leg as you fell asleep? That is a hypnic jerk.

PLEASE tell me more about my RLS (restless leg syndrome). All the women in my family back to my great great grandmother have it, and one of my uncles on that side does as well. It's so bad that my gramma took quinine for years as a fix and killed off 75% of her kidney function. We have recently started taking Ropinirole which seems to help somewhat. What can you tell me about this condition? Most GP's seem to know jack about it. Thank you!

Some doctors read epocrates or uptodate for a summarized guide to treat conditions they aren't familiar with. I wrote the epocrates monograph for restless legs syndrome (RLS), and will past below (you may need an account to read it). There are two general types of primary RLS. One runs in the family, affects people early, and progress slowly. The other is the opposite. I like to check people's iron stores (ferritin lab work should be greater than 50 nanograms/mL, this is a different "normal range" for those who have RLS). And also review any medications that worsen symptoms. Diphenhydramine (some sleep meds), caffeine, for example, make symptoms worse. Massage at night before sleep (even before symptoms) can help. Try these even if on medications. Full disclosure: I am the epocrates author on this, and have been on the advisory committee of some drug companies used to treat this condition. More info: https://online.epocrates.com/u/291165/Restless+legs+syndrome

What are some common sleep myths that are actually false?

Here is a big one. When people get a low amount of sleep (like 4-5 hours) for a long time, they think they've gotten used to it, and don't need the usual amount. It is true, that they don't feel as sleepy as they used to. And as far as feeling sleepiness goes, it is true. For example, if someone who normally gets 8 hours of sleep drops to 4 hours, they will feel pretty tired / miserable for a week or two. But after more time, they won't notice sleepiness. So they start to think they've trained themselves. But, that simply has to do with how they feel (feeling sleepy). Being sleepy is different. Being sleepy means your brain isn't working as fast as it used to. So there have been studies on this. They would take 8 hour sleepers and train them to 4 hours. Even after they felt like they were trained (not feeling sleepy), when they would do performance tasks, they were as delayed as they were in their first week. Get those 7-9 hours of sleep!

So, under-sleeping is obviously bad for you. What are the effects of over-sleeping? Because I'm currently seeking employment and, thus, largely set my own schedule, so my sleep habits are TERRIBLE, and I often sleep WAY too much.

I had some patients who became so successful they retired early, and could do whatever they wanted to do. Whenever the wanted. So their schedules became highly variable, and they felt more tired than ever. They would be former executive or entrepreneurs who used to work 60+ hours a week but feel full of energy during the day, but after "retirement" would hardly work, sleep more hours, and feel more tired. It was a sleep timing problem, and since the brain craves routine for good sleep, the solution was to wake and sleep about the same time everyday. This was for the purposes of feeling good during the day. Try a 2 week experiment and see how you feel. Feel better!

I have a question related to this answer, are some stages of sleep more beneficial than others? I've been reading a book by Dave Asprey, he claims that he reduced his sleep to 5 hours a day for a year, but claims this was fine because he fell into a deep sleep. Can there be any truth to any of this?

Sure, happy to answer. It is true that when you are super tired / sleepy, that your arousal threshold changes. For example, if someone hasn't slept in a week, when they do sleep, it is hard to wake them up, and they can sleep through alarms. It's the brain's way of getting as much sleep as possible. I'd see this when I read sleep studies, and when someone is treated for a sleep condition they've had for decades they rebound some stages of sleep than others. So I don't doubt that someone sleeping 5 hours a night for a long time will report few sleep awakenings and reduced sleep fragmentation. But I doubt the compensation of correcting their sleep drive / sleep debt is 100%.

I want to optimize my time sleeping. What techniques could I use to try to either reduce my overall sleep needs or improve my mental focus between sleep intervals?

Great question, it is one of the reasons I studied sleep medicine, because I wanted to optimize how I feel during the day. It was a focus of my practice. There are three ways to feel sleepy. Poor timing, poor quality, poor quantity. If one suffers, usually people try to compensate with more hours of sleep. Timing includes waking about the same time every day. Otherwise it is similar to experiencing jet lag twice a week. The issue is that not all stages of sleep change time zones at the same rate. Then work on quality of sleep. There are parts of the brain that never sleep, they act as guard dogs to arouse the rest of the brain for things such as smoke alarms. If that part of the brain is overly stimulated, then it the threshold for waking from sleep changes. And now every little thing wakes you up. The problem is that you can wake up without remembering it the next day. I've had patients who think they wake twice a night actually wake up 30 times an hour. But they don't realize it. Sleep hygiene doesn't sound exciting, and most people think it is only to fall asleep faster, but it really works at making sleep deeper and less fragmented. Yeah, of course, there are drugs / caffeine to help improve mental focus, but nothing is as good as good sleep. This is a huge topic that I am really interested in, so will be expanding upon it on the blog. Good luck!

How close together do wake up times need to be to be beneficial? Is +/- 30 minutes sufficient, +/- 1 hour, etc?

Within the hour is good. But anything can happen on the weekends!

Hi there! I suffer from horrible sleep paralysis.

An example: Last week I woke up after about 3 hours of sleep, completely unable to move, listening to the threatening voices talking about coming in to my room. I immediately knew what was happening and tried to open my eyes.. When I opened them, a terrifying bloody woman with a black hole for a mouth was lying next to me in bed, looking straight at me. The feeling of horror was indescribable. I managed to close my eyes, but as soon as I did that, a head splitting 'wooshing' sound happened, it was deafeningly loud and felt like it was happening in my neck somehow. I believed I was listening to myself have a stroke or an aneurysm .

I drink almost every night, and I find it only happens when I don't go to sleep drunk. I'm not sure how to eloquently word this but, is the cause of my attacks drinking? Or does drinking stop them?

That sounds difficult, sorry to hear you are having such difficulty from your sleep! I had patients who would drink frequently (4-5+ nights a week) and would have poor sleep not just for days but for several months after they would stop drinking. They'd have light sleep, nightmares, and significant sleep disruption. I'd see a doctor about this if I were you. There seems like this would be hard to fix on your own. Feel better!

I have had a problem with needing a lot of sleep since I went to University over 20 years ago.

Now, often when I wake up I feel unrested and really tired the next day. I've had blood work done and nothing has shown up.

It's getting to the point when I need to get to bed at 7pm to feel fully rested the next day. So I'm basically going to bed at the same time as my kids...

And I can't go out in the evenings as it makes me feel so tired the following morning. I don't drink, or smoke or take drugs.

What's going on? Thanks in advance!

I had quite a few patients with similar difficulties. They had issues with the quality of sleep. Becuase if was poor, they'd need more hours of sleep to compensate. For example, if someone poked you with a stick every 10 minutes during sleep, you'd feel pretty tired even if you slept 8 hours. While you certainly should continue an investigation with your doctor, one common cause is sleep apnea. Some people suffer from it without even realizing it. I hope you feel better soon!

How does it go from there?

I had a sleep study and was found to be hypersomniac and it's not apnea or restless leg. Where I live, sleep clinics are staffed by pneumologists. Well, my problem is not related to, by far, the most common issue and not respiratory. It's not sleep hygiene either, I take good care of that to help my situation.

Are there more diagnostic steps? Is it just trial and error?

Sleepiness is terrible, so you should not give up. Sometimes apnea hides in REM sleep, and in only certain sleep positions. I've seen patients who sleep fine on their side, but have apnea when sleeping on their back. If you slept on your side during the test but on your back at home, more investigation is needed. But it's true, some people can have major sleepiness affecting their daytime function but not have apnea. That's because there are many causes of sleepiness. Some people can have narcolepsy (it's rare) and while they won't have apneas on their sleep study, they may have fragmented sleep and fast onset REM that would be present in their sleep study report. The best way to evaluate for narcolepsy is seeing if someone has cataplexy, a condition where the face and / or muscles go limp with strong emotions or surprise. Also, a nap test (MSLT) is also informative. A second opinion by a doctor familiar with other causes of sleepiness (not just apnea) is a good next step. Good luck!

Hello doc! Narcoleptic here. I have been doing a lot of research on the theory of narcolepsy as an auto-immune disease and it really intrigues me. I'm pretty sure this comes from the studies being done at Stanford so I assume you have a lot to do with this. What kind of new treatments are you looking forward to that are being developed for Narcolepsy?

So when I was training there, there was research into the auto immune possibility of narcolepsy, with studies looking into IVIG treatment to those just recently starting symptoms. But as you know, sometimes the full complement of symptoms can take 10 years to evolve, so it would be hard to find people just starting symptoms (I was not part of the study). I'm not sure what Dr. Mignot is working on now, but it'd be great to solve narcolepsy at it's source. I'd also be really interested in learning more about how hypocretin / orexin could be used to help with other sleep disorders.

What are your thoughts on daily marijuana use as a sleep aid?

Good question. I have had patients report improved insomnia and restless legs syndrome with it. I am personally hesitant to prescribe (or take) medications in general, and favor lifestyle changes so I'm not 'dependent' on anything. (By dependent I don't mean tolerance or addiction.)

First of all, congratulations on starting a company. I admire people who have both medical expertise and entrepreneurship in a field that has been largely complex and misunderstood in the public realm.

My questions are: 1) What has your experience been with the use of fast-acting Melatonin? Supposedly a lot of dementia patients suffer from sleep disorders when they are no longer able to produce melatonin. 2) Have you tried Hyperbaric Oxygen therapy treatment for those who have sleep disorders or disorders of the brain? I have read that this treatment has helped people with brain trauma and stroke victims. 3) What was the largest ethical dilemma you have come across as a doctor in California?

Thanks in advance for your answers.

Thanks for the encouragement! There is evidence for melatonin for patients with Alzheimer's disease but I didn't get a chance to use it. Most of my patients were 20-50 years old. Same with hyperbaric oxygen. I once had a very important person in society who had an alcohol problem. He didn't see his primary care doctor, just me (for apnea). I talked with him about this, and he was not happy to hear it. But we kept working together, and thankfully he's better now.

Are you familiar with so-called sleep analysis software on mobile devices?

Are there any legitimate examples of how such software may help improve your sleep?

Currently, most apps and wearables act as actigraphy monitors. The assumption is that if someone is not moving it means deep sleep, moving a little means light sleep, moving a lot means wake. I'm really looking forward to devices looking at actigraphy plus heart rate variablity, pulse transit times, and EEG and putting it all together to take a deeper look into sleep cycles. One day, one day.

Haven't slept all night! I have a question about hypnogogic hallucinations (I think that's what they're called). I suspect that it runs on my dad's side. I had some experiences in my mid-teens: I would "wake up" to auditory hallucinations (low to high frequency), visual hallucinations of my body "coming out of itself", and out of body experiences, followed by sleep paralysis. My father told me not to be frightened, that it happened to him and his brothers and some of his sisters (large family), and that he seemed to grow out of it as he got older.

How common is this, and is there any research on it?

Sleep hallucinations can happen at sleep onset or during the waking process. It's different from daydreaming and there are some effects you can see on an EEG during a sleep study. Sleep hygiene can help, and a disrupted sleep can worsen it. Try a 2 week experiment of really good sleep habits and see if it helps. It sounds like this runs in the family and there is a good chance you'll outgrow it. Feel better!

What are the three most common reasons for people not being able to sleep properly?

The most common reason to take too long to fall asleep is insomnia. It can be caused by stress, medications, anxiety. It can affect more than half of people occasionally (including me).

what would you say is a long time to fall asleep?

You should fall asleep before 30 minutes.

What surprised you most about sleep when you began learning about it?

I'm a lucid dreamer (I don't know if that's a term... but that's what I've always called it), I learned to control my dreams at a young age to deal with some recurring bad dreams. It's a lot of fun, but sometimes the dreams are far to short. Is there anything I can do to increase the duration of my dream state? The amount of sleep I get doesn't seem to have a direct correlation to how long my dreams last.

Thanks for your concideration, and thanks for the AMA!

Happy to help! Most dreams occur in REM sleep, but REM sleep doesn't fill the whole sleep period. For example, even if you sleep 8 hours, your first REM period would be pretty short. There is more REM in the second half of the night. There has been some tricks for increasing REM sleep. For example if you go to bed later you can have more REM sleep in the first half of the night. Sleeping a 90 minutes longer than usual might squeeze an extra sleep cycle in as well. Have fun!

How many cases have you seen someone suffering from sleep apnea eventually stop needing to use a CPAP nightly? I've tried researching this on my own, but just curious what a professional would have to say regarding if someone with sleep apnea will just need to use the CPAP for the rest of their life.

I think of CPAP like glasses, you'll need them unless you do something else to fix the problem. It is unlikely that a CPAP user will outgrow their apnea, or that the CPAP is a cure. Instead, if someone who needs to lose weight succeeds in losing weight, the apnea can be cured. This is the best way. Some people have surgery for apnea, and when it's successful, they are cured. Otherwise, yes, CPAP is forever. Good luck, and I hope you feel better.

My son and husband both suffer from night terrors. My son (2 years old) has had less than 5 episodes, but my husband has them almost weekly. What info could you give to help alleviate the number/severity of episodes?

Night terrors are common in toddlers and elementary school children, and it is related to sleep talking and sleep walking. It is a disruption of sleep out of slow wave sleep, occurring usually in the first half of the night. Most outgrow it, but sounds like your husband has not. It can be made worse with stress. Good sleep hygiene, a good bedtime routine, can help. I usually recommend this for about two weeks (it may not work right away). I usually hesitate to recommend medications to patients and offer lifestyle changes first, especially with children. The American Academy of Sleep Medicine has a patient website that points to a local sleep doctor: http://www.sleepeducation.com/ Good luck!

Hello, thank you so much for doing this! I have had trouble sleeping for as long as I can remember and I have a question!

I have had trouble sleeping for as long as I can remember. From middle school, all through high school (ages 12-18) I would lay awake almost every night feeling very awake with racing mind until about 2am, having to wake up at 6am for early morning classes. I believed at the time this was normal. I felt very tired.

As I grew older I looked for medications that could help. Initially, my doctor prescribed me clonazepam, but I still would not get that "tired" feeling, and would then lay awake while relaxed, which has even caused me to stay awake later than intended.

Enter Cannabis. For the past 4 years, I have been smoking cannabis recreationally as well as right before bed as it induces sleep for me. Now I sleep like a baby, but I'm not sure that I want to be a drug user (illegal in my state).

What advice can you offer someone in my situation? Medication? Therapy?

This is very common, and often misdiagnosed. I'll hold off making a diagnosis, but these symptoms are similar to delayed sleep phase syndrome (DSPS). I had a physician who was my patient, who brought in his family with similar symptoms. They would go to bed, can't sleep, have racing thoughts, and say they get their best sleep just before their alarm clock. They'd fall asleep quickly on weekends when they'd go to bed late, and if they sleep in, they feel refreshed and great. They'd also report they were 'night owls', doing their best work in the evening. It is a sleep timing issue, related to circadian rhythm. It is similar to experiencing jet lag but without the plan, and it is unhelpful to 'just go to bed earlier'. It can be treated without medications but rather by light exposure. There is a lot involved, and maybe I should make a blog post on this, but the idea is to get bright light exposure just after waking and create a dark environment a few hours before bed. It shifts alertness and sleepiness earlier, so you'd wake happier in the morning, and sleep faster at night. I hope you feel better!

I work sunday and monday nights, Thursday and friday days. How bad is it for you to switch between night and day like this when trying to sleep? I often find I only manage to get 5-6 hours of sleep when working nights. Obviously I realize thats not ideal.

This is a difficult sleep schedule, I did it in residency and it is a common sleep condition. When the schedule causes poor sleep and focus, it's called shift work sleep disorder. Obviously, keeping the same schedule the same all week is best, but it is impractical for social and family reasons. So most of my patients switch schedules on days off to be with family. So if the switch has to happen, there are ways to transition faster. At home, you'll need blackout curtains to make sure your sleep is as high quality as possible. Also get earplugs and silence the phone. You can also get a white noise machine / fan to drown out other noises. Taking a nap before your night work shift will improve alertness on the job too. At work, keep the lights as bright as possible to stay alert. Good luck!

Thanks. I guess I am doing all of what you suggested already, minus the white noise fan. Is there any proven long term problems for sleeping in this kind of manner?

There was a BMJ (British Medical Journal) article last fall comparing shift workers with non-shift workers. They saw a change of cognition (decreased cognition) in those working shift work, particularly those working more than 10 years of shift work. They also saw that it took 5+ years to recover, those that did. http://oem.bmj.com/content/early/2014/10/08/oemed-2013-101993

Is there a neurological problem with people that act out their dream in real life? Like if a person is fighting in their dream and they kick someone, but end up kicking a wall in real life?

Normally the body is semi paralyzed in REM sleep to avoid acting out dreams. In REM behavior disorder, that switch is broken, so if you are fighting in a dream, you are acting it out, and not remembering it the next day. It has been discussed and tested in a few high profile criminal court cases.

What made you focus on sleep for your studies? And what was the path that led you to starting PeerWell?

I love sleep! I did a sleep rotation in residency and I was just fascinated with all the things that happen in sleep. While I loved seeing patients, I wanted to try to help a larger group of people. So I started PeerWell to help people with chronic disease and allow them to track their progress.

What is the cause for nap attacks? (Appear suddenly out of the blue, intense sleepiness for about 10-15 minutes, then disappear like nothing happened.)

Thanks!

Sleep attacks are often related to narcolepsy. They can last for seconds or several minutes.

I sleep the normal 7-8 hours but wake up at least 5 times each night. Each time I fall back asleep pretty quickly. I don't think it's sleep apnea. What else could it be and what can I do?

Waking up a few times a night is ok, especially if you're healthy and fall asleep quickly. In fact, I've never seen a sleep study where someone has fallen asleep and slept for 8 hours without any arousals. Unless you have other symptoms, I'd do nothing if I were you.

After playing sports at night, I struggle a lot to catch some sleep for 4 in-bed hours . This does not happen when I do weightlifting for instance. What is your explanation and how can I overcome this painful situation?

I had a semi professional martial arts patient about a year ago with a similar problem. On days of extreme activity at night, the metabolism is increased for several hours. That causes increased heat, and confuses the brain to stay awake. It increases the struggle to catch sleep. That heat is different from a blanket, or taking a warm shower. (That's why a warm shower helps sleep). Try an experiment of shifting sports earlier (if possible). Good luck!

What would you say are the most common causes of sleeplessness and how do you treat them?

Stress often causes insomnia, or increased time needed to fall asleep. It can be treated by sleep hygiene (best) or with medication. Sleep hygiene works by giving your brain time to relax after the day to sleep faster and deeper at night. The opposite is also true, because when I have a particularly stressful day, I don't sleep as sound at night. Increased sleep fragmentation due to waking for 'every little sound'.

Interesting. Would you mind answering a quick follow-up question? I tend to have a lot of trouble falling asleep just because my brain doesn't want to quiet down. I'm not necessarily anxious, but my brain just starts trying to make plans for tomorrow, analyze what went on earlier in the day, get excited about fun things I can do after work, etc.

This can keep me up, fully alert, for hours after I turn off the lights and try to fall asleep. A lot of the time I know I'm tired, but just can't do anything about it (other than take a benadryl or melatonin supplement), but other times it feels like a carryover from college, where I could naturally fall asleep whenever I felt like it (usually 2-3 AM rather than midnight) and sleep however late I needed to get the 10 hours my body seems to prefer.

What can I do to help my brain relax when it's time for me to get some rest? I usually don't have notable issues after I fall asleep, but getting to sleep seems to be a real hassle most nights.

This is pretty common, and sometimes it's hard to know whether it's insomnia vs. delayed sleep phase syndrome. Delayed sleep phase syndrome is when someone is naturally a 'night owl', can fall asleep quickly if they go to bed late, and like to sleep in. Going to bed earlier can cause frustration and delay in falling asleep. It can be helped by bright light exposure in the morning, and dim light exposure in the evening, and over a week or two naturally shifts the circadian rhythm earlier. I'll try to do a blog post to break out more detail. Good luck!

Is it true that it takes so long after the point of falling asleep that you enter REM?

I ask because I have a mild case of apnea (5 times an hour), and do shift work for a living, and I'm just wondering if I've never reached a point of REM sleep because of the frequency that I wake up.

It's true, REM sleep doesn't start right at sleep onset. And most REM occurs in the second half of the night. But REM sleep is also when apnea tends to be worse. I've had some patients with mild apnea in non-REM sleep, and have severe apnea in REM sleep. Even mild apnea should be treated. Feel better soon!

Do you find any correlation between people that have a hard time falling asleep/staying asleep and lucid dreamers? I lucid dream every night (most people don't believe me, but it's true!), and almost always remember my dreams in the morning, but it is incredibly hard for me to fall asleep and I wake to any little noise.

Also, someone asked about Melatonin, but you didn't really say much about it. What are your feelings on daily usage?

And, more of a statement than a question, but do you know how infuriating it is for an insomniac to be told by doctors that they just need "better sleep hygiene?" Last time I discussed this with my doctor he just handed me a print out of "sleep hygiene" and said, hope this helps." Yeah... we've heard this before... 0/10 even with rice... does not help!

Good questions. Difficulty falling asleep and waking easily to noises is consistent with insomnia. While sleep hygiene is a good first step, some people do everything right, but the condition persists. The next step would be to start cognitive behavioral therapy for insomnia, which is successful in treating refractory insomnia. But there is a acute shortage of doctors that treat it, and frequently not covered by insurance. There are some online programs though, like the Cleveland Clinic program (don't remember link) or the sleepio program www.sleepio.com You also asked about melatonin, I am not a fan of daily insomnia medications in general, because many of my patients start to feel dependent on them. Not necessarily in a tolerance or addictive way, but rather feeling that "if I don't take the medication, I won't sleep" causing stress and a vicious cycle. For people with chronic insomnia, it's good to start with a CBTi program, and consider sleep medications as bridge treatment. I hope you feel better soon.

My ADHD started to get better when I got treatment for a sleep disorder (PLMD). Is it possible that ADHD and long term sleep deprivation are the same condition?

Symptoms of poor sleep include daytime symptoms of poor focus, attention, ability to multitask. These are pretty similar symptoms to ADHD. The tricky part is that if someone has these symptoms because of sleep, they will also improve with ADHD drugs, because after all, these drugs decrease sleepiness. Always best to treat the cause rather than cover the problem. I'm glad you sought treatment for the sleep disorder (too). Good luck!

What advice do you have for narcoleptics?

Narcolepsy is easy to treat, but hard to treat completely. My narcoleptic patients would still need scheduled naps, even after medications. Scheduled naps really help. It's a condition where a good support network helps. Check out http://narcolepsynetwork.org/

I have sleep apnea. I use a CPAP machine and I absolutely hate it. If I don't use it my fiance can't sleep because I snore so loud and I feel less rested. However I often roll onto it and hurt my nose, wake up through the night. I also often get sinus problems because of it.

What in your opinion is the best option. I'm a young guy and once I got the sleep machine the agency I was dealing with seemed much less interested.

I've heard of mouth appliances. That seems annoying for different reasons, and they seem expensive. But I'm sure I could get used to it.

I've also heard surgery can be an option, does that work well? How would one get referred for that?

That's terrible that the company that sold you CPAP isn't paying attention. A trial of different masks is a good start, but otherwise oral appliances (usually dentists) or surgery (usually ENT surgeons) are good alternatives. If you have insurance that requires a referral, start with your primary care doctor to help you with the insurance / referral. Good luck, and feel better.

Hey there! Thanks for doing this.

I know you can't give medical advice over the Internet, so maybe just provide your opinion. I have pretty bad sleep apnea but am not severely overweight and had my tonsils and adenoids out. Unfortunately I can't afford to get the remaining sleep study I needed or the CPAP (sp?) machine. However, I discovered that if I wear those breatheright strips (nose strips on outside of nose) I wake up feeling well rested and have been told my snoring is cut to minimum. Is it possible for the source of apnea to be primarily in the nostrils? And if I feel fine wearing those, so I need to be concerned about not getting a sleep study and all that? It is seriously a night and day difference, pun definitely intended.

Thanks again!

Good question. It's terrible that you're left hanging in the middle of your diagnosis. There are two types of sleep studies, the one where you sleep in a clinic, another using a device you take home. While the one in the clinic is more comprehensive, have you been offered the take home one as an alternative? The strips can help with snoring, but they aren't designed for apnea. So they'd be only helping with the noise. Your question is whether apnea can be primarily in the nostrils. Well, yes, nostrils can be a major source of airflow resistance, and you can flare them while awake to test how much they contribute to that bottleneck. I would hate for you to still have apnea, though, so know that some companies have programs to sell CPAPs at reduced costs (like demo units). Ask your doctor for a local DME company (Durable medical equipment) so you can check out your options. In the meantime, know that avoiding alcohol at night helps apnea, and avoiding sleeping on your back helps apnea. Good luck!

How frequently can apnea be addressed by weight loss alone?

Weight loss is great at improving or curing apnea. I've had patients who gave up their CPAP machine because they cured their apnea with wt. loss. Good luck!

I am looking into getting an Mandibular Repositioning appliance to help with snoring.

Before potentially investing $2K into a treatment like this, I was curious if you had insight into how well these MRA things work when it comes to helping prevent/lessen snoring.

In your experience/opinion, do MRA's have a significant impact when it comes to reducing snoring?

There are devices for snoring, and other devices for snoring and apnea. $2k is a lot of money, so I agree with you it'd be nice to do a test run first. Some doctors have temporary devices to 'try it out'. Ask your doc if he / she has something for that. The oral appliances for apnea are pretty successful in treating mild cases. Good luck!

Does sex or masturbation before bed lead to better sleep or is that a myth?

It often helps people sleep better. I've heard from other sleep researchers that it could be due to a temperature drop afterwards, which is a signal for sleep initiation. But I also think the parasympathetic system is involved.

Why am I so damn sleepy right now??

I feel your pain. I am super sleepy too!