Alpine Apnea and Aging

The Mother of All Clinical Trials, which I announced in April, continues to progress at a charmed pace.  This is a project to collect information from people who are already using a variety of measures to extend their life expectancy, and to use a methylation clock and some innovative statistics to tell us which combinations are effective.  It is to be an open-source study, with all data, results and analysis freely available to the public and the research community.We have done no fundrasing as yet, but have collected remarkable volunteer talent and a mammoth donation-in-kind from Zymo Research, the only company that presently offers methylation age testing commercially.

Our principal unfilled role is a project director, who will recruit, train and manage 5,000 subjects from within the life extension community, oversee collection of data, and keep them motivated.  This could be a volunteer position, or it may involve fundraising your salaray + related expenses.

We are also looking for a lawyer who can advise us on privacy, HIPAA, IRB matters, and related IP issues.  Write to Josh Mitteldorf <[email protected]> if you are interested in working with us.</[email protected]>

My Himalayan Experience

I’m going to invoke my prerogative as a blogger and talk a bit about my personal experience.  Two weeks ago, I was trekking in the Himalayas. This adventure has been on my bucket list for many years, both because of the grandeur of the landscape and the challenge of exercise at high altitudes. This spring, I finally got around to it.

your blogger, day 3

On the rare occasions when I’ve been above 4,000 meters in the past, I was a little short of breath but didn’t have headaches or nausea that are commonly experienced.  A week before my trip, I looked up the Chinese word for altitude sickness and stopped into the herbal pharmacy at the shopping mall near where I was living in Beijing. The pharmacist offered a box of pills, whose ingredients included rhodiola, Goji berry, ginseng and taurine, all of which have some evidence as longevity aids.    

I arrived at Lhasa airport at 7 in the evening (3600 meters) but the sun was still high in the sky, due partially to the fact that it was close to summer solstice, but mostly because China’s single time zone should really be 3, and Tibet is in the far west.  I had a limo to the city, and didn’t feel bad at all. I went out for a late dinner, and felt the first headache symptoms as I went to bed. In the middle of the night I awoke with a rip-roaring headache, and a sense of déjà vu.  Only then did it dawn on me that I had forgotten to ask the waiter at my restaurant to avoid MSG in my meal, a mistake which I had already made twice before in my 8 weeks in Beijing.  The headache was gone by mid-morning, and never returned during my week in the Himalayas.

For the trek, I was tacked onto a group from Singapore, all half my age.  We were out at 4,000 to 5,000 meters over four days, covering about 20 Km per day of ups and downs.  Air at 5,000 meters is just about half the pressure (half the O2) compared to sea level.  I never felt sick, but I was out of breath whenever we walked uphill, even a small incline.  For the second day out when we first crossed 5,000 meters, I was doing kapalabhati for hours on end (fast, yogic belly breath) — pumping air into my lungs as fast as I could to avoid the lightheadedness that would stop me in my treks.

Apnea – the mind cure

I have had sleep apnea for 20 years.  When I’m asleep, my body forgets to breathe, until my brain senses oxygen deprivation, startles me half-awake, I gasp a few breaths, fall back asleep, and the same cycle repeats.  I’ve just barely managed the condition by sleeping on my stomach. Sometimes I’m aware of the apnea as it happens, but mostly I’m not; during the day I have bouts of sleepiness, presumably because my nighttime sleep is not deep, and I’m fortunate that usually I have the freedom to take naps as needed.

What I didn’t learn until I got to Lhasa:  Altitude makes apnea worse. On the one hand, there’s less oxygen, so we need to be breathing faster; on the other hand, there’s also less  CO2, and it’s the buildup of  CO2 in the blood that the body senses in order to regulate breathing.  I usually take 1 mg melatonin at bedtime, for longevity benefit rather than for sleep.  While in Tibet, I suspended melatonin because statistically it exacerbates apnea, and in my experience, melatonin at higher doses seemed to be a major factor.

My first night out on the trail, I really sensed the apnea, much more so than in Lhasa.  I repeatedly felt myself startled awake, panicked and panting. I wasn’t sleeping much.

The second night, my difficulty sleeping was more severe, and I was inspired in the middle of the night to try an experiment.  I sat erect in a meditation pose and found a rhythm that gave me enough air = 3 heartbeats inhale, 5 heartbeats exhale. (This was about three times faster than my resting breath at home.)  I used meditation techniques to keep my mind returning to the breath, aware of the rhythm, and aware when the O2 budget felt insufficient, and I needed to breathe deeper and faster for a bit.  After about 20 minutes, I lay down and maintained the same counts, the same breathing rhythm, the same relaxed, meditative mental posture.  I deliberately formed the intention to impress the rhythm on my unconscious, so that it might continue to breathe in the same pattern after I dozed off. The technique worked.  It was awhile before I dozed off, but the time meditating was fully relaxing, and gave me the feeling that my brain and body were restoring as they might have if  asleep. When, eventually, I did fall off to sleep, there was no panicked awakening. I can’t be sure whether the apnea was returning because I was in a tent alone, but as far as I could tell, it was relaxing sleep.

I regard the experience as a breakthrough in my relationship with apnea, and I’ve continued to rhythmically breathe myself to sleep in the 2 weeks since I’ve returned to sea level.


Adaptation to Altitude

Many peoples around the world who are adapted to high altitude living have more red blood cells.  This works to carry more oxygen more efficiently to the tissues, but high RBC inclines the blood to clotting, and increases risk of heart disease and stroke.  The Himalayan peoples have a better idea.  They actually have lower RBC counts than the rest of us, but they have a genetic variant known as EPAS1 that enable their mitochondria to function just fine, to burn sugar efficiently at low oxygen levels.

Until recently, the origin of EPAS1 was a mystery.  Then, in 2014, the geneticists traced it to a group called the Denisovans, 40,000 years ago.  Denisovans were an offshoot of Neanderthal man, chronicled from a single finger bone of a single young woman, found in a cave in Siberia in 2010.  The bone had enough DNA to do a complete sequence, and an entire subspecies known fro this single example. The Denisovans interbred with other human tribes of Asia, and the EPAS1 gene was originally their contribution to humanity.  It disappeared in many places, but in Tibet, it was useful, so it stuck.

It may be counterintuitive that more is not better when it comes to red blood cells.  P.D. Mangan has been beating the drum to advise us that iron levels on the low side of normal are better not just for cardiovascular risk, but for many other aspects of health as well.

Benefits of Hypoxia

Tibetans have short life expectancy compared to other Chinese groups.  This may be due to poverty and inadequate access to medical care. But, curiously, there is also a high concentration of nonagenarians and centennarians in Tibet.  Could altitude be a factor?

There is indirect evidence linking hypoxia to longevity.  Hypoxia shifts gene expression toward a stress response that is known to overlap with longevity genes [ref, ref].  Hypoxia increases lifespan in bees [ref], fruitflies [ref], and lab worms [ref].  A study correlating altitude with life expectancy across the US found tentative evidence for a benefit from living at higher altitude.

I’m not impressed by the arguments that hypoxia is a factor in the longevity of whales, naked mole rats, and other animals whose lifestyles incidentally lead to hypoxia–too many confounding variables.

Evidence on apnea

Apnea is two separate diseases.  Obstructive Sleep Apnea (OSA) has a mechanical origin in blockage of the windpipe.  It is associated with obesity, but studies find that independent of obesity, apnea is a mortality risk.  Central Sleep Apnea (CSA) originates in the central nervous system, but its logic and mechanisms remain obscure.  

OSA incidence increases modestly with age.  CSA increases dramatically with age.

 (from a Korean study 2018)

CSA is much rarer than OSA, but its incidence increases dramatically after age 65.  (For CSA, I was unable to find a graph like the above.) CSA is associated with heart disease and stroke, and the direction of causality is unclear.  It may be both that heart failure contributes to apnea and apnea contributes to heart failure [ref].  For those of us who suffer from CSA, it would be interesting to know if treating the symptoms (say, with CPAP) lowers cardiovascular risk.  Consensus of the medical community is “yes”, but this conclusion may be driven by economic and legal factors. I have been unable to find a definitive answer in the primary literature, because the direction of causality is so hard to discern.   This small study (2005) found a major decrease in 5-year CV mortality for those who accepted CPAP treatment compared to those who could not tolerate CPAP.  This larger study (2016) found that CPAP effectively alleviated the symptoms of apnea, but had no discernible effect on CV mortality.  Of course, better sleep at night and better alertness during the day are sufficient reasons to treat the symptoms of apnea.  But some of us aren’t helped by CPAP.


The Bottom Line

Hiking at high altitudes is a great challenge, but not necessarily the best conditioning for long life.  Unless you’ve got Denisovan genes, you will adapt with higher red blood counts, which, for most of us, is a net negative.

Sleep apnea is entwined with heart disease, so it is difficult to separate cause and effect.  Lowering the risk factors for apnea may be as important as treating the apnea itself. There is but little indication that sleep quality directly affects your mortality risk, but it certainly affects quality of life.  

From what I have seen, there is a well-established correlation between apnea and increased mortality, especially CV mortality, but it is not clear that apnea patients using CPAP have lower mortality than untreated apnea patients. I’m taking a controversial position based on 2 days reading, and I could be very wrong about this, so I invite response and discussion.

My own experience suggests that it’s possible to use meditation techniques to plant suggestions in the unconscious that alleviate sleep apnea and improve sleep quality.  Hypnotism, autosuggestion, and biofeedback might be effective as well. It’s hard to do controlled studies to demonstrate this benefit, and it may be even harder to get them funded.  But it’s an approach worth exploring.


27 thoughts on “Alpine Apnea and Aging

  1. There’s no confound on the hypoxia.

    The mistake people make, even experts, is that they confound low ambient oxygen with metabolic hypoxia, they are not necessarily the same. If one looks at mole-rats, bowhead whales, diving/fasting seals, & hibernating critters & beasts one sees a low pO2 but this is correspondingly matched by a reduced metabolic rate. A dysregulated system, on the other hand, leads to situation in which O2 supply cannot match demand, which presents as frank metabolic hypoxia & a shift to anaerobic metabolism, etcn i.e., it can all be pushed too far. In these animals, a powered down metabolic rate is also associated with a reduced core temperature, though the metabolic life-equation allows manipulative play of certain variables to offset this effect, e.g., phenomenal warm/ tropical torpor does exists. All these animals do breathe less frequently, which from a relatively elevated metabolic position would seem as frank apnea; subjectively it isn’t. In some instances, however, especially at sea-level, the inter-breath duration may be very prolonged to permit remaining at a low, energy-conserving metabolic rate, e.g., hibernating bears (3′), hibernating lemurs (20′), sleeping seals (20′), etc. The problem with OSA is that one transitions from relative normoxia to a too acute metabolic hypoxia & too often, i.e., it’s like doing frequent extreme dives, leading to system over-use/abuse, dysregulation & pathology …. & shortened life-span. The point, low O2, like low core body temperature will slow metabolism & dilate biological time but it has to be orchestrated properly, kinda Goldilock just right, otherwise it will lead to hypoxia & hypothermia which as we all know does the opposite, & in a time-dose manner.

    PS: it is worthwhile noting that with age metabolic rate slows & core temperature falls, which would suppress vitals, like the need to breathe.

  2. Josh your study seems to vast and unprecedented and analysis may reveal gems for anti aging researchers. Thank you for keeping it open source. This will become a great service to the field. Trek in the Himalayas sounds wonderful! Saddened to learn about sleep apnea. I am sure you already know about these two but am sharing just in case:

  3. 1) I think increasing red blood cell count (and thus hematocrit) is one of the few adaptations (together with hyperventilation) to altitude that have not “fallen” (discredited) with time, at variance, for instance with the ever repeated DECEREASE in haemoglobin affinity for O2 ((higher pO2) which happens in humans and rats whereas well adapted to altitude anaimals like llamas do the reverse (Higher affinity), similarly to hypoxia adaptation in fish.
    Another issue is the hematrocrit value. Higher than normal seems adapative to altitude, but only up to a ceretain value. Too high hematocrit is celarly unadaptive becasue it increases blood viscossity making difficult for blood t¡o reach the brain which is critical in altitude (and important for risk of death while sleeping high altitude). High hematocrits seem also part of the reason of the high altitude chronic seakness.

    2) I agree that low iron (not reaching so low as truly iron deficiency) can be better than “normal iron”. A main reason why is because without iron toxic derivatives of oxygen (ROS) will never form in the body. I am worried because doctors (military-like) have lowered the limit for iron in Spain at least. They are giving iron supplements to too many women that have not reached iron-deficiency. I wonder if this is related to the fact that from various years in the past now more post-menopausal women in Spain are dying from heart attacks compared to men of the same age (the opposite of what happened in the past). I wonder also ahy this centering on giving iron to women? It is the same with hypothiroidism. I can not beleive the huge amounts of supposedly hypothiroid women exist in Spain (and not men). (Joke: perhaps the MeTooers should take this problem on their agenda too…
    Iron is needed to make haemoglobin, mioglobine, mitochondrial cytochromes, etc. But the simple assuption that “more of a good thing is always good” is usually wrong in biology. Aristoteles alrerady warned us about it more than 2000 years ago (and people continue today to do the same mistake). Same for food (good, but bad if it is too much: that´s why CR increases longevity). This happens practically for almost everything. Too much iron, oxygen, calories, fats, even water (intoxication) or sex, is no good.
    In any case, controlled classic experiments in Drosophila have clearly shown that the higher the amount of iron in the diet , the shorter the lifespan (both mean and maximum). And it works both giving more (smaller longevity) and giving less iron (longer longevity).
    In addition, when you study intestinal absortion, there is a system at the brush border designed to eliminate around 90% of the ingested iron to be lost in the faeces, and only a few percent of the ingested is allowed to enter the blood. The body is “wise” (thanks to million year of evolution). It knows how bad it is to let iron levels increase inside the body. Even traces of free intracellular iron cause cellular necrosis.

  4. Some herbs and chemicals slow aging, others are accelerating it… My current custom herb mix makes some of my grey hair (at least those less than are 2 years gray…) is turning back some of them into their natural color and shape. But, including tea (white tea green tea black tea any tea) into mix nullified that effect completely. :< So want to live forever? Treat any tea as arsenik poison and act accordingly.

  5. Josh, I don’t bring anything in particular to the table, but how can I get involved in the work you’re doing with the mother trial? I would like to help in some way, even if just as an advocate, as a volunteer subject, etc. I understand that you are in the beginning phases but I think a future post on this would be helpful as I suspect there are others in this boat who haven’t come out of the woodwork.

  6. Josh, thanks for the mention. There are actually quite a few studies showing health benefit to living at altitude, with lower rates of heart disease and cancer. Besides hypoxia, high altitude means more solar radiation, background radiation, cleaner air, and probably very important, more exercise.

    Interestingly, one benefit of living at high altitude might be lower body iron levels. Since more hemoglobin is needed at high altitude, iron is taken from body stores to make it, with the result of lower stored body iron (ferritin).

    I’ve suggested that anyone really serious about life extension should consider living in the mountains.

    • To your point PD, some of the longest lived peoples in the world live in mountainous tribes like The Hunza, the Abkhazia, and the Vilcabamba. At those altitudes they are certainly exposed to a higher dose of radiation and have elevated hemoglobin levels.
      You have totally convinced me of the evils of iron and so I take IP 6 and donate blood.

  7. Hi Josh:

    I have used Piracetam while hiking at altitudes as high as 12,183 feet, coupled with all the other nutrients I take, and it did attenuate altitude sickness.

    I felt my heart racing a briefly while walking, but it resolved within minutes and I felt a renewed sense of energy.

    Other people on the trail experiencing altitude sickness did not recover and had to leave,

    There are studies to support benefit in hypoxia with piracetam, but the dosages were very high.

    I only took 1000 mgs, twice per day.

    A natural form of Piracetam is pyroglutamic acid.

    Also There are studies showing the methylcobalamin a more easily absorbed analogue of B12 works to attenuate hypoxia/hypoglycemia

    Maybe this will help with oxygen deprivation in a human brain caused by sleep apnea.

    Also before using the piracetam, I once experienced a brief bout of high altitude cerebral adema that caused a raging headache. The inadvertent cure was to vomit, after I vomited I felt immediately far better. It reduced the pain and pressure in my head, likely due to causing slight dehydration.

    I slowly rehydrated with small sips of water.

  8. hey Josh,,first off ,,/thanks,, second ;Ive been doing anti aging protocols for 20+ years,with much testing and retesting,, I’m 70 and will do T. Grossmans teleomers length testing from Spain soon which he correlates with VSEL treatments,, If I add Methylation DNA to that ,I might just have a good idea of my Bio age..I’ve done 92 Chelations ,85 Rolfing’s, HRT since 1995 , vitamin regiments ,fasting ,exercise/wt training,CR diet,etc,etc,, Recently I’ve addd NAD+,IV,[6 times] 1VSEL[IV+intra nasally] ,low dose Naltrexone,3mg/day,,Rapamycin,2mg/week..PLUS,, Metformin,1000mg/day,,time release DHEA100mg/day,,and special exercise /fasting to bring up the HGH[based on Greg Fahy’s work,to regen the thymus],hopefully he will tell all at the RAAD fest this September,,]Cialis,5mg/day for BPH,,,,I’d like to be in ‘the study’ for sure, and volunteer for something[??] , Paramedic and building trades is my skill,not overly useful now tho…Your idea for the testing [and most other things] is superb,and efficient.. I can only test certain treatments I’ve done with any accuracy ,however those definetly show good/great results!!Most take to much time to be tested ..

  9. In the 1970s I had an experience like yours on planting suggestions to operate below conscious awareness. I had just moved from San Francisco to Tulsa to start a job as computer programmer for American Airlines. Only then did learn that the company had a thing about hearing tests. My hearing seemed fine but I had lots of earaches as a child, and it would have been awkward to lose the job at that point, and be stuck 1,700 miles from home with no money, no job, no leads, and not knowing anyone in the state.

    I had worked at NIH with researchers who had studied evoked potential, so knew that the nervous system registered sounds too faint to reach conscious awareness. So as each sound frequency in the test got less and less, I trained my finger to press and release the button as the sound came and went. When the sound became too faint to hear, I let the finger keep going.

    The tech said I scored off the charts, one of the best she had seen.

  10. It would be really cool to try and meditate all night and see what the effects were, and whether you would be able to get the same restorative benefits of sleep. One of the disadvantages of sleep seems to be that even though your brain benefits in some respects, I often find I’ve lost some of the insights or hard won perspectives I’ve worked on the day before, and have to work again to attain them. Perhaps meditation could overcome this.

  11. Mark:

    I have used brainwave entrainment machines to create theta or delta brainwaves.

    When using a Delta wave program for one hour, I often feel as refreshed as if I had a full nights sleep, albeit more alert, afterward.

  12. Hello Josh,

    I take rapamycin, allantoin, spermidine, pterostilbene and Niagen (all cycled). I would be interested in participating and of course paying my way. Please let me/us know where and when to sign up.

  13. Have no idea how various brain waves might affect sleep apnea, but I do know that Youtube has hundreds of selections of alpha and theta brain entrainmnet videos (use stereo headphones) via binaural beat and isochronic tone technologies.

    These are so effective at promoting a deep meditative state that I wrote an article about it: “Meditate Like A Monk In 20 Minutes”, which you can find here:

    My mother has sleep apnea so I’ve seen close up the challenges of getting enough healthy sleep and not succumbing to the various chronic ills that this health issue can instigate.

    Josh, may you find a way to get deep, uninterrupted sleep every night!

    • Joe – I have several binaural mp3 files, though I have never used them at night because headphones interfere with lying on my side, which is the best position for me to avoid apnea. The recording I use most is “Abyss – Alpha to Delta”. Do have recordings that you’ve found particularly effective?
      – Josh

  14. Johs, in principle thank you for your photo, your greeting is kind and affable, thank you for it.
    I mentioned a long time ago the Chinese herbs you indicate but the problem is always the dosage and obviously the formula because you can never take a single herb in CMT, as well as in ayurveda – different are the fungi.

    I read comments about brain training and I still have the Megabrain Inner Quest (199x) in my toolbox but I use the Mind Alive CES and AVE. I’m going to read in detail for my opinion.
    One detail, listen to the them of Marconi Union “WeightLess” Ambient Trnsmissions vol. 2,
    I bought it in FLAC format, unsurpassed. You should already know that the Youtube audio format is compressed so that its acoustics and apparently inaudible sounds are suppressed, so its function is almost null.
    This type of file is NOT suitable.
    The Mega Brain Zones (1,2 y 3), Audio-CDs, are the best psychoactive music available recorded in German studios that has not yet been surpassed, despite its antiquity.
    Finally, an interesting publication of Nature’s “Senolytics improve physical function and increase lifespan in old age” can be read in full (15 pages) in Time Health
    Enjoy with care.

  15. My story in brief: born in 1945. Was regarded in my youth as “never living up to my potential” (scored in 99th percentile in verbal skills). Diagnosed at age 49 with ADD, at the VA, after being checked for any and all physical causes (as opposed to psychological or strictly neurological causes), except one: sleep apnea. Took the usual ADD drugs (Ritalin, Prozac for the depression component) for 20 years.

    At age 69, diagnosed (again, at the VA) with Obstructive Sleep Apnea. Was startled to learn that the symptoms of ADD and OSA are virtually identical. After using a CPAP machine for a month, I felt no need for the medicine and stopped taking it. Result: I felt, and did, better than ever before in my life.

    The issuance of the CPAP machine for my use was against protocol, wherein either a formal sleep study is done or the CPAP machine is used for a trial period, after which the internal data chip is analyzed and an appropriate-use decision is made. In my case, when I went to pick up the machine, a resident expert happened to enter the room, and volunteered to take a look at me. After examining my throat, she said “Forget the test. He has it.” (On the basis that the tissue at the back of my throat, tonsils and adenoids intact, made it highly unlikely that I didn’t have OSA.)

    I used the CPAP machine faithfully for 4 years, continuing to enjoy lack of ADD/OSA symptoms. A VA doctor heard my story, and insisted that I MUST have a sleep study done, a request with which I happily complied. A week before the test, I went on a vacation, forgetting to take the machine with me (and have not used it since; you will soon see why).

    On awakening the morning after the sleep study was done, I asked the tester how it went. She said, “Normally, for someone with OSA, we awaken the subject when breathing ceases, and fit them with a CPAP for the rest of the night. With you, that never happened. you don’t meet the criteria for receiving a CPAP machine.”

    Naturally, I was surprised, and puzzled. If I had been misdiagnosed with ADD, and I didn’t have OSA, what the bleep was going on?

    Here is my theory: It took several years, but the CPAP machine succeeded in training me to never sleep on my back! Every time I did, the machine woke me up by cranking its pressure to maximum to force my airway open. When it did, air leaked out around the full-face mask, bringing me fully awake and forcing me to roll over to shut the machine off and restart it, the only way to return the pressure to its default minimum. (Thereafter I went back to sleep.)

    The OSA-specialist doctor at the VA, after seeing the result of this study, ordered a second test, this time with a CPAP fitted on me at the outset. I have yet to get feedback on the results of the second test. (I suspect it will again show that I “don’t need” a CPAP.)

    I also suspect that there is either an existing device or a device that could be devised to do the same “training” function more efficiently than do existing CPAP devices.

    After getting the latest feedback from the VA doctor (and presenting my hypothesis to him), I will update this post.


  16. Hi Josh,

    I also have OSA, and I do take 1 mg time release melatonin at bed time which as you said can make it worse. However, over the last year I have been taking 3 mg of methylene blue before bed time as well and I feel that it has helped. I think what is happening is the methylene blue prevents reperfusion free radical damage that occurs when I start breathing again and my blood is reoxygenated. Methylene blue has been used for a long time in surgery to prevent reperfusion injury. Here is one of many articles about this effect.

  17. Two observations, I have. Firstly, there is a up tick in the chart above at age 40 and age 65. I have often wondered, if there are distinctive developmental mile stone ages for humans. To me they are: birth, 18 months long term memory start, age 7 seems to age of beginning of conscience and general awareness, age 11.9 onset of puberty, age 24 brain fully wired, (age 30 I noted in my business age where it gets harder to teach people), age 40 end of reproductive years and first onset of self inflicted death inducing diseases, age 65 a weird acceleration and second more steep decline which is likely cell Senescence impact, age 93 for those that don’t die of a specific disease by this time there seems to be a more general body shutdown like a flipped off switch which few make it past 10 more years. Just my observations over the few thousand people I have worked with, observed, and been able to interview over last 35 year in the public. Just a hunch. One customer, was getting her PhD in psychology/psychiatry, and had a thesis that brain neurons at age 54 have a threshold where learning new things becomes exponentially harder. Age 65 is 10 years past her threshold. I would say age 53/54 is about the age where I have found few are trainable except the most humble. Not sure about her thesis.

    Second obvervation on this article : could this imply that serious swimming for exercise, may have anti aging benefits beyond just the calories and muscle gain? Has this been studied?

  18. I would be very curious for an update to this post. Have you been able to mitigate your CSA solely with meditation?

    I also suffer from CSA and am being treated with a CPAP machine but I am beginning to regard it as mostly superfluous since nearly all my events are central, not obstructive even according to the machine’s data. I also make an effort to sleep on my side but years of this is causing me some shoulder/joint problems.

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