So the thought that Apple wouldn't have their ducks in a row isn't true. Especially since any feature they release, will be used by millions of people pretty quickly.

Just to be clear, I'm not claiming Apple doesn't give themselves special treatment in the App Store. They absolutely do (as you'd expect). Just pushing back on the notion that they wouldn't have documentation and all their legal stuff taken care of.

As in, did their refusal say "no because the way you're tracking if the user is on their back is not accurate enough?" or did they say "we don't allow people to write watch apps related to medical diagnoses / treatments / etc?"

A very long time ago, I got the impression that sleeping on your back is healthy, and successfully "trained" myself into the practice… now I'm trying desperately to untrain the habit 9_9

In some cases sleeping on the stomach might be preferred, as that helps the lungs take in more oxygen, which is why patients on respirators are often kept on their stomachs in hospital.

That being said: if you don't have sleep apnea or reflux, any position that's comfortable is probably fine. No one stays in one position the whole night anyway.

I sort of feel my body telling me, my back hurts because I never sleep on my back (because of sleep apnea, or at least horrendous snoring) but when I lay on my back it feels much more comfortable, but can't sleep that way because I will wake up the house.

Try a body pillow. Having something to wrap your arms & legs around and keep your spine aligned counteracts at least some of the discomforts of sleeping on your side.

The opposite is RAO (right side down on belly oblique), when we want to show the opposite esophageal emptying into the stomach.

But any one position is probably not good to maintain for a long time. That’s why patients on respirators get turned so they don’t develop pressure ulcers.

Personally I have found 15-20 minutes prone (on my belly) is helpful reducing fatigue after intense exercise.

The short answer is that your organs are mostly asymmetric and the esophagus connects to the stomach on the right so by laying on your right your stomach acid flows to the sphincter connecting your stomach and esophagus, making it easier to leak into the esophagus. This is especially a problem with GERD because you don't have pain receptors on that end of your esophagus but the stomach acid can still damage its tissue, which can lead to further complications including cancer.

A common cause of acid reflux is a herniated diaphragm (hiatal hernia) in which part of the stomach slips through the diaphragm into the upper chest. In this the esophageal sphincter will not be the highest point of your stomach, further adding to the problem when sleeping on your right side. Imagine a plastic water bottle deformed in such a way it stands slanted with the opening to the right, now imagine laying it on that side or the other. Laying it on the side with the opening makes it more likely to spill if the lid isn't forming a perfect seal.

Yeah, since COVID-19, and even then, only for patients who are severely hypoxic (ARDS or severe respiratory failure). That said, it is not universally applied to all ventilated patients, and in many countries it is not even practiced at all.

I was told that my sleep apnea didn't rise to the level of a medical condition needing intervention, but I should try to avoid sleeping on my back to help with the problems that do present.

My parents never thought I needed a diagnosis, but when I was just a few years old I got pneumonia from a bad cough and was prone to chest infections all my life afterwards. It was after I had whooping cough that my dad came in to check on me, and he noticed that I "wasn't breathing" (which he told to mum in a typically 'Irish Farmer'). She thought he was telling her that I was, in fact, dead and to my bedroom in a panic. Turns out she had previously noticed that I "didn't breathe". Basically, I'd appear to stop breathing entirely for very long periods of time. I think that the air would be very slowly leaking out for about a minute, and I'd be making a low whine noise. Then I'd take in a huge breath... and the low whine would begin again. I wasn't overweight, I was actually as thin as a rake, and my mother nicknamed me "Boney M" (which might show my age).

It was when I met my wife, back in the late 90s, that it became a "problem". She'd tell me I was making a terrible noise in my sleep, and I said "oh yeah, I do that". Every time my weird breathing woke her up, she treated it as if I were snoring: elbow me and say "YOU'RE DOING IT AGAIN". And I'd kinda wake up and then focus on breathing properly as a fell back asleep. I also took up running around that time.

After a few years the weird breathing (which, I now think, was asleep apnea) stopped. I had better sleep and woke refreshed, whereas all through my childhood, walking up and getting out of bed was a gargantuan effort. I could sleep till noon and still be foggy.

Anyway, aside from losing weight and doing cardio, maybe a watch that activated an elbow would be an idea?

Incidentally, another thing I trained myself to do was sleep with my mouth closed. I used to wake up extremely dry and absolutely need a pint of water beside the bed. I read once about surviving in the desert: keep your mouth shut too conserve moisture. So I'd intentionally keep my n mouth closed and breathe only through my nose. That worked too - except when I have a head cold, but I take antihistamines before bed to avoid blocked sinuses.

It seems less likely to me that this is Apple being ruthless or pigheaded and more than you really do have to be careful how you market your iPhone apps.

I take your point; the FDA doesn't recognize "snoring" as a medical condition (but OSA is!)

Apple isn't liable for you looking up medical misinformation that kills you using your iPhone on the Safari browser. Why would it be for an app that is clearly made by someone else? The difference is only because of the vetting, and they only do vetting to charge their fee, otherwise they'd vet other things too.

It's incredible how companies bend backwards to bullet proof any liability whatsoever on anything, except if they can make money on it.

1. if your watch tells you that you might have apnea go get a sleep study! 2. apnea and snoring do tend to happen together but not necessarily. you can have apnea without snoring(sometimes the other way but not as common) 3. apnea is like high blood pressure it's slowly killing you. 4. there are a lot of options now to help you. one might be losing weight. one might be sleeping on a side or stomach.. you won't know until you do a sleep study! get it done.

After I got my apnea fixed I feel like a new person. I did not even know how tired I was or what being "awake" was like anymore. My body adjusted to a new normal. Please look into treatment!

Got a source for the "not as common" part?

From my personal anecdotal experience snoring without apnea is excessively common. Most of people whom I had a pleasure hearing snore would just go on in a steady rhythm and that's it.

Apnea, by definition, is not breathing, so if they are snoring and breathing, they aren't likely to have apnea, are they?

> You’re making the assumption that the snoring people are healthy

I am not making this assumption.

How long until you got it? Did you have to 'fail' CPAP & the mandibular device?

mandibular devices.. rarely work.

I am using inspire. It's great. Turn it on when I go to sleep after 15 minutes it turns on and it moves my tongue depending on my breathing. It is basically a pacemaker but connected to tongue instead of the heart. And if you look at pictures of an inspire and a pacemaker they look exactly the same.

So the reason everyone isn't getting it.. is not really for the side effects. But cost. My bill was 150k.. luckily I only paid a few thousand. So in order for your insurance to approve it you have to meet certain criteria.

(talk to your doctor for an exact list) 1. Can't have a high BMI. Snoring and Apnea are closely related to weight. Your doctor should get you on semaglutides first. 2. You must have failed at using CPAP. It failed for me for multiple reasons. But like I said I have friends who love CPAP and get the same relief as me. 3. You have to get a type endoscopy to see if the procedure will work.

I'm sure there are some other things they check but those are the main ones..

Now once you get the surgery.. recovery isn't tons of fun. When they are programming it while you are in surgery they are moving your tongue in all sorts of ways.. It took about a month to get to the ability to eat a sandwich again; and I was still sore for some time after that. They also have to do some craziness to get the wiring from your chest to throat(where the nerve for the tongue is actually stimulated. So my chest was sore and my arm was unable to pick up anything heavy for a couple months..

Also it takes a few months for everything to heal and for them to first turn it on. Then 3 months of programming to be stronger and stronger without waking you up.

But one day it clicked and I was sleeping like a baby!

I realize these are intrusive questions, but can't help but ask - Are you overweight? Did sleeping on a side/stomach not help?

Here's how Inspire works: Components: The device consists of a generator, sensing lead, and stimulation lead, all implanted under the skin. It also includes a handheld remote that patients use to turn the device on and off, adjust stimulation strength, and pause it during the night. How it works: When the sensing lead detects breathing, the generator sends a signal to the stimulation lead, which then stimulates the hypoglossal nerve. This causes the tongue to move slightly forward, which helps keep the airways open. FDA approval: The FDA approved Inspire in 2014.

Some potential side effects of Inspire include: Damage to blood vessels near the implant, Excessive bleeding, and Nerve trauma or damage"

There's a reason it hasn't taken off in 10 years.

It's a shame Apple is having patent issues with their SpO2 sensor. The O2Ring was a huge help in me understanding my sleep apnea early on, in combination with a formal sleep study. Sleep apnea is a very common and harmful problem, any sort of way of helping detect it will improve a lot of lives.

Also: SpO2 is less useful here than you might think. Most at-home sensors are pretty unreliable, and it's possible to have sleep disordered breathing without having significant desaturation.

I have sleep apnea and used Lofta’s service for $187 and paid for the machine out of pocket. So there is definitely a need for this type of testing.

>Apple Watch tracks movement with triaxial accelerometer signals, which capture coarse motion of the body as well as fine movements including motion associated with breathing. Apple developed an algorithm that uses the accelerometer time series data to classify Breathing Disturbances that occur during sleep tracking, which are temporary interruptions in the breathing pattern.

> A total of 1499 participants were enrolled, with 1448 completing the study. The sensitivity was 66.3% (95% CI: 62.2% to 70.3%), and the specificity was 98.5% (95% CI: 98.0% to 99.0%), demonstrating that the feature meets the design objectives to confidently identify sleep apnea while minimizing false positives.

>It’s important to note that the specificity was 100% (95% CI: 99.7 to 100%) for the normal category, indicating that all participants with a “positive” algorithm result had at least mild sleep apnea. Also, sensitivity was higher in the severe category at 89.1% (95% CI: 83.7% to 93.2%), indicating that the large majority of severe cases were identified.

0:https://www.apple.com/health/pdf/sleep-apnea/Sleep_Apnea_Not...

I get it, Apple is a business, I love their products, but I can see why people hate the company.

I just did 3 nights with mine and conclusion: it's all about the type of mask + settings.

First 2 nights was terrible (and painful on the face) due to wrong masks and wrong settings. 3rd night was best I've slept in a longgggg time.

I can't tell you which masks or settings (it will be completely different per person), but reddit is pretty great at providing hints.

My case: disaster with nasal mask and full face mask size L and high pressure settings (lots of central apnea). Almost perfect with 4 to 10 pressure setting and face mask size M (which should be too small for me according to the manufacturer).

I use a Resmed Airsense 11, soon getting a heated tube so I can crank up the moisture setting without getting condensation and noises in the tube. Will try more different full face masks as well.

It took me a few weeks to truly get comfortable but now I can't imagine life without it. Never thought there would be a time when I could get 6-7 hours sleep and I would be fully rested.

1. When getting a new CPAP I had to reduce the pressure from 15 to 14 or 13 to mitigate the suffocating feeling. I still get my normal 0.5 events per hour while I’m use. I also got a different type of mouth and nose mask which may have contributed to needing to adjust the pressure.

2. I was trying to mitigate the colder air being distracting by enabling the humidifier and tube heater. With the humidifier level too high at 5 I got a suffocating feeling, reduced it down to 2 or 3 and the air was warmer while not feeling suffocating. 3. I also turned off the dynamic pressure on breathe out as the timing felt off and would cause a hitch in breathing, so I have just plain constant pressure.

The name of the game is tweaking and experimenting.

Best thing to do is install Oscar [1], take screenshots of your data, and post it to Apnea Board [2]. The folks there will likely be able to offer some solid advice.

Without knowing anything about you or your data, all of this speculation, but: APAP sucks, it is always too slow to respond, it won't know to increase the pressure until after you needed more pressure. This is especially true for wide ranges which are often the default (like 5-20cm). If you need 15cm, it will take forever to get there, because you'll start at 5, start to drift off, get an apnea, the machine will increase the pressure, you'll wake up ever so slightly from the apnea, the machine will decrease the pressure because now you're breathing fine, and the cycle will continue.

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

- nose mask rather than full face mask

- nasal spray if my nose feels congested

- upping the pressure. In theory a professional is supposed to set your pressure but I do tweak mine. If the setting is not visible it's probably in a hidden menu - Google for how to enable it for your machine.

- sleeping pills

I hope you find a solution. Sleep apnea is terrible.

I wish at-home sleep tests didn’t require a physician to prescribe and review results. It would allow people to experiment with sleeping positions, snore guards and other methods to get their AHI down.

You may need your pressure adjusted. You are awake so whatever pressure the machine is using is fine. Then you start falling asleep and that's when your apnea kicks in.

If you are using the standard autoset 4-20 setting it may not be enough. Ideally this would be done by a medical professional and yada yada - insert standard disclaimer here. I would suggest increasing the lower pressure (say, to 7) to see if it helps you. I was using the default for years and, while it did help me, apparently it wasn't enough. After increasing, it's been night and day.

It _could_ be an issue with your mask but given what you described, probably not.

- #1 - switch to Nasal pillows.

- I had to learn to breathe through my nose

- I had to learn to sleep on my back with a pillow that cradled my head without raising it

- I had to make sure the level of distilled water in the humidifier was not too high.

- make sure the tubes are not higher than your nose (otherwise condensation water drips into your nose)

GP needs to find out how to set up the pressure in their CPAP device. YouTube has tons of videos on that subject.

Set the minimum pressure to something higher, like at least 10, possibly more. If it’s an auto machine then it will adapt to you anyway. At the minute it’s probably set to something like 4 which isn’t any air at all.

My plan is to get a prescription I can use to buy a bunch of different masks (I don't care about the cost), and get a few days of sleep aids. That should sort it out.

The few hours I did sleep with a CPAP were crazy. I forgot that I stopped having dreams. I had so many dreams while I could breathe at night.

The most notable exceptions I find are Japan and Singapore, where it can be purchased without an Rx.

Here is an example of what I found:

> Do I need a prescription to buy a CPAP mask?

> You do need to provide written confirmation of CPAP suitability when ordering a machine, but this is not required for a CPAP mask.

Source: https://www.cpap.co.uk/help-and-advice/cpap-mask/

As for other developed countries, they typically have universal healthcare and the patient does not need to pay for CPAP devices. Regardless, insurance and prescriptions are orthogonal.

The real trick is to fix your mouth leak. Getting on the right pressure helps with that. Fixing your sleeping position can help. Mouth tape can help. A cervical collar can help. Anything that will help you keep your mouth shut at night.

After the surgery, he was finally able to get quality sleep, and his personality changed. Before the surgery he was super-intense, slightly ADHD, not doing great in school. All this went away after the surgery, he is just a regular bright kid now. We noticed changes in the first week, took about 2 years to find new normal. Before the surgery, we tried CPAP for a while, and it helped a bit.

My wife also had the same surgery. It helped, but did not completely cure her apnea.

I felt the same way when I was prescribed a CPAP about 20 years ago. I'd be set to go, get panicky, take the mask off and not feel like trying again for longer periods of time until I gave up. Then about 2 years ago I decided to get a doctor again, talk about my sleep apnea, get a new set of sleep studies done, try to get a machine (it took forever!). I got prescribed a similar machine called an ASV.

For me, the thing that works is a breathing technique the technician at the sleep study told me, which was breath in manually, but then just relax to breathe out rather than forcefully breathing out. Currently I do that by breathing in manually, and then relaxing while counting to three as I let it out. I don't know if it's just a mental way to relax or what, but it works for me. Also, when I was taking the sleep study, I was determined to complete the test, so taking it off wasn't an option, even if I got anxious. So I did the breathing thing, and they were able to get enough data to proceed.

I go to sleep when I'm very tired; that might help. As far as I remember, I fall asleep very quickly. If I wake up in the morning, I can't really get back to sleep since I just notice the mask too much while not falling asleep; I guess I'm not tired enough any more at that point. 7 hours is good for me, but often I'll get 5-6 hours.

Edit: oh yeah, my number of sleep events (when you stop breathing) went from 120 to ~1 per hour. For comparison, >5 is mild, >15 is moderate, >30 is severe.

It's low pressures that feel suffocating (because there isn't sufficient airflow). High pressure feels great... as a life long asthmatic it's the best I ever breathe.

Now I'm on a bipap and tolerate it through the night.

how exactly was Apple able to preannounce approval for this before the, yknow, approval?

like exactly no other agencies work this way, precommiting them to a decision they havent formally taken, even if informally it was already taken they would frown very strongly on leaking their stuff

Very likely all of the core approvals were done, and they were just waiting on things like approval of software testing methodology (yes, they have to approve your software testing system), or something of the like.

All to say I am elated to have my watch helping me just monitor and understand the issue and help give me more actionable data if I need to pursue the doctors again.

I just wish we could solve this with something other than needs-AC-plug machine. I’d like to be able to travel without needing to think about that

The notion that sleep apnea is generally caused by weight needs to die. People also conveniently forget that being woken up multiple times every hour causes weight gain, so often times being overweight is the consequence of sleep apnea rather than the cause.

I started noticing clear symptoms of OSA when my BMI was less than 20 and my VO2Max was around 51. That is to say, I was leaner and fitter than most.

I completely agree that they should screen folks routinely.

Obstructive sleep apnea is not caused by being obese or old, although those things don't help. In some people, losing enough weight may allow for sufficient airflow despite their airway restrictions.

Maybe I should learn my lesson and stop buying Apple Watches, it's really a joke.

Tirzepatide is already more effective and better tolerated for most people, and there is also semaglutide as a daily oral pill available as Rybelsus. Further generations of obesity drugs are already in human trials, and are showing even greater effects relative to the side effects (e.g. retatrutide and combination therapy with cagrilintide).

Price is an issue, but with multiple pharma companies that have effective drugs, the prices have already come down quite a lot. My tirzepatide is running me less than £200/month now, and I'm saving at least that on groceries and eating out. Not even counting that it's effectively cured a few weight related medical conditions that were costing me more.

From what I've seen anecdotally, Ozempic adherence is much higher than most other meds. And the side effects are minor compared to, say, being 200 lbs overweight.

I was about the reply the same thing. Obesity is directly or indirectly a risk factor for almost every health problem imaginable.

Even for a situation that looks completely unrelated like getting shot in the knee by a gun, the risk of dying during the surgery will be significantly higher if you are obese.

I heard all the same crap when vaping became big 10 years ago.

I don't think there's any reasonable definition of "a lot" where this is true. A significant number of people experience GI issues. Most of them subside after a time. There is some evidence that a small number of people may experience more severe GI issues that don't go away after stopping.

"It’s still best for people to naturally control their weight and diet."

What is your evidence for this? Right now, it's looking like the "unnatural" GLP-1 agonists are racking up quite a score against "natural" methods like "willpower" and programmed diets. It's not a useful distinction, in any case. These medications cause reduced calorie consumption, and reduced calorie consumption causes weight loss naturally.

You can also backup your phone outside of iCloud.

You could make the argument that the Apple Watch can be used to manage your sleep apnea condition. On the off chance you get audited by the IRS you might just be better off paying for it with non-HSA funds rather than dealing with that mess.

PSA: HSA expenses are based on the honor system, but obviously don't go to Best Buy and buy a PS5 on a HSA debit card. You are allowed to reimburse yourself for medical purchases. For example, if you have a large ticket medical expense you can use a credit card that provides a perk like air miles and then just transfer the funds from your HSA checking account to your regular checking account. Just remember to keep detailed records/receipts.

This is the same with an HSA. The difference is that you can invest funds from an HSA and the growth is tax free.

> By affixing the CE marking to a product, a manufacturer declares that the product meets all the legal requirements for CE marking and can be sold throughout the EEA.

> Please note that a CE marking does not indicate that a product have been approved as safe by the EU or by another authority. It does not indicate the origin of a product either.

https://single-market-economy.ec.europa.eu/single-market/ce-...

CE marks for other categories may well be self-certified.

I suppose I could have been a bit more precise in my terminology, and said the EMA (who gives the CE mark) is the equivalent of the FDA in Europe.

Can Apple do something about eliminating all these bureaucratic barriers that hurt the health of so many?

I disagree. In lab titration is not about regulatory capture. It's the best place to get a good ballpark start. The rest should be up to the patient, but informing the patient of that is where things go wrong, alas.

> CPAP machines can auto adjust your pressure and people like to tweak numbers manually to their comfort level anyways.

They cannot. See my rant about APAP in the comments here, or my previous APAP rants in my history. Current generation APAP is awful and it needs to die. PAP machines are awful at detecting events. This could probably be partially mitigate with better software. But there is a reason why a sleep study is very much the gold standard. 12+ channels of valuable information. Versus 1 channel on the PAP device.

It doesn't. Your PAP machine doesn't even know whether you're awake or sleeping. It can only ever play catch-up to your breathing getting worse. Properly titrated CPAP (or BiLevel or ASV) is vastly superior both in terms of therapy and comfort.

> What needs to die is regulatory capture and bureaucratic barriers

That I agree with.

> which is what the sleep study scam does

It's not a scam. It provides incredibly useful data. Sleep problems are not just a boolean sleep apnea yes/no. All kinds of shit can go wrong during sleep. Maybe you have central sleep apneas, or complex apneas, maybe you need ASV rather than CPAP. Maybe you have restless leg syndrome (orthogonal to sleep disordered breathing). Maybe you just have positional apnea. Maybe you have REM disorders. Your apple watch won't tell you any of that.

Many people end up getting a sleep study because they're tired. That doesn't have to be apnea. Other people get sleep studies because they snore or because a bedpartner tells them they breathe weird in their sleep. That's more likely to be apnea.

I sure hope so, because my experiences with sleep apnea made it seemed very quack-ish. I keep on hearing ads on the radio by a company called ADVENT with a catchy jingle promising that surgery is the solution to snoring. At the time I had my study (2013) I did not have an in-home test and had a sleep test (which was an awful experience). I was prescribed a Phillips CPAP machine and was very good about adhering to it and keeping up with regular doctor visits. During the 3 years I had it, I lost a significant amount of weight and each time my doctor re-programmed my CPAP SD card so it was a lower and lower setting. I always had very little face time with the doctor, I wish I knew about Sleepyhead earlier as I could have done this myself. The practice I was referred to would always try to sell me stuff like new masks, tubes, etc. when everything I had was in good condition and frequently cleaned. I even used distilled water in the CPAP itself. Eventually I went on a long vacation and didn't bring my machine and been off it since. I'm glad I did, it turns out Phillips was negligent about foam breaking down in their CPAP machines and even the replacement devices have this issue as well. At this point I don't know who to trust, and with something with Apple's name on it would give to some more legitimacy.

Integrate with the existing providers (= making deals with all the existing players and provide the adequate SDKs) and bring more accurate and reliable measurements than dedicated, calibrated devices.

That sure could be possible, but has Apple ever done anything like that ?

They couldn't come to an agreement wit Massimo, I wouldn't be holding my breath on them sealing deals with the incumbents in the field.

Note that you can be diagnosed with sleep apnea based on the home study alone, you don't always have to go to a sleep clinic. If you are really sure you have sleep apnea (and you can be pretty certain with a home sleep study + symptoms) you can just go online and get a prescription for free by talking to a doctor at one of the companies that resell CPAP machines. At least in the US, other countries can be more bureaucratic.

Is there anything objectively groundbreaking at this point ?

Apologies in advance if this question is somehow obvious to others.

Samsung received FDA approval back in February:

https://aasm.org/samsung-galaxy-watch-sleep-apnea-feature-re...

It works on a different monitoring method and requires 2 sleep cycles over 4 hours each in a 10 day window to start detecting.

>The feature, a software-only mobile medical app, uses smartwatch built-in sensors to monitor the user’s sleep for significant breathing disruptions associated with OSA. Users may track their sleep twice for more than four hours within a 10-day period to utilize the feature.

Great job to the team at Apple for getting this together & getting real approval for it.

However how many people will this catch that had no idea they should get checked? Not unlike some of the people who found out they have afib after their watches suggested they get checked? I agree this is great.

It’d be interesting if we find out that a very different percentage of the population have sleep apnea than we thought simply because so many more get checked as a result of this.

Citation needed here. My understanding is that being overweight just narrows part of your airways and will make any existing flow restrictions worse. But given that most sleep apnea patients don't get off treatment even when they lose weight (although the severity may decrease), I'm pretty skeptical of this claim.

There is in fact a mathematical relationship. [1]

> For every 7-pounds drop in weight, expect a 7% drop in [apnea severity index].

It's basically caused by tongue fat, pharyngeal/neck fat and visceral/fat in the upper belly. [2]

I strongly suspect it's just a question of how much weight you lose. If you get down to 15% body fat you really won't have apnea anymore. Not for everyone, there's probably some structural issues that can also cause it, but if it's adiposity-induced, which it is for a huge number of people...

For the rest with skeletal or nasal structure issues, surgery may be appropriate.

[1] https://jcsm.aasm.org/doi/10.5664/jcsm.10190

[2] https://www.pennmedicine.org/news/news-releases/2020/january...

They wouldn't want their brand to be associated with some half baked feature that either runs very slow, or draws too much power/heats up, or unreliable.

So even if another version is technically capable of that feature, if it runs slowly/inefficient, they'd not enable it to protect their brand value which makes sense: as a user if Apple announces a feature, I know it's more "done" compared to the competition like say Samsung/Android etc. and I trust that it's not half baked (which sometimes fails to meet the expectations, but still MUCH better than the competition)

The business reasons are just a plus _on top of_ these reasons.

There must have been some hardware difference.

Different processor, battery life, etc sure..

Business reason is clear: they lost the oxygen sensor, so people hesitant to upgrade.

So there’s no way a better processor would be needed to get acceptable all night battery life and that could be the reason?

Sounds like you may have nailed exactly why they did it.

Of course I’m not saying it doesn’t line up nicely with a business reason to incentivize upgrades.

With 36 hours being the absolute best-case scenario for battery life, it would seem your options are to either have two watches, or be perfectly fine only wearing your watch every other day? Otherwise, when do you charge?

ETA: there’s plenty of valid reasons to prefer other watches (ANT+ compatibility being one of mine) but honestly the battery life thing is really not that bad for most users.

Having to plan your day around when to charge your Apple Watch doesn't sound like a good experience to me.

That only makes sense if you think it takes 12+ hours to charge. 20 minutes on the charger in the morning while I'm taking a shower and getting dressed and it's fine for the next 24 hours. Oh no, I can't wear it in the shower. I wasn't going to anyways.

Your point that a 36 hour battery life on a watch is pretty inconvenient stands. I have an Ultra 2 almost entirely because it can be described as an Apple Watch with a slightly more reasonable battery life. That’s a price I don’t expect most folks to pay.

"All-day battery life is based on the following use: 90 time checks, 90 notifications, 45 minutes of app use, and a 60-minute workout with music playback from Apple Watch via Bluetooth, over the course of 18 hours;"

The answer is, of course, that sometimes you don't wear it, but charge it. Like a few minutes in the morning and/or a few minutes in the evening while you shower or eat or whatever. Done.

But Apple Watch is part of my routine, same as with the iPhone.

Maybe to you, assuming you don't have sleep apnea.

Far too many people have it and it goes undiagnosed. Until that person goes on to have a stroke, heart attack or sleeps at the wheel.

It's a silent killer and I suspect we have an epidemic.

I used to religiously wear Pebble watches because they lasted forever between charges. But in all honesty I just don't find the one day battery life of AW to be that bad considering how quickly they charge. IMO they do have all-day battery.

Otherwise I am just in the habit of waking up, sticking it on the charger, getting ready for my day and putting it back on. Doesn't take long to get to a full charge.

I get access to all of the features and just loose it for 30 minutes to an hour.

Lower states of charge will charge faster, so 2 smaller charging sessions would result in less total time spent charging, actually.

If it lasted 36 hours that would be enough for me to sleep with it.

I agree the battery life is shit compared to Garmin, but then you need to compare features and usability too. And as a long-time Garmin owner I am 100% certain that is not a fair comparison either.

Because every friend I've talked to about the apple watch tells me charging isn't a big deal because they just throw it on the charger at night with their phone and use it in the morning. If I'm wearing it all night to track sleep apnea, when do I charge it? Per my original post. It looks like it takes an hour and a half to do a full charge, so it's not like you can just throw it on the charger for 15 minutes in the morning while getting ready for work.

Charging to 80% is likely to be more than enough for most uses, and topping it up with another 15% just before bed is enough for overnight (probably).

I had the Series 4 previously and the Ultra 2 now; with the older watch, I would charge it for about an hour while watching TV in the evening. With the Ultra 2, I charge it for about 20 minutes here and there depending on what I’m doing and whether I remember. I’m currently at 39% which will be just fine for my hourlong exercise ride (with GPS), and then I can toss it on the charger while I shower and it’ll probably be at 70% which is good enough for another full day.