Had a supermorbidly obese mania pt where (imo) a big part of the problem was poor sleep at night. They would sleep sitting straight up against the wall and when they would finally nod off and their head would fall to the side and you’d immediately hear them start choking on their own throat until they jerked partially awake enough to pick their head up. That mania was crazy hard to break because they were too manic to tolerate the CPAP but also too sleep deprived to break out of the mania. 100% medically cleared and ambulatory enough for psych but that snore was just aaaawful to listen to.