Advice for JKemp

[JKemp]

Hello everyone!

Very excited to have discovered this place. I lurked for a few days trawling through the old threads and seeing how many people's lives have been improved, and I'm hoping that with a little advice, I can be one of those people.

A bit of background: I suspect my story is a familiar one. I'm 33, and I can scarcely remember a time where I haven't felt mildly to severely tired on a given day, with all of the impatience and frustration it entails. More specifically, I encounter rarely feeling rested after sleep, mild to heavy mental fog every day, and occasional bouts of insomnia (waking up and not falling back asleep).

When researching apnea (again), I discovered that UARS is a thing, and by gum it sounds like something I might have. For full context, I've provided whole situation, but for those with something better to do this evening, my goal with this first post is to get advice on a couple of questions before I embark on my first at-home sleep study. For basic context, I personally ordered a Watchpat One to get a baseline to follow for OSA or UARS.

• What's the general philosophy on "sleep assistance tools" for an at-home test? Is it recommended I skip some/all of those so that the test can give the worst (most accurate?) possible picture?
  • For context, I use (occasional) melatonin, body pillow for positioning/support, nightly nasal rinse, and a nasal strip.
    
• Last few days I've on/off had the tiniest hint of cold/congestion; might even be weather-related. Should I wait until it goes away to do the test?
  
• Even though this is mostly exploratory, am I being a total moron for skipping the normal sleep specialist process, as brutally expensive, endlessly time-consuming, and soul-crushingly frustrating as it always seems to be?
  

Here's the full picture:

• Sleep study (and a nap study) 7 years ago revealed no apnea. Naturally, the doctors went with depression as the cause and put me on Wellbutrin for a few years. I eventually weaned off of it. 
  • It's really hard for me to say whether or not the meds helped. I had kids around the weaning time, so sleep disruptions were pretty common regardless.
    
  • Also worth noting, since the sleep study, I've lost about 70 pounds total (healthy at 180 now), started exercising daily, and eating mostly clean.
    
• Increase in sinus pressure and infections over the past 3 years. Also noticed that at least one nostril can't breathe at any point during the night (when I don't wear a strip/dilator).
  • I believe this was always the case; it was only recently pointed out to me that this might not be normal and/or ideal.
    
• Noticed occasional teeth clenching at night in the past 3 years, confirmed by dentist who mentioned some wear and tear that looked like grinding.
  
• Some snoring, mostly when I sleep on my back. I'm a side sleeper most of the time, but I definitely seem to reposition a bit in sleep; I occasionally (frequently?) wake on my back.
  • Hard to say whether or not I snore every time I sleep on my back, but it kind of seems like it happens a majority of the time.
    
• Frequent bathroom trips each night (2-4), which I discovered recently can be a sign of sleep disruption.
  

Here's what I do and/or have done:

• Just before COVID, I (wearily) decided to give the medical rigmarole another shot. I started with ENT and allergy test.
  • Biggest takeaways were a deviated septum and a mild dust mite allergy. Both likely contribute to the sinus/breathing issues mentioned above.
    
• For sinus/allergies, I take Flonase, rinse sinuses daily and wear nasal strips (or a dilator) at night. The rinsing seems to help the most out of anything (if I forget, my next day goes from sort of tolerable to horrid). Hard to say how effective the other things are.
  
• Intermittent melatonin use, mostly when I've had a particularly brain foggy or exhausted day.
  • Seems to help me fall asleep, but I still wake up every so often. I also can't take too high a dose or I get groggy the next day.
    
• Body pillow for knees/elbows. Partially a comfort and alignment thing, but anecdotally it seems to also keep me from rolling onto my back, which may prevent the snoring.
  
• Tried wedge pillow in the past, MAD, dietary changes and restrictions (in case mental fog was related to food intolerances/gut biome), and a fair number of other minor things.
  
• Lab work is clean; all normal.
  

Finally, I've had a lot of bad luck with health care in recent years. There have been a lot of care providers who have taken whole lot of time and money on medical care and advice that could have been given in an email, and more than once I've gotten what feels like some really, truly horrible advice. It's made me really skittish to seek professional help. Couple that with what I think might be the main culprit (UARS) being notoriously hard to diagnose, harder to treat, and seemingly impossible to get worthwhile insurance support for... oh and COVID-related care delays, I'm not feeling a lot of confidence in a timely, functional solution.

I can mostly function any given day, but the prospect of spending a couple years and several thousand dollars on jack fills me with a particular flavor of weariness and dread.

Bringing me to today. I picked up a Watchpat, and before anything else I want to make sure I use it "right" because I'm terrified of it either not really working at all or giving a result that says, "You're fine." or "It's probably depression." Depending upon the results there, I'm already prepared to either bite the bullet and get cracking on the sleep doctors OR potentially to pick up the AirCurve Auto (out of pocket) and get cracking on my own therapy.

Thanks to anyone for reading all this, and thanks in advance for anyone willing to impart some wisdom.

[becker44a]

Hi JKemp,
Welcome to the forum.

You won't read too many kind words here about Sleep doctors.  There are a few that are worth their salt, but many that aren't.  In your situation, I would be inclined to get an in-home sleep test, and work with your regular doc to have him write a prescription.  Decide about the Vauto or whatever after you have some data.  If you choose to attempt the xPAP route, get OSCAR and post charts - you'll certainly get help here to dial in your therapy.

Good luck whatever you decide.

[SarcasticDave94]

If you have insurance and want them to pay for a PAP, you will likely have need of medical necessity via a sleep study. With that, you can get a CPAP unless there's conclusive evidence standard CPAP isn't going to work for you. Yes, you can buy it yourself, and I've heard good purchase results with Supplier #2. I think they even have medical staff to provide a script if you've not gotten one yet.

Maybe your area is more restricted than PA, but I had a sleep study this past Friday evening at a local hospital. I must go via insurances paying, because my medical need is into NIV category and there's no way Dave is scraping enough coin for even a used one.

Do yourself a favor and decide now to stick with ResMed machines. Therapy differences do exist between ResMed and Respironics. This is for old or new models, so to save you the disappointment of lesser therapy just stay with ResMed. Masks are a different ballgame however. There, just get what you want to try.