Advice on what to bring/tell Sleep Doctor?

[TiredYoungMan20]

24 year old male, 5'11 160lbs, pretty healthy and active. The current working theory is that I have UARS and or Mild Sleep Apnea.

For the last ~20 months or so I've been struggling with sleep, waking up 1-3 times a night and feeling completely unrested every single morning since this has started.

Have been prescribed 4-5 different sleep medications (10mg Ambien being the most recent) and none have helped, whether I'm medicated or sober I still wake up the same amount of times. I don't take anything currently because I find that the meds make my already terrible sleep quality even worse.

Had a home sleep study done (WatchPat thru Lofta) and the results came back RDI 9.5 (REM: 17.0, NREM: 7.4) and AHI 0.9 (REM: 1.6 NREM 0.7). Attached a picture of the study in case anyone would want to see. I've been renting an BiPAP for about 4 months now (Starting at PS: 3 and Min: 4 Max: 12) and been self-titrating week by week until I see improvement, which I unfortunately haven't (Despite my AHI being basically zero).

...Anyway, I see a new sleep doctor at the end of this week and I'm wondering what information should I try to provide him/questions I should ask to make sure I'm heading in the right direction towards getting the treatment I need?

Is there anything else I should have him check out in case this isn't actually sleep apnea/UARS? I have had my thyroid levels and iron levels checked and both are in the normal range.

Obviously I will provide him the sleep study, I assume I should also print out some data from OSCAR too right? Any advice would be greatly appreciated.

Edit: Also I did have a septoplasty/turbinectomy which greatly improved my nasal breathing but did not help my sleep at all.

[Sleeprider]

Your profile indicates use of a Vauto. Let's see a daily details graph in Oscar. You're on the right machine to deal with the flow limits that are characteristic of UARS, and I suspect your therapy is very good with the pressure support, but if you're not sleeping well, there may be a clue in the data. The PAT sleep studies are not particularly helpful to establishing a case for therapy. There are essentially no desaturations, event rate is all RDI and without comorbidities, this would not ordinarily qualify for insurance coverage.

The most important question is actually, what do you want to accomplish with your appointment? The lack of sleep continuity is really the only thing I see that you are looking to improve, and the detailed data in Oscar is the most likely way to to see if the problem is related to a respiratory related sleep disorder. I'm suspicious of a sleep position that promotes clusters of increased airway resistance (chin-tucking) and that may be all we need to know.

[TiredYoungMan20]

Thanks for the response.

Honestly my 'goal' is just to hopefully verify that what I'm dealing with is actually a sleep breathing disorder and that I'm on the right track to getting proper treatment.

Previous to this I was able to sleep 8-9 hours and feel well rested and energy with no issues whatsoever. These sleep issues seemingly came out of nowhere in early 2021 (no lifestyle changes or any clear event that caused it, pretty certain I never got covid) and I just feel a bit lost on what could be the true issue here (assuming its not SDB).

Here are a few screenshots from the past 4 weeks or so, each are a different pressure

[Sleeprider]

You have used the Vauto to good effect to address both apnea and flow limitation as well as RERA. There are a number of flow spikes through the night that suggest arousal, and we can use Oscar data to zoom in on the moments ahead of those spikes to see if it is related to respiratory resistance or effort, or if the events are spontaneous pr a change in sleep stage. For example, 10/27 at 00:20, 00:40, 00:50 and others. 11/5 at 22:55, 00:15, 02:30. They are pretty easy to pick out. Another tool you could use is when an arousal occurs, create an intentional leak to mark the time so you can go back and check the next morning.

Overall, therapy looks good, and I would not be surprised if your doctor advises that arousals may not be related to sleep disordered breathing. I think your best bet is to discuss your issues with arousals and your goal for better sleep. The sleep study and therapy data both argue against a serious breathing disorder as the source of the problem.