08-04-2024, 12:52 PM
(This post was last modified: 08-04-2024, 12:53 PM by sleepquality.)
Likely UARS - Help with initial bilevel settings
Hi all,
37M with nasal breathing and headaches/poor and fragmented sleep quality that started when I was about 12/13 and got worse in my 20s. I´m of normal weight, but with a typical ¨small jaws¨ risk factor for UARS in that I had premolar extractions and have a high narrow-arched palate. I had a septoplasty and turbinate reduction in 2021 that improved my nasal breathing moderately, but not my sleep.
I had done a WatchPAT study last year that showed moderate sleep apnea, and on that basis saw a sleep specialist ENT, who told me there was nothing obvious like large tonsils to go for surgically, although they could do a septoplasty revision to get it perfectly straight (it was 90% blocked and now like 15-20%) and possibly also address the nasal valve area. To try avoiding CPAP, recommendation was to try nasal dilators + MAD appliance. I´ve done both and the nasal dilators help very marginally, while the MAD has not seemed to help at all. I´m not a mouth breather, but I believe the issues come from nasal resistance (as opposed to in the throat) as I feel a bit like I´m slightly sucking air every time I breathe (even though it doesn´t turn into mouth breathing). CBCT scan from a dentist showed an airway volume of about 120.
I recently did the AXG type II sleep study, which found a 0.2 AHI, with an overall RDI (all RERAs) of 5.6, but notable, a REM RDI of 11.2. This makes sense as the later parts of my sleep usually seem much more traumatic/resulting in morning headaches vs the earlier parts of the night.
I think that overall based on my gut feeling and everything I´ve researched, I likely have UARS at least as a major factor in my sleep quality (I don´t have trouble falling asleep, but I wake up a bunch of times briefly and generally feel very fatigued and super headache prone, also have some acid reflux issues).
Reco from the AXG contact was to try to get Bilevel machine and do a trial, which is my immediate plan and hope to receive it this week or next.
I´m new to PAP therapy, so in terms of settings, I have a couple options I´ve heard - one is to set EPAP min at 5 and PS at 4, and max IPAP at 9 for a few days, then move min EPAP to 6, then 7, then 8, and check the data in OSCAR and take from there. Another is to set the PS to 4 and overall auto-bilevel range from 5-20 for a few days, and then base more stable settings based on where my 95% pressure is. I´m assuming what I´ll be looking for in OSCAR are flow limitations from everything I´ve researched. Does this sound good as a starting point, or are there any other recommendations from all of you with more experience on here?
37M with nasal breathing and headaches/poor and fragmented sleep quality that started when I was about 12/13 and got worse in my 20s. I´m of normal weight, but with a typical ¨small jaws¨ risk factor for UARS in that I had premolar extractions and have a high narrow-arched palate. I had a septoplasty and turbinate reduction in 2021 that improved my nasal breathing moderately, but not my sleep.
I had done a WatchPAT study last year that showed moderate sleep apnea, and on that basis saw a sleep specialist ENT, who told me there was nothing obvious like large tonsils to go for surgically, although they could do a septoplasty revision to get it perfectly straight (it was 90% blocked and now like 15-20%) and possibly also address the nasal valve area. To try avoiding CPAP, recommendation was to try nasal dilators + MAD appliance. I´ve done both and the nasal dilators help very marginally, while the MAD has not seemed to help at all. I´m not a mouth breather, but I believe the issues come from nasal resistance (as opposed to in the throat) as I feel a bit like I´m slightly sucking air every time I breathe (even though it doesn´t turn into mouth breathing). CBCT scan from a dentist showed an airway volume of about 120.
I recently did the AXG type II sleep study, which found a 0.2 AHI, with an overall RDI (all RERAs) of 5.6, but notable, a REM RDI of 11.2. This makes sense as the later parts of my sleep usually seem much more traumatic/resulting in morning headaches vs the earlier parts of the night.
I think that overall based on my gut feeling and everything I´ve researched, I likely have UARS at least as a major factor in my sleep quality (I don´t have trouble falling asleep, but I wake up a bunch of times briefly and generally feel very fatigued and super headache prone, also have some acid reflux issues).
Reco from the AXG contact was to try to get Bilevel machine and do a trial, which is my immediate plan and hope to receive it this week or next.
I´m new to PAP therapy, so in terms of settings, I have a couple options I´ve heard - one is to set EPAP min at 5 and PS at 4, and max IPAP at 9 for a few days, then move min EPAP to 6, then 7, then 8, and check the data in OSCAR and take from there. Another is to set the PS to 4 and overall auto-bilevel range from 5-20 for a few days, and then base more stable settings based on where my 95% pressure is. I´m assuming what I´ll be looking for in OSCAR are flow limitations from everything I´ve researched. Does this sound good as a starting point, or are there any other recommendations from all of you with more experience on here?
