My sleep studies' results, asking for your help/opinion

[DavidAM]

Hi! I'm a 21-year-old with progressively worsening EDS and brain fog which started around 5 years ago. Since then, I've come to be sleepy and very foggy (which I consider worse than sleepiness) all the time, everyday. I had loads of medical tests until I got to sleep apnea, and that's why it took me so long to get here. I'm not overweight, and I'm fairly active; I occasionally weight-lift, and my BMI is 24.1. (I'm 181 cm tall/5.11, and I weight 79kg/174lbs)

Some months ago I got in contact with a sleep clinic's neurologist, and she prescribed me an in-lab PSG, which I underwent. My results were a mild apnea (7.3 AHI) and 300 "spontaneous arousals" (41.4 arousal index), and no RERAs, as that hospital turned out not to record RERAs, unfortunately. I wasn't on any medication at the time of this PSG. Seeing this, my neurologist prescribed me gabapentin (900mg/night), which I still take, in order to stabilize my sleep and decrease the number of arousals. 

After doing some of my own research and stumbling across UARS, I booked an appointment with that same sleep clinic's neumologist, which told me to get a WatchPat One test done. So I did. I'll upload the report down below. I underwent that at-home test while taking gabapentin, and my pneumologist was aware of it; she said that it would give us an estimation of RERAs, anyway. 

I wanted to ask you all, what does this seem like to you? OSA? UARS? Neither my pneumologist nor me know quite well what this is, but I'd like to hear your opinion and recommendations regarding treatment; I think it's weird that my RDI is 31 during REM. I'm currently two days into my ResMed Airsense 10 (For Her) treatment, and I'm seeing an otolaryngologist next week, as I have a stuffy nose almost all the time. I'm using a 4-13 pressure range, and my AHI was 3.2 last night.

Thank you in advance for any help.

[DavidAM]

Update: I just switched my EPR to 2 for the entire sleep time (and not just the ramp time) and my pressure range from 4-13 to 6-15, as I seem to hover around 12 all the time (or so it says on my Airsense 10's screen).

[PeaceLoveAndPizza]

Please post some OSCAR charts. That will help quite a bit. The links in my signature explain how to format the charts.

[DavidAM]

I will post them! I'll get my SD-card reader tomorrow.

[staceyburke]

Until we can see OSCAR charts give this a try 

EPR full time
EPR 3
Min 8
Max 15

[BoxcarPete]

REM dominated OSA is a thing that is acknowledged by the medical community, but is generally considered a simple curiosity and not indicative of any particular cause or requiring any particular treatment plan. I personally had AHI of 25 in REM and 0 in nREM according to my first sleep study.

I would recommend that you keep your ENT appointment, as I have noticed a pattern that UARS in younger people is most likely to be caused by an anatomical obstruction that is resolvable by a corrective surgery (think tonsils, nasal structures, etc). Your described symptoms are also quite familiar to me.

I haven't been as active here lately as I was some months ago, the reason is that I had a triple nose surgery, and it WORKED. AHI is down to 0 in the sleep lab, though it was still around 3 at home according to the home study. People will tell you that if one nostril works better than the other you likely have a deviated septum, but I didn't notice that in particular. What I had was a deviated septum to the left and a bone spur to the right, so both sides were equally obstructed. I also had significant adenoid tissue removed which I believe was the most important factor in my success, as I have had it done twice and both times was life-changing.

[DavidAM]

Thanks a lot to you both! BoxcarPete, upon a quick inspection of my ENT during my last appointment with him, he found out that I have a large nose cavity, and an MRI from a couple of years ago showed an inflamed turbinate; does this resemble what you were thinking? Also, did you also wake up every morning with a dry mouth? If so, and before being able to think about a potential nose surgery, is sleeping with a nose mask and my mouth taped enough?

[BoxcarPete]

Enlarged turbinate can contribute if other factors are present. My ENT said that he has noticed the pattern in sleep apnea patients that it's not just the size, but position as well. Apnea patients he says tend to have turbinates that go farther back toward the nasopharynx. This combined with removal of the adenoids cleared my issues up nicely. Your mileage may vary. If the only thing they have found is some turbinate swelling, the recommendation might be a medicated nasal spray, but I wanted surgery because I only had to suffer once and I don't need to maintain a routine to reap the benefits.

Was your evaluation by scope or just looking? Additionally, in the MRI was the imaging done for your airway or was the turbinate swelling just an incidental finding?

Adenoid tissue is unusual in adults, but if it's there make sure you get it taken out. Made all the difference to me.

Edit to answer other questions:

I only had dry mouth when I used an oral appliance to position my jaw. Didn't end up working all that well and caused other trouble so I switched to CPAP, where I definitely had the best results with a nasal mask and mouth tape.

[DavidAM]

After changing the pressure from 4-12 to 8-16 and the EPR settings as per the indications that @staceyburke gave me, I wanted to wear the mask for a while with the APAP on and see how well I could adapt to the new pressures, and I felt like I couldn't breathe; even now, like 15 minutes after taking the mask off, I still feel a little out of breath. Is this normal?

To @BoxcarPete, my evaluation was by scope, and the MRI was initially directed at studying my brain, I think; back then, I was worried I had some sort of brain injury or disease due to my brain fog and sleepiness. Thank you for the info on everything else, btw; I'll keep you updated on the matter.

[BoxcarPete]

EPR is something that most people like because it reduces pressure on exhale. I personally never cared for it and found it disruptive to my natural breathing pattern. There are some things we look at in OSCAR that are typically associated with upper respiratory resistance which can be improved through the use of this feature, so your mentioning UARS in your original post was probably what led to the recommendation in the first place. It's an optional machine feature that was put there for your benefit, but if it's not helpful to you, don't use it.

As for feeling breathless for some time after taking the mask off, that's most likely a psychological thing. Breathing is closely linked to anxiety in a number of ways, so it's possible that you were feeling stressed about the way your breathing was, which caused some breathing trouble to persist for a few minutes. The best way to use the machine is to relax and let the air out passively; exhalation should require no effort, even with pressure. Your lungs may feel a little more full when you inhale, but you will cycle a normal amount of air this way.