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New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
#1
New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Hello all,

It's been ~1 year since my OSA diagnosis via PSG and I'm struggling to get any kind of relief. My doctor didn't mention this at the time but I believe I really have UARS as I have low AHI + high RDI, severe daytime fatigue, and severe memory/concentration issues. My initial sleep study found AHI 3.3, RDI 28.2, and PLMS index 85.1 which alone resulted in 16.7 arousals/hour which was a huge surprise to me. I've been told I move around a lot in my sleep but I didn't expect something that severe given that I have zero restless leg symptoms during the day.

I first tried oral appliance therapy for ~2 months and felt no relief in symptoms. I did a follow up PSG while wearing the appliance which showed AHI and RDI decreased to 0.3 and 9.1, but PLMS index increased to 89.5 and spontaneous arousals increased from 2.7/hour to 11.8/hour so I'm skeptical of this "improvement" with OAT. I discontinued OAT due to lack of symptom improvement and tooth/jaw pain.


I then tried APAP therapy with RedMed AirSense 11 and heavily struggled to tolerate it due to difficulty exhaling. I maxed out EPR but only noticed a slight difference, so I went to an ENT to get my airway evaluated and found I had a severely deviated septum, turbinate hypertrophy, and interior nasal valve collapse. I had the Vivaer procedure at my ENT to address these and after my recovery I noticed a huge difference in my nasal breathing; nasal breathing felt so much easier, especially exhaling. I also started on regular Cetirizine and Flonase to address any allergy issues.

Even despite my nasal breathing improvements, I still can't tolerate my APAP even at a low pressure (4.0-9.0). I can at least tolerate it while awake now, but  I always end up taking the mask off 1-3 hours into sleeping and don't remember doing it. I don't know how to keep the mask on the whole night since I don't remember taking it off, and I'm really struggling with symptoms at this point and nothing has provided any relief.

Can anyone point me in the right direction on getting some kind of relief? I've posted my last few nights OSCAR results if that helps.

Also just wanted to express my gratitute and appreciation for everyone on this forum, I've learned so much about OSA and especially UARS and it's given me so much validation and explanation that my sleep doctor hasn't.


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#2
RE: New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Please read the link in my signature “Formatting OSCAR Charts” and repost. We need to see those specific charts to better assess what may be going on.

My instinct is your pressure is too low. You can have a great AHI but still feel like a dog’s breakfast in the morning. I need to see the proper graphs though to offer any suggestions on what I think you should be using.
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#3
RE: New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Sorry about that, new screenshots are attached


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#4
RE: New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Thanks, much better.

I still believe your pressure is too low. You have a great AHI, but it is so low you are taking off your mask whilst asleep due to not being able to breathe. You are basically gasping for air, which likely is the root cause for the suspected UARS.

Try the following:

Mode APAP
Min pressure 7
Max pressure 12
EPR 2 full-time
No ramp

Give that a go for a few days. Let us know how you feel and post a few charts.
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#5
RE: New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Thanks so much for the tips!

Are these settings something I can adjust myself or does my doctor have to do it? I know they have some kind of remote management bc that’s how they set it up originally.
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#6
RE: New User with Suspected UARS, No Relief From OAT/CPAP/Nasal Surgery
Indeed you may. Go to the following link and find the clinician/setup manual for your machine. It is simple once you have the decoder ring.

https://www.apneaboard.com/adjust-cpap-p...tup-manual
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