PSG Results: Could this be UARS?

[jomama]

Everything you're saying is so familiar. Especially the "tried and ruled out everything" stuff. And being sick of trying things. I even tried the "stop thinking about it," but of course that didn't work either. I have gone to bed many times feeling totally at ease, and BAM! I'll have terrible anxiety dreams, or extra broken sleep/more awakenings (I tend to wake up 25-30 times a night, most of which I don't remember). It's almost like my mind balances it out if I have a really good day emotionally. And sometimes when I was really depressed, and had a terrible day, I'd sleep a little better. There's no rhyme or reason. I have thought often of PTSD stuff, given that I have been through some really difficult stuff that no question damaged me emotionally and physically (result of prolonged intense grief). Maybe my sleep is permanently screwed up because of that. But I've always struggled with sleep, at least as an adult. It's just feeling worse as I get older (makes sense), and being hit with that intense grief for so long...a couple years... I feel like it's maybe a combo burrito, of trauma reactions during sleep, combined with mild-to-moderate flow limitation issues, which themselves may trigger the trauma stuff worse than it used to.

So, yeah, I feel your pain. It's been extremely frustrating, especially since I have difficulties with PAP given that the flow limitations require higher pressures. In your case, if it were me, I'd do a set trial of a month or something on the PAP, since you can use low pressures and seem to tolerate it. If after a month I wasn't seeing any benefit, I'd probably let it go. Heck, I WISH I was in that position. I'm kind of stuck, being unable to rule out PAP therapy helping because I can't get it going enough. And, as you mentioned, PAP is disruptive even more than normal, which just adds to the brokenness of the sleep, making everything harder. It's a really hard position to be in. So, yeah, I feel ya.

[Dormeo]

"Whatever's going on is probably just much bigger, and unfortunately probably has more to do with my overall life situation. It also probably doesn't help that sleep has become the entire focus of my life right now. I almost want to just take the power away from it and stop thinking about it, stop talking about it, stop taking all the little supplements like valerian/magnesium/melatonin/Ashwaganda/ that seem to be doing nothing, and just go back to behaving the way I did a year ago when everything was 'normal'."

Two interesting ideas in there that you could act on. One is to get some professional help, even short-term, with your overall life situation, e.g., trying to decide whether this is the wrong time in your life for free-lancing. And another is to dial down the intensity of your focus on sleep, understandable though it is. That could take concrete forms: e.g., for one month, no more supplements and no more looking at Oscar. (But continue CPAP!) Then see how you feel.

You've just reminded me of a passage I like:

"You can’t, in most things, get what you want if you want it too desperately: anyway, you can’t get the best out of it. “Now! Let’s have a real good talk” reduces everyone to silence. “I must get a good sleep tonight” ushers in hours of wakefulness."—C. S. Lewis

[jomama]

I'd also like to point out that, from my own experience having tried it for chronic pain, as well as lots of research, I've come to the conclusion that in affordable, reasonable doses, CBD is effectively snake oil. Unless I'm mistaken, the research indicates that it MAY have an effect at high doses (hundreds of mg), but given how expensive it is, those doses are not financially realistic for most people, and there's no real long term research on safety. Lots of people swear by low doses of CBD, but I think it's placebo effect (no offense intended to those people).

[tarah]

Hi.  Have you had an ENT take a look at your nose/sinuses?  I think these graphs, especially of flow limitations, can be quite misleading.  What can appear to be "minor" chronic flow limitations can actually be quite devastating in terms of sleep quality.  And as my sleep doctor just reminded me, take anyone, and basically choke them a little bit all night long for months/years/decades and tell me if they don't have depression and anxiety.

[tarah]

I will add one more thing.  I was just reading about how people with UARS have an intact nervous system, meaning that their nervous system is what senses that are being choked/not receiving enough air.  It is this fight or flight system that is being activated hundreds of times per night.  It is why people with UARS almost always have high levels of anxiety.  People with more overt apnea have nervous systems that do not register that they are being choked.  There is some speculation that heavy snoring may help to desensitize certain areas of the throat over time.  It is falling oxygenation levels that alert their body to the fact they must wake up, and that is much less associated with anxiety symptoms.

[Geer1]

I'm not writing breathing off yet, for someone with almost non existent ahi/rdi your charts show more odd periods of breathing than others on here. The hard part is understanding why, is the breathing the issue or is the breathing being caused by something else. For example when my breathing looks the strangest it is usually correlated with body movements (twitches etc) and the odd breathing usually follows those twitches so I have thought it is the twitches that is the issues and not the breathing.

If you want to try to diagnose more setting up something to record yourself sleeping is the next step imo.

Unless I missed it I don't believe you posted examples of those periods of snore. Please do so as that could be a good indicator of potential SDB.

You could try increasing pressure a cm or two and see if that seems to affect things at all. Try two but if it feels uncomfortable just do one.

Another thing I have issues and have been working on is that my guts are a mess. Doctor says probably ibs. It is fairly common and related to a number of these things especially anxiety etc. Fiber supplement has helped regulate things and I am trying probiotics now. Something to consider, bad guts can mess up a lot themselves. I haven't mentioned it too much on here as I am still waiting to see how much improvement I get from treating the problem.

[deebob]

I'm not writing breathing off yet, for someone with almost non existent ahi/rdi your charts show more odd periods of breathing than others on here. The hard part is understanding why, is the breathing the issue or is the breathing being caused by something else. For example when my breathing looks the strangest it is usually correlated with body movements (twitches etc) and the odd breathing usually follows those twitches so I have thought it is the twitches that is the issues and not the breathing.

If you want to try to diagnose more setting up something to record yourself sleeping is the next step imo.

Unless I missed it I don't believe you posted examples of those periods of snore. Please do so as that could be a good indicator of potential SDB.

You could try increasing pressure a cm or two and see if that seems to affect things at all. Try two but if it feels uncomfortable just do one.

Another thing I have issues and have been working on is that my guts are a mess. Doctor says probably ibs. It is fairly common and related to a number of these things especially anxiety etc. Fiber supplement has helped regulate things and I am trying probiotics now. Something to consider, bad guts can mess up a lot themselves. I haven't mentioned it too much on here as I am still waiting to see how much improvement I get from treating the problem.

I attached the zoomed in screenshots of my snoring sections on the last page (Page 10).

I think I might try increasing my pressure to 9 to see what that does, since it did go up to that when I had it on auto. But it is hard to tell if the CPAP is really affecting my sleep positively. I seem to be mostly dealing with insomnia type issues, but who knows, maybe I am waking up from breathing issues too. 

I am also starting to wonder about the restless leg thing. I have had feelings of restlessness in my legs the past few days, and sometimes I catch myself twitching or having hypnic jerks, which may or may not be normal....and my PSG did show some limb activity. I just don't think I was experiencing anything like that a few months ago so I'd be surprised if that's been the issue all along.  But I just purchased a night vision security camera off Amazon so that I can watch myself sleeping to see if there's anything crazy going on. That is a good idea.

I have noticed some feelings of irritable bowels at times of greater anxiety....it's currently been a bit stable the past couple weeks, but sometimes can act up if I become more stressed. It was noticeably worse around the time of my sleep study when I was really anxious about that, and anxious about getting the results.  I have been taking a priobiotic and trying to eat foods that are better for the gut. I should get some more fiber in my diet and get some kimchi and other stuff like that as well.

[Geer1]

Hypnic jerks are normal when falling asleep. Jerks and twitches can be caused by all sorts of things from what I understand which is why I am now scheduled for my own PSG to try and diagnose mine. I was less focused on it with yourself because you already have had the PSG and I would assume they would have been able to determine if they were an issue or not. I believe RLS is more of an issue when awake rather than asleep.

It took me at least 2 weeks before I started to feel like CPAP was helping. The first week my sleep was crap and I was about ready to throw the thing out because I could barely function at work I was so tired from sleeping less with the machine. 3rd week in I started to realize it was helping. That is why I have been saying we need to give this time, there is a good chance it may hurt your sleep more than help it during these first days.

[sheepless]

yes give it time but jerks & twitches aside, the OP had 6.8 plm arousals per hour in the sleep study. I know I feel like you-know-what when I wake or partially wake 6 times an hour all night.

[deebob]

It’s also very likely that the PLMs during my PSG were a lot worse than normal because I was extremely anxious that night. I was literally shaking when I first went to bed and they turned the lights out. I was so anxious I went to the bathroom like 3 times in 90 minutes. I eventually just took the Trazadone pill I brought just in case or else I would probably not have slept at all. They put me to bed at like 11:45pm and woke me up at 6 AM. So I only had a few hours to sleep at best since there was no way I’d fall asleep in under an hour or two. So my guess is those circumstances made my limb movements worse. Probably the same way my legs have begun to feel more restless and twitchy recently since I’ve been under more stress and been more sleep deprived. Because these symptoms did not exist even a couple weeks ago, let alone several months ago when my sleep started to get really bad.