PSG Results: Could this be UARS?

[Geer1]

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.

And his spontaneous arousals were far worse than that. His arousal index in N2 was probably over 60 and I am sure it is the issue, the question is why?

Not sure what your doctors commented about regarding the arousals, might be worth bringing it to their attention if they just glossed over it. Maybe need to get a referral to see a sleep doctor that specializes in those issues.

[sheepless]

deebob, in my experience, stress and anxiety seem to trigger or aggravate restless legs. I assume the same with plm but obviously can't be sure because I'm completely unaware of it. otoh, my restless legs come and go while plm seems to be every night so maybe it's not a clean assumption relative to plm. regardless, my personal experience based intuitive guess is that if rls/plm is affecting you, it's quite possible it's intermittent.

[Geer1]

I believe these things can also be set off by tiredness and lack of sleep itself. I have minor hand tremors and they can be noticeably worse when I am tired or anxious. I don't believe sleep or anxiety are the causes of the tremors(have had them for years now, well before I believe sleep was an issue) but I do know for certain they make them significantly worse so I now accept that and avoid aggravating them.

[deebob]

Here are my charts from last night. https://imgur.com/a/Foj0qkX

I got a call to go in to work for a company (I'm a freelance video editor) so I was a bit anxious about getting a good night sleep...I managed to sleep OK for the first few hours of the night, but woke up a couple times. And then I couldn't get back to sleep from about 430 to 630, and I might have slept a little bit before 8 AM when I needed to get up but barely.  I think the CPAP is making insomnia a bit worse in the middle of the night. I do okay for the first part of the night but then when I wake up in the middle of the night I have a tough time getting back to sleep with it. So I took it off from about 630 to 8 and might have got a bit of sleep in there. I'm super tired today so hopefully I can sleep better tonight. I'm curious if I could use higher pressure, since it was going up to 9 when I was on auto. I wonder if it's worth setting a range up to something like 11 just to see if it ever goes that high. I had it at 8 and I think the flow limitation was maybe a bit better.  I think I was also sleeping on my back for the first 3 hours of the night which I usually never do so that probably made breathing/snoring worse.

[tarah]

Have you had an ENT take a look at your nose to determine if there is a physical obstruction?

[Dormeo]

With your AHI so low, you have plenty of room to experiment if you want to. But I'm not sure what you're aiming to accomplish with higher pressure. Your FLs don't look so bad, and if I can draw one tentative conclusion from your full chart, it is that mouth leaks may have awakened you twice. Higher pressure could make it harder for your to control mouth leaks.

In several of your zoomed-in charts, we see a flow rate in which the area over the zero line for inhalation is greater than the area under the zero line for exhalation. I would have supposed that this meant you were having air escape from your mouth, but you are not showing leaks in those spots. I know I've seen this discussed in other threads, so I hope an expert will be along to shed light.

[JoeyWallaby]

Looks similar to what my mum had...

Yours



That breathing pattern improved when taping her mouth and went away once she switched to BiLevel/ASV (with mouth tape).

[Geer1]

The moments where exhalation is restricted for both Deebob and Joey's mom appear to be related to palatal prolapse (when palate blocks airway during exhalation). 2:59:40 is best example of this. Take a look through data and see if you believe this is a one off or if it appears to be happening elsewhere.

The reason for lack of leak is because the palate seals (or close to seals) so air doesn't leak past. He likely exhaled through mouth at those points.

I have noticed the odd episode in my own data. I assume like flow limitations it is mainly only an issue if it happens regularly and is causing arousals.

[deebob]

I actually sleep with my mouth taped, so I don't think there's anything going through my mouth. But I did see an ENT who stuck a camera down my nose and looked at the space in my nose and my throat. He honestly wasnt a great doctor, and was kind of a grumpy old guy with not a lot of patience so it wasn't very thorough, but he did notice that my nasal passage was kind of narrow, and the space in my throat is pretty thin.  He actually diagnosed me with UARS based on his physical examination and a few nights of home oximetry tests. And every other doctor or clinician I saw was kind of scratching their head that he diagnosed me before I had even done a PSG or anything. He may be right but there definitely wasn't a lot of conclusive evidence to make that diagnosis so his credibility is a bit questionable. 

 I have a narrow high arching palate and my mandible is set back a little bit, which seems to be common for many people with UARS. His report says I have a shallow velopharynx which would make sense with what Geer1 said about my palate prolapsing. I've attached his report which shows some (crappy) images of my nose and throat.

I've been looking into methods of doing palate expansion to fix my malocclusion and narrow palate, but it is pretty challenging in adults and there are a lot of conflicting reports about the success people have had doing this so it makes me a bit nervous. But I am pretty sure whatever is going on in my mouth/throat is not actually that major since I don't have severe OSA. So I feel like if I could get a slight bit of expansion in my palate it could potentially make enough of a difference to reduce flow limitation.

[JoeyWallaby]

What's your mallampati classification and intermolar width?