[Diagnosis] WatchPAT sleep apena diagnosis low AHI higher RDI. Need advice

[godiego]

Found this looking for WatchPAT posts but saw no one replied to your latest post so wanted to let you know the obstructive events are because your EPAP minimum is set too low so you may consider raising it to 8 and then adding 1cmH20 per night until they entirely disappear optimally.

Thanks for your reply to my old post! I am going to try CPAP again (fell out of compliance) and will try your suggestions. 

In the meantime, I visited more specialists for more information:

• According to an ENT & facial plastic surgeon, my nasal airways are ~75% blocked due to nasal valve collapse, very deviated septum & enlarged turbinates. 
  
• Mallampati class III with macroglossia tongue & scalloped edges, meaning my tongue is too large to fit in my mouth 
  
• What I think is happening is: while I sleep, nasal breathing difficulty causes me to switch to mouth breathing, worsening the oversized tongue problem
  
• In REM sleep, my tongue muscles relax further, causing my oversized tongue to fall back & seal my airway, disrupting my REM & overall sleep 
  

My nasal valve collapse was worsening and I couldn't comply with the nasal CPAP due to pain, and then my power was out for 3 days, so I tried to keep my nasal passages open with nasal strips & flonase and found I had no problems getting to sleep and my o2 levels were averaging 96%. But, I don't think the problem is solved.

I have been getting by with nasal strips & flonase, but want to start using CPAP again or trying a mandibular advancer or tongue retaining device, because I still am waking up unrefreshed, exhausted & brain fogged. My sleep is not restorative and I think my oversized tongue is causing airway obstruction in REM sleep. 

So - I am in the market for a full-face mask that isn't nasal pillow due to worsening nasal valve collapse. I would use nasal strips under this mask with flonase. 

I would like to thank the forum, and thoughts or comments about my situation are welcome.

[Gideon]

In your last charts your OA events are well managed but I'd increase your min EPAP to 10, which is a bit less than 2 below your med pressure. Also you're flow limits are high which could correlate with your nasal issues. For that I would try a higher PS so set PS=4.

[godiego]

Back to trying CPAP/BiPAP again after trying many masks; my nasal issues are too severe to use nasal masks, and I'm currently using a Resmed Quattro Air full-face with a knightsbridge chin strap. 

I took a video recording of my sleep (sans mask) and noticed a few things: 

• When I'm sleeping on my side and one side of my nose is resting on the pillow, inhalation collapses my nose, causing a sleep disturbance
  
• I rolled onto my back and started mouth-breathing, which appeared to cause a sleep disturbance. This was the worst position in my sleep study for disturbances  
  

I've started wearing a t-shirt with tennis balls on the back to hopefully stay off my back. 

Here is another chart - I'll try bumping up the min. EPAP to 10 and see what happens. 

Also - does my sleeping pulse rate chart look normal? I seem to average 75bpm while asleep, which seems high. 

Thanks!

[godiego]

Another update - I have gotten a few nights of AHI 0 using a soft cervical collar. I think my sleeping head position is part of the problem. When my head droops down, I can easily seal my airway by relaxing my tongue (which is already too big for my mouth, Mallampati score III). 

Now, I have a new issue which is aerophagia waking me up after ~4-5 hours. I'm also having a lot of flow limitations that correspond with pulse spikes, so I think some of my flow limitations are causing RERAs. 

So - if I can resolve the aerophagia and flow limitation issues, I think my sleep disordered breathing could be treated. I welcome any advice about what pressures or things to change next. Thanks!

[godiego]

Sorry for the bump - 
Aerophagia seems to have gone away, and my latest things to work on are reducing my flow limitations and trying to sleep more than 5-6 hours using the machine.

[godiego]

It seems like going to an in-lab sleep study lacking the ability to officially diagnose UARS was a mistake, because I'm currently attempting to self-treat a sleep disorder that I'm not entirely sure I have. Maybe it's time for me to travel for a more accurate sleep study. 

In the meantime, my current experiment is reducing flow limitations with increased pressure support. I'm just going to try it for a few months and see if I'm feeling better.