[Symptoms] Oscar Help! Brain fog, fatigue, anxiety, etc.

[Jackpine]

I will thank you!

[DaveSkvn]

Hi Jackpine,

I've been looking into UARS for my own benefit recently. Its a somewhat confused topic.

Testing for / diagnosing UARS is very difficult even for tooled-up professionals. With OSAHS, the airways is totally/almost totally obstructed. Breath does not flow for 10+ seconds. You run out of oxygen in your bloodstream (read using a "SpO2" fingertip oximeter). The lack of oxygen wakes you (to some extent) leading to unrefreshing sleep.

With UARS the airway is always open - just obstructed a bit. You can breathe the oxygen you need - just more slowly and over a longer time. Because you get enough oxygen in the end, UARS does not show up on an "SpO2" fingertip oximeter trace. The nasal flow meters in a sleep tests can be bypassed if you breathe through your mouth etc. The unrefreshing sleep is believed to be due to the additional effort of breathing meaning you never get into a proper sleep.

I understand the key indicator is a "flattening of the inspiration part" of the flow rate graph.

A brief sidebar...

I have reason to believe my problem is 20% OSA and 80% UARS. Here is a graph from last week (shortly after I discovered Oscar).

   

The cluster of blue OA events is due to the positional Apnea I have when on my back (I've been filming myself with an infrared camera) - but that's another story. The new thing to me was where the purple respiratory rate climbs to over 40 breaths a minute. Flow limitations are detected. The "tidal volume" drops. The "minute vent" stays the same. I was more panting than breathing. The SpO2 is broadly untroubled - so I have enough oxygen (pulse - not shown - does nothing spectacular). That happened on both left and right side.

The positional OSA, I've just discovered from this board, is unlikely to respond to increases in pressure so I got a soft foam surgical collar and wore it on Monday for the first time. The flow limits recorded plummeted but are still present.

   

I max out at about 20 breaths per minute now. It looks much like your flow limits at 0300 and 0500 ish.

I've not been diagnosed with UARS - no medical pro has looked at this - so feel free to ignore my assertion that this is what UARS looks like.

Back to the main story...

You may recall that I asked a couple of days ago for a detail graph about 03:40. We need to compare that with your normal breathing. Here is something I did for a different post earlier today - all the graphs are from my data in the last week. The second graph is during flow limitations  of 0.1 being reported with the surgical collar on. (I've just noticed that the scales on the top two graphs are different which is not ideal. Focus on the shape rather than the height. Flow limitations should be wider and shorter above the mid-line.)

   

We need two screenshots from you to see if the flow limits show a "flattening of the inspiration part" of the flow rate graph - like the first and second traces. They should both be for the same length - say 1 minute - and ideally have the same vertical / y-axis scale. One should be awake / 'normal sleep' and the other when flow limitations are flagged.

[Jackpine]

Hi Jackpine,

I've been looking into UARS for my own benefit recently. Its a somewhat confused topic.

Testing for / diagnosing UARS is very difficult even for tooled-up professionals. With OSAHS, the airways is totally/almost totally obstructed. Breath does not flow for 10+ seconds. You run out of oxygen in your bloodstream (read using a "SpO2" fingertip oximeter). The lack of oxygen wakes you (to some extent) leading to unrefreshing sleep.

With UARS the airway is always open - just obstructed a bit. You can breathe the oxygen you need - just more slowly and over a longer time. Because you get enough oxygen in the end, UARS does not show up on an "SpO2" fingertip oximeter trace. The nasal flow meters in a sleep tests can be bypassed if you breathe through your mouth etc. The unrefreshing sleep is believed to be due to the additional effort of breathing meaning you never get into a proper sleep.

I understand the key indicator is a "flattening of the inspiration part" of the flow rate graph.

A brief sidebar...

I have reason to believe my problem is 20% OSA and 80% UARS. Here is a graph from last week (shortly after I discovered Oscar).



The cluster of blue OA events is due to the positional Apnea I have when on my back (I've been filming myself with an infrared camera) - but that's another story. The new thing to me was where the purple respiratory rate climbs to over 40 breaths a minute. Flow limitations are detected. The "tidal volume" drops. The "minute vent" stays the same. I was more panting than breathing. The SpO2 is broadly untroubled - so I have enough oxygen (pulse - not shown - does nothing spectacular). That happened on both left and right side.

The positional OSA, I've just discovered from this board, is unlikely to respond to increases in pressure so I got a soft foam surgical collar and wore it on Monday for the first time. The flow limits recorded plummeted but are still present.



I max out at about 20 breaths per minute now. It looks much like your flow limits at 0300 and 0500 ish.

I've not been diagnosed with UARS - no medical pro has looked at this - so feel free to ignore my assertion that this is what UARS looks like.

Back to the main story...

You may recall that I asked a couple of days ago for a detail graph about 03:40. We need to compare that with your normal breathing. Here is something I did for a different post earlier today - all the graphs are from my data in the last week. The second graph is during  flow limitations  of 0.1 being reported with the surgical collar on. (I've just noticed that the scales on the top two graphs are different which is not ideal. Focus on the shape rather than the height. Flow limitations should be wider and shorter above the mid-line.)



We need two screenshots from you to see if the flow limits show a "flattening of the inspiration part" of the flow rate graph - like the first and second traces. They should both be for the same length - say 1 minute - and ideally have the same vertical / y-axis scale. One should be awake / 'normal sleep' and the other when flow limitations are flagged.

Thank you for the helpful response! Here are a couple of different snap shot comparisons during periods of flow limitation. The flow rate appears very choppy and flat-tops at the peak of inhalation. 

   

[DaveSkvn]

Looks like plenty of flat tops there.

My understanding has evolved a bit since then. You might want to have a read of:

https://www.apneaboard.com/forums/Thread...#pid541651

And (esp. the "awkward" bit towards the end about Auto CPAP machines only looking for OSA-type breathing problems and not UARS-type breathing problems)

https://www.apneaboard.com/forums/Thread...#pid541885

In short I wouldn't necessarily trust an auto CPAP algorithm to choose the right pressure if you have UARS-type breathing issues. It might be worth setting a relatively high "min" pressure so that you don't need the algorithm to detect/react to things.

I only just noticed you had high breathing rates logged on 24 Dec posting (something I also saw in my plots). I see they come in patches which would indicate they may well be positional. If you don't know which position caused them, it might be worth investing in a cheap Infrared webcam and recording yourself sleep. You can then attempt to avoid that position.

From what I've read, I wouldn't be surprised if the current issues are different from your original OSA issues. It may well have resulted from the neck injury in March - your body started wanting to sleep in positions that don't necessarily facilitate easy breathing.

[Sleeprider]

Jack, you need to increase EPR to 3 and let's try Autoset mode for a while to see where pressure settles in. Your fatigue comes from an increase in flow limitation, and my be due to normal aging, weight gain or just an increase in upper airway resistance. You're not alone. Bear with me, and let's try minimum pressure 8.0, maximum pressure 12.0 and EPR full-time at setting 3. I'm pretty sure we can decrease your flow limits, and that should translate to better sleep quality.

[Jackpine]

Jack, you need to increase EPR to 3 and let's try Autoset mode for a while to see where pressure settles in. Your fatigue comes from an increase in flow limitation, and my be due to normal aging, weight gain or just an increase in upper airway resistance. You're not alone.  Bear with me, and let's try minimum pressure 8.0, maximum pressure 12.0 and EPR full-time at setting 3.  I'm pretty sure we can decrease your flow limits, and that should translate to better sleep quality.

I will give this a try and report back! A couple questions:

Should I keep ramp off?

I saw that even though I use a dreamwear nasal pillow mask I should keep the mask settings at full face mask. Is this true?

[Sleeprider]

If you tolerate the starting pressures without ramp, there is no benefit to ramp. Most members here have no need for ramp which is just a way to make COAP tolerable for new users. 

As far as I know you should be using the nasal pillows setting for that mask.

[Sleeprider]

If you tolerate the starting pressures without ramp, there is no benefit to ramp. Most members here have no need for ramp which is just a way to make COAP tolerable for new users. 

As far as I know you should be using the nasal pillows setting for that mask.

[Sleeprider]

If you tolerate the starting pressures without ramp, there is no benefit to ramp. Most members here have no need for ramp which is just a way to make COAP tolerable for new users. 

As far as I know you should be using the nasal pillows setting for that mask.

[Jackpine]

Here are the last 2 nights of sleep. Please let me know which time frames would be helpful to zoom in on to get more screenshots. Thank you so much for your help!!!

1/1
   

12/31
   

Last night was the typical amount of time I have the mask on for (8-9 hours). Woke up feeling terrible. extremely tired, left shoulder/trap was tight and raised. left jaw sore from clenching, tinnitus in left ear was ringing at an 8/10. Anxiety through the roof. Dizziness/off-balance. Heightened sympathetic tone.... One interesting note is that I tried sleeping on my left side for the first time in a while. I got through most of the night on that side, but then turned over to my right side at some point that seemed to be more than half way through the night. Woke up on my back all sprawled out lol. I sleep with a Medcline incline wedge and body pillow. I have the smaller of the two incline pillows.

More background info I should have mentioned:

I recently started working with a PT that is certified in PRI and AIA. He identified I have trouble breathing into the right side of my chest. He gave me some exercises and they have been helping already after 2 weeks. He also examined my mouth and identified I do have a mild tongue tie and have a hard time keeping my tongue on the roof of my mouth. I have a consult scheduled to see a myofunctional therapist. I'm sure this is causing restriction in my upper airway.

I also mouth tape at night. Leaks usually are only an issue if the tape comes loose throughout the night. I have a beard and it happens from time to time.