[Treatment] UARS suggested settings?

[taikoe]

Hello! I’m trying to solve a sleep onset and wake issue, along with a few abrupt night wakings with an increasing heart rate that causes a major stress reaction; I believe my condition is UARS.

I’m a historic stomach sleeper with my face turned to the side - I think that’s enabled my marginal unrefreshing sleep for so many years.

My first week of CPAP was a game changing experience - I could breathe easily throughout the night and no longer had *as many* awakenings in the “wee-smalls” (1-4am).

OSCAR has been amazing too - I really love the program! 


I’ve also been using a FitBit Versa 2 to track my Heart Rate and Sleep Stages throughout the night - their algorithm/Sleep Score seems to align pretty well with how I perceive my sleep quality.


With 2 young kids and pandemic homeschool life it’s been very difficult to troubleshoot/optimize my sleep therapy. I’ve been digging through the forums to see similar results/findings to help optimize my therapy further — I really loved the positive vibe and deep expertise (!!) -- and thought it was time to reach out for support.


I GREATLY appreciate your thoughts and comments on my data below; although getting better, I still have a really tough time with sleep onset because I jerk/snap awake as I am drifting off.

Most nights I resort to 25-50mg Benadryl as a sleep aid, which I would like to discontinue if I can get the CPAP dialed.


Data:

WatchPAT home sleep study - 1 night

8.5hrs recorded
1.4/hr  Apnea/Hypopnea Index
92% Min 02 Sat
15.8/hr = RDI 
Per doc “Testing consistent with OSA; NCPAP recommended”

Age 45
5 ft 9in
165lbs
Athletic build, cyclist
Short jaw, overbite, smallish face
History of GERD/LPR - have recently eliminated caffeine and alcohol; no eating 3hrs before bedtime.


-taikoe

[OpalRose]

You could try using some EPR (Expiratory Pressure Relief).  Set it at EPR 2 and watch for a couple days. Note how you feel.
We don't wan't to create more CA's. If that happens, please repost your graph for further advice.

You may need a slightly higher minimum too, but make one change at a time.

[slowriter]

I agree with OpalRose. The EPR in effect works like pressure support in a blievel machine, which can help address flow limitations that can result in the RERAs associated with UARS.

How long have you been using the CPAP?

[taikoe]

Thank you OpalRose for the prompt response! I'll give the EPR a try and report back with data. 

I agree the minimum pressure hasn't really felt like enough to counteract the UARS effect at sleep onset; however, during the night it seemed ok (I was awaken briefly but gently fell back to sleep is my general recollection). 


Slowriter - I've been using CPAP for about 45 days. 

I'm also wondering if a tongue restraining device (TRD) would be better solution to the root cause - I've tried one briefly, it was fairly uncomfortable and I think the UARS effect still disrupted my sleep onset even with it in - perhaps I need to try some other ones. 

CPAP and the OSCAR data review has been a much more comfortable approach but my sleep quality has been all over the map.

[taikoe]

Here's the last 2 nights - even though I had an AHI of 0.0 Sep 3 (!!), I had poor sleep at 330+AM due to what I can best describe as jerk-awakening.

I took Benadryl as a sleep aid that evening; and that's about the time it might be wearing off?

I put a new mask & nasal pillows evening of Sep 3 because I though the prior evening leaks were due to mask wear. Still see large leaks, however.


Could a sleep guru look at the Sep 3 330+AM detail and offer thoughts on what is occurring? 

I can zoom-in for detail but am uncertain which parameter is most helpful (I'm so new to this).


-taikoe

[slowriter]

You've obviously got some leak problems you want to resolve.

Also, have you tried an EPR of 3?

[taikoe]

I need to research where leaks arise can from - I sometimes mouth tape but end up pulling it off during the night - I'm uncertain if mouth breathing shows up as a leak?

I was going to stick with the EPR 2 for a handful days just to see how things track.

And although I don't think I've ever had an AHI at 0.0 in the last 45+ days, I don't perceive much of notice a difference with it on/off in either breathing difficulty or my sleep quality.

I'd be in the sweet spot of sleep quality if I can get 2 more hours of sleep per night without these arousals on the start/tail ends. 



Outside the pressure therapy, I am starting Flonase in the AM and Claritin in the PM to see if my sense of smell can improve and how the sleep quality improves. 

I have moderate seasonal allergies/california wildfires/pollen and wonder if the UARS is due to allergies/allergic rhinitis inflammation. I thought the Benadryl dose in the PM would handle that, but perhaps not!


-taikoe

[OpalRose]

Yes, mouth breathing will show up as a leak if you are doing this for a good part of the night.  Look at the leak rate graph.  Usually flat tops are mouth breathing.  Spikes in the graph can be due to mask movement.  Either way, they are leaks.

What I see is mouth breathing.  You are in large leak territory, and when that occurs, your AHI readings may not be all that accurate.  

http://www.apneaboard.com/forums/attachm...?aid=26263

If your using nasal pillows, you will need to work on that.  You can tape your mouth as some do, or practice the tongue suck technique.  Also, some use the soft cervical collar that can help keep the jaw/mouth from dropping open at night.

 The fact that you suffer with seasonal allergies would be enough to unknowingly mouth breath while sleeping.

Tongue Suck Technique:
Place your tongue to the roof of your mouth with tip of tongue behind front teeth.  Slowly suck upwards and back.
This places the tongue in a natural position, with the back of tongue sealing the back of the throat so that if you open your mouth/jaw while sleeping, no air will escape.

This takes practice, but can be done during the day too. Soon you will just do this without second thought.

[Gideon]

Your numbers are excellent. That means you can tolerate large leaks better than most. You still should work on them, but do not worry about them.

Yes they are likely mouth leaks.  It took me months to master the younger technique.
To practice while under pressure and practicing the tongue technique, actually cause a mouth leak, then stop it.  Don't be surprised if you have to stop the machine to reset.  The concept is to actually learn what causes it and stops it.

Other things to try

Talk while under pressure.
Open your mouth while maintaining nasal breathing
With a nasal mask, take a drink, a straw is needed.


The mask primer has a section on mouth breathing.

[taikoe]

Thank OpalRose for the literal tongue twister technique - I will practice!

Excellent tips bonjour! Makes complete sense to be experimenting with different techniques during the day and then download the data to see the profiles. 

I've greatly appreciate all the wizardry and will read through more of the FAQ responses (those are great)!