UARS Waking up All night - pounding heart

[LanceDrG]

I have been using my CPAP for 6 years now and my apnea has gotten worse over the last year or so.  Keep waking up multiple times throughout the night. 

It seems like I fall in to the category of Severe UARS with Mild Apnea.  I had multiple sleep studies with AHI ranging from 5 to 15. The issue is my high RDI  

I'm 42 yrs old, fit, use a cervical collar, sometimes mouth tape.  I have tried laying on my side, supine very elevated, on stomach with pillow under hips with chin extended to open airway.  Frustrated that nothing seems to help.  After reading the forum I am curious to try BiLevel.

I practiced as a dentist and have pretty bad vertebral cervical (neck) degeneration with a reverse curve and herniated discs.  According to some research studies I have read these neck issues seem to contribute to sleep apnea.

Oscar data from two nights and sleep study attached.. Any guidance would be appreciated.

Thank you!

Lance

[G. Szabo]

Before switching to bilevel, it is worth testing the increased minimum pressure setting to 9 cm. It will give you a smoother pressure ride and can reduce the flow limits.

[THEVGE]

I am in the same boat for 3,5 years like you. My story (summarized) may help you.

Me: mild OSA (7 not on my back, 14 on my back), self diagnosed UARS, Afib, pain in legs/cheeks, zero energy during the day.
CPAP/APAP: suppressed AHI to 0 even at a pressure 6, but introduced arousals (5 per hour). All typical OSA/UARS issues mentioned remained.
Bi-level: helped from the start, but effect gone very fast. Still better than CPAP, significantly less pain (only some days in my legs, no idea what causes it), probably the improvement is due to the PS which gives me much better flow rate. Arousals remain with same frequency, and like you I suffer from therapy induced CA which is not going away in my case. I also developed a huge SpO2 dip at sleep onset.

Yesterday I gave up on bi-level as well, now trying to start up therapy using ASV.

As for the heart issues you mention, as stated I suffer(ed) from Afib. I got rid of it not by my (ineffective) PAP therapy, but with simple breathing exercises that are focused on calming down your nervous system (no medicine). This made me believe stress is my main cause for the heart issues. I do believe badly treated UARS, obviously, is a stress factor that does not help. But I found my heart issues solved even with bad PAP therapy. Besides solving Afib I now get daily "morning wood" again, I completely forgot I did not have that for the last few years ;-).

So in short, I do believe bi-level will be better for you but I doubt if it will really help long term. I especially foresee even more CA's for you and very likely no change in arousals. Your data already looks pretty good by the way compared to me on CPAP.

All that being said, I agree with G. Szabo that you should try increasing your EPAP and maybe try EPR 2 iso EPR 3 as well to reduce therapy induced CA's. Don't change everything immediately, 1 setting at a time and try it a few days (advice easily given, hard to follow myself ;-)).