When UARS Is Lung Disease? Lung experts?

[Apnea23]

So I've used CPAP since 2021, started on the Dreamstation then switched to Autoset in 2022.

I've never had apneas, it has always been about the RDI and significant flow limitation. Also REM sleep with waxing/waning and worse flow limitation. 

I've been on a crazy mission this year to find out what's causing my UARS, and my chest scan last weekend came back today showing diffused hyperinflation of both lungs.

This is what the radiologist noted:

Both the lungs are diffusely hyperinflated/emphysematous. No lung parenchymal mass or 
sinister looking nodules are, however, seen. No pleural effusions noted. Minor Linear atelectasis is seen in the right middle and left lingular lobes. There is no evidence of 
diffuse pulmonary fibrosis or cystic bronchiectasis.

Scans are below - I would love some input by experts.

I always knew something more was going on due to my raised blood pressure and various other issues.

Non smoker. 40 years old.

[car54]

Do you have asthma or allergies?
I also have hyperinflated lungs because of asthma and COPD.
Since my doctor has put me on a nebulizer 3 times a day I have seen great improvment.

[Apnea23]

I have allergies, probably dust and dog/cat which is kept at bay with steroid nasal spray.

No asthma.

I have ordered a beta 2 agonist to relax my airways during sleep and I'll be performing a sleep test after taking it that includes measurement of flow limitation by nasal cannula. It will be interesting if it's significantly reduced, and all this time I never really needed CPAP.

I'm really intrigued and will be confused if it turns out I have COPD/emphasema.

[Sleeprider]

Earlier this year you posted you had or were considering a Vauto. You never have posted an Oscar chart that would let us see what your respiratory stats look like in terms of tidal volume, breath rate, minute vent and flow limitation. Hyperinflated lungs are not a particularly unusual condition, and can be seen in individuals with asthema or COPD as well as relatively athletic people that grew up with higher altitude or high respiratory volume needs. A pulmonary function test (PFT) can help you to understand whether you have excessive dead space that would make ventilating excessive CO2 a problem or not. Radiography is a snapshot of the physical lung, but how it manifests in a PFT is probably more important. I have not heard of a pulmonary diagnosis being made on X-rays alone.

[Apnea23]

Hi Sleeprider,

No diagnosis yet, I'm following up with my GP on Monday for spirometry testing and to see where to go from there.

I'm in the UK so not at high altitude, certainly not an athlete but I'm always within 170-180lbs roughly and 6ft tall. I suffer most when I carry a few extra stone, as it sits mostly around my belly.

I have attached a selection of screenshots below showing various settings of different modes and the tidal volume figures etc. Hopefully it is useful to you.

I was born 8 weeks early and ventilated. I had a spontaneous pnumathorax in 2008 at 25 years old.

2021 I was prescribed CPAP after a sleep doctor noted high RDI in sleep studies, but no apneas. UARS was suspsected and the severe daytime fatigue was cured by CPAP.

My memory and cognition has gone to complete crap over the years. I may as well have early onset dementia as that's how bad it is.

There are many other symptoms to speak of but I won't rattle on.

Here's the screenshots thank you - you will note 3 distinct periods (I believe REM) where I have my most issues. Outside of these areas my flow limitation is cured.

I find it interesting that early signs of COPD are waxing/waning and disturbances during REM sleep.

[Apnea23]

What I'll also do is, I have my own Resmed Airlink unit with nasal cannula that I have recorded 2 nights of sleep with so far.

I'll paste some snapshots later tonight so you can see exactly what my breathing flow rate is like without PAP involved at all.

I'll try to show normal sleep flow rate patterns and the suspected REM periods when things get more flow limited and a little waxy/wany and out of hand (in my opinion, of course).

[Apnea23]

Something I've realised today - why my Dexedrine stimulant (taken for ADHD-like symptoms) has the effect it does.

Within 30 minutes it makes me less breathless, less hot and sweaty, less dizzy, less heat intolerant, it reduces my heart rate and blood pressure which I can find no literature for, as stimulants speed up the heart and increase blood pressure.

Until my lung scan I had no idea why it was having this effect.

Well maybe it's because it's stimulating my respiratory system - faster and deeper breaths, improved oxygenation.

It is all making sense to me now.

[Sleeprider]

Speaking for your Oscar results, the CPAP therapy looks really good. Tidal volume tends to be normal to moderately low, but your respiration rate of 19 is high, resulting in over 7.5-8.0 L/min which is what I would expect to see for your minute vent. Spirometry and PFT are the same, so that may reveal more information about pulmonary health. Fatigue, memory issues and other symptoms you cite can range from hypogonadism to infectious disease like Lyme's or even simple imbalances in the blood. I hope you find some useful solutions.

[Apnea23]

Thanks Sleeprider.

My FSH levels have been on the rise since I had Mumps Orchitus a few years back, and one testicle significantly atrophied I assume due to the orchitus.

However - a hormone specialist confirmed all my other values are good, so he said the increased FSH is doing it's job at producing enough testosterone. Free testosterone, etc. Sperm motility test also good.

I have had a battery of blood heath tests in the past year all of which revealed nothing interesting, except this recent lung scan.

The tiredness and fatique is cured completely with CPAP. Without it, I'm so drained it's ridiculous.

This is why I'm convinced my UARS is actually an issue with the lower airways after this CT scan.

I'll keep the thread updated if anything interesting becomes of investigating the lungs further.

[Apnea23]

Can I ask, if I do have mildly impaired lungs due to early disease or whatever, would the tidal, minute and respiratory rate appear fine because of the CPAP treatment?

Would the same measurements be completely different if measured without the assistant of pressure?

My flow rate as measured by Resmed Airlink cannula is significantly impaired compared vs the flow rate on Oscar with PAP treatment, as an example. Surely any other values like minute vent, respiratory rate etc would be the same. A completely different story?