heytherefriend777 - My Journey - do I have UARS?

[heytherefriend777]

*I'm a new user from reddit /sleepapnea* where the links work, my apologies for making you run around--I can't do real links yet
**/r/SleepApnea/comments/tw6ei8/my_sdb_journey_looking_for_answers/**

I was hopeful after having septoplasty and turbinate reduction earlier this year I would eliminate my symptoms. Alas, the daily malaise continues. Unfortunately as well, my breathing remains to feel a bit strained, especially when my turbinates decide to swell up in the evenings.
After depleting other plausible health pathways and personal journeys: IBS/SIBO, chronic insomnia/CBT-I, every supplement and sleep medicine known to man, diet alterations/hacks–I am stuck here with symptoms only seemingly explainable as perhaps “Upper Airway Resistance Syndrome”--I know this diagnosis seems to be a curse word around this forum (originally posted this on Reddit /sleepapnea), but the fact remains, I am around average weight for my height/athletic build (5’ 9” 155 lbs) with limited evidence of typical OSA.

I finally managed to recently take a more comprehensive sleep test[url=https://76e1071e1.flowpaper.com/03092022AXGType2LaceReportRedactedv2/][/url] (results in link) (type-2) in-home where I could actually sleep some (I suck at in-lab testing). My (remote) sleep tech (axgsleepdiagnostics) found RERAs (followed by heart rate spikes, see bottom pg. 7 red highlight) that made me feel a little less crazy about all this.
Some extra background as well: in 2020 I took a WatchPAT test (results linked) via Lofta that said I had moderate apnea… I tried the Resmed 10 APAP for a couple weeks, but couldn’t remain asleep more than 3-4 hours and was more exhausted than ever, often waking to high pressures (full facemask f30i). Of course, this experience was all experimental and I did not have a qualified physician assisting me (despite my best attempts to understand OSCAR and play with pressures) I didn’t get far.. I still wasn't convinced I had sleep apnea (I assumed lofta.com was a bit biased, considering they sold the equipment!) so I took another home sleep test/(results in link) WatchPAT-ish-test, just to throw in more data for us. I resulted in “no significant evidence of sleep apnea”.

The type two test linked above (axg) was the first I managed to sleep through without using sleep medicine–in retrospect I now suspect my use of zaleplon/sonota on the WatchPAT tests only contributed to higher AHI

My symptoms:

• Consistently wake unrefreshed (last 3 years or so)
  
• Heavy daytime fatigue/cognitive impairment
  
• Wake up out of breath sometimes, sometimes headache. Many nighttime awakenings
  
• Notice some back of tongue/throatish resistance with breathing especially on back, like “breathing through a straw”
  
• Nasal congestion especially PM, attempted septoplasty/turbinate seemingly unsuccessful in alleviating unrefreshing sleep
  
• Often waking very early AM sometimes short of breath with noticeable racing heart, sometimes to a running dream. Very difficult to go back to sleep
  
• Sleep meds seem to make matters worse overall. I theorize their relaxing effect on my palate etc. aren’t helping with breathing.
  
• In the morning after a more particularly rough night I sometimes notice my face has two faint red blotchy lines–along my smile lines. It almost looks like my capillaries burst ever so slightly from straining to breath? They usually go away after a day. Very strange.
  
  

My sleep tech (axgsleepdiagnostics) recommended I trial the iNAP–so I have this coming in the mail now and will update here with it’s effectiveness. I know it's super new and controversial with it’s effectiveness… but I manage to have decent enough nasal breathing with allergy spray in the mornings and night time saline/breathing strips before bed– so I’m going to give it an experimental go. If that doesn’t work, I suppose it's back to the traditional PAP methods for another go?—maybe I call up ole Dr. Barry Krakow (I’ve read he’s a UARS advocate?) and ask him to prescribe an ASV machine!?

TLDR: I suspect my RERAs may be causing my super daytime malaise and would love some help looking through my sleep tests and theorizing what may be going on.

Love you all and thank you!

[SarcasticDave94]

Welcome to Apnea Board,

If you have CPAP sessions data on OSCAR, please post as a new attachment. Default detailed daily screenshot via F12 would work for a start. The format most likely necessary at first will be Events, Flow Rate, Pressure, Leaks, Flow Limits. OSCAR data has a story to tell about your therapy.

[heytherefriend777]

Thanks Sarcastic Dave, here is my Oscar data!

drive.
google.com
/file/d/1anuWUAe0Mm7g1PZ_x_d43bwODfjLqDYB/view?usp=sharing

[Crimson Nape]

heytherefriend777 - While you are unable to post links currently, you can post images. Please take a look at the links in my signature on how to post an OSCAR screenshot here.

[heytherefriend777]

@Crimson Nape thank you!

Here is a random screenshot (attached) from my limited time using PAP--I guess I'm more writing if anyone on here can look over my sleep tests and symptoms and think through UARS with me?

---

Sorry, attached here

[heytherefriend777]

I have suspected UARS, is bipap aircurve10 vauto a good start for a machine? Does anyone have recommended starter settings?

Thank you

[heytherefriend777]

My sleep tests:

First (June 2020)
https://76e1071e1.flowpaper.com/LoftaTest2020/#page=1

2nd: (Aug 2020)
https://76e1071e1.flowpaper.com/SnapDiag...20/#page=1

-Had turbinate reduction surgery, deviated septum surgery:

Third: (March 2022)

https://76e1071e1.flowpaper.com/03092022...v2/#page=1

My symptoms are awful for the past 4 years (unrefreshing sleep, constant tiredness/inability to focus, very tired). My hallmark situatoin is waking too early, usually to a racing heart feeling, and unable to go back to sleep. Tried all other forms of sleep medicine/cbti/blood work. I once trialed an APAP and struggled to breath against the pressure. Only tried for about a week. I don't have data from that experience.

Lofta gave me a BiPAP, I'd love to try and experiment in treating suspected UARS.

Anyone have a starting point/settings they recommend? Or do you think I even have something going on here?

Thank you,

[OpalRose]

This is just a generic suggestion as we haven't seen an OSCAR chart or any data from previous Apap use.

Your AHI wasn't that high on the sleep report.
You had no Obstructives showing on the sleep report and looks like mostly Hypopnea.

Set the Max IPAP at 14
Set the Min EPAP at 6
Set (PS)Pressure Support at 4

Easy Breath - On

Leave other setting at default for now.

See how it goes tonight... post an OSCAR chart tomorrow.

[heytherefriend777]

@OpalRose 

I don't see an Easy Breathe setting on--also, from my memory of having trouble exhaling on the APAP, is there a setting we can turn up to ensure exhaling is as easy as possible? Is this what Easy Breathe is?

Thank you!

[heytherefriend777]

Should I use the Mode in VAuto or S?

Thank you,

If VAuto, what would a recommended PS be?

Thanks again,