tl;dr I feel like I’m suffering & haven’t been myself the last four years, have exhausted all my options. Attached are WatchPAT results, would appreciate feedback. (Not asking for a diagnosis per subreddit rules)

https://imgur.com/a/3uzpZlU

Hi! recently completed a WatchPAT test from Lofta and got my results back today. Really confused on what my next steps should be so I was hoping someone could give me their opinion/help interpreting my results before I shell out $1200 on CPAP supplies. I’m a male in my mid-20s with a BMI of about 22, relatively healthy and try to work out often. I’ve had symptoms of completely debilitating brain fog/can fall asleep pretty much on command almost daily for the last 4 years. I can literally have a cup of coffee then take a nap - tried almost everything including MRI/EEG/Blood work/elimination diet/supplements, all with practically no effect, leading me to this sleep study. I’m at a loss as Lofta says I have VERY mild sleep apnea (AHI 1.8 / RDI 8.9). I feel like I’m hearing all sorts of different interpretations like a CPAP would just be a waste of money / others saying this may be UARS and should be treated. Would GREATLY appreciate your opinion.

1. I get that ASV picks the right amount of PS for each breath to avoid overventilation, but how does ASV prevent CA events when minPS is already high enough to normally cause overventilation? E.g. how does ASV with minPS=6 avoid CA events, whereas on BIPAP S I already get significant CA events at PS=4?
2. What effect does lowering maxPS have? I want to lower it because I get chipmunk cheeks at high pressures.

Hi everyone I’m 24M, recently diagnosed with UARS, nasal valve collapse, bruxism, TMJ and allergic rhinitis. Since my 19 i started to feel tired and with extreme brainfog. Both were gradually worsening over the years to the point i cant hold a job or do anything that requires mental effort. I have severe memory and attention problems and problems with my vision (cant focus, probably secondary to brainfog). I will get surgery next month for nasal valve collapse. What should I expect? I am looking for some anecdotes.

Hello, my name is Ethan and i am 24 from Phoenix, Arizona. I am planning an MMA revision with Dr. Michael Gunson and he wants me to do a DISE first. The closest doctor to me I know that does it is Dr. Zaghi in LA but I really don't want to have to go all the way to California, and am finding it difficult to find anybody locally. Any help is greatly appreciated.

i (19F 100lbs) am on the path of DJS to correct UARS.

my symptoms are severe in the form of chronic lethargy and general feeling of unwell, bad endurance, mood and focus issues.

my RDI was only 8.7 and my surgeons office basically told me that they expect a fight with insurance to get this covered for me. it might not happen for me, and then we have to decide whether it’s worth it to pay out of pocket. according to the surgeon. they’ve submitted the post op as orthognathic because i have short face syndrome, but i’m not feeling very hopeful about it being covered. this is because im one of those people with a normal bite but two recessed jaws.

i am already being treated with an oral device and it’s not enough, and definitely not a long term solution. i can’t tolerate cpap. also i’m not even 20yrs old i can’t stand the idea of wearing a cpap for life.

i feel really sick and don’t know if i can manage another semester of college feeling like this, especially as a stem student and double major with labs and heavy course loads. feels like this is such a first world problem because no one takes UARS seriously, but it really does suck.

edit: i’m just trying to vent and not looking for alternative therapy suggestions. i already have multiple doctors on my case who have ruled out other therapies besides jaw surgery.

Hello and welcome to r/UARS! The purpose of this thread is to discuss positive airway pressure (PAP) therapy. CPAP is currently regarded as the gold standard for the treatment of obstructive sleep apnea. But what about UARS? Many patients who suffer purely from respiratory effort-related arousals (RERAs) and (non-hypoxic) hypopneas find that regular CPAP isn't the best modality to treat their sleep-disordered breathing.

Bi-level/BiPAP for UARS

There isn't a wealth of information on this topic, however there is some data by Barry Krakow, an AASM board-certified sleep medicine specialist, to suggest that bi-level modalities could be the superior form of PAP therapy to treat UARS (or non-hypoxic OSA). Barry Krakow was previously a medical director of two sleep facilities in New Mexico and titrated thousands of UARS and OSA patients with bi-level PAP therapy. "We stopped using CPAP in 2005. We only use the advanced PAP machines bilevel, auto bilevel, ASV, because we found it much easier". A very informative article written by Barry Krakow about bi-level modalities for UARS can be found here.

How to analyze your PAP data

OSCAR is a free program used for analyzing PAP data in-depth, it is compatible with most popular models of PAP devices. A wiki can be found here. It is recommended that you use OSCAR if you wish to self-manage your therapy.

Posting

Discuss PAP devices and therapy, configurations as well as tips and tricks for optimizing therapy, pose troubleshooting questions, and help out those who require a helping hand.

To see previous posts in this series click here.

​ ^(|DISCLAIMER: this information is for educational purposes only|)

Like many of you I've found that I can eliminate flow limitations at a high enough pressure support (for me, IPAP 17.5/EPAP 8) but it comes with a ridiculous amount of central apnea events (especially if I'm on an inclined bed).

Some popular ways of addressing TECSA seem to be:

1. Waiting until your chemoreceptors adapt to the lower CO2 levels i.e. making your breathing more sensitive to CO2.

2. Having a backup rate

3. Raising trigger sensitivity

But it seems to me these are actually really unhealthy because:

1. Most people, especially those that are anxious like UARS sufferers, are already overbreathing i.e. in a state of hypocapnia. By lowering your CO2 levels even more, you are causing huge problems; a reduced ability for O2 to disassociate from haemoglobin to become available to tissues (Bohr effect), vasoconstriction (especially for the arteries and capillaries leading to the brain), bronchoconstriction, nervous system overactivity and muscle tension (low CO2 raises pH causing hypocalcemia) and more. Presumably, making your breathing more sensitive to CO2 also makes it more likely that you'll overbreathe during the daytime too, exacerbating the problem.

2 and 3) These force you to breathe when your CO2 is low and 'solve' your central apnea, but in doing so they lower CO2 even more which, for the reasons outlined in 1), causes hypoxia even though your oxygen saturation is probably high.

When it comes to TECSA, shouldn't we be focused on trying to lower CO2 washout, rather than trying to adapt our breathing to unnaturally low CO2 levels?

Which brings me on to my next question...

Has anyone had success with EERS or tried combining NEPAP (Nasal EPAP) devices, e.g. ZeeBud, ProVent, BongoRX, TheraVent, OptiPillows, with their BIPAP therapy to treat TECSA (in a healthy way)?

I had sleep issues as a kid. I didn’t develop POTS until I was 19. After speaking with Dr Joseph Borelli who cured his POTS with BiPap, I’m absolutely convinced that the two are connected in my case. Curious how many of you also have POTS, and which came first for you.

Hi everyone. I had a CBCT scan taken at a maxillofacial surgeon's office. He said that my airway looks small. Comparing it to others I found on Google, yes it does look small. I saw a Sleep & Respiratory specialist the other day who is giving me an at home PSG (Level 2 PSG). He says this records RERAs so I am hopeful. But as my turbinates are swollen he was very quick to suggest I need nasal surgery. He didn't ask to do a scan of my airway or look at the one I had, but I did show him at the end. He said 'yes it looks somewhat narrow'.

Now I don't really want nasal surgery because I think that my turbinates are swollen due to UARS caused by my narrow airway. I've had this issue for quite a long time but IIRC the chronic nasal congestion came on after I started to experience sleep deprivation symptoms. I asked if there was some device I could put in my nose to mechanically open the airway but he said no (I have tried some nasal dilators on the market but none worked).

That being said, if the real solution is jaw surgery (I have recessed jaws, I had extractions at 15 and this is when the symptoms started) I could be waiting up to 2 years for the procedure. So in the meantime would it be prudent to just get the nasal surgery and use a PAP machine? Because I'm really falling apart here. Also, how narrow does my airway look?

Thanks!

https://preview.redd.it/eyh73a1z1kvc1.png?width=429&format=png&auto=webp&s=df82e67128045c55323152b97dfe97e1edecee82

Hi, i am on journey for getting my health back, since 2/3 years i’ve been having not refreshing sleep. Waking up with headaches and sleepiness during day. I’ve had sleep study in hospital that showed ahi of 5 in rem and around 2 ahi in other sleep stages, unfortunately Cpap didn’t help me so i went for another sleep study in another hospital that showed that i have ahi of 6 but not only that. It revealed that i have micro awakenings during the sleep (around 12/h) during my sleep i woke up up around 80 times and didn’t remember single one, to addition of that many awakenings came with hr jump from 50 to around 100 for few seconds, and after that i would always feel asleep instantly. Because of that my sleep pattern was extremely fragmented especially during the REM STAGES which i had too much and was constantly jumping out of them and into them. Now i am waiting for BIPAP which will come tomorrow because doctor suspects UARS causing that but i am a little bit sceptical. Can anything else than breathing disorders cause frequent sleep awakenings? are there any diseases that mimic sleep breathing problems? for example you know heart/lungs/neurological etc etc.

Can you tell me your experience?

What’s the best sleep tracker to use to get the most meaningful data (being able to infer sleep stages, possible respiratory events via I guess an inferred value like HR)

So about 3 years ago I was confirmed to have UARS via a watchpat study with an RDI of 13.7 and an AHI of 2. Since then, I’ve tried a CPAP, BIPAP and ASV with different pressures and have noticed only slight improvement when using a BIPAP. My flow limitations are resolved, but I keep getting heart rate spikes / arousals / awakenings without any sign of flow limitation or RERAs. These arousals and awakenings are why I think I still feel terrible and exhausted every day. Regardless of which machine I use or which pressure I use, I get about the same number of arousals and awakenings each night.

They all look like these in the flow rate graph: https://imgur.com/a/Q264Vgf

Which got me thinking, maybe something else is going on here. So I set up a night camera and I got a pulse oximeter to get more data on these events. My pulse rate spikes match up exactly with these arousal events, but a strange thing is happening with my body at this time. My body kind of jerks, and my mouth does this weird thing which looks like it is expelling air.

Examples: https://imgur.com/a/YwLmq1c

I thought maybe the CPAP is causing these arousals due to aerophagia? Nope. I recorded myself last night without a CPAP, and I got the same exact awakenings with this pattern at these pulse rate spike moments. The amount of pulse rate spikes is also similar to the amount I get with xPAP and my original watchpat study, (about 25 spikes per night). Also these patterns happen in every sleeping position, I just posted supine because it is easier to see.

Examples: https://imgur.com/a/0ELBZBF

What is going on here? Could these awakenings/arousals be caused by LPR? PLMD? I am stumped. I am going to see a sleep doctor soon and hopefully I can get a polysomnography and DISE to see what it could be, but I was wondering if anyone had any insight into this.

Hello everyone !

I'm new to this board, I was told from reddit that I could get some help with my situation here on this board

English is not my native language so I do hope I don't do many errors in my explanation,

I got diagnosed with sleep apnea back last year, here's a quickrundown of my profile

Me : Age 30 , M , 1m76 (5,77 ft I think ?) , 86 Kilos (189 lbs)

1rst sleep study (before cpap) : sleep study an RDI of 33 (AHI 14 and RERA 19)

2nd sleep study (with cpap 7,5 Pressure) : RDI of 15 (RERA 7 and AHI 8), AHI are only hypopnea (50% are central, 50% are obstructive), RERA seems to be central but physician is not sure

I can scan them but they are in french, if you need some more infos about them maybe can I do some more translation

Current equipment : Lowenstein prisma smart, at first pressure was 5-11 then set to 7.5 , Pressure relief of 2 , Humidification , Mask is full-face (BMC F5 : https://www.medicalexpo.fr/prod/bmc-medi...89662.html )

Additionnal info : Always sleeping side, the 2 sleep study confirm this, really really low mouth breathing

To explain my situation a bit more,

I was always foggy and tired but since last year my condition really extremely worsened, Saw doctor, told me to do a sleep study, Bam, OSA

My sleep doctor then gave me a CPAP device (description above), we started in september at 5-9 pressure , at first it was a true revival, but it made my stomach hurt, we then switched after one month (october) to a fix 7.5 pressure, it worked too with less stomach pain,

In the meantime I saw a doctor specialized in Tongue placement in the mouth (honestly no idea how to translate this one), it seems that my tongue was really misplaced

Before doctor: Tongue was resting in the bottom of the mouth, tip touching lower jaw and teeth

After doctor: Tongue is resting in top of the mouth, bending like a hammock

After changing my tongue placement, It was easier to breath, and I feel more air can pass in the windpipe (hard to explain)

Also I take 2mg of melatonin before sleeping on the recommendation of my sleep doctor

Here are some screenshots (If you need additionnal OSCAR screenshoot I can provide them)

Random nights:
https://www.apneaboard.com/forums/attachment.php?aid=58229
https://www.apneaboard.com/forums/attachment.php?aid=58228
https://www.apneaboard.com/forums/attachment.php?aid=58230

Zoomed nights (5-10 min)
https://www.apneaboard.com/forums/attachment.php?aid=58265
https://www.apneaboard.com/forums/attachment.php?aid=58266
https://www.apneaboard.com/forums/attachment.php?aid=58267

One night with Soft cervical collar
https://www.apneaboard.com/forums/attachment.php?aid=58306

But after some time tiredness came back, november and december i felt more tired than at start of CPAP, still way more energic than before cpap nonetheless,

My stomach started to hurt again, I suspect that my tongue training helped me breath better but as I side effect to swallow more Air I guess ?
Anyway I switched to 5-9.5 pressure, no humidificator, no EPR

It is not that better and some days are horrible

https://ibb.co/239JG0W

https://ibb.co/NnvnZRB

https://ibb.co/Lg5P8n1

https://ibb.co/vBKNzm1

Could I get your insights on my situation ?

Thanks a Lot, if you need more data do not hesitate to ask me and I will provide

Hello and welcome to r/UARS! The purpose of this thread is to discuss positive airway pressure (PAP) therapy. CPAP is currently regarded as the gold standard for the treatment of obstructive sleep apnea. But what about UARS? Many patients who suffer purely from respiratory effort-related arousals (RERAs) and (non-hypoxic) hypopneas find that regular CPAP isn't the best modality to treat their sleep-disordered breathing.

Bi-level/BiPAP for UARS

There isn't a wealth of information on this topic, however there is some data by Barry Krakow, an AASM board-certified sleep medicine specialist, to suggest that bi-level modalities could be the superior form of PAP therapy to treat UARS (or non-hypoxic OSA). Barry Krakow was previously a medical director of two sleep facilities in New Mexico and titrated thousands of UARS and OSA patients with bi-level PAP therapy. "We stopped using CPAP in 2005. We only use the advanced PAP machines bilevel, auto bilevel, ASV, because we found it much easier". A very informative article written by Barry Krakow about bi-level modalities for UARS can be found here.

How to analyze your PAP data

OSCAR is a free program used for analyzing PAP data in-depth, it is compatible with most popular models of PAP devices. A wiki can be found here. It is recommended that you use OSCAR if you wish to self-manage your therapy.

Posting

Discuss PAP devices and therapy, configurations as well as tips and tricks for optimizing therapy, pose troubleshooting questions, and help out those who require a helping hand.

To see previous posts in this series click here.

​ ^(|DISCLAIMER: this information is for educational purposes only|)

I am 6'2 90kg I have most imp exam of my life in a month or so I can't consentrate I can't study i feel like I have not had a restorative sleep in 5-6 months I am always tired I do snore but I don't have sleep apnea from the sleep study but what I do have is dry mouth when I wake up sore throat and I can feel I have very narrow space left for breathing when lay down my tongue goes back or my tonscile is causing problems

Also when I did my sleep study my bpm was spiking like mountains it was 50-60 and then it became 100-90 and it was regular

I just want to know what do you guys think about the symptoms does it sound similar like yours?

I’m giving BiPAP a go, but I know that dialing everything in takes time. I was wondering if there is someone I could hire who could go over my results during the early part of the process and help me make the necessary adjustments?

I’m pretty convinced I’ll end up needing to get EASE or something down the road, but I’m hoping that BiPap can help me have a higher quality of life. I’ve been through a lot. To be honest, I’m skeptical whether I’ll be able to tolerate it because I had a rough time with CPAP. However, I want to give myself the best chance I can for BiPap to work for me!

Didn't have much success with EERS so far, though I haven't tested it for long. Its quite annoying anyway because of increased humidity, noise and less mobility.

So on my Quattro Air mask there are a bunch of little vent holes formed in a circle. Is there any reason why I can't plug a few of them and get the same result of rebeathing some of the CO2 to treat central apneas?

Try it while being awake to make sure I don't suffocate? Would this even work, or are there any risks to it? Thanks!

​

CBCT, and then...?

My battery is only at 80% health, so I can either replace the battery or buy a series 9. I think it makes alot of sense to do an apple trade in since it's the same cost of a new battery. That said, im wondering if I shouldn't just tough it out until the series x comes out. Is the battery any better on the series 9? My se2 hardly lasts a day because I sleep with it, now I have charge it twice a day since I lost alot of capacity. Im also interested in the skin temp and blood oxygen sensors since I have sleep apnea, though I highly doubt they will help at all since they dont measure blood oxygen in real time.

Series x comes out September? Thats a pretty far time to wait while running on the crappy battery I have.

As you can tell from the title, I am as desperate as you can get. I will travel if I have to. I just want a diagnosis 😭

I've heard about Vik Veer in the UK, any experience?

Has anyone here tried using BiLevel with the same PS but at EPAP 2. Does it make any more tolerable?

AASM says the following thing about UARS (source: https://dokumen.pub/international-classification-of-sleep-disorders-third-edition-icsd-3-3nbsped-0991543416-0991543408.html ):

Some patients have relatively few arterial oxygen desaturations but a significant number of respiratory events characterized by narrowing of the upper airway result-ing in brief arousals from sleep. Depending on the definition of hypopnea employed*,* these events typically meet criteria for either hypopneas associated with arousal but no desaturation, or for RERA**s. When initially described, this latter group was said to have UARS.

AASM 1A rule is:

1A. Score a respiratory event as a hypopnea if ALL of the following criteria are met:

a. The peak signal excursions drop by ≥30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative hypopnea sensor (diagnostic study).

b. The duration of the ≥30% drop in signal excursion is ≥10 seconds.

c. There is a ≥3% oxygen desaturation from pre-event baseline and/or the event is associated with an arousal.

But this souce from Australian/new zeland sleep association claims the following thing:

Respiratory effort-related arousals (Items F.13–14) Reporting the number/index of respiratory effort-related arousals (RERAs) is OPTIONA according to the AASM Manual but is RECOMMENDED by the ASA/ANZSSA Panel. Although the AASM note that the evidence for the clinical utility of reporting RERAs is limited and that there are fewer RERAs scored when using a hypopnoea definition allowing for an associated arousal [17, 18], it remains possible that RERAs may be more important for some individuals; more so in lean individuals and women [19, 20]. RERAs were considered by consensus to provide significant additional information on event contribution to sleep fragmentation and identification of otherwise unclassified respiratory events as an aid to interpretation.

source: https://link.springer.com/article/10.1007/s41105-020-00259-9

So I guess that ideal sleep study would be AASM 1A + RERA. If you count hypoapnoeas that end up as arousal you are also underestimating RERAs (there was some ppl saying that hypoapneas related to arousals was also okish). It seems that chatgpt also agrees, but as we all know he cannot be trusted 100%.

Hey all - so glad I found this forum. I was diagnosed with mild OSA (AHI of 7.8) a few months ago and now am wondering if I have UARS.

After first trying CPAP back in December, I went through a honeymoon period where I felt amazing for the first few weeks. But slowly, my sleep got disrupted again and now I'm having troubles sleeping through the night. I wake up at 3/4/5am often feeling very fight-or-flighty and it can be really hard to fall back asleep.

I feel better with CPAP than without but I'm still not sleeping normally or feeling rested most days.

This has me wondering if I might have a combo of OSA and UARS (is this possible?).

I'm trying to figure out what to look for in OSCAR to help figure this out. I've been researching around and reading some of the wikis but still don't quite know what to be looking for.

Thanks for this forum, glad I found it as I was feeling very discouraged and now am hoping there might be more solutions I can explore.