Just got my cpap. I was recommended over at the SleepApnea Reddit to check this out. I have mild OSA with a AHI of just below 10 but what’s interesting is my RDI was the exact same number at 10 Is this normal? My doctor basically told me that we can try cpap but he wasn’t sure that AHI // RDI of 10 would make me as tired as i am. I also was diagnosed with TMJ about 2 years ago which is where my problems of fatigue etc kind of started

Symptoms; Fatigue More tired the more sleep i get Groggy morning Eye burning in morning Anxiety Seems I’ve developed some depression because of this scenario. Coffee does not affect me, like whatsoever it almost makes me more tired?

I guess my question is, is UARS potentially my cause or should i just stick with the OSA diagnosis.

Hi. For a long time I've had poor breathing that caused chronic brain fog and shortness of breath which I thought must've been related to a narrow airway but recently I think I pinpointed what I think is the actual issue causing all of this. Whenever I fully close my mouth (with molars touching) I can see my nostrils close and I start breathing poorly, then I open my mouth a bit and my nostrils flare back to normal and my nasal valve isn't collapsed anymore, as if the extra height in the lower third of my face from having my mouth more open somehow creates more support for my nose tip. Is this a common cause for poor breathing? And what kind of procedure would you have to fix something like this?

Could someone help me interpret this watchpat sleep test I did? I’m 21M. Not sure if I should continue down this route or if something else is causing my constant tiredness.

I have acid reflux bc of hiatal hernia and lower esophageal weakness so on CPAP the air just rushes down into my stomach

(& then right back up bc of my issue. & I burp all night waking myself up.)

I have it on 10 and -3 all the time.

So - anyone with this or a similar issue try bipap & did it help? Considering if I should try the more expensive machine, if it would make a difference at all or just be a waste of time and money

I am slightly recessed and worried about my poor sleep. Is there anything notable in this X-ray regarding my airways?
I am 19M.

https://preview.redd.it/9lda24lzoiyd1.jpg?width=1360&format=pjpg&auto=webp&s=4eb7ab723916dac385583fb10dc06406d9926159

Are these unflagged centrals? I got like 33 of them in a 7 hour sleep. Most of them while at unstable breathing periods, which I presume was REM sleep. One of them was 8.5 seconds long which triggered my 7 bpm backup rate.

https://preview.redd.it/8jz0w2ktnhyd1.jpg?width=3839&format=pjpg&auto=webp&s=1db5056c8cfa2865657700959a8991c8a23b4679

It's like every annoying thing that could possibly go wrong with therapy happens to me & peaceful sleep eludes me no matter what I do.

First night in CPAP instead of APAP resulted in aerophagia with such severe continuous burping that it woke me up.

I wear a nasal mask that fits well.

Pressure was only at ten & -3.

I was on my side.

How can I fix this problem??

I am 22 and male. I am 6 foot tall and 150 pounds, so I am not fat.i did the lofta study and was diagnosed with sleep apnea. My AHI was 4 but the RDI was 19. I am so young, and I struggle to accept I have such a serious illness at a such a young age. I am no longer eligible to join the military, and it hurts. Do I have to live with this forever?

Test results: https://imgur.com/a/NYv77uW

Link to original post in r/SleepApnea: https://www.reddit.com/r/SleepApnea/comments/1gfc8l3/watchpat_results_14_ahi_no_sleep_apnea/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

Comment there suggested it could be UARS. Does this seem right? If so, how should I proceed with treatment. Thank you!

Been using the chin strap a year now (knights bridge) and got it down quite well as of recent.

For it to work well, I have it tight.

I have two distinct bold patches under my chin now and a very very thin upper middle front part of my head / hair.

This is from pressure restricting blood flow. Not sure what I can do to get around this without having it looser and losing effectiveness

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|)

Hope you guys enjoy the new video. Always available to answer questions and receive suggestions: No.1 Sleep Tech in USA reveals Sleep Study Secrets (Part 1)

So, remember my post months ago about asking for solutions with a old age apneic guy (viscerally obese and was a lifetime 1-pack-a-day smoker) who had what looked like CPAP/treatment-emergent residual UARS?

Well. Have you ever heard of EFL, or Expiratory flow limitation? the same thing so talked about in COPD patients or smokers? Apparently as you age, what happens is that the soft palate begins to become longer. and in some OSA patients the soft palate is long compared to their age-matched peers (Asians have longer soft palates, so thats probably part of the reason why they get UARS up to full-blown OSA at a lower BMI on top of visceral fat on top of the whole "Age related lengthening of the soft palate") and they do find that in some OSA patients. that soft palate is longer compared to their non-apneic age matched peers. EFL from COPD or aged lungs AND expiratory apneas from PP can also co-exist! If Alaxostent is not available where you are, then you need to get Palatal radioablation surgery to get rid of a long, flaccid soft palate. UPPP could also work, but it has more serious side effects (MSE/EASE/FME/Any boneborne palatal expansion might kinda work by forcing the soft palate to get shorter with a wider palate. and DJS MIGHT pull the soft palate away from the nasopharayanx)

OSCAR was very telling-At 10 cm pressure there was a RDI of 16, most of them PPs (it got so bad the airsense got confused thinking it was CSR breathing). at 12 cm-14 cm2 it went down to 2.5. but PP breathing patterns still happened (it varies between 0.6-2.3 AHI/RDIs currently. with 2-2.5 minutes of being in obstructive apnea from PP)

How can you tell? Try blowing through your nose, if your palate prolapses. you will notice because it will suddenly feel very hard to blow through your nose (Also note that PP and expiratory mouth breathing patterns are almost identical-if you have a taped mouth with a soft cervical collar with no mouth leaks and yet you see a PP before a apnea. then that's definitely palatal prolapse). Keep in mind EPR/BIPAP EPAP WILL worsen palatal prolapse since the pressure difference is going to cause the palate to swing like a sail in the wind (I tried once before-the apneic dude suffered a minute-long OA ending in a arousal)

The epiglottis can also be a problem - If its floppy. then it can act like a trapdoor and cause apneas or UARS that way, unfortunately this one is the hardest to solve since you need surgery for it to stiffen the epiglottis (CPAP will not help and side sleep would not seem to help much whereas it still has a effect on PP). In either case, if you want to know if you have PP or a floppy epiglottis/epiglottic collapse. then you probably want to get DISE (Tongue-base collapses are the most common, followed by phragyneal/throat collapse. then PP. then epiglottic collapse)

Also, asthma can cause Expiratory flow limitation much like COPD. so yeah.

Also. PP can still cause RERAs by itself in part because the dramatic movement of the soft palate and it sticking to the nasopharayx is apparently strong enough to cause arousals (according to the study that described it)

Oral mask therapy does bypass the soft palate entirely. but its not a true solution (one of the reasons PP is such a PITA-in part because it only emerges if you use nasal CPAP or happen to discover it during DISE and in part because PP immediately shuts down EPR or BIPAP unless you want obstructive expriatory apneas from the palate flopping around due to the pressure difference) - if you have a untaped mouth. PP will cause you to mouth exhale (it shunts your air way out the mouth) or if taped. you will instead get mouth puffing phenomenon/MPO or the chipmunk cheeks and up to a expiratory apnea since the air has nowhere to go

To wrap this up.

Edeuntlism (Macroglossia as a a consequence) with jaw bone recession (Correct with all-on-4 implants to try and stimulate the lost jaw bone as well as de-CCW-rotating the mandible? Double jaw surgery to try and get back lost jaw length as well as MSE or possibly MARPE for the nasal airway given old age?) - Reason - Jaw bone loss from tooth loss and compensatory CCW rotation means there's a lot more room for the chin to drop (though most will use a soft cervical collar anyway). plus, the facial muscles become sarcopenic and weak from the lack of jaw bone. Dentures ironically also accelerate this process since they irritate the jaw bone (and once they become unstable. you wont be able to have good oral posture without the maxiliary denture popping out. which is going to promote a bad tongue posture/Tongue thrust, or a reverse swallow/OMD on top of all that especially as the dentures begin to become unstable). In theory. implants may be able to prevent further progression. but once that bone is gone? Maybe bone grafts could help? And the tongue does become macroglossic/grows bigger as it tries to fill the remaining space that the teeth once occupied. This may be part of the reason why newly edeuntlous people with complete dentures rapidly develop sleep apnea in just several months. with a good chunk of them being in the severe OSA category and why tooth loss seems to predict OSA severity and frequency

high loop gain aspect- Typically after a obstructive event a big breathe occurs leading to hyperventiliation, in some OSA patients this is more severe. leading to CO2 loss and a follow up central apnea. and in these with a collapsible upper airway there is also bad airway muscle recruitment. the NCBI articles touches on that about dysfunctional breathing in the OSA phenotypes and on restoring functional diaphrgamatic breathing. upper airway collapsibility (Ectopic neck fat from visceral fat/thick fat neck) I don't know if breathing re-education would help for UARS since the article focused on OSA patient phenotypes. but its certainly worth at ry.

Hi guys,

The title says it all...

Basically my problem is a really serious one, at least for me, despite the fact that my RDI is very low. As you may know, the first seconds of sleep are the lightest ones in terms of arousal threshold.

Therefore any arousal caused by a partial obstruction can become a conscious awakening (with me choking and gasping for air) if it happens in the first minute of sleep.

I showed the problem during several PSGs, and it's a hypopnea, not a RERA.

To me the problem is NOT perceived as some sort of sleep onset insomnia.

It's more like: I fall asleep (obviously without realizing it), I start dreaming (obviously without realizing it) then the choking wakes me up bringing me back to reality. Then I look at the clock, and the clock tells me I've slept 1 minute. Then, 5 minutes later, I fall back to sleep, and it happens again. Then repeat.

APAP failed.

Why?

Because I cannot use the ramp.

And I cannot use the ramp because the obstruction is in the first seconds of sleep (maybe a maximum of 1 minute of sleep).

Therefore APAP creates insomnia, and I can't even fall asleep. Why? Because it's impossible, at least for me, to breathe out against a 4% continuous positive pressure.

I am desperate.

I can't use the ramp for my personal problem.

Btw, my R.D.I. on my side is 4. My R.D.I. on my back is unmeasurable because I can't fall asleep anymore on my back, because of the choking that wakes me up in the first seconds of sleep.

It's been 12 months that I can only sleep 5 hours per night if I stay in my bed for 10 hours.

Doctors are non-receptive because officially I'm not a serious case.

Would BiPap treat this partial obstruction that happens in the first seconds of sleep, even if I don't use the ramp?

At which settings should I set BiPap?

Which brand and model?

Thx in advance guys.

(Already tried a M.A.D. and failed)

https://www.iqoro.com/a-simple-routine-to-combat-sleep-apnoea_land-ggla/?gclid=Cj0KCQjwpvK4BhDUARIsADHt9sSwM04jHrXtRtvRqlp6MDSpHSMKCp9NwBk8DItzKikiYObwfBzc4UYaAuM7EALw_wcB

What a journey

I first got a sleep test in 2021. I had a 15 RDI. I didnt really understand RDI, so when I saw my AHI was <1, I ignored it.

I asked for a CPAP to trial but my dr was cagey. They sent me a MAD trial instead, and i got a fitted one, but it never helped. And it was super uncomfortable.

Finally in 2023 i took another sleep test, which showed the same result: 15 RDI.

I had had enough.

I got a BIPAP off craigslist (took two attempts... since the first bipap smelled disgusting)

But even with the bipap, i went down the UARS rabbit hole

I had spent MONTHs researching vids, forums, youtube videos, posting my charts on apneaboard...

i also tried 6+ different masks, side sleeping bakcpacks, sigeridoo, tongue exercises, saline rinses, nasal strips, consultations, CBCT scan, etc... I video taped myself sleeping.

I journaled and experimented with settings. I noticed in my last year's journal entry that i had good success with 0 PS, but i never tried continuing it because i was so bought into the theory of UARS requiring PS/BIPAP and needing to avoid EPI (expiratory pressure tolerance)

Finally in a desperate attenpt i researched some more, and discovered some videos from lanky and the other cpap review guy, saying that turning off EPR can be beneficial.

I also saw tons of reddit posts and forum posts saying turning off EPR was what worked. So i gave it a try, and it worked for me.

The ONLY thing that worked for me consistently, as of late, is straight CPAP. Meaning: 0 PS. I start it off at 8 EPAP, 0 PS, and let the vauto setting increase it as needed throughout the night.

Every time i wake up i feel refreshed and i can finally have internal monologues and not feel like a zombie all day.

Note: on higher pressures like 10 or 11, it becomes much harder to breathe out against the air, and that's when PS may be necessary. I've had worse sleep on higher pressures because of this. On 8 EPAP, it's easy to breathe against without PS.

I also tried following the krakow and apneaboard advice by using high PS (since i thought high PS or IPAP would overcome flow limitations/RERAs), but it only worked for me about 10% of the time. The rest of the time i felt nothing or it made me feel worse.

For example, 8 EPAP with a 4 or 5 PS made me feel much worse than 8 EPAP with 0 PS.

I have a couple theories as to why PS made things worse.

1. palatal prolapse. I saw this online, described as having it flap like a sail in the wind.
2. gravity. My theory is that if you have 0 PS, the airway is stented with more stability. But let's say you use 5 PS and you're sleeping on your back. Your airway is flapping up and down with the differential in EPAP/IPAP, but the additional force of gravity drops your soft tissue to an even greater degree, eventually blocking the airway enough to cause a sleep disturbance event. (I'm no sleep dr so don't quote me on this)

With that said, i know PS works for many UARS sufferers, but try turning off EPR or PS and see if that works. I always worried about EPI, so i always turned on PS, which didn't help. So try turning it off.

It also makes sense, because normal apnea sufferers often don't use bipap PS or even EPR, and many of them don't suffer from EPI of breathing out against EPAP, so why would it be any different for UARS?

Btw, try every setting. Everyone's different. Experiment. Try 0 PS and try EPR/PS.

This is just what's worked for me

Im glad i dont have to worry about the issue anymore since i used to spend SO much time looking into it... in reality, the answer was much simpler than i thought it would be.

I've seen those backpack type things on Amazon, which are ridiculously priced, so I'm curious if there's any type of alternative or home remedy people have found effective.

Thanks!

Was pretty skeptical after I've had poor results with a lot of "sleep hacks", but last night I tried an improvised wedge pillow (combined a large sofa pillow and some other pillows to securely prop my head and upper body up at about 20 degree incline).

Best night sleep in a LONG time, what was particularly noticeable was the reduction in sleep fragmentation and I set a new PB for continuous time in deep sleep (in the six months I've used the sleep tracker). Only managed 5h or so with the improvised pillow (due to discomfort and my jaw falling open ultimately) but that's a huge win for me. Beats the socks off my tennis ball in the back of the shirt experiments.

Theory was I noticed on really bad nights i seem to get a kind of sinus congestion when laying down. I never experience congestion during waking hours so I thought that was a bit notable. I also have some evidence of upper airway involvement due to an experiment with mouth taping absolutely wrecking me.

Maybe I'll try propping the head of the bed off the ground, some studies suggest only something like 7.5 degrees might be needed.

So it's been a few night on BiPAP now. Since I have this machine only for a month I've been messing with the settings more on a day to day basis than weekly. I know, not optimal but I got not much time.

Here are the flow curves from the different settings. Any advice on how to proceed to get the curves better?

I'm using the Aircurve10 ST. One last remark: Because I'm renting it, they delivered a little plastic bacterial filter which I am supposed to use. I forgot to put it on the other day and noticed how much stronger the pressure felt due to it.

Initial CPAP 10 EPR 3 curve (according to my sleep doc, optimal):

IPAP 10 EPAP 4

IPAP 11 EPAP 5

IPAP 12 EPAP 6

IPAP 13 EPAP 7

IPAP 14 EPAP 7

IPAP 14 EPAP 8

IPAP 15 EPAP 8 (with bacterial filter)

IPAP 15 EPAP 8 (without bacterial filter)

IPAP 15 EPAP 9

Does anyone want to have a chat?

I feel like untreated UARS with autism is hell. Having a rough time and feeling alone here...

I have managed to finay fall asleep with my CPAP for 1 hour tonight and apparently in that hour I had 10.8 registered events.

I guess that means I'm not crazy? I had to fight to say I have a sleep disorder because I had a normal sleep study 3 years ago.

I'm waiting for a new one now...

Hi,

I'm looking to flash my AS10 with the Aircurve 10 VAUTO firmware as I've been having mediocre results with the AS10. The VAUTO isn't even available in Australia so I can't even rent one to try out which is pretty annoying..

Please PM me if you're able to help, thanks very much.

Been 5 years on CPAP with no relief. Super brain fog, zero motivation/emotions. Finally trying to rule stuff out, doc wants me to do a over-day sleep test to rule out Insomnia/Hypersomnia, but I have none of the big side effects of those.

So it sounds to me like UARS, given that my last sleep study showed 20+/hr Spontaneous Arousals and 15+ Resiratory Arousals even though I have minimal AHI. But my oxygen is never below 90. I have an appt with a ENT Doc in February to check having a DISE or checking for UARS, because I think all my signs point to UARS, but does 90%+ oxygen mean it shouldn't be UARS?

This is 3 days of Oscar reports and sleep studies from 2023 and 2024: https://imgur.com/a/sleep-apnea-docs-ehKVRh3

Thanks for any help!