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[Diagnosis] Negative sleep study, still ordered a CPAP
#21
RE: Negative sleep study, still ordered a CPAP
(11-16-2020, 08:16 AM)marasmus Wrote: Sleeprider , one of the reasons I joined this forum is to give insight to the people who have been suffering quite a long time from a standpoint of an MD and also learn from their experience so that I can improve my own sleep as well as my patients. It just hurts me to see that a lot of patients are unable to receive the appropriate care they need due to tackles in medical system. I have been suffering from UARS and being a physician I find myself struggling significantly navigating in the path through recovery and I probably can only imagine what patients have been going through. 

I would say this is an extremely important forum that gives hope and relief to patients. It needs to be supported and as a physician and a patient myself, I would do my best to contribute.

Periodic Limb movement tends to happen during lighter stages of sleep and disrupt the first half of your sleep more than the second. Due to muscle atone during REM, any type of movement decreases unless you have REM behavior disorder in which you act out your dreams in sleep. But if you had that, you would know it. It is much more than toss and turn.
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#22
RE: Negative sleep study, still ordered a CPAP
gerd could itself be a reason for your troubles. cpap significantly reduced mine but you don't seem to have much of a problem with apnea so other means of treatment might be beneficial to ease that and to determine whether it's a factor in causing your disturbances. cotton mouth is from mouth breathing. I'm not sure if you've always had it or only after cpap but the solutions are the same: chin strap, soft cervical collar, tape, the tongue suck method and xylimelts or similar.
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#23
RE: Negative sleep study, still ordered a CPAP
(11-16-2020, 02:01 PM)sheepless Wrote: gerd could itself be a reason for your troubles. cpap significantly reduced mine but you don't seem to have much of a problem with apnea so other means of treatment might be beneficial to ease that and to determine whether it's a factor in causing your disturbances.  cotton mouth is from mouth breathing.  I'm not sure if you've always had it or only after cpap but the solutions are the same: chin strap, soft cervical collar, tape, the tongue suck method and xylimelts or similar.

Had not thought about that yet honestly. Just searched it up on google and it appears GERD can lead to arousals and fragmented sleep, so I'll have to ask for an acidity measurement test for my esophagus then. I'll also try taping my mouth shut tonight. I was afraid that if I taped my mouth shut, I won't be able to gasp for breath when I wake up at night and that I'm too confused to realise my mouth is taped shut.
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#24
RE: Negative sleep study, still ordered a CPAP
if you're anxious about taping, as I would be if I could tape (won't stick to beard/mustache), buy or fabricate a chinstrap or preferably a soft cervical collar. most straps pull the chin back which aggravates osa. a collar keeps the chin up and for some reason is also reasonably effective against lip leaks from pressure. in the US, a collar can be found at many pharmacies, & maybe dme suppliers, for 20 usd or less. I've purchased from walgreens and rite aid. of course you can find a better selection online. meanwhile, anything that'll hold your chin up may help - a pillow, one of those neck collars that hold your head up sleeping in a car or airplane, a towel rolled around a necktie... I'm sure you can find something around the house to use temporarily.
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#25
RE: Negative sleep study, still ordered a CPAP
I recorded my sleep last night and noticed no breathing stops or anything and no large amount of turning/rolling either. I think I can say that sleep apnea is not the case here, but it was worth the try. I'm picking up antacids at the doctor this afternoon which I'll have to try for a month, if that makes no difference she said she'll ask for a study at an ENT or gastroenterologist. I also got a referral for a psychologist who will contact me in a few weeks to make an appointment to see if I have PTSD or any other syndrome/disorder that could interfere with my sleep. If the possible GERD and PTSD are not the cause, I will ask them to check for PLMS/RLS, but I'll have to record some more nights of sleep before I can say that I suspect that.

I want to thank you all for your time and appreciate it sincerely. For now I have no more questions, but I'm glad something has atleast been set in motion.
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#26
RE: Negative sleep study, still ordered a CPAP
(11-17-2020, 06:17 AM)Anargy Wrote: I recorded my sleep last night and noticed no breathing stops or anything and no large amount of turning/rolling either. I think I can say that sleep apnea is not the case here, but it was worth the try. I'm picking up antacids at the doctor this afternoon which I'll have to try for a month, if that makes no difference she said she'll ask for a study at an ENT or gastroenterologist. I also got a referral for a psychologist who will contact me in a few weeks to make an appointment to see if I have PTSD or any other syndrome/disorder that could interfere with my sleep. If the possible GERD and PTSD are not the cause, I will ask them to check for PLMS/RLS, but I'll have to record some more nights of sleep before I can say that I suspect that.

I want to thank you all for your time and appreciate it sincerely. For now I have no more questions, but I'm glad something has atleast been set in motion.

I would not jump into conclusion that breathing related sleep disorder is not the case here. It is always good to rule out other potential reasons but you may very well be suffering from UARS and the only difference is that UARS you stop breathing less than 10 seconds and wake up which does not qualify for apnea or hypopnea. It disrupts your sleep as much as OSA would if not more.
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#27
RE: Negative sleep study, still ordered a CPAP
The problem is that UARS is not recognized here and I have no way of getting my hands on a BiPaP and neither do I have the funds for it at this time.  I tried the CPAP setting on my ResMed, but it changed nothing for my sleep quality, it even seemed to be worse. I’d like to get tested for UARS, but I don’t see how? I got referred to my sleep study only after waiting for 2 years and demanding it. Do you think a WatchPAT study could help?
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#28
RE: Negative sleep study, still ordered a CPAP
In support of the comment by marasmus, you are using therapy which treats any apnea that might otherwise occur. It is premature to conclude that you don't have sleep disordered breathing, however that was the conclusion of your diagnostic study. In your results we see occasional flow limitation, but levels are quite low. Without a close-up examination of the flow rate, we really can't make a more detailed evaluation. We usually try to look at the flow rate for a 2-3 minute segement of sleep to see what it tells us. At that zoom level, we can clearly see the inspiration and expiration wave shape, and that is usually conclusive if there is any flow restriction. Keep in mind, that your current settings should effectively treat apnea and UARS.
Sleeprider
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#29
RE: Negative sleep study, still ordered a CPAP
With current settings, do you mean APAP mode from 7 to 8 or do you mean CPAP mode on 7cm2OH? 

I’m still using the machine and will do so again tonight. I’ll upload a new OSCAR screenshot tomorrow. I’ll zoom in on the flow rate. Is there anything else I can show you to better see what the problem is?
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#30
RE: Negative sleep study, still ordered a CPAP
As per your advice I have continued using the CPAP. I have received Famotidine to treat my GERD and am also taking Iron supplements. A cervical collar will arrive at my home in a few days too to prevent mouth breathing. I have bought a WatchPAT study from a private clinic which I will do upcoming wednesday, they were kinda shocked I was using a CPAP without diagnosis and told me to stop using it immediately, for my own safety and to make sure the results next week aren't fiddled with because of my CPAP usage. I hope this can show me if I have UARS. This was my OSCAR chart last nigt including zoomed in 1 minute timeframe screenshots of the flow limit. Can you people see anything out of the ordinary here? If there are any other charts you need to see to better visualize what's going on, please let me know. 

Thank you in advance.


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