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Mild Sleep Apnea (but still tired)
#11
RE: Mild Sleep Apnea (but still tired)
@alexp zoomed in on a couple interesting spots. Most of the night looks pretty uniform though.

@Melman Thanks!


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#12
RE: Mild Sleep Apnea (but still tired)
Here's one that looks like and may be a RERA :
   

If you see this kind of patterns in a lot of places, this may indicate that you have a lot of microarousals during your sleep and may explain why you're feeling sleepy.
Otherwise, your numbers are pretty good.
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#13
RE: Mild Sleep Apnea (but still tired)
Since Day 1, there were two recorded days with 1-2 RERA events each fwiw.

I did zoom in to that one particular area as my wearable sleep tracker detected enough movement where it thought I was awake around that time (although I have no recollection of it).
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#14
RE: Mild Sleep Apnea (but still tired)
Good but the reason I was asking is your machine may not able to pick all the RERAs and therefore may not increase the pressure to resolve the events.

People suffering from UARS are really sensible to flow limitation for some reason and wake up to small changes  before the machine has a chance to flag the event and increase the pressure. The only way to tell if is it's happening or not is to check by yourself and see if you can spot some flow limitations that weren't registered (or do a proper in lab sleep study but that's expensive). 

I'm not saying you have UARS but since you are suffering from mild apnea and feeling tired, it's a possibility that shouldn't be ignored.

Just to give you an idea, my AHI is only 20 but my RDI is 36. At first, my pressure was just high enough to prevent my apneas/hypopneas but I was still experiencing lot of RERAs. I was feeling like crap until I took care of these events as well.
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#15
RE: Mild Sleep Apnea (but still tired)
@alexp I have my first follow up with my doctor this week after having the CPAP for a month. I will bring up UARS with him. The more I dig into the literature, the more it seems likely (relatively young, fairly lean, grind my teeth, AHI is <1 on average yet still wake up feeling unrested, frequent bouts of lightheadedness/dizziness from standing up due to low blood pressure, etc).
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#16
RE: Mild Sleep Apnea (but still tired)
(08-07-2019, 11:15 AM)alexp Wrote: ... Since most apneas events happen during exhalation, it does increase the pressure you need to prevent apneas.

Do you make this statement in reference to the person in question and his presented data, or is this your understanding based on global apnea?  I can't find any evidence to support it if it's the latter.
Serial Tapist
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#17
RE: Mild Sleep Apnea (but still tired)
(08-26-2019, 01:03 PM)mesenteria Wrote:
(08-07-2019, 11:15 AM)alexp Wrote: ... Since most apneas events happen during exhalation, it does increase the pressure you need to prevent apneas.

Do you make this statement in reference to the person in question and his presented data, or is this your understanding based on global apnea?  I can't find any evidence to support it if it's the latter.

It's probably an over generalization. What I meant is that you need to raise the EPAP until you have no more full apneas and then you adjust the IPAP to deal with hypo and flow limitations. This is the Philipps bilevel titration protocol. See : https://philipsproductcontent.blob.core....3de0e6.pdf
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#18
RE: Mild Sleep Apnea (but still tired)
(08-26-2019, 12:00 PM)brainf0g Wrote: @alexp I have my first follow up with my doctor this week after having the CPAP for a month. I will bring up UARS with him. The more I dig into the literature, the more it seems likely (relatively young, fairly lean, grind my teeth, AHI is <1 on average yet still wake up feeling unrested, frequent bouts of lightheadedness/dizziness from standing up due to low blood pressure, etc).

Good luck. I hope you'll feel better. Just don't be surprised if your doctor has no idea what is UARS. Most doctors don't know about it or don't care about it. I don't want to be pessimistic but it's the sad reality of current sleep medicine. Most doctors only care about your AHI and nothing else.

The good news though is that a sleep study can confirm if you are experiencing many RERAs and give you your RDI which in my opinion is the number doctors should focus on. If your RDI is high, you'll know that's probably your problem and can start trying to fix it yourself and if not move on.
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#19
RE: Mild Sleep Apnea (but still tired)
@alexp and everyone else following this thread:

As you predicted, the follow up was disappointing. The doctor was aware of UARS, but it was clear he did not take it seriously nor did he think it was a legitimate diagnosis. All he was focused on was how my numbers looked great and how I should be feeling better and I just need to give it more time and let the CPAP run longer. He did offer a lab study when I asked, but he said it would be with the CPAP running, no titration testing, and no endoscopic viewing of my breathing. It would provide the RDI, but he claimed my insurance wouldn’t cover it, so it would be 100% out of my own pocket. Ultimately, we decided to part ways.

I am in reasonable proximity to the Stanford Sleep Medicine Center (where the late Dr. Christian Guilleminault, the “father” of UARS operated out of). I think I will try my luck with them next, but the comments regarding their office administration are overwhelmingly negative. I will also do some research on the practicing physicians there as Dr. Guilleminault recently passed.

I am in a temporary state of limbo in the meantime and am not quite sure what I should do with my CPAP at night.
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#20
RE: Mild Sleep Apnea (but still tired)
Update:
 
I now have an appointment with a sleep doctor who collaborated with Dr. Guilleminault on UARS related research before he passed. Unfortunately, the appointment is 4 months away and I do not have a sleep doctor until then. What do I do until then?
 
I tried moving the pressure range on the AirSense 10 to 8-12cm EPR 3 for about a week and surprisingly that seemed to help a little bit (in terms of how I felt the next day).  But if I turned the minimum pressure up to just 8.2 or 8.4cm I felt like I couldn’t breathe, slept horribly, and felt like death the next day. First screenshot is with the AirSense 10 at 8.0cm where sleep was starting to improve slightly and feeling "okay" the next day.

Then I had an opportunity to purchase a lightly used AirCurve 10 VAuto. I’ve only been able to use it once so far (second screenshot), but with the settings nearly identical to the AirSense 10, I was amazed at how much easier it felt to breathe. I woke up a couple times at the end of sleep cycles, but I was shocked I felt no temptation to tear the mask off my face. (Min EPAP 4cm, Max IPAP 12cm, PS 4cm). I also feel "okay" today, but that is much better than straight death! I returned the AirSense 10 to the DME (as it was still considered a rental).
 
This feels really promising and I’m hoping to do more self-titration before my appointment in 4 months. As a side note, I also ordered nasal pillows to try that out and hopefully improve the leakage when they arrive.


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