PSG Results: Could this be UARS?

[Geer1]

I believe scoring RERA's is optional by the standards that are supposed to be followed. It is definitely worth looking into whether or not they scored them. If they didn't score them see if it would possible to review the data to do so (either in entirety or as a quick scan just to confirm if RERA's apeared to be an issue).

[JoeyWallaby]

Yes RERAs are optional to mark so most sleep labs don't mark them. Palate expansion isn't cheap or easy in adults, most orthodontists don't even do it.

Can you post some waveforms closer up?

[deebob]

Yes RERAs are optional to mark so most sleep labs don't mark them. Palate expansion isn't cheap or easy in adults, most orthodontists don't even do it.

Can you post some waveforms closer up?

Here are a few https://imgur.com/a/SrrGLF8

There are a bunch of others earlier in this thread.

[jomama]

Also, have you tried blue light filtering glasses? I know it sounds silly, but in my experience, they actually do work when it comes to allowing your melatonin to naturally do what it does. For example, after wearing them at night, starting 2-3 hours before bed, almost immediately, it had a positive regulating effect on my bowels in the mornings. Strikingly so. This is not actually too surprising, as there is melatonin in the gut, too. But the point is: they actually work, they actually have an effect. I also noticed that I got drowsy a little earlier. Unfortunately, it didn't help my broken sleep, but I keep using them because I feel it's good for my health at this point. This is what I use:

[Commercial Link Removed] Search Amazon for B000USRG90

[I put them on around 9pm. I don't use them when I watch TV, but whenever I get up and turn on lights, I use them. I also dim my TV a little if I watch something before bed. I've tried reading instead, but that doesn't make a difference. 

Okay, so I just learned that I made a mistake by posting a commercial link. Forgot about that rule. All caught up now. Sorry for the faux pas. 

The OP isn't interested, but in case someone else is, the glasses I referred to are "Uvex Skyper". (Unless I'm misreading the rules, it's okay to name the product, which, by the way, I have no connection to.) They're about $10.

[deebob]

So the last couple of nights haven't been great.  I've been sticking with 8cm of pressure with a short ramp from 5.  I've been waking up very frequently, and staying in bed for like 11 hours just to get enough sleep.  The majority of nights this past week have had good chunks of 2-4 hours of not being able to get back to sleep in the early morning.   I think the CPAP has been making things worse unfortunately. I don't know if my sleep was as broken before this, and the insomnia wasn't as consistently bad in the middle of the night.

I recorded myself last night for the first time with a night vision CCTV camera I got on Amazon.  It doesn't look like I have any crazy limb movements going on...maybe it's hard to tell since it's not a super close-up angle but it doesn't look like I'm kicking myself awake or jerking around much. But what I did find a bit disturbing was that I seemed to wake up and move around even more than my Oura ring reported. It seemed to be pretty accurate about a lot of the times I woke up, but then it also seemed to miss a few as well, which is puzzling since it should be pretty easy for it to catch me moving around and fixing the mask or whatever. But it looked like I was rarely sleeping for more than 30-45 minutes without moving around or waking.

I'm meeting with the respiratory therapist tomorrow to talk about the first two weeks of my CPAP trial and figure out what I should do moving forward. I suppose I will just continue for two more weeks in hopes that I get more used to it? But right not the CPAP doesn't seem to be doing anything...I think other than having to adjust the mask once in a while, I don't find the feeling of it to be particularly uncomfortable, and even exhaling against pressure like most people say can be a problem, doesn't seem to bother me. Like I don't even really feel much of a resistance on the exhale.  So I'm not really sure what else I need to get used to. Is it just that my body/brain is subconsciously bothered by it, even if I find it subjectively comfortable enough?

I'd like to consider getting a BiPap since so many people say that's the best thing for UARS, but I'm worried that it won't really make a difference since I currently don't think exhaling against pressure bothers me. Maybe I just don't realize that it's bothering me?  I just don't really see how that extra pressure support would make that big of a difference for me and magically reduce my awakenings. Is exhaling against pressure really causing me to wake up? I'm waking up about the same as I was without the CPAP.

Then there's the question of whether or not this is even UARS. I can't help but think all signs point to UARS, given my physical characteristics, symptoms, similarities to other peoples' experiences and ones I read about from people like Dr. Barry Krakow. There isn't a ton of data in my sleep studies or OSCAR charts to support it, but I don't think that necessarily rules it out.  Otherwise what else could it be?? I just can't imagine it's some kind of insomnia that wakes me up so consistently and frequently. And it doesn't look like I have some crazy limb movements that are causing awakenings either.  I definitely find myself waking up almost always during dreams. And Dr. Krakow has said that UARS sometimes only occurs for some people during REM. Otherwise is it possible for an anxious person with a low arousal threshold to simply wake up from the intensity of a dream and nothing else? Is there such a thing?


https://imgur.com/a/d2VOAs8

[Dormeo]

My two cents: It is too early to draw any conclusions. While a few lucky souls take to the new experience without breaking stride, most of us don't. It's a very new and different experience, and even if there's no real discomfort involved , our brains and bodies are going to need time to adapt to a new normal.

Also, be aware that it is absolutely normal to wake up multiple times during the night and to change position multiple times during the night. By themselves, these are not problematic. What *is* problematic is to wake up and stay awake for 2 - 4 hours. After about 20 - 30 minutes, if you can tell you're just not going to be dropping off any time soon, the sleep experts tell us it is best just to get up, go sit somewhere in subdued lighting and read a (paper) book or magazine for a while until you feel sleepy again. I think one reason they give this advice is to help us avoid strong associations between being in bed and being awake and anxious.

[Geer1]

I'd stick with it. Like I said earlier the biggest change you may notice is when you quit CPAP and that change will be the most noticeable the longer you use the machine for.

If this is UARS and those were RERAs then CPAP has to be helping. It might not be resolving all of the breathing issues but the chance that it is actually making things worse is slim. What it is making worse is your anxiety about the situation though just as it does many users.

[tarah]

It's normal human behavior to move ALOT during sleep. Average is like 15 times an hour, so I wouldn't let the camera stuff freak you out too much.  My mom has PLMD and it's very apparent on her flowrate. My sleep doc did say to get ferritin levels checks and treated if below 60 ng/mL because low levels can decrease dopamine in the brain, which can worsen limb movement.
The constant feeling of awakening is a problem and it sucks badly.  I am still battling it.  If it were me, I'd try to move to a bilevel and see if you can get more relief.  It will take time though, even if it works.  It took about 6 months for the gasping as falling asleep to fully stop. Even as bad as things are still at times, I have tried to sleep without my machine now and it's a hundred times worse.  I wish it would just completely go away immediately, but I dont think that's how it works for most people. It took my mom about a year to find a good mask, stop leaks, and insomnia to (mostly) go away, and she still battles plmd, currently unmedicated. My sister adjusted quickly, but after several years, is waking up fatigued and has to figure out what is happening. I have been on cpap/bipap for 2 years, and have done cpap, nasal surgery, now bipap, and it's not the end of the story by a longshot. My point is that this may be something to shift your perspective on, like this is a chronic disease that most of us will battle for the rest of our lives. Therapy works but it's not perfect and there will be hard times on the road to getting better.

[deebob]

Well I’m starting to suspect I might be dealing with that Palatal prolapse issue, Expiratory Palatal obstruction...in which case CPAP and bilevel could be making it worse. The description of that issue posted by NightVigil in that other thread sound very fitting to my situation, especially since the ENT said I had a shallow velopharynx, and some of my breath curves had that flat line that you said could be a prolapse. 

I’m wondering if I should try turning off EPR, since that could make it worse. 

I’m not sure the best way of figuring out if I have this EPO or regular UARS, but I may need to talk to another ENT. Because if I do have EPO, I may need to be looking into some kind of surgery instead of pap therapy.

[Dormeo]

Again, I think you’re thrashing around prematurely. Have patience, hard though that is.