Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

PSG Results: Could this be UARS?
RE: PSG Results: Could this be UARS?
I know I haven't used the CPAP very long, but there are quite a few clues pointing to Expiratory Palatal Obstruction as well....especially my flow curves that look very similar to the ones on this site put together by yrnkrn, so I can't help but wonder if that's what's going on. It would make a lot of sense based on a lot of my physical characteristics and experiences. I think I've even felt this palatal prolapse happen a couple of times during the split second that I wake up from REM...almost like a snoring suction feeling in my soft palate.

 It definitely makes my situation challenging because I know CPAP/BiPAP can take a while to notice results, but if I have this EPO, then spending a couple months waiting for me to get used to the CPAP will actually be a waste of time as it isn't helpful for EPO. It's kind of a tough call. It would be nice to be able to get a definitive diagnosis so I can plan a treatment option, but it's really hard to do that without getting bounced around to different specialists which can take months waiting for appointments, and possibly months for another sleep study.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
So breathing like this occurs even with your mouth securely taped? And how often does it happen? Multiple times every night?

[Image: lweiUYK.png]
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
I’ll have to look through my charts some more to see how often it happens but it looks like the flow is pretty similar a lot of the time. Not as bad as those flat lines but usually a little bit of a squiggly line before the peak. My mouth is always securely taped, but since I’ve been using the CPAP, especially at higher pressures, I’ve noticed my mouth has seemed to get a bit dry even with the tape on (which never happened when I was taped without CPAP), and it almost feels like the CPAP air is pushing through and maybe escaping through cracks on the side of the tape or something. I’ve been taping it even more securely but it was previously almost coming off while using the CPAP when I put on one or two strips of tape (I’m using three now). 

But I’m wondering if I should experiment with no tape and see what happens, because if I do have this EPO, taping could potentially be making it worse if the air has nowhere to escape. I don’t really know much about the mechanics of all this though.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
(02-23-2020, 04:42 PM)deebob Wrote: 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?

I don't see why not. Makes sense, to be honest. I've woken up during intense/disturbing dreams lots of times. But I also wake up during dreams that don't feel incredibly intense. And I also wake up for reasons that I'm still not clear about. But it's well known that PTSD and depression can cause fractured sleep which is very similar to what you're describing (and what I, too, experience). 

In my case, I think it may be a combo burrito of mild SDB issues, and something related to anxiety/PTSD type stuff, my nervous system being easily triggered, because it's kind of used to being on high alert. From what I've read, things like PTSD and depression and anxiety, if experienced for a long time, can alter neural pathways (I don't have a reference for it, but I've come across that idea). I continue to wonder if mine are just permanently altered/on high alert when sleeping, and either they will heal, or not. 

I also wonder if I have a defective gene or something along those lines, something that's happening that should , or something not happening that should. Because my body does want to sleep, and it does fall asleep, it just is jolted awake. Maybe some chemical or something that suppresses functions for restful sleep is not activating enough. PSG just doesn't seem subtle enough to detect such things, which is frustrating. 

But I also present like someone with apnea, or UARS,,which is why I'm exploring PAP therapy to see if addressing my mild SDB issues (like flow limitations) will help. 

It's hard when it's so hard to get truly worthwhile data, which I don't think medical science can provide at this point, at least when it comes to complex, mysterious cases like yours, and mine, and many other people's I've read about.

But yes, anxiety, depression, PTSD type stuff can wreak havoc on sleep. Seems well documented. Trauma, for example, is not something that the body easily or quickly lets go of. 

And I often wonder if many people who sleep "normally" might also experience a few "apnea" type events through the night, but it just doesn't mess them up. But then, I also have experienced feeling my throat kind of close/hiccup upon an arousal. So, again, it might be more than one cause, which makes it that much harder to solve.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
I looked through the data you sent me and palatal prolapse only occurred once in a while. The guys that really struggle with it have it most of the time and can barely fall asleep because of it.

Your data looks surprisingly similar to my own. For the most part what looks like normal breathing, if anything there is some consistent flat tops/minor flow limitation, the odd RERA at times and some other arousals of unclear cause. You definitely aren't having 30 arousals per hour like the PSG indicated so perhaps CPAP is helping.

I like the current settings (CPAP 8 cm, 3 EPR), your sleep seems a bit more consistent on it than when at lower pressures and the handful of higher pressure moments don't seem to improve flow limitations. Last night was one of your best looking nights so far.

Lets stick with things as is and rest easy knowing you are getting somewhere on this stuff. Try to dig into whether or not the PSG clinic scored your RERA's and if they didn't if it would be possible to do so as your ENT thinks you may have UARS and if so it may explain the high number of "spontaneous" arousals in the report.

Near the end of the trial we can revisit the data again if you would like. Once we have some clarification on PSG data and a better idea of how this trial went we will have a good idea on how to proceed.

Sleep well and try not to worry!
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
Thank you! I really appreciate you taking the time to look through my data.


Unfortunately last night was probably one of my best looking nights because I wasn't asleep very much.  I have filmed myself with an IR camera the last couple nights, and last night I was barely asleep for longer than 40 minutes at a time. I was visibly awake and repositioning myself very frequently. I may have slept a total of like 5 hours. And I was awake from like 5AM until like 9 AM.

I hope you're right about the prolapse though.  

I met with the Respiratory therapist today at the CPAP clinic, and he seemed to think the 8cm was good to stick with as well. He actually suggested we could try turning EPR off to see if that improves the prolapse situation, since EPR wouldn't help with that if that is going on. Might not hurt to do that as an experiment and just go back to EPR 3 if it doesn't help. He also gave me an over-the-nose mask to try instead of the nasal pillows...since the pillows may have been a bit leaky, and sometimes would dig into my nose and hurt a bit.


And jomama,  everything you said in your last post sounds exactly like me. I don't have any trauma really, but anxiety and depression definitely seem to make my awakenings more frequent. I also think I'm dealing with the mild SDB/sensitive nervous system/anxiety burrito.  The biggest clue for this theory is that I was experiencing unrefreshing sleep for months before I gradually got more and more anxious about it, at which point the frequent awakenings started. I was also a really bad mouth breather, and didnt use my diaphragm until recently, so I think I had some dysfunctional breathing that caused dry mouth and frequent water/bathroom breaks in the middle of the night....There are just too many mild SDB clues to rule that out and say it's all just anxiety/depression insomnia.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
I am 98% sure that palatal prolapse is not a significant issue with you otherwise I would agree with reducing EPR. In 13 days on CPAP it has only showed up a few times and only once would I have considered it to possibly be an issue and during that time your breathing showed other issues at the same time so I am not sure if the palate prolapsing was actually the issue or if it was just a side effect. Simply put something like this cannot be your primary problem if it only shows up in such limited instances.

The problem with reducing EPR is that it reduces the treatment for your inspiratory flow limitations which are causing more issues at times. Your 95% flow limitation was 0.04 to 0.05 the first 4 days because your average EPR was ranging between 1.66 and 1.96. On the 15th we raised the pressure so that you were consistently getting EPR of 3 and since then 95% flow limitations has averaged around 0.02. Please do not reduce your EPR, I guarantee doing so will be counterproductive.

You didn't sleep that long last night but you slept better than you have on some other nights. Don't let video data convince you otherwise, you don't have video data of those other nights to compare to. Here is 42 minutes of uninterrupted sleep last night.

   

Stick with the plan and keep letting your body slowly adjust. Keep collecting data and video recordings(unless doing so affects your sleep then minimize doing so) then when you finish the trial and stop using CPAP record yourself and see how you feel. If you don't notice an obvious difference at that time I will be surprised if your issues is UARS. If you do notice a difference it will confirm breathing is an issue and we will take the next steps.
Post Reply Post Reply
Grin 
RE: PSG Results: Could this be UARS?
Ok thanks a lot! I will stick to the plan. Hopefully the new mask helps a bit too because the nasal pillows have been a bit annoying as well. 

You have been more helpful than any healthcare professional I’ve seen in the last few months  Smile
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
(02-24-2020, 06:05 PM)deebob Wrote: I also think I'm dealing with the mild SDB/sensitive nervous system/anxiety burrito.  The biggest clue for this theory is that I was experiencing unrefreshing sleep for months before I gradually got more and more anxious about it, at which point the frequent awakenings started.

There are just too many mild SDB clues to rule that out and say it's all just anxiety/depression insomnia.

Yeah, I feel the same way with my case, too. But, then again, it's really hard to know for sure, since so many of the SDB events on my charts are questionable.

I wonder if the unrefreshing sleep you mentioned actually indicated that you were already having a lot of awakenings, but just weren't remembering them, like they were not enough to wake you up to the point of adrenaline or whatever kicking in and really waking you up, if that makes sense. So, then, when you started getting anxious, you were getting too awake to immediately fall back asleep, and then you're awake in the middle of the night, anxious, and that's classic insomnia. At that point, implementing techniques like deep breathing, meditation, things to help you relax start applying, right?

But I am in the same boat of the unrefreshing sleep, which is caused by frequent "micro-arousals." I, too, videoed myself before going down the PAP road, and was surprised to see that I was shifting position a lot more than I thought I was. Obviously I was waking up a lot more than I thought I was, around 25-30 times a night. But no apparent snoring or limb movements preceding. I'd just start shifting, or roll over or something, maybe a sigh. And then I'd stop moving, likely falling asleep again. The thing is, as tarah already pointed out, it's absolutely normal to partially wake up many times a night, especially as we get older. I found this study to be really interesting, for example, which talks about how arousals increase with age. But at all ages, they're higher than I would expect.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564772/

So then the question is: if it's normal to have that many partial wake ups, why do I wake up so exhausted? Since my charts show flow limitations, I wonder if that's the reason, that maybe I'm tired from struggling against FL. But it's still rather confusing, as to how people can have the same number of micro-arousals, but feel refreshed, whereas I feel like crap. 

In your case, I wonder if you need to deal with the anxiety, too, now, so as not to be awake for long periods of time. That involves what they call CBT, I suppose. I am guessing you've looked into it. That stuff can help with anxiety. Especially, I think, deep breathing/meditation techniques. Even just a simple deep breath, hold for a few seconds, and slowly exhale, repeated 3-4 times can have a powerful affect on your parasympathetic nervous system, telling your body that it's safe and that it's okay to let go and fall back asleep. That technique really does help in those situations. And mediation, as well, learning to let go of thoughts, which are what often keep us awake at such times.

I am currently trying to get used to my PAP machine again to start another trial period. It's hard for me to get used to the machine, being so sensitive to all the sensations that come with it. And I'm not sure I'll be able to successfully eradicate dry mouth (which is a more serious complication than many people seem to think). So, I'm definitely going to keep following your progress. It's hard to have patience and keep doing this stuff, so maybe at least try to feel good that you're actively trying to solve your problems, and that there's a chance you will.
Post Reply Post Reply
RE: PSG Results: Could this be UARS?
So two nights ago I experimented with taking two 0.5mg pills of Ativan that my dad gave me, just to see if that might quiet some of my brain activity and sensitivity to whatever has been going on in my sleep.  I had probably the best sleep I've had in a couple months. It almost felt like a 'normal' sleep. I still woke up a few times, but I think I got a big chunk of deep sleep a the beginning of the night, with maybe 4 or 5 awakenings that I remember the rest of the night, and I was able to get back to sleep easily after.  I felt quite refreshed and normal in the morning (at least compared to what I'm used to the past couple months).

The tricky thing is I don't want to go down the slippery slope of taking drugs like this to sleep, so I still want to get to the bottom of what's going on....but it is somewhat helpful to know that there is a component of anxiety and overactivity in my nervous system that is contributing to the problem. It seems like there's probably still something making me wake up because I didn't sleep perfectly through the night.  But I wonder perhaps if this hasn't been SDB all along, and it is just some kind of messed up anxiety/insomnia that my body has become accustomed to waking up so frequently, would it be possible to sort of reprogram my brain to wake up less frequently if I took Ativan or something like it for a few weeks?

I also tried using the new over-the-nose mask, but I forgot that the RT turned EPR to ramp only, and I never put it back to 3, so I woke up multiple times with chipmunk cheeks and didn't know why. I ended up taking the mask off after a few hours last night. But I'm 95% sure that's what caused it....so I will try again tonight with the new mask and EPR back on. I didn't take ativan last night and I was back to waking up like 10 times or more. But the chipmunk cheeks didn't help.

I'm seeing my doctor next Monday so I'm going to ask him what he thinks about me taking something like ativan temporarily, or even just to have it as a safety thing once in a while if I need to get a good night sleep before work or something. I'm pretty disciplined about these things and I can just not take it regularly if it's a bad idea. I'm also going to see about getting him to refer me to an ENT that the RT highly recommended, just to get another look at my throat and maybe get some insight about prolapse or even if there might be some other solutions there.

I am still tempted to do the AXG Diagnostics home PSG just to rule out if there are RERAs or anything else....because right now there's still just a lot of speculating and trying to treat problems that are all theoretical.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  BiPAP Pressure for Possible UARS bertchintus 20 935 6 hours ago
Last Post: SingleH
  Therapy Help - Possible UARS - REM jkossis 8 156 Yesterday, 02:09 PM
Last Post: Sleeprider
Sad [Treatment] Struggling to treat UARS with BIPAP Humancyclone7 0 61 Yesterday, 12:05 PM
Last Post: Humancyclone7
Question [Diagnosis] Home Sleep Study Results & Feedback togapilot 6 530 03-26-2024, 02:36 PM
Last Post: togapilot
  Can someone take a look at my OSCAR results? 3-4 weeks of CPAP & still improvements senseisaitama 5 132 03-24-2024, 10:43 PM
Last Post: Deborah K.
  New BiPAP user with UARS(?) tk2234 23 617 03-24-2024, 08:11 PM
Last Post: tk2234
  [Pressure] Bipap settings help? UARS and not sure what I'm doing Christina5818 6 195 03-23-2024, 02:52 PM
Last Post: Christina5818


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.