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PSG Results: Could this be UARS?
#51
RE: PSG Results: Could this be UARS?
Argh I've reached my attachment quota....I need to make those images smaller files next time. So I've uploaded them to Imgur. Here are some zoomed in shots of 5 and 7 pressure.

https://imgur.com/a/wqSGv91

I'm curious why you don't think that looks like a RERA?  Doesn't it show some flow limitation + flow rate irregularity + pressure increase right before an arousal?
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#52
RE: PSG Results: Could this be UARS?
Yeah you are having some flow limitation even when it isn't flagged (fairly common).

Definitely need to increase minimum to 7 to try and ensure decent treatment.
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#53
RE: PSG Results: Could this be UARS?
I'm curious why you don't think that looks like a RERA?  Doesn't it show some flow limitation + flow rate irregularity + pressure increase right before an arousal?
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#54
RE: PSG Results: Could this be UARS?
I don't see an obvious arousal at that point. There might have been one but I think it was just some irregular breaths. Those irregular breaths happen more often in rem sleep and the time of this event does agree with Oura ring rem period.

The funny thing is that there might have been a RERA at 6:49. It looks like some sort of arousal and afterwords your flow rate peaks slowly decreased then you had the irregular breaths. I believe Resmed flags RERA's based on a slowly reducing flow rate followed by a disruption and hence why this RERA got flagged where it did although as mentioned I don't think that is correct.

This is one example that indicates why I am a proponent for set pressure as the 1.5 cm pressure increase due to this situation likely wouldn't have been helpful if your pressure had already been at 7 cm. Since your pressure was lower it was beneficial as it increased your minimum pressure to where it needs to be for EPR but if your pressure had already been 7 cm at this time what the increase in pressure might have done is woken you up rather than just having the brief arousal that occurred.

I am not writing off UARS at this point, your breathing does show the possibility of it. That is why I want you to get to effective treatment range so you can see if you start sleeping/feeling better while on this trial period.
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#55
RE: PSG Results: Could this be UARS?
(02-14-2020, 03:16 PM)Geer1 Wrote: I don't see an obvious arousal at that point. There might have been one but I think it was just some irregular breaths. Those irregular breaths happen more often in rem sleep and the time of this event does agree with Oura ring rem period.

But the flow limitation, pressure increase, and irregular breathing happened right before I woke up. Which matches the time the Oura ring said I woke up (period of REM right before I woke up). My experience for the last few months has been mostly waking up during REM, and this data is the first time I’ve maybe confirmed a breathing problem prior to that REM awakening. Unless I’m misunderstanding something in the data.
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#56
RE: PSG Results: Could this be UARS?
The thing is that even if that was a RERA it was a minor arousal. These alone don't cause significant issues, if they are occurring in large quantities then they become an issue. Sleep disordered breathing is not uncommon and I have seen estimates that 1 in 4 people have SDB, unless it is symptomatic it is not a significant issue.

I thought my rem breathing was for sure an issue until I realized that breathing is messed up during rem even in healthy individuals. This video helped me understand this. 

https://youtu.be/gR6o5XT3O6I?t=697

UARS for the most part causes issues in N2 from what I have read and your sleep study showed far worse sleep quality during N2. Not saying it is because of UARS (sleep study should have indicated more RERA's if it was obvious) but that N2 arousal issue is likely your main problem. Now that you know kind of what arousal breathing looks like perhaps try and review your N2 sleep to see if you see a significant number of arousals and if your do see what the breathing looks like in those situations. People remember waking up in rem because they remember the dream and because they are more mentally alert, that doesn't mean that the main issue is necessarily happening in rem. If you post the OSCAR data showing the arousal prior to wakeup during rem and breathing leading up to that point it might better understand what was going on at that time and whether or not the breathing seemed to be the issue.

Regardless of whether or not these arousals are caused by UARS one of the main goals needs to be focusing on getting back to sleep after they occur. You need to try and figure out what causes you to stay up and then work to minimize this effect. One of the common causes is anxiety, you need to accept that worrying about your sleep doesn't help. Take some deep belly breaths and relax, tell yourself you are fine and that sleep will come. Just rest there and don't pull out your phone, laptop etc to pass time. If you absolutely cannot get back to sleep get out of bed and do something relaxing for a bit (read a bit of a book etc) then when you start to feel a bit tired again get back in bed. 

Anxiety is a physical phenomenon. It is meant to protect us in dangerous situations but our bodies aren't used to our current lifestyles and we turn this physical phenomenon on by stressing out about things that aren't really worth worrying about. One of the key steps is realizing this and learning how to avoid it, if you let your anxiety get triggered it pumps you full of epinephrine and your body enters fight or flight mode then good luck getting to sleep.
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#57
RE: PSG Results: Could this be UARS?
Here are some zoomed in screenshots of my breathing prior to waking up at 02:33, the 'RERA' at 06:50 and another awakening at 08:55 during REM (according to Oura).

https://imgur.com/a/rqDNlma

The one at 06:50 that was flagged as a RERA is the most compelling, because it shows some breathing irregularities, and flow limitation, and pressure increase right before I woke up. Oura said I was in REM before waking up at the exact time that OSCAR says I experienced a RERA.
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#58
RE: PSG Results: Could this be UARS?
https://imgur.com/a/0Ep0Gpa

Here is last night with a couple flagged OAs and Hypopneas, and a few of these events resulted in me waking up. But I'm still not sure what to make of this.  I'm clearly waking up consistently because of something and my gut is telling me it's more than just some anxiety/insomnia issues, especially since many nights I do a good job mitigating anxiety and go to bed feeling pretty good, only to wake up like 7 times throughout the night.

I am remaining at the same auto pressure for now, since I've only been using it a few days, and it might at least be useful to collect some data to make a case for UARS or not.

I'm worried that I might not get any answers by using a regular CPAP that isn't equipped to solve my problems, and a BiLevel might be the solution but there will be no way of me knowing without buying one to try it.
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#59
RE: PSG Results: Could this be UARS?
There will be no way of knowing if CPAP will work if you don't change settings ;-)
Caveats: I'm just a patient, with no medical training.
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#60
RE: PSG Results: Could this be UARS?
Yup. Don't even think about bilevel as you haven't given your current machine a chance to work yet. Most people hope to find the magic cure after a night or two but that isn't how cpap works. First you need to find the right settings and then you need to give it time, like weeks and sometimes months time. The reason is that you need to adapt to sleeping with the machine and your body needs to adapt as well. You have months/years of training your body to try and deal with whatever is disrupting its sleep, things aren't going to change overnight.

I really think you should be running in cpap mode at 7 cm, 3 EPR. The changing pressures are not helping you and the main time the pressures are changing is during SWJ which is when your apneas were occuring. Pressure fluctuations disturb sleep and also mentally effect u, 5 cm pressure with 1 epr feels significantly different than 7 cm with 3 epr and as this change is occuring your brain and body are sensing the changes and trying to understand why your breathing is different. A steady consistent pressure setting removes this and will likely improve your sleep as it did mine.

OAs are common enough during SWJ and often occur when changing position (rolling onto side etc). CAs are common too as is just about any sort of strange breathing. Any events occuring after an arousal(when obvious smooth sleep waveform get interrupted by usually larger amplitude strange looking breaths) should be ignored and in fact if you were getting a PSG done they are. Simply stated sleep disordered breathing can only occur if you are asleep.
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