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PSG Results: Could this be UARS?
RE: PSG Results: Could this be UARS?
I may see if the sleep clinic will let me use a full face mask.  I've spent quite a bit of time training myself to breathe through my nose since I started learning more about this stuff in November. I started taping my mouth, doing Buteyko breathing, and working on keeping my tongue on the roof of my mouth (Mewing). But it seems these things have also created new problems since I seem to have some kind of issue with my soft palate and my nasal passage which is making me snore in a different way than I used to when I was mouth breathing, and it's almost worse airway resistance.  But mouth breathing is also worse for your health and caused me to have an extremely dry mouth and wake up like 6 times a night to drink water. So it's kind of bad either way. But with my mouth taping for the past 9 months, I don't even know if my body will resort back to mouth breathing even if I didn't tape my mouth. AND I don't know that I even want to breathe through my mouth.

But what is also kind of confusing to me is that I first started experiencing sleep problems a year ago when I wasn't breathing through my nose, so I'm not really sure why I am experiencing what feels like UARS when I'm breathing in two different ways. It means I've either been experiencing UARS through my mouth and my nose, presumably in different ways, or the airway resistance is occurring further back in my throat so it doesn't matter where the air comes in, OR I'm just not experiencing it at all.  But my recent experiences are really convincing me that something is going on with breathing. The last couple nights I've woke up several times out of breath with my heart racing. And my nasal congestion seems to get a bit worse in the early morning sometimes which usually makes the sleep even worse - so there's a breathing connection there as well. Right now I can't quite tell if my problem is on the inhale or exhale. I've been trying to figure out if I'm actually struggling to breathe against the exhale pressure, since that did seem to be a problem when I was experimenting with higher pressures of 9 and 10, and seemed to improve when I dropped the pressure to 8. And the past couple nights the RERA-type of awakenings I've been experienced felt similar.  But when I dropped the pressure to 7.8 a few nights ago it seemed to make it worse.   

I didn't experiment with the Aircurve yet because I was feeling pretty crappy yesterday and didn't want to try anything crazy, but I might try it tonight. I think higher pressure on the inhale with lower exhale could work if I can tolerate the difference in IPAP and EPAP.

I noticed some flattened tops on my breathing curves last night, as well as some funky squiggly lines, does anyone know what that means? And are those curves flattened enough to indicate flow limitation?  https://imgur.com/a/v60NNOr
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RE: PSG Results: Could this be UARS?
If your nasal congestion is bad enough then forcing yourself to breath through your nose (by mouth taping etc) is an obviously poor decision. It is like forcing yourself to breath through a straw. Determining the reason and treating nasal congestion is perhaps better in the long term but in the short term a FFM might help.

I had started to mouth breath leak more for some reason (I think because of shallower breathing). It was starting to become an obvious issue which is why I switched to a FFM. It helps when my nasal congestion acts up a bit because then I can breath through mouth, in the past there were times I had to take the mask off now I don't have that problem although some of that would be because congestion is now improving.

As for the flow limitations you could call some of those breaths minorly flow limited but flow limitations alone are not a problem. That is why they are not a diagnostic criteria for sleep disordered breathing. The issue is when successive flow limitations(which often worsen) cause a build up of CO2 causing an arousal/RERA, something like the RERA I had a few nights ago. 

   

It is easy trying to chase perfect breathing but if your imperfect breathing isn't causing arousal or oxygen desaturation then it likely isn't the source of your problems. 

Definitely try a higher PS. You most likely don't need higher pressure so I would set EPAP to 4 or 5 and try higher PS. EPAP holds airways open, PS helps force more air through a restricted airway. If you are having obstructive apneas (airway closing) you increase EPAP, if you are having flow limitations then higher pressure is unlikely to help and causes more discomfort and harder exhalation and in some cases centrals (usually caused more by higher PS and what the brain is perceiving as too efficient of CO2 removal).

Edit: Like the original process you might have to try and give higher PS some time. If you notice some improvement on flow limitations (which you should) but say are having central apneas because of the higher PS then you need to give it time to see if your body will adapt and centrals will stop. Starting point would probably be a PS of 4 btw (not sure what all you have tried though).
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RE: PSG Results: Could this be UARS?
If breathing is flow-limited throughout the night, it can have negative effects even if it doesn't result in RERAs. The extra effort of overcoming the flow limitation on each breath can really add up over the course of a night, plus it can mess with sleep architecture on its own, I believe. Occasional and minor flow limitation without RERAs is another story.
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RE: PSG Results: Could this be UARS?
So I experimented with the Aircurve last night, with the 8.0cm of pressure I'm used to, but I did EPAP of 4 (PS 4), which I had previously struggled with.  It felt a little weird at first but I managed to fall asleep and seemed to get through the night without any centrals. But unfortunately I was back to having the same crappy sleep that I was having over a month ago when I was using the BIPAP steadily. I pretty much woke up like clockwork every hour, usually during dreams, which is exactly what was happening a month ago.  My Oscar data looks fine, other than there were a lot of mask leaks for some reason, which didn't seem to be noticeable so I don't know if that was causing me to wake up - my awakenings were very much the same as they used to be when there were no mask leaks so I don't think that was a factor in me waking up every hour. https://imgur.com/a/gCIUp2v

So I really don't know what's going on here. Maybe someone with a bit more knowledge about all this stuff might be able to consider all the clues and figure out why the Aircurve at 8 cm with PS of 4 is causing me to wake up every hour during dreaming/REM, and why the Autoset with the same pressure, but EPR of 3, allows me to get longer stretches of sleep, sometimes 2 or 3 hours. What exactly could be going on here?   

It makes me me wonder about Expiratory Palatal Prolapse, which I know we kind of ruled out back in February, but I have heard that Bilevel can make that worse so that's the only thing I can think of....and I am pretty sure I am dealing with some kind of soft palate/velopharyngeal issue which can be associated with Expiratory Palatal Prolapse.  My flow curves don't seem to suggest that so maybe it rules it out....but at the same time I don't want to definitively rule anything out when there's something going on that is hard to explain.

I have also done a bit more thinking and reading about issues that I am quite positive are part of problem, relating to the mental/psychological/lifestyle factors.  I had mentioned way earlier in this thread that I went from working for a good company with a lot of friends and coworkers that had a great sense of community, to suddenly working as a freelancer by myself from home, and my sleep problems began and coincided with this shift in my life....and I have definitely noticed my life has been a lot more isolated and lonely during times that my sleep has gotten worse, so it caused me to look into this, and there are actually quite a few articles and studies about this exact issue. https://pubmed.ncbi.nlm.nih.gov/22043123/  the study concluded: "Loneliness was a significant predictor of sleep fragmentation. Humans' social nature may partly be manifest through our dependence on feeling secure in our social environment to sleep well."

I've also read about how loneliness causes actual stress on the body and contributes to depression and anxiety that can affect the nervous system and can contribute to that sort of low arousal threshold that makes someone quick to wake up at the slightest disturbance. It seems kind of crazy but it actually makes a lot of sense, and definitely seems relevant in my case. These last 6-9 months have been a vicious cycle for me in which I've become more and more isolated as my sleep problem have persisted, and I've been much less willing to do certain activities or go out at night, or go on dates, because I'm either tired, or I'm worried about making my sleep worse, or I'm worried about how my sleep problems will affect a potential relationship. I also don't like the idea of having to use a CPAP around a girl...which I know is kind of vain but I cant help but think about that. I've even been worried about trying to change my job situation because as a freelancer I have more flexibility to deal with my sleep problems, or sleep more in the morning.  But it's kind of a Catch 22 because I may actually sleep better if I come out of my shell and force myself to go to an office every day and work with people, or have a girlfriend to keep me company and do stuff with regularly.  It feels really sad to say, since it hasnt been a problem for me in previous years, but I've definitely become quite lonely lately, and with a lot of my friends getting married and having kids, I don't have many people to do stuff with anymore, other than my family and a few friends occasionally, but I often find myself being alone most days with no one to do anything with. And from what I've read about loneliness, this is a definite contributor to stress and I'm sure can be capable of making my sleep worse. It doesn't seem to be a well documented phenomenon but it makes a lot of sense.

I still think there are some physical factors at play as well, since I have observed sleep problems at times when I was in a good mood, and not feeling depressed or lonely...and I have been noticing snoring and awakenings where I feel out of breath (especially with the BIPAP), so I'm still not ruling that out. But I'm certain that overcoming some of my mental health and loneliness issues in my life will at least strengthen my body's tolerance to disturbances in my sleep. It definitely makes sense that if my nervous system is stressed from these issues in my life, that I would be way more on-edge and be more inclined to wake up from any kind of stress during sleep - possibly even from elevated heart rate/funky breathing during REM?
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RE: PSG Results: Could this be UARS?
Deebob, before you continue to hypothesize, I would suggest that you give yourself a week or two to get used to the new settings.
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RE: PSG Results: Could this be UARS?
I'm just not sure that there's anything to get used to. I know there's a bit more PS, but it seemed to be a very similar experience to what I was doing for 2 months. It felt pretty comfortable and 'normal' when I was awake, but something is going wrong when I fall asleep. I feel the same this morning as I did during those two months, waking up every hour, and feeling much more tired in the morning. I did experiment with higher PS and different trigger/cycle settings back then as well and it didn't seem to help. I can't explain it, but something about the Aircurve is causing me to have a very particular kind of frequent awakening. And for some reason the Autoset doesn't cause this.  I think I may actually do better without anything compared to the BiPAP. I think all the Autoset is doing for me is preventing me from snoring and having some FL that may make my sleep a bit worse when I go with no PAP. But I clearly don't have bad SDB so I'm kind of on the edge of not even needing any PAP device. So it's possible that whatever the BIPAP is doing is just doing too much and disturbing me even more since I am very sensitive. I know it seems wise to give it more time, but I feel like I've kind of already given it a chance with pretty similar settings...and I don't really want to continue feeling crappy for another week.  I'm kind of just fed up with the Aircurve, and I'm starting to feel like this is maybe just a sign that there's something else going on.  Dont-know
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RE: PSG Results: Could this be UARS?
I noticed when I started that my sleep was very fragmented. Right or wrong I associated it to the fact that I was getting more rest in an hour than I was in a whole night. My pre-treatment AHI was over 90, which means my sleep was disturbed every 40 seconds on average. Your body just is not yet recognizing that you need more sleep because this is so much better.

Be persistent, always put your CPAP on when you either nap or go to bed, and keep it on. If it come off, put it back on.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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RE: PSG Results: Could this be UARS?
I believe I already commented earlier about stress and anxiety and loneliness would fall into the same category. We have two nervous systems, one for fight or flight, one for rest and relaxation. It doesn't matter what puts you into fight or flight mode, the hormonal, neurological and physical reactions are the same. Our nervous systems are designed to help us cope with short time stressors, chronic stress can wreak havoc because your body is not meant to deal with stress continuously. Our bodies are old technology that haven't adapted to living in today's high stress high paced environment.

Stress, anxiety and loneliness likely aren't the only thing affecting you right now but they are definitely making everything worse instead of better.
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