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Sleeping problems for years, desperately hoping CPAP will save my life!
#1
Sleeping problems for years, desperately hoping CPAP will save my life!
Hi All,

As the title suggests I've had sleeping problems for the last 5-6 years.
I've tried every avenue possible.

I am fairly healthy, 36 years old. BMI 24 and non-smoker.
I have had two nose surgeries in the past for a deviated septum and to clear out lining. I also have had jaw surgery about 15 years ago to correct an open bite, at the same time i had braces put on.

I find myself waking up 4-5 times a night with an urge to go to the toilet and hardly ever wake up refreshed. I also have restless legs. Its ruining my life...my mood is always off and my memory is shot.
I've seen urologist, psychologists and sleep scientists. I've tried it all!
I did two overnight sleep study's that didnt indicate i had sleep apnea.

I gave up for years and i came across a level 2 home sleep study. I thought i'd give it a shot as its a good time with CV19 to try out some things as i am working from home.
The guy that runs it has been doing for 15-20 years and suggests he's an expert at finding anomalies that other studies dont.
I did the sleep study and saw him the next day to analyse the data. It doesn't appear that i completely stop breathing but he's says my breathing is shallow and is disrupting my sleep by causing me to lightly wake up regularly (I've attached my results). He also identified my restlegs that would be impacting my sleep.

He is suggesting a BMC G3 sleep machine with a nasal pillow. He believes it will change my life! I hope it does but i have been promised this by an abundance of specialist that has never come to fruition. So naturally, i'm sceptical.

My question is, does my sleep study report indicate apnea? And does any have any thoughts on the machine he is recommending?

Thanks and what wonderful forum this. I sense plenty genuine support and informative posts.

Thanks.


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#2
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
First welcome to the Forum.

A good usefull sleep study.
While technically you have no apnea you do have SDB Sleep Disordered Breathing mostly in the form of RERAs, Respiratory Effort Related Arousals. Overall you barely are classified as severe.

There are a continuum of obstructive events starting with Apnea, then Hypopneas, then Flow Limits, then normal breathing.

RERAs are a series of flow limits that end in arousal. 0flow limits are not measured but you have them.

The machine I would recommend is a ResMed AirSense 10 AutoSet an apap or a step up, the ResMed AirCurve 10 VAuto, a BiLevel

These machines because of their capability and OSCAR can read and display detailed data literally down to a breath by breath basis which you will need to optimize treatment for your RERAs. You will use EPR with the AutoSet and PS with the VAuto to treat your events.

The AutoSet is limited to 0,1,2, or 3 cmw of EPR/PS where the VAuto can go considerably higher. This is the mechanism that treats what ails you.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#3
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
Ok, thank you for the reply.

I am new to this so have a few questions that may sound naive, apologies in advance.
I also understand that these questions are specific and you may not be able to understand them with the limited knowledge you have off my scenario.

Right so no sleep apnea, but RERA. Is RERA similar to sleep apnea in that something is obstructing my breathing and forcing me awake regularly? How bad is my RERA? Bad enough to potentially be the cause of my ailemts? E.g. Waking up regularly(Every 2 hours) with a strong urge to go the the toilet and overall lack off refreshing sleep?

Could i be possible that dental implants may be better suited for me?

Other than the EPR is there anything else i should adjust or look out for on the machine?

Thank you again, i have been spending time on this forum learning about other peoples and experiences.
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#4
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
Expect adjustments to your settings, everyone is different. Here we want to see data, and that data comes from OSCAR. By the shape of your individual breaths we can literally see what is going on. Look at the OSCAR logo, the waveform there is an "ideal breath", see how it is smooth and nearly sinusoidal? I expect the tops of the curves on your charts to be somewhat flattened indicating restricted inspiratory breathing which are either hypopneas or flow limitations. RERAs are a series of these that end in arousal or disturbed breathing. Your RERAs are happening every 2 minutes on anerage or 30 times an hour. How good is your sleep when your partner is elbowing you in the ribs every 2 minutes, all night long.

You are waking up for bathroom calls every 2 hours because you are not getting restful sleep where your body actually shuts down your urge to go until morning. This will improve, but not overnight.

Oral devices will make improvements but very frequently do not eliminate apnea.

Inspire, the surgical implant may or may not work either.

CPAP is the Gold Standard for treatment and unfortunately it is typically for a lifetime.

EPAP or exhale pressure is the main treatment for Obstructive Apnea which was absent from your Sleep Study. On CPAPs this is calculated by subtracting EPR from your single set pressure which can vary on an AutoSet. On a BiLevel EPAP is just called EPAP. This is the base pressure that all therapies are based on. I expect your EPAP to be fairly low.

The difference between inhale and exhale pressures is called Pressure Support (PS)
It is this difference that is used to treat hypopneas and flow limitations, and thus RERAs, (UARS and snores too).

A BiLevel is what is used to treat hypopneas, flow limits, REARs, UARS, and even snoring, usually AFTER a CPAP has failed BUT ResMeds implementation of EPR behaves like a BiLevel limited to 1,2,or 3 cmw of PS and as such is very effective for many.

OSCAR unfortunately does not support BMC. Thus the recommendation for ResMed
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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Optimizing Therapy
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#5
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
(05-21-2020, 05:35 AM)Baswold31 Wrote: Right so no sleep apnea, but RERA.

No sleep apnea, but UARS (Upper Airway Resistance Syndrome), which is characterized by a preponderance of RERAs (Respiratory Effort Related Arousals).

Listen to bonjour on machine recommendation.

Ideally you'd get the VAuto just because it would give you more flexibility, but whether you get that or the Autoset really depends on your financial and insurance situation.
Caveats: I'm just a patient, with no medical training.
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#6
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
Also, PLMD, from what I've heard from other people who have it on this forum, is going to complicate your treatment. 

You will need to treat the UARS with the PAP therapy, and then find out how to address the PLMD in concert with that.
Caveats: I'm just a patient, with no medical training.
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#7
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
+ 1 on the recommendation for the VAuto. And here's a little information about periodic limb movement/restless leg treatment:

https://www.utmedicalcenter.org/medical-...ing-sleep/

I think that with treatment of the RERAs and leg movements, you stand an excellent chance of sleeping better. Keep us posted!
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#8
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
BMC Medical Co., Ltd. was founded in 2001, and now is the leading developer, of products for the diagnosis and therapy of sleep-disordered breathing in China. I would not touch a BMC machine with a 10 foot pole. The data is sub-par and the features are knock-offs. The redeeming feature is they are cheap.

Get a Resmed Airsense 10 Autoset. It will cost a bit more money, but the 3-cm pressure support that the machine has (like bilevel) is the best feature to treat your flow limitations, hypopnea and RERA. The data it provides for you to use to optimize therapy is second to none and comfort is unsurpassed. I know I sound like a Resmed shill, but your doctor is about to talk you into a huge mistake.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
if your apnea is low and leg movements are significant, there's a better than passing chance your rera's are caused by your leg movements. if so, no cpap modality will help them. the rls / plm must be treated separately.
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#10
RE: Sleeping problems for years, desperately hoping CPAP will save my life!
Thank you for the replies. Its prompted me to go back to the sleep scientist and ask for an Resmed Airsense 10.
Interesting comments about the leg movements.

Sometimes throughout the night i am awake and it keeps me up. Its hard to explain but its a periodic jolt that i am unable to stop.
Now it also appears that it is happening in my sleep leading to arousal.

I am going all in with the CPAP treatment so i want to get this sorted. However how do i know if the RERA is the root cause of my sleep arousal rather than the plm?

Sleep scientist suggested that being warm/hot can lead to leg arousal. What is the recommended treatment for plm? Does anyone have any methods they have tried and has worked?

I was hoping that the CPAP machine would be my saviour, however i am having doubts.



Barry.
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