[Diagnosis] Why are my RDI/RERAs so High?

[rc102177]

I have had 3 sleep studies since early 2023, with the most recent last month Dec. 2023. Regardless, let me preface this threads subject by first discussing a little background information about when my issues all began.

I started binge drinking alcohol in 2019, prior to drinking, I have never had issues sleeping in my entire life, atleast not to my knowledge. I have been highly functional, a double major graduate with honors from a very acclaimed national university, and never had cognitive issues, memory impairments, sleep issues, confusion, and lack of recognition before this. I quit in Sep 2021. It seems minimal, which sounds great, except by the end I was drinking almost 3 bottles of whiskey per day - if I had not quit this pace, I would have died very soon after. 

Anyways, so I have had a medical workup, up, down, side to side including, colonscopy, endoscopy, hida scan, multiple cat scans, multiple ultrasounds, an MRI, many many blood tests, stress tests, etc. and all have come back ideal. I am 28 btw, 6'2, around 190 lbs. 

Anyways, I randomly told my doctor I wanted a sleep study because I kept noticing I never woke up feeling refreshed in sobriety, and he basically said it was very unlikely to yield anything. I have seen and been treated with psych meds a million times since sobriety, and everything just continues to get worse. 

I am now at a point where I cannot drive, the confusion is seriously debilitating, walking at times is imbalanced, and I feel very impaired. I struggle to talk without forgetting my words, have no drive or energy no matter how many medications of different types I have tried, and  I cannot remember a damn thing. At this point I am confined to my room, because all I can do is type and do non-mentally stimulating tasks. My recognition of things is horrendous and I cannot work. I lost a very very lucrative investment banking job as a result. WORTH mentioning, I developed excruciating bowel pain near my liver about 1 year into drinking, kept going, and it persisted into sobriety nearly a year, the only thing that helped was time, Magnesium - Glycinate/L-Threonate and Vitamin C among a B complex multivitamin and vitamin D.

Anyways, the only constant is that on 3 sleep studies, I am showing an AHI that is literally like 5 flat, but my RDI index on each are minimum of 50, and I believe the highest was around 70. Almost all of them are RERAs from what I remember.

I am here seeking a second opinion on how to proceed. I have a BiPap machine on the way again, as I had one before and didnt stick to it because I couldnt tolerate it, maybe the pressure was wrong, and I have become so psychotic and listless I returned it. So I had to go back through all of this again. Should arrive in the next week or 2 max. 

So, long story short, why am I having so many RERAs? I know the answer isn't necessarily simple, but I am getting very desperate here, as I am waking up, and I have no idea whats going on around me, cant process any complicated thought, any logical computations, I cannot do without tech assistance - and I am talking about very basic computations. I am struggling to cook, or do anything because I cant remember what I am reading and am struggling to read. I am planning on seeing an ENT as I have also developed a very strange breathing sensation in my nose, like pressure, resistance, and very hard breathing despite being cleared in mostly every other way, no oxygen loss is notable during these episodes, sometimes they stick around for weeks, others brief, sometimes not at all, but it has really screwed with me. Despite this, this problem of the breathing sensations didn't exist prior to May of 2023, by which, I already had 2 earlier tests before that were basically the same as my most recent one.

My doctor is considering sending me for a neuropsych test and to start looking at potential neurological issues if this isnt improved to some degree soon into this new year.

This took me awhile to type up so, please understand, I am not exaggerating the severity of these issues. 

I am just curious if anyone could provide some answers on what is happening, it has just gotten progressively worse and I am wandering around my home at this point with very little understanding of whats going on or just sitting in 1 or 2 positions all day with very little physical movement. I am familiar with UARS to a degree, and am planning on pursuing more of this direction if BiPap is not effective in the coming weeks to months.

I will happily attached my sleep study as I dont understand it fully.

[Dormeo]

It must be awful to feel the way you do. I'm sorry. But it's very encouraging that you've ordered a new machine and come to this forum.

Yes, do upload your sleep report after blacking out personal information. And let us know what medications you're taking.

When your machine arrives, my own suggestion would be to start with EPAP minimum of 5, PS of 3, and IPAP maximum of 8. Don't change any of the default settings. This will in effect give you fixed pressures, mostly for the sake of comfort. Use the Oscar software so you can post a daily chart or two.

To get used to the machine (again), try setting it up during the day or evening outside your bedroom and use it while you watch TV or read or use your devices.

Do you breathe through your nose during the day? If you do, you might try a ResMed P10 nasal-pillow mask. It's pretty minimalist. Do get the fit pack, which includes S, M, and L pillows. If you breathe through your mouth, though, you'll want a full-face mask.

Has your doctor ruled out all of the following: long Covid, autoimmune disease; especially in the connective-tissue-disease family; testosterone deficiency; iron deficiency; thyroid problems; Lyme disease; mono; deficiencies of vitamin B6 and B12?

[Gideon]

The VAuto is a very good machine and likely will help what you have described.

Have you had any overnight oxygen studies? Post them here, also any sleep studies, the whole thing including charts and tables.

My wife was diagnosed with depression and Asthma which were false. She was involved in an accident, nodded off and rear-ended a friend's car, much like what you could see with sleep apnea. Anyway she was having so much trouble breathing they reached her. Her comment was that instantly everything was clear and no longer foggy. I'll guarantee you do not have what my wife had but the point is it is very important to rule out oxygen depravation.