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POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
#1
POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Hello all!  I've recently had a sleep study done, and did not have obstructed sleep apnea.  However, I strongly think I have UARS.  Here is some background:

I have a high arched palate and I believe that resulted in continued mouth breathing when lying down.  

I have narrow arches - both upper and lower.  Intermolar width is under 30mm.

I'm 36 now, and recently had MSE.  However, due to my lower jaw being so narrow there wasnt too much expansion that I was allowed on the upper arch.  The result was maybe 6mms of expansion.  This I believe helped slightly with nasal breathing at night, but the airflow is still restricted and now instead of waking up with a sore and dry throat from mouth breathing all night, it's a headache from restricted oxygen levels due to the slightly better nasal breathing.  

My orthodontist referred me to an oral surgeon with the recommendation of a possible MMA surgery.  The first process of that was getting a sleep study which I have attached and any analysis would be greatly appreciated.  I am getting really desperate now that I know that I possibly could have UARS.  I have considered getting a CPAP to help mitigate the headaches until I figure out my surgical options.  

Thanks all!  I'm happy I found this board!


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#2
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Your apparent issue is flow limitation, which is ideally treated by positive air pressure with pressure support. Pressure support means that there is a difference between the inhale and exhale pressure delivered by the machine (or mask pressure), and pressure support is the simple mathmatical difference between inhale in cm-H2O and exhale pressure in cm-H2O. In bilevel or BiPAP pressure, you might use an exhale positive air pressure (EPAP) of 8.0 cm and inhale pressure (IPAP) of 12.0 cm, and the difference is the pressure support of 4.0. Pressure support comes in behind your inspiratory effort and gives it a boost, normalizing breathing flow and volume when upper airway or nasal restriction is present.

You are being sold on MMA or a MAD device. Either is very expensive and generally ineffective from what we have seen on the forum, but bilevel positive air pressure can be very effective in overcoming the flow limitation, and is non-invasive. You are working with an orthodontist and his recommendation is going to be predictable. If you want to treat your UARS or flow limitation, then the best positive air pressure device choices are either the Resmed Airsense 10 Autoset CPAP which offers up to 3-cm of pressure support, or the Resmed Aircurve 10 Vauto which has full bilevel pressure support as high as you need to go. The Resmed CPAP is unique in that its exhale pressure relief (EPR) is actually a bilevel pressure support. If you're looking for support for MAD or MMA you're in the wrong place. How can we help? I'm certain you can be effectively treated for the UARS and mental fog using positive air pressure therapy, but since you don't have clinical sleep apnea, insurance coverage is unlikely.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#3
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Sleeprider thanks for the thoughtful response!  I really do appreciate it.  

I'm currently in the process of obtaining the Resmed Airsense 10 Autoset CPAP (don't ask me how i'm obtaining it)  Do you have recommendations on what settings I should start out with?  It's coming with a nasal mask, I understand the mask tweaking may take some time.

I definitely take the responses of my orthodontist with a grain of salt.  I might be a candidate for MMA, however I'm exploring all options.  Meeting with an ENT is another path i'll be visiting.  If the CPAP works wonders, then I may be happy with it as permanent solution and forego looking into nasal and/or jaw surgeries.

Again, I really appreciate how quickly and how thoughtful your response was.  
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#4
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Welcome to Apnea Board.

FWIW what Sleeprider said is pretty consistent with what's been experienced and seen since I've been here. To me your report looks pretty straightforward in events being mostly Hypopnoea and flow limits likely mixed in to give that impression from the suggested surgeries to open things up.

Your AutoSet maybe should start in Mode APAP, skip the Ramp, EPR at 3 and pressure Min 7 to 20. The 7 minimum allows EPR 3 to do its job as EPR reduces pressure on exhale. It can't reduce below the minimum of 4 so that gives both EPR and can give Min pressure but go up as needed. Max at 20 just to see what Max you're needing. Give it a good try and if you've not gotten it yet, get the free report tool OSCAR. After that 1 night, OSCAR and your answer to how you feel will help us dial in your pressure set more specific to event need and maximize comfort too.

Recap
APAP mode
Pressure 7-20
EPR 3
No Ramp

You'll need to try the built-in humidifier to see what level of humidity is best for yourself. It has off and 1-8 which increases humidity, and then it has Auto and Manual mode, Auto here has a sensor to help adjust but manual the setting is only from the setting numbers. I found manual to be better control as I could directly dial in what I wanted.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Dave I really appreciate the intel.  I will set the CPAP to your recommendations and adjust accordingly.  Thanks again!
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#6
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Best to your success. Be sure to get OSCAR running. It does require an SD card in the top left slot on the PAP. If you need to buy one, look for 2-32 GB SD or SDHC format to FAT32, any brand is good. Walmart, Best Buy, Staples, digital camera stores all should have something. The SD must be in before you sleep to capture detailed info and then use the SD to upload to OSCAR on the PC. Show a default standard Daily tab screenshot. We can direct the PAP therapy just in that one shot.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Dave's suggestions are good, but I'm going to curtail that maximum pressure recommendation. A minimum pressure of 7.0 and maximum pressure of 14.0 should be more than enough, and any higher won't do much good. Be sure to set the EPR to 3, full-time. That will start you at a pressure of 7.0/4.0 (inhale/exhale), and limit the high pressure to 14/11. Without obstructive apnea there is no reason to allow full-range. Your Autoset comes with a standard and soft mode that affect how quickly pressure changes are applied. Soft mode might be easier to start with. Be sure to download OSCAR. If the nasal therapy works for you, I will suggest you change to the Resmed Airfit P10 nasal pillows mask. It is the lightest and quietest mask on the market, and since it applies the air pressure directly to the nares on your nose it acts to decongest the nasal passages and really does a number on flow limits. As far as where you got your machine, no worries. I just bought a backup unit on Craigslist for $150 plus shipping. Feel free to ask any questions on setup.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#8
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Thank you both!  I'll adjust accordingly.  First use will be tonight - i'll report back.
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#9
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
Yep it makes sense on the Max cap. If you're a patient of Dave, he'd torture you with making you drink Sumatra coffee then tell you to have a nice nap.

lots-o-coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: POSSIBLE UARS from SLEEP STUDY. PLEASE HELP!
First night unfortunately wasnt a success. It looks like I have the Resmed airfit p10 nasal pillows. I've always had resistance when breathing through my nose normally, so maybe the nasal pillows may not be for me. Throughout the night I tend to open my jaw as well as drool, I'm guessing i probably mouth breathe at night. Also, the CPAP notifies me of a bad seal.
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