Uars/need help please

[Jlcdsc]

I have UARS ,a titration study said to do 8 EPR3 but they don't test correctly or completely understand UARS. I have no AHI really , lots of arsouals and rid also plmd movement . I have been doing horrible on cpap , I tried upping my pressure, vcom, lowering EPR. I still can't figure out hoe to sleep through the night .I m in a full face hybrid because if I tape my breathing is worse , and my nose clogs a lot, bad LPR and Gerd , some kind of pain on right side of throat when I yawn ? I think I have soft platte issues especially on exhale . My stupid doctors think I should be fine Im not , some nights if i clog up I don't sleep at all, others I wake up a ton in REM esp.

[CPAPfriend]

hey Jlsdsc,

many UARS patients will need a much higher pressure than the "optimally titrated" one they get from a lab, because many labs don't treat for SDB events but instead more narrowly for AHI or RDI. This poses a problem for patients who's events are generally more subtle, which could be the case for you.

There is also a chance that CPAP may be limited in what it can resolve for you, but that's not something we can know given what information you have shared so far, and so it's a bridge that can be crossed when needed, should you arrive at it.
 
You still have flow limitation, and your flowrate does sort of look like palatal prolapse, but it's not very clear given the resolution you shared.

[lessgroggy]

Please see a good ENT about whether there are surgical treatments for your nasal airway obstructions.
Common issues/solutions include such things as
1) radio frequency ablation for enlarged nasal turbinates. This is a minimally invasive outpatient surgery that takes 10-15 minutes.
2) nasal valve surgery (Vivaer)  This is also a minimally invasive outpatient surgery that doesn't require a lot of recovery time.
3) surgery to correct a deviated septum
4) removal of nasal polyps


Otherwise you may need a BIPAP machine for your UARS to increase pressure support. But surgery may allow your current CPAP machine to be more effective. 

Do pay attention to your flow limitations and try to keep working toward making those less than 0.05 at the 95% level.

[lessgroggy]

also if you have a narrow high-arched upper palate and a crossbite where your upper jaw is smaller than your lower jaw due to improper jaw development (apparently possibly influenced by factors such as allergies during childhood and where you placed your tongue in your mouth, tooth extraction and having braces as a child) you may be a candidate for palatal expansion to increase the size of the nasal valve and provide more room for your tongue. User Single H provides a helpful overview of various ways to do this in post #54 of this thread. 
https://www.apneaboard.com/forums/Thread...hlight=mse

[DaveSkvn]

Hi Jlsdsc,

You do seem to be at the receiving end of the "apnea-industrial complex" but I have to say you seem to be doing really well managing to get from 20:30 to 06:00 without switching off the machine - which I rarely manage. You've got many of the same indicators as the problem I have: the "patchy" respiratory rate and the flow limitations.

The key indicator I use (the equivalent of the AHI if you will) is the 95% flow limitation number from the left hand box in Oscar. In November and early December, before I discovered the issue, it was between 0.2 and 0.3. I'm now down to 0.04 and have many days without a late morning nap for the first time in many years. I see your figure is 0.09 which is still in my nap zone - though each person will have a different threshold.
 
I guess the question is what can you do about it.

• Mandibular advancement device: I tried one once and it was not successful. If you have jaw pain I wouldn't bother considering it.
  
• CPAP Pressure: I've been doing experiments with my issue and CPAP pressure doesn't seem to make much difference. I was on fixed 13 (aerophagia kicking in) around new year and am now on fixed 10 and the traces are very similar (95% figure hasn't changed).
  
• CPAP EPR: I did most of January on EPR 3 and 3 days each on EPR 2, 1 and zero. On EPR 3 days the 95% score was around 0.05. On the 3 days with EPR zero, the 95% score was 0.19, 0.19 and 0.14. It makes a big difference.
  
• Bi Level: EPR is a limited version of bi level therapy. It quite possible that using bi level for larger EPR / pressure support will improve things further. I'm heading towards trying this.
  
• Soft Foam Cervical Collar. On Dec 22 I slept without a surgical collar -> 95% figure 0.12. On Dec 23 I slept with a collar -> 95% figure 0.05. Again it makes a big difference.
  
• Surgery: I'm considering this but only if there is very strong indication of benefit and the procedure is not "risky". I'm not sure nasal issues would lead to fatigue (without CPAP) because mouth breathing would just kick in.
  

From your perspective, if you haven't already, try a soft foam surgical collar, it made a big difference to me. Also try your own experiment with EPR. Try it for a few nights on 3 and a few nights on zero and compare the 95% figure. If there is a substantial improvement you may want to consider heading towards bi level to see if you get more improvement with increased pressure support. You could try increasing pressure but, as I say, its not making much difference to me. If you are considering surgery, you might consider a DISE with someone who knows what they are doing (i.e. not someone who films you "breathing anaesthetised" https://www.youtube.com/watch?v=r9R_IwafDMo ).

Good luck