Diagnosed UARS--Help with next steps?

[nyteowl]

Huh. Well after reading this thread I don't feel quite so weird... (I did post my own thread.. but whatever) UARS diagnoses (RDI 15.3) but I also have co-occurring PLMD.. which I think is really just the fact that I could not get comfortable in the sleep lab, twitching and flopping around because having all the wires / sensors attached and lacking my usual comfortable bed and home surroundings.. made for an extremely anxious sleep lab experience.

Yeah.. I think this problem "went to 11" for me when I was hit with a bunch of life stress crap last summer, plus I'm of an age where my hormones are out of whack, and I've always had issues with grinding my teeth and flipping around while I'm asleep..

Now I'm trying to actually sleep with a nasal mask on.. (trying to figure out which is going to work better.. the nasal mask. or pillows). Not having much luck.

What's funny is the whole surgery thing was suggested to me, but only as a "people sometimes have surgery, but it doesn't work for everyone", and in general I feel like my primary concern around struggling with anxiety and insomnia are taking a back seat to the UARS.. So I'll just hop on the parade float here and follow along..

[tan]

Uars is not treatable with cpap.

Yes, it is. There are issues though. The major one is there is no good meaningful indicator that can be extracted from xPAP data stream.

People with uars understand what I mean.

No, I don't

[tan]

Now I'm trying to actually sleep with a nasal mask on.. (trying to figure out which is going to work better.. the nasal mask. or pillows). Not having much luck.

One of the issues I had with all nasal masks is leaking (big and small). Can you publish your SleepyHead charts? If there are leaks of flow limitations, I would try to alleviate them one way or another. Predominant mouth breathing can disturb your sleep too. There are a few options to prevent your mouth from opening: chin-strap, neck collar (suggested by ChicagoGranny), cloth cover (suggested by Jay), mouth taping (different methods suggest by different people, depending on a few things, for example, I use vertical taping to keep my chin up in order to compensate pressure on my jaw by the full face mask I use).

and in general I feel like my primary concern around struggling with anxiety and insomnia are taking a back seat to the UARS..

that's right, having UARS under control usually resolves things like anxiety and insomnia quite well from my experience.

A few more things: sleep hygiene, which is secondary to me personally, but can be primary for you. And most important is stress, which, I think, makes your suffer from even minor leaks and flow limitations due to HPA axis disbalance (read up on HPAX axis, UARS by Dr. Gold)

[blitzmr2]

Now I'm trying to actually sleep with a nasal mask on.. (trying to figure out which is going to work better.. the nasal mask. or pillows). Not having much luck.

One of the issues I had with all nasal masks is leaking (big and small). Can you publish your SleepyHead charts? If there are leaks of flow limitations, I would try to alleviate them one way or another. Predominant mouth breathing can disturb your sleep too. There are a few options to prevent your mouth from opening: chin-strap, neck collar (suggested by ChicagoGranny), cloth cover (suggested by Jay), mouth taping (different methods suggest by different people, depending on a few things, for example, I use vertical taping to keep my chin up in order to compensate pressure on my jaw by the full face mask I use).

and in general I feel like my primary concern around struggling with anxiety and insomnia are taking a back seat to the UARS..

that's right, having UARS under control usually resolves things like anxiety and insomnia quite well from my experience.

A few more things: sleep hygiene, which is secondary to me personally, but can be primary for you. And most important is stress, which, I think, makes your suffer from even minor leaks and flow limitations due to HPA axis disbalance (read up on HPAX axis, UARS by Dr. Gold)

Sleep hygiene is obviously crucial, but I've been suffering for 4 years now and have learned what matters and what doesn't, at least as I am today. I can go to bed at 10 pm in a nice cool room with no blue light for two hours prior to bed, no alcohol, and no caffeine, and I feel (usually) the exact same as if I go to bed at 2 am after a beer (more common--natural sleep pattern for me has always been 2 am-10 am for as long as I can remember).

My guess is as I am able to resolve or at least begin to mitigate UARS/breathing issues, improving sleep hygiene will actually yield noticeable results. I know this will be considered absolute heresy on a board dedicated to quality sleep, but I sleep *better* with two beers before bed than I do with no alcohol. I am well aware of the effect of alcohol on both sleep architecture and on muscles in the face/throat which relax further to exacerbate flow limitations. Mouth breathing, too. But whatever losses I have there seem to be outweighed by reduced sleep anxiety to sustain sleep throughout the night. With no beer, for example, I feel the exact same when I wake up in the morning, but also wake up every 2 hours during the night. Again, I'm assuming that once my apnea oral appliance arrives and I begin to experiment with cpap/bipap, as well as seek out other ways to improve airflow, I will be able to create a healthier sleep routine--earlier bedtimes maybe, definitely no alcohol, less/no caffeine, no late eating, and so on.

Anxiety and depression are both a cause and an effect here. Vicious circle. After treating A/D for years, I've also come to see (or least hope--time will tell) that UARS seems to be the root of a lot of other symptoms I've been chasing. Until that gets addressed, you're working with a problematic "baseline."

[Julie]

Hi, this may be way 'out there', but the business of beer, your wake-ups, the normal response to Cpap of people not waking x 3-4 to urinate all makes me wonder if you've had your kidneys checked up lately... not saying there's necessarily anything wrong, but it's a bit curious the reaction you have to the beer (vs the usual one ) and I might want to talk to a doctor just to be sure everything's fine.

[Jay Aitchsee]

Until that gets addressed, you're working with a problematic "baseline."

I don't want to be harsh, but it sounds to me like you want to pick and choose the elements of Good Sleep Hygiene as they suite you, when they suite you - and there is a lot more to them than a cool room and avoidance of blue light. What about exercise? A brisk 30 minute walk, early in the morning, often does wonders for fatigue, depression, and the like. As you implied, anxiety, depression, and sleep disorders are often inter-related without being clear which is causal. Good Sleep Hygiene practices overlap those of Good Mental Health practices, so it makes sense to follow them. By the way, there is some evidence that abstinent alcoholics (not that you are either abstinent or an alcoholic) may suffer disturbed and fragmented sleep years after they quit drinking.

If you don't fix all that you can, you will always be working with a "problematic baseline."

I'm just sayin'.

[blitzmr2]

Hi, this may be way 'out there', but the business of beer, your wake-ups, the normal response to Cpap of people not waking x 3-4 to urinate all makes me wonder if you've had your kidneys checked up lately... not saying there's necessarily anything wrong, but it's a bit curious the reaction you have to the beer (vs the usual one ) and I might want to talk to a doctor just to be sure everything's fine.

Legit concern. Had extensive blood work done three times in last 18 months. All perfect. I don't drink that much.

[blitzmr2]

Until that gets addressed, you're working with a problematic "baseline."

I don't want to be harsh, but it sounds to me like you want to pick and choose the elements of Good Sleep Hygiene as they suite you, when they suite you - and there is a lot more to them than a cool room and avoidance of blue light. What about exercise? A brisk 30 minute walk, early in the morning, often does wonders for fatigue, depression, and the like. As you implied, anxiety, depression, and sleep disorders are often inter-related without being clear which is causal. Good Sleep Hygiene practices overlap those of Good Mental Health practices, so it makes sense to follow them. By the way, there is some evidence that abstinent alcoholics (not that you are either abstinent or an alcoholic) may suffer disturbed and fragmented sleep years after they quit drinking.

If you don't fix all that you can, you will always be working with a "problematic baseline."

I'm just sayin'.

I definitely don't want to sound like I have it all figured out or I wouldn't be asking for help, so I definitely appreciate any feedback at all.

I eat extremely well. Do hot yoga 5 times a week. Watch very little tv, thought admittedly what I do watch is before bed. Live a low stress life. Am generally very happy. Never had a drop of alcohol until I was in my 30s (now 41). Have only drank with any consistency at all in last 12 months, whereas eds/fatigue have been an issues for last 4-5 years and still really don't drink very much. Drink about a gallon of water a day. Probably too much coffee, though.

I definitely have room to improve sleep hygiene and healthfulness overall.

[Jay Aitchsee]

Probably too much coffee, though.

Any could be too much. The half life of caffeine in the blood stream is approximately 5 hours, or longer, and the effects could last much longer depending on individual sensitivity. Caffeine is also present in many other foods such as soda, chocolate, some meds, etc.

I harp on Sleep Hygiene because it worked for me. After my SDB was controlled, sleepiness, fatigue and feelings of depression remained. I looked for and tried various treatments and medications, but It was only through the serious application and adoption of good sleep hygiene (and mental health) practices that I was able to start feeling better. It wasn't a quick fix. It was like I had to train my brain it was OK to sleep deeply again and it took time. One of the things I think that helped me the most was incorporating a daily, early morning, outdoor, moderate exercise (brisk walk) routine of 30 minutes to an hour. As I mentioned above, it works wonderfully (for me) to reduce feelings of fatigue, anxiety, and depression while promoting a lasting feeling of well being.

I mentioned alcohol because you did and I have a history of alcohol abuse. As you pointed out, I don't think many would agree that using alcohol as a sleep aid is wise.

It is my opinion that many who come here exhibiting classic symptoms of mild depression who are looking for fix by tweaking their machine settings fail because CPAP can only fix poor sleep due to SDB. It can not fix poor sleep due to other causes and until those other causes are remedied no amount of CPAP machine dial twisting will help.

[blitzmr2]

Probably too much coffee, though.

Any could be too much. The half life of caffeine in the blood stream is approximately 5 hours, or longer, and the effects could last much longer depending on individual sensitivity. Caffeine is also present in many other foods such as soda, chocolate, some meds, etc.

I harp on Sleep Hygiene because it worked for me. After my SDB was controlled, sleepiness, fatigue and feelings of depression remained. I looked for and tried various treatments and medications, but It was only through the serious application and adoption of good sleep hygiene (and mental health) practices that I was able to start feeling better. It wasn't a quick fix. It was like I had to train my brain it was OK to sleep deeply again and it took time. One of the things I think that helped me the most was incorporating a daily, early morning, outdoor, moderate exercise (brisk walk) routine of 30 minutes to an hour. As I mentioned above, it works wonderfully (for me) to reduce feelings of fatigue, anxiety, and depression while promoting a lasting feeling of well being.

I mentioned alcohol because you did and I have a history of alcohol abuse. As you pointed out, I don't think many would agree that using alcohol as a sleep aid is wise.

It is my opinion that many who come here exhibiting classic symptoms of mild depression who are looking for fix by tweaking their machine settings fail because CPAP can only fix poor sleep due to SDB. It can not fix poor sleep due to other causes and until those other causes are remedied no amount of CPAP machine dial twisting will help.

I definitely appreciate your perspective and will continue to integrate these kinds of ideas. To be clear, though, I'm not looking for a 'quick fix' through the 'twist of a knob.' Human behavior and physiology is a complex tapestry, as you hint at. I want to know that my body can breathe properly while I sleep.

[tan]

if you optimize your treatment and remove stressors like caffeine, you can have your "quick fix"

[avi123]

Do you have UARs?



Clinical Features Associated With UARS:

Daytime symptoms:

Excessive daytime sleepiness
Fatigue
Morning headaches
Myalgias
Difficulty concentrating

Sleep disturbances:


Frequent nocturnal awakenings
Difficulties initiating sleep
Insomnia
Bruxism
Restless leg syndrome
Unrefreshing sleep

Autonomic nervous system:


Hypotension
Orthostasis
Cold hands and feet


Functional somatic syndrome associations:

Depression
Anxiety
Chronic fatigue syndrome
Irritable bowel syndrome
Fibromyalgia

Polysomnographic abnormalities:

Increased RERAs
Increased nocturnal arousals
Increased CAP rate
Alpha intrusion during sleep

--------------------------------------------------------------------------------



A summary:

Although UARS has a symptomatology close to the one seen in patients with OSAS, there are distinct clinical differences between the two syndromes. In clinical studies, it is seen more in younger, slim subjects and in premenopausal women; it is more commonly associated with an increase in vagal tone during sleep than with sympathetic hyperactivity (as seen in association with apnea and hypopnea and oxygen desaturation).21 Can individuals with UARS become patients with OSAS? Guilleminault and colleagues1 suggested that weight increase (with development of a chest-bellow problem related to abdominal obesity) and the association of the supine position and sleep (leading to a restrictive impairment and secondary oxygen saturation drop and sympathetic hyperactivity) will lead to passage from one presentation to another with different complications; but more data are needed from additional systematic, longitudinal studies.1 UARS is underdiagnosed owing to unfamiliarity with the syndrome and the lack of polysomnographic criteria for either hypopneas or apneas that are associated with other types of sleep-disordered breathing. The advent of use of an esophageal catheter for esophageal pressure measurement (Pes) has allowed clinicians to more clearly identify patients with UARS. Although Pes measurement is the most sensitive method available to detect the abnormal respiratory events in UARS, it has not been used widely for several reasons, including lack of clinician experience and patient reports of discomfort. Usage of the nasal cannula pressure transducer allows recognition of flow limitation.43 But guidelines on how to tabulate the amount of flow limitation during total sleep time are lacking. Patients with UARS have significant impairment in their daytime functioning, with reports of sleepiness, fatigue, and sleep disruption. A follow-up study of these patients has shown that they often go untreated and experience progressive worsening of their symptoms. Among those patients who have been treated, typically with CPAP therapy, many have experienced symptomatic improvement. The current fund of knowledge regarding UARS has been growing, and we are beginning to understand the underlying pathophysiology.

Source:

http://69.36.35.38/accp/pccsu/upper-air ... e?page=0,3

This source was accessible in 2011.

[esel]

> I sleep *better* with two beers before bed than I do with no alcohol.

Hi blitzmr2,

Thank you for this post and discussions. It is great to see that people jump in with comments not feeling that weird after all with their own troubles.

Me too, I definitively sleep better with two beers before bead !

I have been treated for anxiety and mood disorder since 1996, got diagnosed with attention deficit disorder (ADD) in 2000, my dad is bipolar and my brother unipolar depressive. Beginning this year I went to check up my sleep. The sleep doctor checked my throat and told me that I did not need any sleep study. He only did it as I got a recommendation by my Dr.

Sleep study 29 Feb. 2016
Sleep time 6.5 h
AHI : 39 /h (51/h on the back, 15/h on the side)
O2 Desat : 27 /h

Sleep Efficiency 90% Yes I did sleep well, and no beer that day.

Sleep Stages
N1: 44%
N2: 48%
N3: 1%
REM: 7% (one periode of 27 min)
Micro arousal: 44 /h
RERAs : 0 (sorry, that is the best I could do (respiratory event related arousal)
RLS: 25 /h (restless legs syndrome)
RRLM: 2.7 /h (respiratory related leg movements)

Have no idea what UARS are but have some about anxiety and mood disorder. I have been through many medications… Some of which do work or are able to help me function. The down side is that they likely also affect sleeping. I don’t know when I started having sleep apnea but things have gotten slowly worth the last 6 years. Night sweating, waking up more often, not sleeping well, often taking naps without actually being able to sleep, just rest.
My sleeping dissorder now is not the same as I experienced during depression, where thoughts go play ping pong at high speed, and I keep looking at the clock every 5 min, just waiting for the time to get up. To me there is some difference between not sleeping well due to mood disorder and not sleeping well due to apnea, or who knows what it is that triggers it if not obstructive apnea.

Once in a while, before CPAP I would sleep OK (once a month or 2 month) and feel great with lots of energy for a couple of days, maybe a week. I have now been on CPAP (APAP) for about 4 month and got my AHI down to 10 but did not really feel any different . Have then changed to CPAP CS (AVS), for almost 2 month and got my AHI down below 2 sometimes below 1. Unfortunately I do not feel much better except for lots of air in my belly and gastric fluid up my throat. Oh well not there yet…

Here my 2 ct on points that came up in the discussion.

My dad with bipolar disorder did not need any sleep when during manic phases lasting 1 to 2 weeks. He just was active days and night, thought that sleep is not really needed to the point that he kept my mom awake all night. Tough nights for my mom which then slept during the day when he was at work. After a manic phase he always had a depressive phase in which he slept and slepet. So, somehow a mental disorder is directly connected with sleep.

Too much coffee. Coffee affects many things and too much coffee will result in a reduction of receptors between nerve cells in order to maintain a needed equilibrium for the organism. Reducing or stopping coffee will require quite some time to readjust and repair the affected nerve cells.

Too much regular alcohol affects the membrane fluidity of our cells. To counter, membranes will exclude unsaturated fatty acids and replace them with saturated fatty acids to make them more stiff. If you now stop the alcohol membranes become so stiff that many membrane related processes are jeopardized. To restore the membranes fluidity lots of saturated fatty acids need to be replaced by unsaturated ones which will take more or less time depending on individium and severity.

The normal response to CPAP of people not waking x 3-4 to urinate…
If I remember right, the bladder will fill and a hormone controls it. It will not overfill. So if you wake up and are very tired you just go back to sleep and nothing happens. If however you urinate the bladder will fill up again. So for people that do not sleep well they will get up to urinate as they cannot go back to sleep and their bladder will fill up again.

So keep it up blitzmr2, which you to figure things out.