History:
- 2/2018: neck injury, nerve pain for 3 months in back of neck.
- 05/2018: GERD, and then LPR. + PPI treatment for 2 month.
- 08/2018: sudden awakenings at night, without obvious cause.
- 11/2018: sleep study showing : 61% sleep efficency
23 arousals/hr
13 arousals/r apnea/hypopnea
6.5 RERAs/hr
REM & NREM AHI: 17/hr
REM AHI: 43/hr
- 12/2109: resmed airsense 10 APAP: 45 days trial, titration protocol used, highly fragmented sleep, low AHIs, a lot of RERA's , no rest or quality sleep from it.
- 01/2019: ENT laryngoscopy diagnosis of : dysfunctional vocal chords. (maybe the reason why i have SBD) but not sure if that is the reason
- 01/15/2019 to present: Aircurve 10 bilevel machine with dreamwear nasal mask and mouth taping.
These are my findings from the Aircurve after following the Resmed titration protocol, advice, and many trials and errors:
1- EPAP min: i can not go past 4.4, if i do, my fragmented sleep is worse, i start waking up every 90mns to 2 hrs.
2- PS: has to be between 3-6 .
3- IPAP max: has to be equal to the (EPAP + PS) e.g: if EPAP is 4 and PS is 4, IPAP max is 8.
If i follow these steps above i might stay asleep for the first 4-5 hrs of the night, which helps me not feel like a zombie next day IF i could sleep few hours for the remaining hours.
The next half of the night:
1- RERAs are a lot more frequent.
2- I wake up every dream, many times hearing and feeling the RERA ( my chest automatically inflating to get air right before my brain is thrown out of sleep)
3- for being able to fall asleep in the second part of the night, PS has to be over 7.2 ( any less, and each time i drift to sleep, a RERA wakes me up).
4- if i manually adjust the PS to 7.2, i will still wake up between dreams, but without feeling the RERA.
Following the above protocol has the highest success rate of me not feeling like a zombie through the day.
I tried to combat RERAs or staying asleep for the whole night by :
1- increasing min EPAP while keeping PS relative between (4-7) : anytime EPAP increase above 4.4 my brain is awakened from the start of sleep.
2- keeping EPAP at 4, increasing PS above 7: i get aerophagia, and start burping air, more air trying to come out of my mouth ( i tape my mouth).
Notes:
1- All my AHIs are low, no matter what i do, it has nothing to do with how i feel in the morning, i am attaching couple recent screenshots if you just want to see some sleepyhead data.
2- my flow limit range between max of 0.5 to 0.9 there is no rule why it is more or less.
3- Through the day i breath normal, but i feel need to swallow my saliva, and when i do, my throat feel like there is stuck mucus in it, which i have been told that is my vocal cords closing. i have been given breathing exercises to try to train my cords to stay open, but i don't see any difference so far ( 3 weeks ).
4- i do not some or drink alcohol or drink coffee or eat chocolate or use drugs.
5- i do not take any medicine.
6- i am male, 6 ft, 209 lbs, healthy.
7- before this i did not have a history of insomnia or depression and slept like a baby.
Questions:
1- what is obstructing my breathing at night ? is it the vocal cords closing or something else or a combination? how can i find out that ? sleep study did not show the cause, is there an image scanning or a test that i can do to know what is obstructing my breathing ?
2- which specialist can i see ( live in nj/nyc area ).
3- is there anything else i can do with the bi-level machine or anything else to try to keep me breathing at night?
4- medication ?
Thanks for taking the time to read all of this.
.
