Chronic fatigue

[weiss27md]

35,M
I know I've had sleeping issues for at least 5 years.  I have a history of reflux, bruxism, TMD, anxiety, sinus infections, headaches and the past couple years fatigue and irritability.  Had an in lab sleep study 5 years ago and basically said no sleep apnea.  4 months a go I got an at home sleep study and it showed very mild apnea with an AHI 0f 5.5.  This same doctor found I had a sinus infection and antibiotics did not clear it up.  He's a sleep specialist and allergy doctor.  So I qualified for sinus surgery, I had chronic nasal swelling for years.  I got balloon sinuplasty, turbinate reduction and septoplasty.  This did clear my nose up but still waking up tired.  My final follow up with this doctor is in 2 weeks.  This same doctors office also said I had a large tongue.  They said they cant consider me for a CPAP until the final appt.  In the meantime I saw another sleep specialist and he gave me the runaround too about my AHI being so low that he probably couldn't do anything.  Supposed to have another sleep study by this doctor but no word yet.  Nothing is looking promising yet.  And if I do get a CPAP it might be a while and all my research says I probably need a BiPAP.  I've tried everything to sleep better with no luck: wedge mattress, weighted blanket, different pillow, night guard, taping mouth, nasal rinses, magnesium, melatonin, diet changes, exercise, etc.  I've done a lot of research and I think I need a ResMed AirCurve 10 VAuto.  My main issue is I'm always tired and it has slowly been betting worse over the past couple years.  Not sure how much longer I'll make it.  Should I just buy a used BiPAP or wait several months and maybe still no help from doctors?

http://imgur.com/gallery/MQH3uIL

[Julie]

How far has testing/labwork, etc. gone in other non-sleep related areas? You don't have apnea, not unless I missed something.

Have you really looked closely at what your meds might be doing to your sleep habits?

Also, in future, remove (cover) any personal info on forms, etc... it's too dangerous out there these days to leave it.

[weiss27md]

Thanks. I'm not on any medications. All my blood work I've done in the past is normal, thyroid levels normal, blood pressure normal and I'm 155 pounds.

[weiss27md]

I updated the link to my sleep results.

[Pugsy]

all my research says I probably need a BiPAP.

What makes you think you need BiPap?

BTW....BiPap is a Respironics trademark term for a bilevel machine...which means 2 distinct pressures.
Other brands use different labels for their bilevel machines.
I know bipap has sort of become a generic term but it actually only is a real type of machine that was made by Respironics.

There are MANY different kinds of bilevel machines that do different things along with those 2 distinct pressures.
Not all bilevels do all things.

[weiss27md]

Well I've seen that most people with UARS do best with bilevel. I think I have UARS because I have most of the symptoms. Low AHI, daytime fatigue, bruxism, anxiety, digestion issues, reflux, headaches, not overweight, wake up atleast once a night.

https://www.huffpost.com/entry/upper-ai ... _b_6649766

[nee]

From what I understand (and I could be wrong), RERAs are the hallmark of UARS.

They are not complete hypopneas or apneas - it's just a narrowing of the airway that causes your brain to freak out and arouse.

From your study, I see that no RERAs occurred, but really the best way to score for UARS would be through DISE (Drug Induced Sleep Endoscopy) or to have a sleep study with PES (esophageal pressure).

Either way, your apneas and hypopneas could certainly be causing the symptoms that you complain of.

Edit: That HuffPost article you posted does a good job of touching on what I typed up. Depending on your financial situation, it might be helpful for you to find an airway-centered dentist who works with a team of ENT's, sleep physicians, etc. and understands UARS for further evaluation. But then again, it might all just be as "simple" as OSA for you.

[Pugsy]

It's not always easy to get a bilevel through the healthcare system. I currently use a bilevel machine...the ResMed AirCurve 10 VAuto.
I got it on my own because I simply don't meet criteria to get insurance to pay for it. I like the extra options it offers. I don't necessarily need them but I just like the bilevel way of delivering therapy (I have plain old OSA).

I have problem with someone wanting a machine like I use for treating OSA or UARS and if a person is going to be buying a machine on their own because insurance is dragging their feet or they don't make criteria...by all means get one.

Just make sure that you get one that will do the job you want it to do. Don't assume that all bilevels are suitable for OSA and UARS...quite a few aren't.

So just be careful if you are going down the buying it privately road.

Will it help you with your issues (whatever they are)? That's an unknown at this time but IMHO if someone wants to try it and they can get a bilevel then by all means try it.

Your question as to whether or not you have UARS....we really don't have anyway to know the answer for sure unless someone has a sleep study with a Pes device. UARS if often what I call a rule out diagnosis....we rule everything else out and UARS is left so that's what it gets called.

The Alice One home study didn't measure sleep status...no sleep stage reporting...no EEG leads on the head and face.
To have any idea as to UARS being a factor there has to be what is called RERAs or respiratory even related arousals flagging ability.
Your home study didn't have that. We have to know if a person is asleep first before we can attribute an arousal happening being caused by something going on in the airway. Not all arousals are caused by airway issues.

You are going to need further testing to maybe know for sure if you have UARS. The sleep study with the Pes device is the most definitive test...not all sleep labs do it.

Now if you are okay with proceeding on your own...you can do it but it is unlikely insurance will get on board.

[Pugsy]

From what I understand (and I could be wrong), RERAs are the hallmark of UARS.

They are not complete hypopneas or apneas - it's just a narrowing of the airway that causes your brain to freak out and arouse.

From your study, I see that no RERAs occurred, but really the best way to score for UARS would be through DISE (Drug Induced Sleep Endoscopy) or to have a sleep study with PES (esophageal pressure).

He had an Alice One home sleep study and it didn't measure sleep status at all....no EEG leads.
It is critical that sleep status be known before RERAs can be flagged.
So the absence of RERA flags in this situation means nothing. There could have been a gazillion of them and they aren't mentioned because there was no way to measure sleep and thus no way to look for RERAs.
Testing limitation...no way to even look for common markers that might point to UARS.

You are correct in that a sleep study with a Pes device is the gold standard for UARS but it's not always easy to get. Not many sleep labs do the Pes thing which is why UARS tends to be more of a rule out diagnosis...educated guess kind of diagnosis.

[musculus]

can you post a pic of your tongue? a large tongue is a big risk factor for UARS/OSA.

which Friedman tongue position do you have:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655544/

[weiss27md]

can you post a pic of your tongue? a large tongue is a big risk factor for UARS/OSA.

which Friedman tongue position do you have:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655544/

One of the doctors did say I had a large tongue.
https://imgur.com/a/3HYvClx

[Julie]

Just having one does not mean it falls back and blocks your airway when you sleep.

[weiss27md]

I just ordered a used bipap. Had to. I can't wait several more months.

[weiss27md]

Any signs of UARS?
download/file.php?id=11236

[musculus]

it's highly likely caused by the tongue. telltale sign is more flow limitations in REM sleep period - like from 4 to 6 am

my situation is similar. are you feeling better with PAP therapy？