Sleep study results - suspected UARS - please help

[msreef]

Hi all,

Can someone please look over my results and let me know if there is any indication that I have UARS. I didnt' sleep very long unfortunately ( 4 - 5 hours).
I've been struggling for a long time with fatigue, brain fog, memory loss. I also have a history of teeth grinding, TMJ (comes and goes) and silent acid reflux. I generally don't have a problem getting to sleep, but often wake up in the middle of the night and then can't get back to sleep.
The sleep study place don't think I have UARS from my results.

[Okie bipap]

The study says you have obstructive sleep apnea (OSA) that is worse in REM. Hypopneas can disturb your sleep just as much as full blown apneas. Having OSA that is worse during REM is not unheard of or unusual. My recommendation is to have your doctor write a prescription for a ResMed auto-adjusting machine.

[msreef]

Okay thanks, how did you pick that up? It says that there are 0 obstructive events in the summary area.

[Pugsy]

Okay thanks, how did you pick that up? It says that there are 0 obstructive events in the summary area.

Hyponeas...they count also.

OA....80 to 100% obstruction in air flow that last 10 seconds or more.
Hyponea 40 to 79% obstruction in air flow that last 10 seconds or more.

Do you really think there is that big of a difference between a 75% reduction in in air flow and 81% in terms of what it does to the body or sleep quality?

My own OSA is worse in REM...it's very common. 5 times worse in REM than in non REM.

[Julie]

Have you made an effort to not sleep on your back - I think it's likely causing most of the hypopneas... of course you'd need to find a way to not do it when asleep as people usually flip from side to back sleeping after a while.

[msreef]

Have you made an effort to not sleep on your back - I think it's likely causing most of the hypopneas... of course you'd need to find a way to not do it when asleep as people usually flip from side to back sleeping after a while.

Yep I have, I do seem to feel better sleeping on my side. I tried putting a tennis ball in a sock then using safety pins to attach it to the back of my t-shirt. Tried that for a few weeks but the sock would move around, and I would wake up as it would dig into my back.
What's frustrating is that I find it very difficult to get back to sleep after waking, my mind switches on and I know I should get back to sleep, but that's what keeps me up. I woke at 4am this morning and couldn't get back to sleep.

[Julie]

Are you taking any meds that might incidentally keep you awake?

Have you tried a small dose of melatonin before bed?

[msreef]

Are you taking any meds that might incidentally keep you awake?

Have you tried a small dose of melatonin before bed?

Nope not that I'm aware of, only some natural supplements, but I don't have an issue getting to sleep, its' when I wake up that I get anxious about needing to get back to sleep, and that keeps me up.

I have tried melatonin in the past (1g), it seemed to make the brain fog slightly worse. I could try dropping down the dosage I guess, but really I just want to not wake up in the middle of the night. Not sure if melatonin will help with keeping me asleep? If there is a reason I'm waking up then I'd prefer to treat the source if possible.

[Pugsy]

Google "sleep maintenance insomnia" and start reading. Lots of potential culprits and it's not an easy solution to find and implement but waking up and immediately starting to worry about going back to sleep just feeds the insomnia monster.
Figuring out the problem and implementing the fix is even harder.

There's a good read in RobySue's blog here about insomnia...skim over the cpap induced stuff to where she talks about her insomnia struggles and she mentions a couple of good books to read and help with awareness. I don't remember the titles but she mentions them here.
http://adventures-in-hosehead-land.blog ... er_19.html

Melatonin helps a lot of people fall asleep but it's not so great with the staying asleep problem and it does have some unwanted side effects (google melatonin side effects) and that morning foggy feeling is unfortunately one of them.
Now they do make a sustained released version of melatonin that might help but again....that morning fog thing will likely be more pronounced. I can't take it myself because one of the other side effects is bad vertigo and I happen to be unlucky enough to get that one.

The staying asleep thing....I feel for you...it's my problem as well and even though I know the cause it is still a struggle but at least I know it isn't related to my sleep apnea nor my cpap therapy. Sometimes we just have other stuff screwing with our sleep that cpap can't fix.

I don't know if you are a candidate for UARS or not. It's not an easy diagnosis to make with the data that most sleep studies gather unless you have a sleep study with the Pes device that actually measures the pressure in the airway needed to keep it open.
It's not something commonly done and not all sleep labs will do it. Most of the time it is a rule out diagnosis....nothing else seems to fit the bill so they rule out other stuff and UARS remains. The treatment is still cpap but you may have to rely more on how you feel than just the data the machine will provide. These machines don't have a UARS treating algorithm built in to them...it's just the OSA and often people with UARS end up actually needing more pressure than the machine will want to give beyond typical OSA therapy or response.

[msreef]

Google "sleep maintenance insomnia" and start reading. Lots of potential culprits and it's not an easy solution to find and implement but waking up and immediately starting to worry about going back to sleep just feeds the insomnia monster.
Figuring out the problem and implementing the fix is even harder.

There's a good read in RobySue's blog here about insomnia...skim over the cpap induced stuff to where she talks about her insomnia struggles and she mentions a couple of good books to read and help with awareness. I don't remember the titles but she mentions them here.
http://adventures-in-hosehead-land.blog ... er_19.html

Melatonin helps a lot of people fall asleep but it's not so great with the staying asleep problem and it does have some unwanted side effects (google melatonin side effects) and that morning foggy feeling is unfortunately one of them.
Now they do make a sustained released version of melatonin that might help but again....that morning fog thing will likely be more pronounced. I can't take it myself because one of the other side effects is bad vertigo and I happen to be unlucky enough to get that one.

The staying asleep thing....I feel for you...it's my problem as well and even though I know the cause it is still a struggle but at least I know it isn't related to my sleep apnea nor my cpap therapy. Sometimes we just have other stuff screwing with our sleep that cpap can't fix.

I don't know if you are a candidate for UARS or not. It's not an easy diagnosis to make with the data that most sleep studies gather unless you have a sleep study with the Pes device that actually measures the pressure in the airway needed to keep it open.
It's not something commonly done and not all sleep labs will do it. Most of the time it is a rule out diagnosis....nothing else seems to fit the bill so they rule out other stuff and UARS remains. The treatment is still cpap but you may have to rely more on how you feel than just the data the machine will provide. These machines don't have a UARS treating algorithm built in to them...it's just the OSA and often people with UARS end up actually needing more pressure than the machine will want to give beyond typical OSA therapy or response.

Thanks, I'm definitely my own worst enemy when it comes to insomnia. I've always kinda hated sleeping, seems like such as waste of time (when it's so obviously not!), when I wake up I'd sometimes just prefer to get up if I can't get back to sleep straight away.

Is there a chance that I could fix the issue with a mouthgard that pulls out your bottom jaw (like https://www.amazon.com/gp/product/B07BT ... UTF8&psc=1) as well as stopping from sleeping on my back? Or is it always pretty much CPAP that is required?

[Pugsy]

Is there a chance that I could fix the issue with a mouthgard that pulls out your bottom jaw (like https://www.amazon.com/gp/product/B07BT ... UTF8&psc=1) as well as stopping from sleeping on my back? Or is it always pretty much CPAP that is required?

Well I suppose there is always a chance but to know for sure you would need a sleep study with the mouthguard in place or rely heavily on subjective feelings.

I would work on sleeping on my side as much as possible if it were me. I know it's easier said than done because it's a struggle I deal with because when I end up on my back it hurts like you know what and that's what wakes me up.

If you have never used a mouthguard....it's going to be annoying in itself.

Find something that can keep you on your side that doesn't cause discomfort. I was never fond of using the tennis ball trick or socks that caused discomfort because to me that's just trading one sleep disrupting thing for another.
I had better luck with using a buckwheat pillow propped up against my back to keep me on my side and when I did end up sort of halfway on it I found the support was actually comfortable and didn't wake me up. The added weight of the buckwheat hulls kept it from wanting to slide out from under me as easily as a lighter pillow or rolled up linens would do.

[Julie]

What I have is a little water bottle and little plastic holder with .5 mg melatonin right beside bed... so if/when I wake up at 3 (too often) I take one right away and try not to come in 'here' to fool around online - otherwise I'd be up til 5 and then the cat wakes me to eat at 6-7, altogether not great. Do you like run-on sentences?

[Miss Emerita]

I hope others will chime in on this, but it looks to me, msreef, as though you spent almost the whole time during the sleep study on your back. (Apparently you turned on your right side at the very end.) That would mean we don't really know from the study whether you are more likely to have events on your back than on your side.

The other thing I see is a very large number of arousals. They are not called out as RERAs (Respiratory Effort Related Arousals), so I would guess they are spontaneous arousals, meaning their cause is unknown. I can't really see from the study what effect, if any, they had on your sleep stages, but they are certainly consistent with sleep that is not restful.

You were relatively short on REM sleep and relatively long on stage 3 sleep (deep sleep). Honestly, given how weird the sleep study business is for the patient, I don't think there's much to conclude from that.

Your instinct to get up when you wake up and can't get back to sleep is not a bad one. The trick is then not to nap during the day. As you google around to try to figure things out, you might take a look at Cognitive Sleep Behavior for Insomnia. Some people have good results in addressing maintenance insomnia with CSBi. Here's some information from a trusted web site:

https://www.mayoclinic.org/diseases-con ... t-20046677

Good luck with this. What you are living with is rough. To follow up on Okiebipap's post, is your doctor writing you a prescription for a PAP machine? Please ask to get a ResMed Airsense 10 Autoset. For most people, it is probably the most helpful PAP machine around.

[zonker]

Your instinct to get up when you wake up and can't get back to sleep is not a bad one. The trick is then not to nap during the day. As you google around to try to figure things out, you might take a look at Cognitive Sleep Behavior for Insomnia. Some people have good results in addressing maintenance insomnia with CSBi. Here's some information from a trusted web site:

https://www.mayoclinic.org/diseases-con ... t-20046677

forum friend dog slobber has had this to say re: cbti. i'm a bit confused by the initials so i'm uncertain if this is the same thing-

viewtopic/t175067/CBTi--Therapy-for-Insomnia.html

OH! just read your link and it is the same thing.

[msreef]

I hope others will chime in on this, but it looks to me, msreef, as though you spent almost the whole time during the sleep study on your back. (Apparently you turned on your right side at the very end.) That would mean we don't really know from the study whether you are more likely to have events on your back than on your side.

The other thing I see is a very large number of arousals. They are not called out as RERAs (Respiratory Effort Related Arousals), so I would guess they are spontaneous arousals, meaning their cause is unknown. I can't really see from the study what effect, if any, they had on your sleep stages, but they are certainly consistent with sleep that is not restful.

You were relatively short on REM sleep and relatively long on stage 3 sleep (deep sleep). Honestly, given how weird the sleep study business is for the patient, I don't think there's much to conclude from that.

Your instinct to get up when you wake up and can't get back to sleep is not a bad one. The trick is then not to nap during the day. As you google around to try to figure things out, you might take a look at Cognitive Sleep Behavior for Insomnia. Some people have good results in addressing maintenance insomnia with CSBi. Here's some information from a trusted web site:

https://www.mayoclinic.org/diseases-con ... t-20046677

Good luck with this. What you are living with is rough. To follow up on Okiebipap's post, is your doctor writing you a prescription for a PAP machine? Please ask to get a ResMed Airsense 10 Autoset. For most people, it is probably the most helpful PAP machine around.

Yep I almost certainly spent it on my back, I had a whole lot of stuff hooked up to me. At the end I was on the right hand side when I was awake (I think), I stayed in bed for a while as I woke up early and wanted to get back to sleep, but couldn't.

I've requesting and am getting the full sleep data from the night - the software is Profusion PSG. The data can be exported to .EDF format - which it looks like can be opened with this tool: https://www.teuniz.net/edfbrowser/
I'll post it here when I get it - hopefully that will gleam more data that may help me.

I never nap/sleep during the day no matter how tired I am, I've always thought I have a weird ability to not sleep even when my body is super tired, my mind is still 'switched on' (even if very foggy!). I can never just fall asleep without being conscious of it. Like if I'm watching a movie, reading a book, even sitting in bed, I don't doze off unaware or accidentally. When I was dating my girlfriend (now wife), we would stay up basically every single night texting/talking for around a year when we lived apart, she would then eventually fall asleep naturally at like 3/4/5am, I then struggled to get to sleep and some nights wouldn't get any, if I was lucky I'd get three hours. She worked later in the day so it wasn't as much of a problem for her as it was me. I'm sure that was terrible for my health. I don't have a problem getting to sleep now, I work from home so am very lucky with that - probably why i'm not as anxious as I don't have to see anyone in person and talk to them. It's just when I wake up in the middle of the night that I will very rarely get back to sleep.

Thanks for the insomnia links, will check them out.