Sleep Study......UARS??

[Padron192664]

I'm a 27 yr old male and for the past 4 months I've had problems sleeping. I am able to get to sleep fine around 11pm but find myself usually waking up at 3 or 4 o'clock in the morning. (5 hours of straight sleep is the norm for me) Some nights I have trouble getting back to sleep or if I do sleep after the 5 hours it seems light. When I do end of getting up its quite a chore and I feel a total lack of energy/fatigue. I have total brain fog, difficulty concentrating, and memory issues throughout the day for the last 4 months. I went to a sleep study in the beginning of March after I tried sleeping pills but the same thing would happen on them, waking in the middle of the night. It was documented by the sleep doctor that I see an ENT for snoring to assess upper air patency, which I did. He examined me and found that I have a restricted opening due to an enlarged tonsil, long palate, deviated septum (nose clog switches back and forth throughout day but can still breathe through nose fairly well) and small jaw/facial structure. He looked at the sleep study (results below) and recommended either surgery or CPAP due to UARS. The sleep tech at the Sleep Lab doesnt feel that the number of RERAs I had during my study were abnormal and doesnt believe I have UARS but I still feel like a walking zombie. The issue with being able to have insurance buy off on a titration study is going to be difficult the hospital says but the ENT thinks UARS is the case. On a somewhat related side note.....I'm not sure if this can cause sleep disturbance but my family has a history of hypothyroidism and I'm going to get blood work done tomorrow. The symptoms are the same mainly being chronic fatigue.

I guess my question is, does 38 RERAs seem excessive and is it indicative of UARS?

Results: (March test - NO CPAP)

Sleep DATA - The patient was monitored for a total of 412.5 minuted and slept for 319.5 minutes resulting in a sleep efficiency of 77.5%. (I'm not sure what point they measured from cause I stayed up watching television till midnight after the tech turned the lights out, and I usually get to sleep around midnight. I was awake sometime after 5am but was told the sleep test was done at 6am so my efficiency should be higher.) Latency to sleep onset was 44.9 minutes, REM latency from sleep onset was 61 minutes.

Sleep Staging:

1- 6.9%
2 - 61%
3 - 9.2%
4 - 22.8%

Notes: Sleep onset was delayed likely secondary to environmental surroundings. Sleep efficiency was decreased. REM onset was normal. Body position: patient slept supine and left side


Respiratory Data

A total of 2 respiratory events were observed during the analysis period as follows: 0 obstructive apnea, 1 central apnea, 0 mixed apnea and I hypopneas, for an overall AHI of 0.4

REM AHI: 1.6

Supine AHI: 0.7

There were 38 RERAs during the study and the RDI was 7.5

These respiratory events were repetitive and were associated with oxygen desaturation and marked disruption of sleep. The lowest oxygen saturation recorded was 92%

Snoring ranged from light to moderate throughout the study, and occured during 70% of the total sleep time


Arousal Stats

A total of 52 arousals were observed during the analysis period as follows: 2 respiratory arousals, 0 PLM arousals, 12 spontaneous and 38 RERA/UAR with a REA index of 7.5. The RERA/UAR index is 7.1


Impressions

Snoring (786.09) - ????? not sure what this means
Delayed sleep onset likely secondary to environmental surroundings

The patient is a 27 yr old male with no evidence of Obstructive Sleep Apnea during the present study
Patients sleep was mildly fragmented
Patients snoring was light to moderate
There was no evidence of periodic limb movements during the procedure
38 RERAs (UARS) were noted during study, see interpretation


Recommendations

An ENT evaluation is recommended for snoring, to assess for upper airway patency (ENT thinks I have UARS)
Encourage the patient to achieve and maintain ideal body weight
Instruct and encourage patient to practice optimal sleep hygiene
Clinical followup to ensure improvement and compliance
Encourage patient to sleep in a non-supine position
If despite the above, the patient remains symptomatic, repeat NPSG is recommended in 3 - 6 months

Sleep doctor and tech dont believe I have UARs despite not having one refreshing nights sleep in last 4 months, just want some other opinions (could be hypothyroidism for all I know, ENT recommended blood work and thyroid ultrasound as well)

THANKS in ADVANCE

[RoxanneY]

UARS ia a variation of Sleep Apnea. I also have a deviated septum, small jaw , under active thyroid and wear a bite guard at night, because I grind my teeth.
I was diagnosed with Sleep Apnea last year and when I used the CPap the first 2 months were great. But I slipped back into feeling exhausted, foggy and all the symptoms you describe. After a few adjustments on the CPap I was still feeling bad. I had another sleep study and day study. I found out that I am also borderline narcoleptic and have RLS. I started on nuvagil and RLS meds in December and belive me, I finally have my life back! If you do not have the confidence in your doctors, switch until you find one that helps you to feel yourself again. I was never sick and all of the above issues started 3 years ago, out of the blue.

I found some info on UARS for you and I hope it helps.Classification

There is question in the medical community as to not only the existence of this syndrome, but whether it should be classified as a separate syndrome or part of the larger group Sleep-disordered Breathing (SDB). This unfortunately has led to a poor understanding of the illness by the medical community at large as well as a consequential lack of acceptance by medical facilities and health insurers.

Diagnosis

It is difficult to confirm diagnosis, as few sleep testing centers have the proper test equipment to recognize the illness.

Polysomnography (sleep study) with the use of a probe to measure Pes (esophageal pressure) is the gold standard diagnostic test for UARS. Apneas and hypopneas are absent or present in low numbers. Multiple snore arousals may be seen, and if an esophageal probe (Pes) is used, progressive elevation of esophageal pressure fluctuations terminating in arousals is noted. UARS can also be diagnosed using a nasal cannula/pressure transducer to measure the inspiratory airflow vs time signal.

Explanation

During sleep the muscles of the airway become relaxed. The relaxation of these muscles in turn reduces the diameter of the airway. Typically, the airway of a UARS patient is already restricted or reduced in size, and this natural relaxation reduces the airway further. Therefore, breathing becomes labored. It can be likened to breathing through a coffee straw.

[roster]

1. Consider surgery to correct the septum. Are the turbinates normal? Surgical removal of tonsils should be considered carefully and very deliberately with ENT.

2. Did the ENT find inflammation of your vocal cords? Do you have any other symptoms of acid reflux?

2. Do not have surgery on soft palate or tongue at this point.

3. Everything else per doctors' recommendations:

A. Encourage the patient to achieve and maintain ideal body weight - very important
B. Instruct and encourage patient to practice optimal sleep hygiene - very important - Need list of practices?
C. Encourage patient to sleep in a non-supine position - very important - can you do it 100% of sleep time? Need tips?
D. Blood work and thyroid ultrasound as well - important.

3A, B, and C may bring the RERA/UAR index of 7.1 into a healthy range.

Hold off on additional actions until results of 3D. are known.

My sole opinion of course.

[Sireneh]

I have UARS. My sleep study results showed 22 RERAs per hour - a total of 128 for the duration of the sleep study. Just to give you a comparison.

[Padron192664]

1. Consider surgery to correct the septum. Are the turbinates normal? Surgical removal of tonsils should be considered carefully and very deliberately with ENT.

2. Did the ENT find inflammation of your vocal cords? Do you have any other symptoms of acid reflux?

2. Do not have surgery on soft palate or tongue at this point.

ENT didnt mention turbinates. (He stuck a camera down my nose pretty far, or so it seemed) just a deviated septum (I use breathe right strips nightly) , which from what I've read about the surgery isnt too bad, a few days possibly off work. (Unlike UPPP)

Didnt mention anything about acid reflux or vocal cords

3. Everything else per doctors' recommendations:

A. Encourage the patient to achieve and maintain ideal body weight - very important
B. Instruct and encourage patient to practice optimal sleep hygiene - very important - Need list of practices?
C. Encourage patient to sleep in a non-supine position - very important - can you do it 100% of sleep time? Need tips?
D. Blood work and thyroid ultrasound as well - important.

3A, B, and C may bring the RERA/UAR index of 7.1 into a healthy range.

Hold off on additional actions until results of 3D. are known.

My sole opinion of course.

A list of practices for sleep hygiene would be great,thanks, and also I am more comfortable on my back but dont sleep as well so tips would be greatly appreciated for side sleeping. I know of the tennis ball sewn on back of shirt, any others??

[roster]

ENT didnt mention turbinates. (He stuck a camera down my nose pretty far, or so it seemed)

Let's assume he "knows his stuff" and would have told you if you have enlarged turbinates or signs of vocal cord irritation.

Some advice on sleep hygiene is here http://www.mayoclinic.com/health/insomn ... e-remedies

I think from what you have described the most important things are regular exercise, eating dinner three or four hours before lying down, and avoiding caffeine. You need to check the surprising sources of caffeine. It is in the majority of soft drinks. They even add it to most orange sodas. I avoid chocolate after lunchtime because of the caffeine.

A list of practices for sleep hygiene would be great,thanks, and also I am more comfortable on my back but dont sleep as well so tips would be greatly appreciated for side sleeping. I know of the tennis ball sewn on back of shirt, any others??

I can sleep on a tennis ball so instead went to the more extreme measure of wearing a small backpack. It is actually a CamelBak with a large rigid plastic bottle inserted. I sleep the first half of the night in the Falcon position, http://www.uarsrelief.com/sleeppositions.html, and highly recommend it.

If budget allows, you might also consider buying a sidesleeping mattress.

[socknitster]

If your tonsil(s) is indeed large and blocking the airway I would strongly recommend you have it taken out. The surgery is not easy but it could make a huge difference in your airway. Make sure the doc uses coblation. That is the least painful way to extract the tonsils, I believe. I had mine done the old-fashioned way.

I am exhibit A: I had 3+ kissing tonsils and the tonsilectomy took me from an AHI of 30 down to almost nothing. I'm actually going to have a sleep study to see if I still have sleep apnea.

However, I still have the chronic fatigue and my sleep is fragmented even on CPAP. I'm actually looking for a lab that will test for UARS. Did they put a transducer in your esophagus or were they basing this on belts--the RERA's?

Listen to Rooster. He is very wise.

If you are really gung ho (like me) you might consider a solution to enlarge your mouth. NOT traditional orthodontics, but non-extraction orthodontia using functional orthodontia or self-ligating braces. The idea being that the bigger your mouth, the bigger your airway. In particular, the roof of your mouth is the floor of your nose. Bigger means more airflow. PM me if you are wanting to know more about finding one of these special orthodontists.

Read the thread about Dr. Avram Gold. There is an mp3 link in the thread you should listen to as well.

Jen

[RoxanneY]

I had my turbinates removed and my deviated septum fixed in 2003, but the ENT Dr. did not tell me that the deviated septum could return and it has! It is a very painful surgery.

[Jade]

I had one deviated septum surgery, but it didn't fix the problem as well as my 2nd opinion dr thought, so a few years later had another dev. sept. plus turbinate reduction surgery. I experienced additional improvement from the 1st time around. At this point in my life, I don't think I'd consider a 3rd surgery even should it become advised.

Pain wasn't too bad for me.

Unfortunately, medicine is not as exact a science as, say, chemistry...