Need help, suspect UARS. Want to try APAP - need advice and guidance.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
prodigyplace
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by prodigyplace » Fri Jun 08, 2018 10:00 am

canyouhearmeaya wrote:
Fri Jun 08, 2018 9:57 am
TASmart wrote:
Fri Jun 08, 2018 9:48 am
Just want to add that I see some flow limitations - minor, but you may be able to up the pressure slightly to correct that. With an EPR of 3, I would guess that your feeling of difficulty breathing is more psychological than anything else. I do know that if I use the suggested size small nasal pillows I feel very restricted breathing, going to a medium solves that issue.
I'm already using large, which doesn't seem to make any real difference. Also, by upping the pressure, it feels even more difficult to breathe. :(
If the pillows are too large, they may fold up some restricting air flow too, I suspect.

I do not currently have a Large pillow handy to validate this theory though. I usually use a Medium.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Fri Jun 08, 2018 10:05 am

"Like OSA, the causes of UARS are primarily mechanical in nature. The tongue is overlarge. The upper airway passages (nasal, pharyngeal) are congenitally narrow. The adenoids or the uvula get in the way. People with UARS often have a high narrow palate or an overbite. Other problems, like allergies, and chronic respiratory infections like rhinitis, swell the mucous membranes lining the airways, thereby narrowing them. A deviated septum might be the obvious source of UARS-related obstruction."

Source: http://sleepyheadcentral.blogspot.com/2 ... tance.html

I've seen UARS referenced like that in many places, basically somewhere in the breathing mechanics there is a restriction, which in turn causes difficulty breathing and then RERA. So I presume that can be anywhere in the breathing system, rather than OSA which is fundamentally the airway collapsing itself? (I belive this is why UARS is regarded as being difficult to treat, because it can be caused by so many different things.)

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Fri Jun 08, 2018 10:14 am

Let me spin it another way, maybe I'm throwing around the term UARS wrongly, I really don't know now lol!

I guess what I'm trying to figure out is:

I have an RDI of 15, which to my understanding means approx. 15 times every hour, I'm having difficulty breathing which is ultimately leading to arousal / sleep disturbance, and at the end of the day this means my sleep quality is shot, thus I feel crap (sleep deprived.)

One medical study I read deemed UARS as RDI over 5 with an AHI under 5. Maybe it's not that clear cut then.

SO I guess what i'm trying to get at is, can I have an RDI of 15, which ISN'T 'UARS', but ultimately IS caused by airway restriction for whatever reason (maybe deviated septum, or narrowed nasal passages etc) which is fudging up my sleep quality by constant arousals during sleep?

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Pugsy
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by Pugsy » Fri Jun 08, 2018 10:20 am

canyouhearmeaya wrote:
Fri Jun 08, 2018 10:14 am
SO I guess what i'm trying to get at is, can I have an RDI of 15, which ISN'T 'UARS', but ultimately IS caused by airway restriction for whatever reason (maybe deviated septum, or narrowed nasal passages etc) which is fudging up my sleep quality by constant arousals during sleep?
Yes.

I can't sleep if I can't breathe through my nose for whatever reason. Just won't sleep...wake often and all that.
Doesn't mean I have UARS though.
Not all restrictions are UARS restrictions and not all breathing issues qualify for sleep disordered breathing issues and not everything can be fixed with cpap.
You are wanting to use the term UARS to cover all possible issues that don't make the OSA diagnosis and it's not necessarily going to make it so.

The fact that you have a problem breathing through a nasal pillow while awake without the machine attached....you need to be seen by the specialist....because that is not normal. Most people will react like your brother did.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Fri Jun 08, 2018 10:26 am

Pugsy wrote:
Fri Jun 08, 2018 10:20 am
canyouhearmeaya wrote:
Fri Jun 08, 2018 10:14 am
SO I guess what i'm trying to get at is, can I have an RDI of 15, which ISN'T 'UARS', but ultimately IS caused by airway restriction for whatever reason (maybe deviated septum, or narrowed nasal passages etc) which is fudging up my sleep quality by constant arousals during sleep?
Yes.

I can't sleep if I can't breathe through my nose for whatever reason. Just won't sleep...wake often and all that.
Doesn't mean I have UARS though.
Not all restrictions are UARS restrictions and not all breathing issues qualify for sleep disordered breathing issues and not everything can be fixed with cpap.
You are wanting to use the term UARS to cover all possible issues that don't make the OSA diagnosis and it's not necessarily going to make it so.

The fact that you have a problem breathing through a nasal pillow while awake without the machine attached....you need to be seen by the specialist....because that is not normal. Most people will react like your brother did.
Right, so that was where I was going wrong then. My understanding was basically that if you have RERA's and it's not OSA, it comes under UARS.

I can breathe through the pillow without the machine attached, it just feels liek there's more resistance than without holding it there.. Which I'm presuming we're saying isn't normal? And that it should feel no different breathing without it v holding it there? It's not major resistance, only very minor, but definitely can feel at least a tiny bit of resistance.

It does seem odd that if I push the mask upward that it seems to make breathing easier.. Maybe I should try another mask other than pillows, maybe pillows just don't work with my anatomy. Before I rule out CPAP anyway.

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Pugsy
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by Pugsy » Fri Jun 08, 2018 10:53 am

To my thinking making the pillow push the nose upwards and altering nose position isn't "normal". Forcing piggy nose so you can breathe less restricted isn't normally the way to go. Makes me wonder what is going on inside the nose itself that needs a change in nostril position to move more air. If you take your finger and push the end of the nose up and give yourself piggy nose with your finger...do you breathe more easily?

You might look at the DreamWear mask system from Respironics.
You have full face option and under the nose cushion option and gel pillow option...all with the same frame.

https://www.usa.philips.com/healthcare/ ... /dreamwear

Of the full face masks out there the DreamWear full face cushion is probably the softest and least restrictive of the ones I have tried.

Until you are actually able to sleep comfortably and soundly with the mask and machine you have zero way of knowing if cpap will even help you or not. It is a long shot even if you could sleep...as it is now...impossible. You have to first get the sleep and fairly decent sleep.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Fri Jun 08, 2018 10:59 am

Pugsy wrote:
Fri Jun 08, 2018 10:53 am
To my thinking making the pillow push the nose upwards and altering nose position isn't "normal". Forcing piggy nose so you can breathe less restricted isn't normally the way to go. Makes me wonder what is going on inside the nose itself that needs a change in nostril position to move more air. If you take your finger and push the end of the nose up and give yourself piggy nose with your finger...do you breathe more easily?

You might look at the DreamWear mask system from Respironics.
You have full face option and under the nose cushion option and gel pillow option...all with the same frame.

https://www.usa.philips.com/healthcare/ ... /dreamwear

Of the full face masks out there the DreamWear full face cushion is probably the softest and least restrictive of the ones I have tried.

Until you are actually able to sleep comfortably and soundly with the mask and machine you have zero way of knowing if cpap will even help you or not. It is a long shot even if you could sleep...as it is now...impossible. You have to first get the sleep and fairly decent sleep.
Normal breathing doing the piggy nose doesn't seem to make all that much difference.

Another odd question for everyone: I've heard it's 'normal' for one nostril to be somewhat blocked at all times, and that it's a nasal cycle, and often we'll get more air through one that the other...

A) Does that seem to be true for everyone?
B) If you plug your nostril that feels more 'free/clear', do you struggle to breathe through the other one?

So for example, at this minute my left nostril feels 'clogged' (but no mucous or allergies), if I block off that nostril, I don't feel much impairment to my breathing, as the other one is clear enough to breathe okay, however if I block off my right nostril, I feel a LOT of resistance trying to breathe through the left one only.

I Do believe this cyles for me... but actually, I'll pay close attention to that tonight, just to ensure it is going from side to side and not always the left blocked (I'm fairly confident I'm observed it isn't previously, but now I'm second guessing.)

I guess I wonder 'how blocked' other peoples feel.. I can breathe through the more blocked nostril, but it feels difficult, like being mildy smothered..

Edit: It definitely changes, because it's now already moved from my left to my right nostril.

rick blaine
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by rick blaine » Fri Jun 08, 2018 2:46 pm

Hi Canyou,

With regard to nostril switching, you may be thinking of the 'ultraradian rhythms' theory put forward by Drs David Lloyd and Ernest Rossi in 1991.
Last edited by rick blaine on Fri Jun 08, 2018 3:02 pm, edited 1 time in total.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by ChicagoGranny » Fri Jun 08, 2018 2:59 pm

rick blaine wrote:
Fri Jun 08, 2018 2:46 pm
With regard to nostril switching, you may be thinking of the 'ultraradian rhythms' theory put forward by Dr Ernest Rossi.
No. It's the nasal cycle.
The nasal cycle was studied and discussed in the ancient yoga literature of pranayama. In the modern western literature, it was first described by the German physician Richard Kayser in 1895.

Full article: https://en.wikipedia.org/wiki/Nasal_cycle

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by rick blaine » Fri Jun 08, 2018 3:10 pm

Hi ChicagoGranny,

"Cyclic side-to-side variations in the autonomic tone of the nasal mucosae produce corresponding changes in nasal patency. This 90 minute to 4 hour 'nasal cycle' is correlated with a number of ultradian rhythms, including asymmetries in left: right cerebral EEG activity and differential performance on visual/spatial psychological tasks (Eccles, 1978; Klein et al, 1986; Werntz et al, 1984).

"Several authors have proposed that the nasal cycle is part of an overall physiological rhythm known as the Basic Rest-Activity Cycle (BRAC). Thus, relatively greater airflow through the left nasal chamber is associated with the 'REST' phase of the BRAG and relatively greater airflow through the right nasal chamber is associated with the 'ACTIVITY' phase of the BRAC.

"During the 'REST' phase of the BRAC there is a preponderance of right hemispheric EEG activity, a spatial cognitive mode, and a parasympathetic predominance in the stomach, intestines, and other unpaired body organs. During the 'ACTIVITY' phase of the BRAG, greater left EEG hemispheric activity, a verbal cognitive mode, and sympathetic predominance in unpaired organs occurs (Kennedy et al, 1986)."

https://link.springer.com/chapter/10.10 ... -9655-1_91

8)

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ChicagoGranny
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by ChicagoGranny » Fri Jun 08, 2018 4:05 pm

rick blaine wrote:
Fri Jun 08, 2018 3:10 pm
(Eccles, 1978; Klein et al, 1986; Werntz et al, 1984)
(Kennedy et al, 1986)
More recent research (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144611/) has rendered the theory you cite invalid.
Conclusions:
The present results do not support previous findings of contralateral cerebral hemisphere improvement with breathing through a specific nostril.
KISS

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by OkyDoky » Fri Jun 08, 2018 4:50 pm

If you think the shape of your nasal passages may be contributing to your feeling, you might try using a nasal strip with your mask to see if that helps.
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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Fri Jun 08, 2018 5:43 pm

OkyDoky wrote:
Fri Jun 08, 2018 4:50 pm
If you think the shape of your nasal passages may be contributing to your feeling, you might try using a nasal strip with your mask to see if that helps.
I bought some breathe right strips last week (before the CPAP arrived), alone I didn't feel they did much, although maybe a night or two of used isn't suffice anyway.

I also picked up a nasal decongester spray earlier, which actually does seem to have cleared my nostrils up a bit. I did try the CPAP after the spray + with a breathe right strip, can't really say it felt all that much different, possibly marginally better but difficult to say. It seems at moments it feels like I can breathe okay with it, then I can't, and I can't seem to figure out exactly why.

Tonight I'm going to just give the CPAP a total miss, because the last few nights have made me feel even worse tbh, so going to use a breatheright alone with the decongester and hope I get some sort of quality of sleep.

If I'm feeling upto it tomorrow, I might have another go with the CPAP with the combination of the other 2 things. I think before I do right CPAP off, I need to try another mask. I have a strong feeling the nasal pillows just don't work for me, for whatever reason annoyingly. It just gives me a feeling of mild suffocation almost, when I exhale I feel like I'm not able to fully exhale, as if I'm partially exhaling then I can't really exhale anymore, which is preventing me from finding a comfortable relaxed breathing pattern.

I also have a MAD device coming nrxt week to try out, I just ordered a cheap one which the company said would be a good trial, and if it works then upgrade to a proper one. I'm skeptical over the MAD devices, especially as I've heard people claim they can cause jaw pain.. and I do worry, will it potentially mess up my jaw alignment? But I suppose if it does provide any benefit, it gives me more clue about what's going on.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by rick blaine » Fri Jun 08, 2018 6:04 pm

To ChicagoGranny:

You're kidding, right?

This latter study, Samantaray and Telles, doesn't mention cycles, and the subjects are not described at any time as having cycles or going through cycles. Just that they were assessed as 'nostril dominant' every four minutes and within a task-period of 30 minutes.

The experiments that Samantaray and Telles were reacting to or against - the ones by Shannahoff-Khalsa and various others - those previous experiments involved both 'natural' and forced choice of alteration of nostril - operating on the belief that 'choosing' which one to use gives a boost to one or other kind of mental performance. Let's call that A.

Samantaray and Telles did the opposite. They didn't say: "Force yourself to use one nostril or the other - see if it helps with the task." They gave tasks which notionally* involved one hemisphere or the other - and checked to see if - under the 'influence' of the task - the subjects preferred (or 'chose to switch') nostrils. Let's call that B.

Two different experiments.

And both studies were looking at cognitive tasks. The Frye and Doty work looked at a number of different aspects of physiology - including sense of smell - which involves the mid-brain and not the cortex - and the whole parasympathetic system. Let's call that C.

You can argue if you want between A and B - but neither of them cancel out C - not if you take into account ALL the aspects of C.

Not to mention, nowhere in either A or B do the researchers mention cycles. Not nasal cycles, not physiological cycles. Nor do they describe any observer being on the look-out throoughout the experiment for people who were coming to the end of their 90 minutes and 'naturally' switched to the next cycle.

So their studies are methodologically flawed. Failure to isolate a major variable.

Study C is all about cycles. The cycle IS the major independent variable. And the dependent variables are changes in the whole physiology.

Keep it honest, Madam. 8)

* There's a lot of evidence now that that whole left-hemisphere/ right-hemisphere notion is far too simplistic. It was a convenient simplification at the time. But more modern work has gone beyond it.

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Re: Need help, suspect UARS. Want to try APAP - need advice and guidance.

Post by canyouhearmeaya » Sat Jun 09, 2018 8:41 am

Well the MAD arrived today, crazy quick as I only ordered yesterday - so shout out to Intus Healthcare for being so on the ball, very impressed!

Tried it in earlier, felt okay, altho felt like it might be difficult to relax with cause its like springloaded almost, as if you'll have to constantly be trying to keep your mouth close with it.. Hmm, not sure how that'll work.

Tonight I'm either going to try: Decongestion spray + breatheright strip, then either the MAD or CPAP again. Will go by feel later.

I must admit, i'm not particuarly hopeful for the MAD, but it would be great if it did work..