UARS and CPAP

Hey,

I think I have UARS. About 8 years ago (I'm now 28), my ex-girlfriend told me that I snore heavily and sometimes choke/gasp for air. I did not think too much of it at that time. I was tired often, but I wasn't leading the healthiest lifestyle at that time (university), so I thought it was normal.
As my fatigue got worse over the years, in 2015, my primary care physician sent me to an ent who sent me to the sleep lab. There, I was not really able to sleep and so I was diagnosed with insomnia. I am very rarely not able to sleep, so, no, I don't think I actually have insomnia.

Frustrated with my poor sleep/fatigue/headache, I bought a CPAP about three weeks ago. I also purchased a security cam so I can record myself during sleep.

I didn't use the CPAP too much yet, as I first had trouble keeping the mask on and then found it much more interesting to see on video what happens when I sleep without the mask:
1) I mouth breathe most of the night (I've always thought that my snoring is nasal snoring, it actually isn't).
2) Whenever I lie on my back, not only do I snore much more frequently, but I show signs of arousal very often. It might happen every few minutes, and it's usually the same pattern: light snoring -> heavier snoring -> sudden stop and some sign of arousal. It happens 1-6 times (10-30 minutes) until I turn to the side.


I attached 3 nights of CPAP (without too many leaks). I hope someone can give me insight on what the graphs show.
Also, what should I do next? Continue CPAP for a month and see how I feel? Another sleep lab?

I too have UARS, you might want to look for mewing/ tongue chewing on youtube, it really helps, though CPAP isn't a complete solution bc with UARS you are going to need CPAP even at daytime as I did. Palatal expansion with adult is really hard but with constant mewing/tongue chewing your maxilla will expand itself and go forward, by moving maxilla forward and upward, it will help lower your nasal resistance and cure your UARS.
You shouldn't breathe through your mouth, it will make your mandible go backward and your face tilt downward, that's why your UARS/sleep apnea get worse each year, tape your mouth during sleep, stop open mouth to breathe during daytime.
You also need to control your weight, water fasting is a very fast way to lose weight without much effort, look for water fast on youtube, but you need to drink a lot of water and supply yourself with potassium and magnesium while fasting.

When someone has UARS the data supplied by the cpap machine isn't really going to be much help because the cpap machines just flag and respond to obstructive sleep apnea stuff.
So people with UARS already have a low AHI..and they don't need much pressure because they don't have OSA side of things.

Your machine didn't do much except for the approx 1 hour in the middle of the night...bet you were on your back then.
Being supine can make everything worse...OSA or UARS because gravity causes the airway to sometimes close up even more and be harder to hold open.

You aren't going to get much help from the data the machine is going to give you unless you want to learn how to zoom in on the flow rate and go hunting arousal breathing. UARS is more about arousals than it is how often the airway closes off enough to earn some sort of sleep apnea flagged event. The machine isn't really designed to flag arousals.
You can go here and watch the videos and learn about arousal breathing indicators and what it looks like.
http://freecpapadvice.com/sleepyhead-free-software

You are going to have to mainly go by subjective feelings more that on what the machine data provides. It's hard to do.
We like to rely on the data to point us in a right direction but with UARS the data isn't going to be much help.

You need to just use the cpap machine and most likely try even more baseline pressure over a period of time despite the machine not really wanting to. You don't have OSA...it's only going to respond to stuff related to OSA.
From past experience here with people who do have UARS and not OSA...they almost always need more pressure than what the machine might want to give them before they start feeling better.
It's not a quick or easy thing to figure out. We are talking weeks and months here and you really have to be in tune with your feelings.

As for what the other forum member said above...not much that I agree with there but he's entitled to his opinion.

I might put it that although UARS people may not need all that much pressure to keep their AHI low, they may need much higher pressure delivered to them to stabilize their airway more than what your average OSA patient needs for good sleep. That's why, in my opinion, APAP is not necessarily the best mode for all, in that once the airway narrowing that would cause a raising of pressure in an APAP to prevent AHI-level events occurs, it may already be too late to prevent sleep disturbance in their case.

At least, that's one possible way of stating one theory on it all.

jnk... wrote: ↑

Tue Feb 12, 2019 3:52 pm

I might put it that although UARS people may not need all that much pressure to keep their AHI low, they may need much higher pressure delivered to them to stabilize their airway more than what your average OSA patient needs for good sleep. That's why, in my opinion, APAP is not necessarily the best mode for all, in that once the airway narrowing that would cause a raising of pressure in an APAP to prevent AHI-level events occurs, it may already be too late to prevent sleep disturbance in their case.

At least, that's one possible way of stating one theory on it all.

Probably true but if in apap mode the baseline minimum is always significantly higher than it might want to go to fight anything...it won't go anywhere anywhere because it won't see the need to fight anything.

Example...if the machine never went above 8 cm for any reason and a person set the minimum apap pressure to 10 cm...it's extremely unlikely that the machine will ever move off 10 no matter what the maximum might be set at. It will end up functioning like cpap fixed mode in apap mode.

From what I gather people with UARS and feeling like it is helping and using apap mode...they aren't doing the small minimums...they are using higher minimums than what the machine would go to in normal circumstances anyway.

mtnguyen wrote: ↑

Tue Feb 12, 2019 6:15 am

I too have UARS, you might want to look for mewing/ tongue chewing on youtube, it really helps, though CPAP isn't a complete solution bc with UARS you are going to need CPAP even at daytime as I did. Palatal expansion with adult is really hard but with constant mewing/tongue chewing your maxilla will expand itself and go forward, by moving maxilla forward and upward, it will help lower your nasal resistance and cure your UARS.
You shouldn't breathe through your mouth, it will make your mandible go backward and your face tilt downward, that's why your UARS/sleep apnea get worse each year, tape your mouth during sleep, stop open mouth to breathe during daytime.
You also need to control your weight, water fasting is a very fast way to lose weight without much effort, look for water fast on youtube, but you need to drink a lot of water and supply yourself with potassium and magnesium while fasting.

There’s something to be said for making more room for the tongue to encourage normal breathing. I’m using an Advanced Lightwire Functional (ALF) device to expand my maxilla after 6 years of CPAP that only ever provided minimal relief (I’ve got a narrow jaw, an overbite and I’ve never felt like my tongue fit in my mouth properly). Since I started the ALF my sleep’s improved dramatically - biggest improvement I’ve seen since starting CPAP. And I’ve been able to lower my pressure, from 12cm down to 8cm.

SteveGold wrote: ↑

Tue Feb 12, 2019 8:03 pm

mtnguyen wrote: ↑

Tue Feb 12, 2019 6:15 am

I too have UARS, you might want to look for mewing/ tongue chewing on youtube, it really helps, though CPAP isn't a complete solution bc with UARS you are going to need CPAP even at daytime as I did. Palatal expansion with adult is really hard but with constant mewing/tongue chewing your maxilla will expand itself and go forward, by moving maxilla forward and upward, it will help lower your nasal resistance and cure your UARS.
You shouldn't breathe through your mouth, it will make your mandible go backward and your face tilt downward, that's why your UARS/sleep apnea get worse each year, tape your mouth during sleep, stop open mouth to breathe during daytime.
You also need to control your weight, water fasting is a very fast way to lose weight without much effort, look for water fast on youtube, but you need to drink a lot of water and supply yourself with potassium and magnesium while fasting.

There’s something to be said for making more room for the tongue to encourage normal breathing. I’m using an Advanced Lightwire Functional (ALF) device to expand my maxilla after 6 years of CPAP that only ever provided minimal relief (I’ve got a narrow jaw, an overbite and I’ve never felt like my tongue fit in my mouth properly). Since I started the ALF my sleep’s improved dramatically - biggest improvement I’ve seen since starting CPAP. And I’ve been able to lower my pressure, from 12cm down to 8cm.

Thank you for your suggestions. I wore braces for quite a long time as a teen and also remember that I had four teeth removed. I also had two nasal surgeries (turbinate reduction and adenoidectomy). So, I'm very interested in the anatomical causes for the increased airway resistance. For now I will focus on CPAP though.

Pugsy wrote: ↑

Tue Feb 12, 2019 9:24 am

Your machine didn't do much except for the approx 1 hour in the middle of the night...bet you were on your back then.
Being supine can make everything worse...OSA or UARS because gravity causes the airway to sometimes close up even more and be harder to hold open.

Yes, I was on my back. So far almost all the pressure increases have happened with my face facing up.

Pugsy wrote: ↑

Tue Feb 12, 2019 9:24 am

You aren't going to get much help from the data the machine is going to give you unless you want to learn how to zoom in on the flow rate and go hunting arousal breathing. UARS is more about arousals than it is how often the airway closes off enough to earn some sort of sleep apnea flagged event. The machine isn't really designed to flag arousals.
You can go here and watch the videos and learn about arousal breathing indicators and what it looks like.
http://freecpapadvice.com/sleepyhead-free-software

You are going to have to mainly go by subjective feelings more that on what the machine data provides. It's hard to do.
We like to rely on the data to point us in a right direction but with UARS the data isn't going to be much help.

You need to just use the cpap machine and most likely try even more baseline pressure over a period of time despite the machine not really wanting to. You don't have OSA...it's only going to respond to stuff related to OSA.
From past experience here with people who do have UARS and not OSA...they almost always need more pressure than what the machine might want to give them before they start feeling better.
It's not a quick or easy thing to figure out. We are talking weeks and months here and you really have to be in tune with your feelings.

As for what the other forum member said above...not much that I agree with there but he's entitled to his opinion.

I saw a video by Barry Krakow yesterday and he pretty much said the same thing. Which sucks because I feel that I need confirmation.

So last night I tried to fall asleep on my back. I couldn't fall asleep because the machine raised the pressure at least twice (in about 30 minutes). I was fatigued after the last pressure increase, so I checked the pressure (from 8 to 9.4), turned to the side only to realize that I forgot to put the SD card back into the machine

I woke up about after about 4 1/2 hours of sleep. I thought that the pressure had increased a lot because it felt very hard to exhale, but I checked and it was at the minimum EPAP 4 with EPR 4. So I'm not sure what happened. Did my muscles get tired to exhale against the pressure? I guess I will get used to it?

Should I be concerned about these events:

Is the first one CSR?

Also, here's the full night. Not very eventful I think - and I slept pretty well. I will try 4.5 EPAP with EPR 3 next night.

No..the first one is not CSR. I know it looks a bit iffy but the pattern for CSR is very distinctive.
CSR has a more even/equal waxing and waning on both sides and not just one side.

werther wrote: ↑

Wed Feb 13, 2019 4:43 pm

Thank you for your suggestions. I wore braces for quite a long time as a teen and also remember that I had four teeth removed. I also had two nasal surgeries (turbinate reduction and adenoidectomy). So, I'm very interested in the anatomical causes for the increased airway resistance. For now I will focus on CPAP though.

You’re right to focus on CPAP - it’s the gold standard and for a lot of people, it’s all the treatment that’s needed. I still use mine and always will.

cpap first please

werther wrote: ↑

Wed Feb 13, 2019 4:57 pm

Is the first one CSR?

The first almost looks like obstructive events, they have the fairly typical triangular shape, whereas CSR is sinusoidal, even waxing and waning.

This is CSR that is very concerning:

Actually, that image was the first indication that the patient had severe congestive heart failure.

palerider wrote: ↑

Thu Feb 14, 2019 12:55 pm

The first almost looks like obstructive events, they have the fairly typical triangular shape, whereas CSR is sinusoidal, even waxing and waning.

Thank you palerider for the insight.

Pugsy wrote: ↑

Tue Feb 12, 2019 9:24 am

You need to just use the cpap machine and most likely try even more baseline pressure over a period of time despite the machine not really wanting to. You don't have OSA...it's only going to respond to stuff related to OSA.

I'm often not sure WHAT the machine is responding to, but it is responding to something. Should I increase pressure slowly?

werther wrote: ↑

Sat Feb 16, 2019 12:48 am

palerider wrote: ↑

Thu Feb 14, 2019 12:55 pm

The first almost looks like obstructive events, they have the fairly typical triangular shape, whereas CSR is sinusoidal, even waxing and waning.

Thank you palerider for the insight.

Pugsy wrote: ↑

Tue Feb 12, 2019 9:24 am

You need to just use the cpap machine and most likely try even more baseline pressure over a period of time despite the machine not really wanting to. You don't have OSA...it's only going to respond to stuff related to OSA.

I'm often not sure WHAT the machine is responding to, but it is responding to something. Should I increase pressure slowly?

Pressure goes up because of snores, flow limitations, hypopneas and apneas.

I'd bump your minepap to 6 and see how things go.

palerider wrote: ↑

Sat Feb 16, 2019 1:06 am

I'd bump your minepap to 6 and see how things go.

Ok, thank you, will do.