REM OSA?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
DepressedGuy
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REM OSA?

Post by DepressedGuy » Mon Sep 20, 2021 10:44 am

Hello
I am 30 years old male. I was diagnosed for depression when I was 18. I was on meds for most of 12 years of my life with some gaps. (mostly SSRIs And two snri and finally moclobemide). My depression got worse 1.5 years ago, maybe I builded up tolerance to meds. After consultation with psychiatrist I decided to try to get off the drug, since they are no longer working and they can contribute to my worst symptom - anhedonia. I'm meds free for 3 months

Recently I discovered that I could be misdiagnosed and I can have sleep apnea.
So I started visiting doctors.
I have to small jaw and bite problems. Deviated septum and enlarged nasal turbinates
Orthodontist and facial surgeon seemed to be confident that I have breathing issues and I should go for surgery. But it takes long time is painful, risky and expensive so I would like to think about other options first.

Finally today I have my results for polisomnography

My polysomnography results :
AHI 4.9
ODI 9.9
AHI during REM 21.5/h
ODI during REM 41.2 /h
Minimal saturation 89%
Sleep efficency below 60 % but normally I have better efficiency, I just had more trouble getting t sleep again beaucse of noises from road near sleep lab.
REM Duration 12%


So officially I don't have sleep apnea because my AHI should be higher then 5, but I have much more ahi in REM sleep.
Any ideas what machine would be good for suspected REM related OSA? Some tips what to do in my case? Or maybe I don't have that disease.. I was nearly sure that I have this. Like I finally found my disease, and all my symptoms made sense. Now after results I'm not sure.

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Julie
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Re: REM OSA?

Post by Julie » Mon Sep 20, 2021 12:16 pm

Well, first off, it's not a 'disease', just a condition like being shortsighted or having arthritis.

Little tip, apart from anything else, do not jump at surgery - it rarely, rarely works whatever your stage of apnea, and 99% of patients need to go back on a machine within a few months.

Our standard for having apnea is different from the 'pulled out of a hat' number of 5, and we strive to be under 3.

As far as the REM goes, other more expert people will answer that.

Congrats on getting off the meds, though even if you have apnea that needs treatment, you could still have a mild case of depression (tho' I don't want to depress you by saying so). :roll: :wink:

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ChicagoGranny
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Re: REM OSA?

Post by ChicagoGranny » Mon Sep 20, 2021 12:21 pm

DepressedGuy wrote:
Mon Sep 20, 2021 10:44 am
Any ideas what machine would be good for suspected REM related OSA?
REM is irrelevant to machine selection. You might need a lower pressure in the other sleep stages. But in any case, you want the flexibility of an auto machine. You will find the most recommended machine is the ResMed AirSense S10 AutoSet or AutoSet for Her - https://www.cpap.com/productpage/resmed ... t-humidair
DepressedGuy wrote:
Mon Sep 20, 2021 10:44 am
I have to small jaw and bite problems. Deviated septum and enlarged nasal turbinates
Orthodontist and facial surgeon seemed to be confident that I have breathing issues and I should go for surgery.
What type of surgery?
"Here I sit. Mother tricked me again. Luncheon is not ready."

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ChicagoGranny
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Re: REM OSA?

Post by ChicagoGranny » Mon Sep 20, 2021 12:24 pm

DepressedGuy wrote:
Mon Sep 20, 2021 10:44 am
Recently I discovered that I could be misdiagnosed and I can have sleep apnea.
This happens way too often. :( With children, it's a wrong diagnosis of ADD or ADHD. :cry:
"Here I sit. Mother tricked me again. Luncheon is not ready."

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Pugsy
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Re: REM OSA?

Post by Pugsy » Mon Sep 20, 2021 12:30 pm

It's common for OSA to be worse in REM. I have it myself. The difference is I have enough events in non REM sleep that my overall AHI is high enough to earn the diagnosis where yours isn't.

Your 12% of the night in REM is a bit low. Normally we expect about 20% of our sleep to be in REM stage.

What do you wish to do? I don't know if your insurance will pay or a machine or not but you need a machine that can auto adjust the pressure if/when you are in REM stage sleep.

The ResMed AirSense 10 AutoSet or the newest model AirSense 11 AutoSet would be what I would recommend if you want to try cpap. It is full data and there is free and easy to use software available so you and monitor things and it will auto adjust.
Easy to learn how to manage things.
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Pugsy
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Re: REM OSA?

Post by Pugsy » Mon Sep 20, 2021 12:34 pm

DepressedGuy wrote:
Mon Sep 20, 2021 10:44 am
I have to small jaw and bite problems. Deviated septum and enlarged nasal turbinates
Orthodontist and facial surgeon seemed to be confident that I have breathing issues and I should go for surgery. But it takes long time is painful, risky and expensive so I would like to think about other options first.
Deviated septum or problematic turbinates are NOT the cause of Obstructive Sleep Apnea so fixing those problems won't fix the OSA but the surgery might help with other breathing issues.

Watch this video to get an idea where OSA actually occurs.

https://www.youtube.com/watch?v=-gie2dhqP2c
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

DepressedGuy
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Re: REM OSA?

Post by DepressedGuy » Mon Sep 20, 2021 1:03 pm

Thanks for answers
I'm not mild depression case. I just feel bad with meds and without them. (suicidal thoughts, anhedonia, always tired) Venlafxine worked for a while but its no longer working. During withdrawal it was awful but now I feel more or less like previous 1.5 years with meds.
I must pay everything out of my pocket. I would have partial coverage for cpap with AHI above 5 but I don't have. Orthodontics is not refunded in my country and its needed before surgery.
I guess that anatomical cause is my to small jaw, but before sleep study my nose was checked and that's what doctor said. I started treating allergy before sleep study and now I remember fragments of sleep much more often. So maybe there is some mild impact on sleep quality from nose too.
Bascialy every doctor seems to have their own opinion what is my problem.

Surgeon said that it would be lower jaw surgery or both. I can consider surgery for aesthetics reasons too but I would like to just feel a little bit better before this decision.

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ChicagoGranny
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Re: REM OSA?

Post by ChicagoGranny » Mon Sep 20, 2021 1:15 pm

At your age, I would seriously consider MMA surgery - https://www.mayoclinic.org/medical-prof ... c-20430404

You need to have access to a surgical practice that has good success with this surgery.
"Here I sit. Mother tricked me again. Luncheon is not ready."

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Pugsy
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Re: REM OSA?

Post by Pugsy » Mon Sep 20, 2021 1:20 pm

https://www.cpaptalk.com/viewtopic/t182 ... pping.html

Check above link if you want to go private purchase route and try cpap.
While sleepquest did sell the one machine I think she has another one.

Do you know if your doctor will give you a RX for cpap anyway?
Prescriptions are required for cpap machines and complete mask packages at most online suppliers.
There are ways around the mask RX requirement by buying replacement parts and building a mask but no way around the RX requirement if a place of business requires a RX.

Surgery or not....your choice but do a lot of research.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

DepressedGuy
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Re: REM OSA?

Post by DepressedGuy » Mon Sep 20, 2021 1:27 pm

ChicagoGranny wrote:
Mon Sep 20, 2021 1:15 pm
At your age, I would seriously consider MMA surgery - https://www.mayoclinic.org/medical-prof ... c-20430404

You need to have access to a surgical practice that has good success with this surgery.
It's an option, but it's scary for me and orthodontis /surgeon said that it would take 2 years prep for surgery with orthodontics and I'm not even sure if it is really my root problem :(. Maybe I'm desperate try to find something to cure my depression and I'm tired of switching meds.

On my smartwatch I often have pulse spikes, fragmented rem and rem duration often below 10%. I know that this is not medical device but it shows that something is wrong with my REM sleep too. But maybe I don't have breathing disorder, and I just try too hard to find cause.

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Pugsy
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Re: REM OSA?

Post by Pugsy » Mon Sep 20, 2021 1:31 pm

It's not surprising that you aren't getting much REM.
Most likely your REM stage is cut short when you have apnea events and they cause arousals.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

DepressedGuy
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Joined: Mon Sep 20, 2021 10:05 am

Re: REM OSA?

Post by DepressedGuy » Mon Sep 20, 2021 1:42 pm

Pugsy wrote:
Mon Sep 20, 2021 1:20 pm
https://www.cpaptalk.com/viewtopic/t182 ... pping.html

Check above link if you want to go private purchase route and try cpap.
While sleepquest did sell the one machine I think she has another one.

Do you know if your doctor will give you a RX for cpap anyway?
Prescriptions are required for cpap machines and complete mask packages at most online suppliers.
There are ways around the mask RX requirement by buying replacement parts and building a mask but no way around the RX requirement if a place of business requires a RX.

Surgery or not....your choice but do a lot of research.
My sleep doctor said that I can rent cpap for one week to set it up (and of course pay for it a lot ;) ) But she said that rem only apnea is rare and she had only 3 cases in her career and it will be impossible to know if my REM AHI is reduced, only overall. One week seems to be short to get used and feel the difference so I'm considering to just buy cpap, as far as I know I can buy it in my country without prescription, but maybe I'm wrong.

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Pugsy
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Re: REM OSA?

Post by Pugsy » Mon Sep 20, 2021 1:56 pm

Where are you located?
We assumed USA since you didn't specify. Other countries have different rules and regulations.

Actually there is a way to see if the REM events go away or not. There are machines that will flag apnea events if they happen.
Might want to look at this thread as it has some examples

viewtopic/t158560/How-to-post-images-for-review.html


and this is the software I was telling you about

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

DepressedGuy
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Joined: Mon Sep 20, 2021 10:05 am

Re: REM OSA?

Post by DepressedGuy » Mon Sep 20, 2021 2:06 pm

Pugsy wrote:
Mon Sep 20, 2021 1:56 pm
Where are you located?
We assumed USA since you didn't specify. Other countries have different rules and regulations.

Actually there is a way to see if the REM events go away or not. There are machines that will flag apnea events if they happen.
Might want to look at this thread as it has some examples

viewtopic/t158560/How-to-post-images-for-review.html


and this is the software I was telling you about

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
Poland

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palerider
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Re: REM OSA?

Post by palerider » Mon Sep 20, 2021 2:24 pm

DepressedGuy wrote:
Mon Sep 20, 2021 10:44 am
So officially I don't have sleep apnea because my AHI should be higher then 5, but I have much more ahi in REM sleep.
Any ideas what machine would be good for suspected REM related OSA? Some tips what to do in my case? Or maybe I don't have that disease.. I was nearly sure that I have this. Like I finally found my disease, and all my symptoms made sense. Now after results I'm not sure.
Resmed Airsense 10 Autoset/Autoset for Her, Airsense 11 Autoset, or S9 Autoset.

Any of those would be fine for you.
Get OSCAR and come chat on IRC: #cpaptalk on irc.libera.chat

Accounts to put on the foe list: mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They're often post misleading, timewasting stuff.