First OSCAR Post here - mild OSA/UARS-type SDB. First night with Bi-Level.

Nocibur - Here are both studies. First is in 3 pages while second is just a URL.
https://www.apneaboard.com/forums/attac ... ?aid=73596

My sleep doctor is pretty well-regarded. From my appointments with him, it seems he knows his stuff. His thinking was that the PLM's themselves are not harmful to sleep, but the arousals are. If we could just stop the PLMs from turning into PLM arousals, then we are mitigating the damage there. The logic tracks in my mind but I am no doctor! That's probably why you don't see the medication on first-line, second line (or any line) treatments. I know the main ones are gabapentin/lyrica and then dopamine agonists. Those meds were all awful for me personally.

The second part about whether they happened at the same study/same scorers is a good one. The answer is no. Different centers and different scorers. I know that makes a pretty large difference.

Pugsy - sorry to hear about your arthritis. Good to hear that you can at least get some extra sleep with the Belsomra. My dad takes Quviviq and luckily got his insurance to pay for it. I probably will go push to for Belsomra and see what happens.

I guess that the PLMD could still be an issue as scoring is done by a human, but I definitely feel that I do feel like I am sleeping deeper (although that just may be the silenor itself, not that it's actually doing anything for the arousals). I know scoring can vary between centers greatly, but I'd find it weird that it would differ so largely between centers (25 to .2 for PLM arousals) and 3 to 25 respiratory arousals).

I think I'll probably put a few nights into SleepHQ and see what happens. I just learned about it today. And if we're still stumped, may be time to reach out for the raw data.

Lastly, I just found another thread on apnea board showing something very similar to myself with the larger breath every few breaths. Not sure if that is harmless as it doesn't seem to be ending in an arousal or if it's still harmful because it seems to be interfering with breathing in some way. https://www.apneaboard.com/forums/Threa ... PLM?page=3

Thank you both for your time - much appreciated.

The attachments are just thumbnails and the link to AB is blocked (there's a reason for that, but not now).

What's your screen name over there?

Gohoos? Really?

Do you have the long report from the second study, especially the graphics? Also post the dictated report here, can't read it over there.

Well, 2 things from the first sleep study. You had 10 central apneas. Those were undoubtedly post-arousal so shouldn't be counted, making your AHI 7.0. If you were Medicare you wouldn't be CLOSE to getting a CPAP. I would certainly argue that trying to get you to use CPAP is a total waste.

Second, your Sleep Efficiency is 57%. You'd have to get up to 70% just to be rated poor!

You got a major SLEEP problem, and you can't fix a sleep problem with a CPAP machine.

Overall questions - Despite what the report says, my doctor wants to start off with medicating for the PLMD first before going the CPAP route. He is confident that the PLMD is the reason for my issues - extreme fatigue, extreme brain fog, extreme anxiety. Do you think that I should push for CPAP? I've read that mild sleep apnea is only considered mild as it relates to AHI, not actual symptoms experienced such as the above.

So did YOU push for CPAP?

Yeah I know Mt. Sinai. Nice place.

bruins2006 wrote: ↑

Mon Feb 24, 2025 10:05 am

I do actually gulp for breaths during the day (nasal breathing is terrible and we are working on that - possibly expansion). That being said, it looks to happen for half of the night, if not more, every single night I use PAP.

If you gulp for breaths during the day (when you are obviously not using a CPAP or Bi-level, then it is reasonable to assume that you breathe like that in your sleep when you are not using a CPAP/Bi-Level.

In other words, it's premature to "blame" the PAP for your breathing looking like when you are asleep. For all we know, this is simply what your sleep breathing looks like.

I'll attach a SS from a few months back and you'll see what I mean. I'm wondering if that means I'm just not used to CPAP and it's keeping me in a "light sleep" that looks more like I'm awake with the big gulps or if there is something else going on.

That could explain why I feel worse with PAP? Definitely doesn't feel like I am awake the whole night, but definitely not as deep of a sleep.

How long have you been using PAP of any form?

Yes, it can take a while to get used to sleeping with a PAP machine. But whether the PAP is somehow keeping you in a light sleep or whether your brain is just refusing to just let go and drift off into a deeper sleep because the brain doesn't want to trust the PAP is an important difference to consider.

If the problem is that your brain just won't let go because of the novelty of the whole "CPAP thing", addressing the problem through sleep hygiene measures might help. As counterintuitive as it sounds, sometimes we can get so wound up in trying to explain why we're not sleeping well that all that effort looking for a cause keeps the problem from being resolved. In other words, sometimes we can focus so intently on the quality of our sleep that all that effort to improve our sleep winds up making our sleep worse.

If the problem is some kind of comfort issue, that needs to be teased out and addressed.

robysue1 wrote: ↑

Mon Feb 24, 2025 5:10 pm

How long have you been using PAP of any form?

Yeah, that's the (an) other thing.

October 2023.

Thanks to both.

robysue1 - It may be that my breathing is bad during the day and that my machine is simply recording what what it is at night (both being similar). Absolutely. And I agree with obsessing over something, making it worse. I actually gave up on CPAP for awhile, tried it intermittently, and now again really trying to give it a go. It feels comfortable when I am drifting off, but my body seems to not love it. I may experiment by taking something that really knocks me out (perhaps unison) for a night and see how the breathing is then. I may just have to wear it before I start going to bed, etc to get used to it. It's just weird because comfort doesn't seem to be a huge issue at this point, but anxiety is much worse when I do use it. That's what's so strange to me and maybe it is in fact my body not loving devices of any kind. I've been on PAP therapy since Fall '23, but very on and off.

Nocibur - I wouldn't pay too much to the sleep efficiency scores. I couldn't fall asleep because of the wires/being in a different bed/too warm, etc. At home, I fall asleep in 30 mins or so. Interesting note on the central apneas. I pushed for CPAP after a couple of months of taking the PLMD medication didn't do much/had unintended side effects. Link to most recent study in below. Can't get the other one here because I can't find the source doc. Need to do some digging. I am gohoos over there..why the "really"? haha.

Would you suggest that a low AHI/High RDI not be treated/I'd be better off with out PAP?

https://docs.google.com/document/d/1joZ ... it?tab=t.0

bruins2006 wrote: ↑

Mon Feb 24, 2025 5:59 pm

I wouldn't pay too much to the sleep efficiency scores. I couldn't fall asleep because of the wires/being in a different bed/too warm, etc.

I have a rough idea of what the sleep laboratory milieu is like and that is taken into consideration. With that and second study SE 65.6% you officially have Bad Sleep.

You might try using some kind of Sleep Tracker to try to prove/evaluate/monitor/whatever, but right now the evidence says that's where you will get the most bang for your buck.

Would you suggest that a low AHI/High RDI not be treated/I'd be better off with out PAP?

The data is insufficient.

That said (there it goes again) if you look at the studies closely and account for the oximetry scoring variables, they are quite similar and consistent, and not

these two conditions essentially "jockey" for supremacy, and as I treated one thing, SDB essentially filled the power vacuum.

The supine RDI are 23 and 29.6 respectively, but since you spent virtually the entire night 12/11/2024 supine the raw total looks much worse (Red Herring).

It may reveal that CPAP makes your bad sleep even worse, but OTOH I don't think you can leave a mid-high 20s RDI on the table without trying to do something about it.

You might try some mandatory side-sleep tricks.

Thanks. I think I agree with you, especially on the positional aspect. It is so strange because I cannot fall asleep on my back. So I sort of assumed that it was not positional apnea until the most recent study. I fell asleep on my back and was sure I stay there the whole night. I did the taped lacrosse ball to a shirt trick, but I still woke up on my back. I think I need something more prohibitive that makes it so you can literally not go on your back - there are some good things out there.

Think that's the obvious next step so thanks for elucidating this.