UARS not relieved with OA and CPAP, What to do?

I am a person who live in Korea (so not fluent with English..) and I very need some advice on my sleep problem.

It suddenly started since last year, September 2009, and I have barely lived my life since it even though I was very energetic and active type of person.

My main symptom is not refreshing sleep (depends on the day, but not ever perfect as before) and daytime fatigue that makes me poorly concentrate on anything that requires mental focuses. (but my physical health is almost perfect. i eat healthy, walk long distance daily, 68inch/130lbs, 22 yrs old, etc...)

At the first, I thought it was an phycological problem rather than physiology. so I had done my sleep study so lately, in July this year, almost a year after the onset.

And the sleep study found that :
Absolutely no Apnea (AHI=0) but Sleep Disorderd Breathing (RDI = 12)

The docter (sleep specialized ENT) said it is an moderate form of apnea, and my tongue may frequently blocks my airway when I sleep. so he suggested oral appliance(madibular advancement device). (※ but I'm not so convinced because the polysomnography doesn't show exactly what happened in my throat, the doctor's explanation stands on pre-existing medical evidences and consensus, right?)

After the sleep study, I had tons of research on the web about apnea and UARS. I was not sure that my case is UARS or kind of sleep disorderd breathing, but i had no choice so I decided to try CPAP and OA successively. (this is beacuse if cpap not works, i can sell it so that i can save my money. i'm a student..)

First, CPAP. I had no pressure prescription (costs a lot...) so i tested pressures myself. i gradually increased the pressure form 5cm to maybe 10cm, and used for 2 full months, and 1 month more after that, but it did not work generally. But strangely, ONLY ONCE (the 3rd day of use) It worked perfectly that I felt very refreshed and had very clear state of mind (yes, my original state!). and after that, it does not work that much at all. even though I have not much compliance issues(i'm on it full night), I can hardly notice the difference between using it and not using it.

After some period of CPAP trial, I switched to OA, as doctor suggested. I visited the dentist who is good with OA and made my OA. I started it with much of hope, but it also doesn't seem to work much again. It may improve my sleep qualitly a little, but not very noticable and I still feel the fatigue. I'm still adjusting the device to be more advanced(with the dentist), but I think there is not much chance.

Now I have a plan to adjust OA more advanced, and if it does not work then go to sleep doctor again (I think he may prescribe CPAP). BUT I really have no idea what to do after that. I even doubt whether the cause of my problem is the breathing-related.

Is my problem really UARS according to my sleep study result?
I also met another sleep doctor with the sleep study result, he also said it is due to tongue fallback.
but I think I dont have much trait that UARS patients usually exhibit (I don't have decending lower jaw, don't have narrow airway according to X-ray image and doctors)

If you can give me some advices, I will really appreciate it.
I really want to bring my life back...


I attatch my sleep study result.
(※ the long awake state of the middle of the graph is due to stomachache, the result of very hot food in dinner. I woke up and could not back to sleep for hours because of it)


AHI = 0.0
RDI = 11.8
So2(average) = 97
So2(min) = 94

apnea/hypoapnea arousal = 0.0
repiratory effort related arousal = 11.8
snoral(snoring?) arousal = 0.0
sleep movement arousal = 0.0
spontaneous arousal = 1.5

Hi, there are many things that can cause sleepiness and fatigue, but from your chart, it doesn't look like you have OSA (and I would not spend more money on dental devices, etc. until I had better information). I would go back to my family doctor, maybe get some blood testing, but also asked to be referred to someone like a neurologist who can tell you about other sleep problems that are not "OSA", or problems that may cause you to be sleepy but have no relation at all to "sleep" as such. Good luck!

Hi strophy and welcome to the forum. Your English is excellent - no problem understanding what you wrote.

I wish I could speak a second language as well as you speak English.

These two things would make me think it is UARS, but I'm not a doctor.
So2(min) = 94
repiratory effort related arousal = 11.8

And these two things seem to rule out two very common causes (Obstructive Sleep Apnea and Periodic Limb Movement Disorder) of disrupted sleep:
apnea/hypoapnea arousal = 0.0
sleep movement arousal = 0.0

I don't really have any suggestion for you other than to continue using either CPAP or an Oral Appliance (OA.) Probably CPAP might be the more effective choice, as the Oral Appliance wouldn't necessarily help if your nasal passages (rather than tongue dropping back) are the primary cause of Upper Airway Resistance Syndrome for you. Muffy (or StillAnotherGuest) once wrote that the "upper airway" is considered to be everything north of the vocal cords.

CPAP could help hold open both areas -- throat and nasal passages. An Oral Appliance would address only a possible tongue problem.

I think you've been working on your problem in a very intelligent way:

strophy wrote:so i tested pressures myself. i gradually increased the pressure form 5cm to maybe 10cm, and used for 2 full months, and 1 month more after that

I'm sorry you've not seen significant improvement so far using either the CPAP or the OA. As Julie suggested, perhaps there are other undiagnosed health problems or sleep hygiene issues you might want to look into. Thyroid? GERD (acid reflux, which can be "Silent GERD" showing no obvious symptoms)? Insufficient vitamins/minerals? Anemia?

Hope you get some relief and more refreshing sleep soon, strophy. You're certainly trying hard to help yourself. I applaud you for that!

strophy wrote:
(※ the long awake state of the middle of the graph is due to stomachache, the result of very hot food in dinner. I woke up and could not back to sleep for hours because of it)

Are you knowledgeable of GERD? That is one possibility for the long awake state.

Regarding the bigger issure, I am concerned about RERA index of 11.8 and believe you should continue to work with your doctors on the diagnosis of sleep-disordered breathing (of whatever type).

If you have another sleep study, eat more sensibly for 48 hours preceding the study.

Hi Strophy, welcome and thanks for posting your info. If you haven't seen it already, good wiki on UARS.

wiki/index.php/UARS

A personal Oximeter has been beneficial to me in regards to keeping an eye out for Desats. Interesting that Rested Gal pointed out your So2 (min) of 94%.

I've got lengthy durations throughout the night of S02 ranging from 95% to 91%. And, Encore Report showing hardly any Apnea. Yet, I feel horrible. I think what Rested Gal is alluding to, correct me if I'm wrong, when S02 dips below 95% for five or ten minute (longer) increments but not below 90%, you can really feel awful the next day.

The Epworth Scale can be beneficial for really measuring your EDS (Excessive Daytime Sleepiness) and come to terms with the seriousness of illness.

If I were to describe the feeling, it's like your cells haven't been properly rested and oxygenated. And, the cells start to give out, giving you feelings of pain, exhaustion, mental fatigue. It may take a few hours before you feel it. Or, for me, when I get up, I don't feel like stretching my muscles.

I really hope you feel better,

SG