UARS (upper airway resistance) Getting help

I should have of posted this first.
This is a coy from my other thread but not with a proper title.

I and the doc think i got UARS



Last night was my 3rd night with the bipap. I feel more tired today then the last couple of days.
Last night i had the machine on for most of the night.

I woke up with it and with water in the hose and little water in the mask humidifier was on 2 i will turn it off tonight.

Basically im having less arousals then i used to but it seems like i am more tired during the day.
i sleep around 8 hrs a night.

My sleep study said i had only 1 apnea AHI and it was no longer then 20 secs. basically doctor made me do some blood work to check thyroid and testosteron as long as other things. i got swollen nasal membranes that im prescribed flonase for. during the night and when i wake up in the morning my nose is congested and i take off the mask to put a little bit of OTC nasal spray but im congested again in few hrs. Who knows how long i sleep with the mask with resistaance in my nose due to inflammation of sinus tissues.

Doctor thinks i got UARS upper airway resistance. Im typically a nose breather but its hard to lately even doring the day due to nasal congestion form the inflammed tissues.




Part2.

In february of this year i had this problem with sleeping and feeling not regenerated in the day and waking up a few times at night and in the morning wake up earlier then normal and very hard to go back to sleep. after a month of this is went away naturally and everything was normal. This time same experience its just not going away. its been going on for 2 months now.

I wanna get rested. What should i do?

Also i forgot to mention my pressures.

I have my M series set by Dme to the lowest pressures of the Bipap Auto to the max range of 15. so its from lowest pressure possible to th 15 pressure if that matters or makes a difference i don't know i figures i would share the info.

Please help anyone that may know. I'm really wondering if it's an issue if my pressure range on auto bipap are too wide. I'm from lowest settings to highest setting at 15

Anyone else with UARS here?

What are your pressure settings? EPAP...pressure support...IPAP max if using auto mode??

We aren't going to be able to offer much in the way of ideas unless we could see some software reports from the machine and even then it is iffy when it comes to UARS. Even more iffy when trying to evaluate from a M series report because we don't have RERAs to maybe help us. UARS can't be gauged easily by the normal software report results because often the AHI isn't all that horrible.

And like I said in a private message to you...the nasal congestion issues really muddy up the waters when it comes to trying to figure out if UARS is present because of the blockage in the nasal passages themselves.

We don't have a lot of forum members here with the UARS diagnosis...a few but not many so you are going to have to be patient till one of them happens to see your thread question...and even fewer using BiPap pressures if I remember right.

Very interested to hear how things go minus the humidity though I'd think a few nights would be more telling - you have to come back from where you are now and it will take a while.

I have been diagnosed with UARS, but use aPAP rather than BiPAP for treatment so I will not be able to provide much specific guidance on your machine setup.

You indicate that you and your doctor think that you have UARS. It sounds like your sleep tests were not done by a lab that is set up to properly detect UARS, as opposed to Obstructive Sleep Apnea (OSA). During my lab tests, I had an esophageal pressure measurement (a catheter through my nose and into my throat, which is very uncomfortable but not painful). When they did the titration tests, the pressure measurement was able to detect the minimum pressure that is required to keep my airway open (9cm). The more common evaluation procedures for OSA would have placed my pressure at a level more like 6cm, which would have been a worthless line of treatment.

As I said, in my lab test they used the esophageal tube measurement, which has been the gold standard for the determination of UARS for many years. There have been other techniques that have recently been demonstrated to be almost as sensitive for UARS, which do not require the uncomfortable nasal catheter. Whatever way the lab uses to address this, if you really do have UARS, you probably need another titration study to specifically look at the settings for your machine for UARS rather than OSA that the machine's software is designed for.

Finally, UARS treatment probably need to be more than just the BiPAP. You said that you are using Flonase as well as OTC decongestants. You need to keep in mind that regular use of OTC decongestants can cause a rebound effect that initially clears your nose, but then comes back worse. Flonase should help you get off of the OTC products. You should also ask your doctor whether you have any other physical conditions that could be creating restrictions. I had a severely deviated septum at one point. Now my problem is that I only have a narrow opening at the top of my throat. Others have had issues with flow restrictions inside the nasal passages that can sometimes be addressed by surgery.

Thanks so much for the input I will talk to my doctor. My IPap is the lowest the M series goes to and E pap as we'll. just set on a high range. I'm thinking about going to dme and raising the pressures to the "11 IPap and 7 epap" which is what I had used when I had apnea. Maybe they will change it a little higher. I also wake up early in the morning and have trouble falling back asleep. Kind of like my mind is thinking/racing. Maybe it's just insomnia. I had this happen in February and all of a sudden it just went away. I'm really wondering what the heck

Probably wouldn't hurt to also consider what else you're doing outside of Cpap time, like diet, when you eat or drink what, have you had any lab work done recently to check for anything else, do you exercise and when, etc. etc.

Probably wouldn't hurt to also consider what else you're doing outside of Cpap time, like diet, when you eat or drink what, have you had any lab work done recently to check for anything else, do you exercise and when, etc. etc.

I completely agree with Julie's suggestion. Your issues with insomnia and your mind racing sound a bit like RLS, which often includes PLMs. There can also be other outside influences. In my case, my worst RLS/insomnia problems coincide with our local spring and fall pollen seasons. I am highly allergic to almost all pollens, so the correlation makes at least a little bit of sense. Either additional or lack of exercise, types and timing of food and also alcohol have been issues for many others.

My diet is so so. I am active daily on cardio burning around 300 calories per workout. Just started that 3 weeks. I'm getting blood work done for testosterone thyroid and some other things


When I wake up I can easily be up and about I just lay there and try to not think about anything and eventually I'm back to sleep but spring the day I feel tired. Also I wake up earlier then normal and when I o I just kinda think about random stuff. So it may be restless leg syndrom? I had these symptoms back in February or March and they went away after maximum on month

So it may be restless leg syndrom?

If you think it might be RLS, you might want to check out the discussion board at RLS.org. If you read some of the introductory threads there, you will find questionnaires to evaluate whether you have RLS. You will also find many discussions about how many doctors do not know how to diagnose or properly treat RLS. If you have it, your case sounds like it would be rather mild even if it is the cause of your sleep disturbances. Fortunately, mild cases are often fairly easy to treat.

Are you getting to bed at around the same time every day, because not doing so can play havoc with someone like yourself (as can exercising or drinking alcohol before bedtime).

I get to bed relatively the same time between 10-11:30 pm every night.
Just wake up not feeling very rested and feeling like I didn't really get deep sleep. I used to sleep deep and hard. Now i feel as a light sleeper. Waking to any sound. I wonder if I should take some OTC sleep aids. Something mild. And take it at 5 am which is my first true arousal. But idk. I'm scared

You really need to know more about what is causing your problem before you will really know which way to turn.

If you really have UARS, then the flow restrictions are keeping you from getting the amount of REM sleep that you need. Each time you start to go into REM sleep, your body relaxes and this can cause the airway to come close to closing off. Your brain detects the reduced flow of air and rouses you from the REM state to reestablish a clear airway. This is what makes UARS patients light sleepers. The normal treatment for this is cPAP at a pressure that will keep the airway from closing off. Unfortunately, the only way to know the pressure required to do this is a proper lab study looking for UARS. Normal titration sleep studies that look at apenas and hypopneas are not able to accomplish this.

Your information does not identify your xPAP machine, but I am going to assume it is a Devilbiss unit since you listed SmartLink. You might want to talk to your doctor and/or DME about adjusting the algorithm on your machine to optimize it for UARS. Devilbiss has a recommendation in their clinician manual to adjust the hypopnea parameter so that it becomes more sensitive to UARS like flow restrictions. If you are using it in APAP mode, it might allow the machine to do a better job of adjust the pressure for flow restrictions as opposed to true hypopneas.

As for the OTC sleep aid, if you have RLS/PLMs you will need to avoid any of the sleep aids that contain antihistamines (Bendryl is the most common). The sedating antihistamines are known to aggravate RLS. Some people are able to use melatonin, but this works more for getting you to sleep and not keeping you asleep at 5AM when you should be in deep sleep. Personally, I have to occasionally use a stronger prescription.

Did a DME actually rent you an M series CPAP machine? If so, RUN and find another DME.

Get a current model CPAP machine, either a Philips PRS1 Pro (not Plus), Auto or BiPAP, or a ResMed S9 Elite AutoSet (not Escape Auto), or VPAP machine.

A current model machine will record your actual breathing patterns. The correct model PRS1 machine will show you RERAs and flow limitations, and the S9 will show you flow limitation, both of which can be used to give you an idea whether you're having flow problems. The shape of the airflow waveforms and minute vent data may also help. It's not as good as a real UARS test, but it can give you some clues.

The trick is to get someone who will actually look at the data and analyze the results. Unfortunately, we're in the period of assembly line medicine and most doctors and DMEs only look at the compliance data needed to get paid by insurance. A good modern CPAP machine gives you the data for sort of a mini sleep test every night.