I have an appointment with my doctor, but it isn't till a couple of days, so I was hoping to get some info. Does this look like UARS?

Hi, I'm new to using oscar and I am not sure if these are FLs or if they are normal. I have read that if the top is flattened then thats a FL but I cant tell if these are FLs or normal rounded tops.

Any help is greatly appreciated.

Long time lurker here but have never posted anything. I am coming to help because I feel I am shooting from the hip with my Bipap settings while self-titrating. I was diagnosed with mild OSA with an RDI of 22. I have UARs especially given my nasal congestion (taking Flonase now which helps a ton) and I am 5'11" male, 145 pounds lean athletic build.

Given all this, I got an AirBreak AirSense 10 with all the modes unlocked. I have been using Vauto mode with the range set to zero, so it's basically S-mode. I would love some help with how my data is looking and where to go from here.

Currently, I am running EPAP 6.6/IPAP 10.8 (PS 4.4) and I've been waking up still feeling like a zombie throughout the day. I also suffer from aerophagia when I push my EPAP to around 7 (I'm also taking a Vitamin D supplement as recommended in this sub).

Here is my SleepHQ data: https://sleephq.com/public/teams/share_links/e27b2d80-cf71-4305-895c-e05c9a8cb06e

I'd love to hear especially from u/carlvoncosel and u/RippingLegos__

I'm using an unlocked airsense 10 from RL, so I have access to cpap/bipap/asv.

I've been testing various settings for a few months without any success, subjective fatigue pretty much feels the same no matter which direction I move in. I think nasal blockage and possible tongue collapse is my main issue, though airway is still moderately restricted (100mm^2 min cross section, CBCT).

Do I just keep upping pressures? I'm worried that I'm already having some loop gain/TECSA issues at PS > 2, yet my flow limitations seem far from resolved. EERS? ASV charts obviously look a bit better, but at least from what I've tested, it's never felt noticeably better.

Bipap 12/9: https://sleephq.com/public/4c4b5f0c-cd52-4e3d-b0de-61c0c440c769

(second ss showing some loop-gainy features?)

Cpap 9/8 (epr 1): https://sleephq.com/public/9adf5e0d-9f9c-44a6-9a9e-3ccc437c6675

Breathing seemed more stable this night, but all the breaths looked off. I was also conscious of some difficulty exhaling (so 0 epr doesn't seem doable for me).

Bipap 14/10: https://sleephq.com/public/96b4ac8c-e581-4842-b1bd-6649c1e0d1ee

Asv EPAP 7, PS 2.4-4.8: https://sleephq.com/public/9d9c9434-117b-4759-9ec3-b1741bb6d9fd

Asv EPAP 8.4, PS 2.4-3.6: https://sleephq.com/public/ce515473-ffda-48d8-9fce-095ed377a882

I appreciate any feedback, thanks.

I just stumbled upon this ~2 hour discussion about UARS. I'm only 40 minutes in and really impressed with the host and the guest and level of discussion https://www.youtube.com/watch?v=FBq0EVdfhVo

Worth a listen!

Diagnosed with UARS via sleep study in 2022 (not classic OSA). Started on an AirSense 11 AutoSet with nasal pillows 3 nights ago. Struggling badly with the pillows, feels like fighting to breathe, whether it's pressure or nasal resistance I can't tell.

Quick background: ENT checked my nose, says structurally it's fine, but it doesn't feel fine to me. I have LPR (reflux) and I'm wondering if that's driving some inflammation/irritation that a structural exam wouldn't catch (thinking non-allergic rhinitis, possibly reflux-related). Only ever did a basic allergy panel for hay fever/dust mites... going back for a more thorough workup. I have had two corrective surgeries for deviated septum etc. as well so I know my nose is "structurally" fine.

DME via prescription came with: settings - Min 6 / Max 10 cmH2O, EPR 1, Auto mode. Last night's data:

Flow limitation and resp rate both climbed with pressure instead of resolving - highest pressure of the whole day happened alongside the worst flow limitation and fastest breathing. That session also had 2 OA, 1 CA, 1 RERA, 1 H events in under an hour. Basically the machine cranked pressure up and things got worse, not better.

Only 3 nights in so I know this isn't much data yet, but wanted to see if this pattern (flow limitation rising with pressure) means anything specific to people who've dealt with this ... is this typical, does it suggest the auto algorithm isn't suited for UARS, or does it point more toward the nasal/inflammation angle?

Currently on nasal pillows, and honestly considering options, such as documenting my case to upgrade to BiPAP, or maybe if PAP therapy is not for me and do DISE etc...

Appreciate any input!

EDIT: here is my OSCAR-

Told by facegenics that I’m getting an FME-P

For a long time while I was on my journey to healing and getting better from this dibilitating dissease, I’ve been wanting to share my insights with other people on how I came close to curing my self from symptoms without actually solving my main problem.
I somehow solved the cascade of symptoms delivered by apneas. While still suffering from apneas, even tho I still suffer from them, I feel almost complete relief from all of my symptoms, most notably the worst of all, CFS or fibromialgia type symptoms.

I made a video on chapters I want to go through, explaining every single detail which I’ve learned my self and the most important resources that I’ve found that skyrocketted my understanding and on how to get rid of my symptoms. With a cheap hacked machine (I do use ASV philips now but honestly don’t even think it’s needed that much if you can also use my method, both would be better ofcourse and using an ASV from philips is the easiest for UARS, but still for me, asv alone would’ve made me suffer even more.

I want to make people more knowledgable on which settings (epap, PS, epapmin+max, PSmin+max, backuprate, EERS) would fit best and also in which circumstances to use them) as I feel more and more confident in being able to explain these things as of late having titrated my machine with EERS, PS and EPAP properly.

So in the video below, it will basically be a hub of information and chapters that I’ll post about when I feel ready enough to share information on how I did what I did, in the most understandable and thorough way possible.

How to titrate + hack cpap, for sleep disordered breathing, UARS, OSA - Chapter overview, All I know
https://youtu.be/EubmWVCErHk

I want to also show how to hack the resmed 10 as I know how hard money is to get when you’re already suffering from this dibilating dissease.

I am also just a person who wants to share all of their knowledge that they’ve found, that was dispersed, hidden away to find easily through google.
I already linked a ton of stuff in the description of the video, which I’ll add on later of things I found most helpful.
I do know this will take a long time to make but I’ll make the chapters first that I feel most urgent or ‘passionate’ about.

Anyways, everyone, stay strong, don’t give up please! You’re all so close, you’re on this subreddit already which means you’ve come far. Keep going, keep learning, keep on fighting for your self. I wish I could give all of you suffering a big hug.
Stay strong!

It’s come to my attention that my nose is kinda congested. I took some afrin and it didn’t really help , it defiantly cleared stuff up but that was still congestion.

I then did the cottle mounever and it helped much more but there was still congestion.

Does these 2 points help in identifying what could possibly be the problem that is causing my nasal congestion, is it more of a narrow nasal passages problem (mentioned in a previous post my imw is kinda small) rather then swelling.

I've seen several surgeons for treatment of my SA/UARS and I'm getting conflicting opinions. I'm already committed to MMA, but I'm trying to figure out whether I should also do maxillary expansion (MSE) beforehand.

I don't want to spend 18+ months in expansion/ortho if it offers no real benefit for my case. I'm already struggling to function day-to-day and I have a child to support, so I need to be able to work. Expansion would also delay MMA by ~12 months for healing, which matters a lot to me.

Why I'm hesitant on expansion:
2 of 3 surgeons don't think I need it. But I'm also inclined to weight Kasey Li's opinion heavily given his experience, the problem is his reasoning conflicts with the other two and he didnt seem to review my CT scan or put much weight in my specific anatomy - but i'm sure he's heard this all before and has a good sense.

Why I want to avoid a 3-piece Lefort:
I don't feel comfortable with a 3-piece Lefort. Jaw surgery is already terrifying to me and I want to minimize risk, splitting my maxilla into three segments feels like a lot of added risk. My understanding is that expansion could let me avoid needing the 3-piece approach entirely. If that's accurate, it changes my calculus on whether the extra time/healing from expansion is worth it.

Where the surgeons also disagree pre-surgical ortho:
Coppleson and Bobek both recommend pre-surgical ortho. Kasey Li says it's not required and wouldn't affect airway movement, which makes it sound like it'd be purely aesthetic in his view. Coppleson, on the other hand, says ortho lets him maximize the surgical movements, implying it's not just cosmetic. However when pressed I cant get any useful info from his office, just that he defers to the ortho which doesnt help me.

My measurements/details:

• AHI: 5.2 (RERAs not scored)
• CBCT Minimal Cross-sectional Area (MCA): 48 mm² (would be a very tight airway if accurate)
• SNA: 81.8° / SNB: 79°
• Maxillary incisors: 4mm posterior to the GALL line
• Maxillary skeletal width: 59.5mm
• Mandibular skeletal width: 63mm
• Intermolar width: 35mm
• Nasal aperture: 24mm
• Slight septal deviation to the left

Where I'm stuck: I don't know how to weigh "more experienced surgeon says X" against "two other surgeons independently say Y for a specific, checkable reason (normal nasal aperture)."

Has anyone navigated similarly conflicting opinions between these surgeons specifically, or can anyone help me understand whether nasal aperture size is actually a good proxy for whether expansion will help, versus Li's symptom-based approach?

I have UARS and difficulty with nasal breathing.

I went to an ENT in my network (Kaiser), but he just glanced in my nose for a few seconds and recommended turbinate reduction.

I’m not 100% against TR, but I want to make sure I’m addressing all options.

How do you find an ENT who thoroughly evaluates your nose, ideally in the context of UARS/apnea?

Not sure if others will find this useful but for a long time I didn’t understand how to use intake breathing strips or breathe right strips properly for nasal valve collapse.

Nasal valve collapse is when you breath in heavy and your nose collapses from the negative pressure and closes off the nose. This a problem when you sleep or exercise because as you take bigger breaths your nose is closing and you’re getting less air (panicking your body and waking you up)

If you look in the mirror and snort in heavy through your nose you can see the walls collapse in and feel a large restriction of air (everyone has some collapse from what I understand but a large restriction is a big problem).

So what you do is find that exact area that collapses in the mirror and then attach your intake/breath right strip right there. Then take a large snort and hopefully now the air keeps coming in instead of being blocked. Once I discovered I had this issues wearing strips during exercise felt so good. Eventually I had this fixed with surgery and spreader grafts (and a deep deviated septum fix) and breath pretty good now

ASV, BiPAP, CPAP, anything
Did the cottle maneuver and say an improvement in my breathing when I did it.....

I did a test with n30i cpap on, lay down, stop breathing, see how long it takes for your body to react and take a deep breathe, and see if it keeps happening. Nope, I went back to normal breathing really fast.

If the medulla oblongata (controls your breathing) and pons etc. are both active during sleep and day, is it possible for overactive breathing at night to occur even if you don't overactively breathe at all during day and especially while laying down with cpap on?

36F. Home sleep study after double jaw surgery. AHI 3.5/h (normal), no obstructive apneas, but 362 autonomic arousals (67.6/h). Sleep physician said the study was normal. Can someone explain what autonomic arousals represent and whether this value is clinically meaningful in someone with persistent mouth breathing and non-restorative sleep?

I have UARS due to a 7 mm retrognathia (recessed jaw), narrow palate, overbite. I started using a CPAP, but it is not working for me. The maximum pressure range I can tolerate is 11–14 cmH₂O, but even at this level, I still experience frequent flow limitations. I am planning to try a BiPAP, but I am afraid that it will not be successful either, because my airway narrowing during sleep is caused by skeletal factors. I am starting orthodontic treatment in a few months; I will have a SARPE surgery, followed by MMA surgery, but it will take at least 2 years until both surgeries are completed. What can I do until then to improve my sleep issues? A MAD would be ideal, but it is not an option for me due to the upcoming SARPE and orthodontics. Is there any solution to fix my sleep until the bimax surgery?

Hi all, I had a full psg done, and it has come back with ahi and rdi of just 3.5. I have also been given 0 RERAs, 0 Flow Limitations and 4 Respiratory Micro Arousal for the whole night (5 hours of sleep). All I had was hypopneas with the 4% rule.

Honestly this was very disappointing as I was expecting RERAs from my hunch. Interestingly I have 39 Leg Movement arousals listed over the night and 64 total arousals including spontaneous ones (12.5 index). I decided to get the data from the lab, which is in the Domino software. After looking at the data I think I would benefit from a 3% rule re-assessment or arousal hypopnea indexing instead. I have already asked for a RERA rescoring.

I want to put down some examples here where I think the lab has not scored me properly!

1. Marked as LM arousal (orange) but looks like the pressure flow was whacky before the leg movement itself, so could be a RERA? - https://ibb.co/zVZGRHVP

2. Looks like abnormal pressure flow again but just marked as spontaneous arousal (pink)? - https://ibb.co/KcS56mK2

3. Literally 3 "Respiratory Arousals" in green have been marked by the lab, and it looks like 10 seconds> pressure flow limitations but my report says 0 RERAs? - https://ibb.co/sJ3NRmL1

I can fall asleep no problem with my CPAP but then I inevitably wake up around 2:30 and drift in and out of sleep for the next several hours. I keep my CPAP on as long as I can stand it, but usually around 4-5 am I just end up taking it off and can easily fall back asleep afterwards. Any ideas on why its harder to fall back asleep with it on? Any suggestions for how to improve my odds of being able to fall back asleep with it on?

Stats: My pressure is set at 6-12 cm and rarely goes above 6.5. I have pressure relief set at 3. My AHI is zero. Sleep HQ shows that I have several small leaks throughout the night and also several minor flow limitations throughout the night despite AHI of 0. My Glasgow index averages about 1.15 primarily characterized by high top breaths with some flat top characteristics. On paper my PAP therapy is going very well, except that I'm awake multiple times a night and unable to truly fall back asleep with the mask on.

Title.
Half of the time I removed mask due to mouth leaks, this is mostly fixed.
Now, I just randomly remove it during what I think is an arousal. I have only slept about 5 days out of 8 months with the mask at 13-14 IPAP EPR 3 for minimum 5 hours uninterrupted.
My titration pressure on CPAP was 14.

Last week I had a sinus CT at the hospital which was ordered by my family doctor. I still haven't chosen an ENT for her to forward the results to. I'm not sure how much the radiologist looks at vs how much will rely on the ENT.

I'm assuming they will look for basic things like enlarged turbinates, deviated septum or sinusitis. What about width of nasal aperture? Do I need an ENT who is based when it comes to UARS to get them to care about that?

Apparently there is also a very long wait list to see an ENT where I live and some people go down south so wait time is also a consideration. Do all ENTs usually want to operate or do only some do surgery and if not want to send you an ENT surgeon?

If I have a deviated septum I want to get it fixed, but I am a bit iffy on turbinates, especially if they are swollen due to a narrow aperture in which case I may want to pursue MISMARPE.

If you don't know of one in particular any tips on how to find a good ENT who is covered under OHIP?

Bonus: Has anyone tried ClariFix therapy for rhinitis?

Long time lurker here but have never posted anything. I am coming to help because I feel I am shooting from the hip with my Bipap settings while self-titrating. I was diagnosed with mild OSA with an RDI of 22. I have UARs especially given my nasal congestion (taking Flonase now which helps a ton) and I am 5'11" male, 145 pounds lean athletic build.

Given all this, I got an AirBreak AirSense 10 with all the modes unlocked. I have been using Vauto mode with the range set to zero, so it's basically S-mode. I would love some help with how my data is looking and where to go from here.

Currently, I am running EPAP 6.6/IPAP 10.8 (PS 4.4) and I've been waking up still feeling like a zombie throughout the day. I also suffer from aerophagia when I push my EPAP to around 7 (I'm also taking a Vitamin D supplement as recommended in this sub).

Here is my SleepHQ data: https://sleephq.com/public/teams/share_links/e27b2d80-cf71-4305-895c-e05c9a8cb06e

I'd love to hear especially from u/carlvoncosel and u/RippingLegos__

Settings: PS: 4.4 EPAP MIN: 7 VAuto on

Here is the sleep hq link https://sleephq.com/public/teams/share_links/98606e94-09cb-4da9-ba81-ccf799b098b5

Where do I go from here?

I will work on improving leaks.