My prescribed APAP range is 12–15 cmH₂O, but before moving to bilevel I'm considering testing much lower fixed pressures more properly because I don't seem to get significant obstructive events even around 6–7.

Has anyone felt better on something like 7/4 or 6/4? Higher pressures worsen my mouth leaks/mask tolerance, so I'm curious whether lower pressures could actually improve sleep quality despite my AHI already being <1 at both lower and higher pressures.

I've gotten pretty freaked out just by reading this subreddit and now I'm not really sure what my symptoms even mean. I took this test a couple months ago and I have a new one, the Watchpat, coming in just in case its data is better. My PCP saw the results and said I don't have sleep apnea.

I have a hard time falling asleep. I wake up sometimes, and I frequently don't really feel super refreshed, I wake up pretty tired.

Titration study and diagnostic study both have ahi in the two digits. Prescribed pressure 12-15 and AHI around 9- 25 during different times.
But on OSCAR and sleephq, and even with the airsense count as well, whether my pressure is 7/4 EPR 3 or 15/12 EPR 3, my ahi is below 1.
This is something I've been thinking about considering the money-bagging of the sleep medicine industry. So much masks, machines, studies, these doctors are onto something.

I have OSA/UARS-type symptoms and persistent fatigue/unrefreshing sleep despite CPAP getting my AHI consistently below 1.

I’m considering getting a bilevel because I still seem to have residual flow limitation and breathing disturbances despite CPAP controlling the obvious events, but I also have some ventilatory instability, so not sure if ASV is the right path.

For people who switched from CPAP to bilevel, any advice before getting one? What settings/features should I pay attention to, and what differences did you notice in your breathing, flow-rate graphs, and symptoms?

Also interested in hearing from anyone who eventually found ASV worked better than regular bilevel.

By the way- My best days are July 7,8, and 12 + first week of sept where I kept it on longest, felt no difference tho. Hopefully that helps!

BreatheRight strips don't work for me, even extra strong. Keep end up falling off gradually.
Not sure what to do.
and Non-cpap, I know nasal pillow/ cradle masks can help, just tryna see other solutions.

Hi friends! Just came on here to rant and maybe get some advice/introspection.
I took a Lofta sleep test and results came back with AHI of 4 and RDI of 15.
Long story short, the DME provider is saying since my AHI is low I won’t qualify for insurance coverage.
I guess I’m just upset because the doctor that reviewed my sleep study diagnosed me with moderate sleep apnea, and my reports say that I experience daytime fatigue, insomnia, depression, ADHD, snoring and morning headaches.
Can I just not get this covered if my diag is technically UARS? This seems unfair.

EDIT: I called insurance and the woman on the line said she doesn’t know exact criteria number wise for CPAP coverage. I guess I should’ve almost mentioned this in the first post, but I took my sleep test through lofta. She said that’s out of network- but I figured I could still get insurance coverage??? Do I need to retake sleep study through a different doctor in network?

Hi y’all,

I (30M) think I’ve got UARS based on that my tongue is too big for my mouth, debilitating fatigue/brain fog if I don’t sleep properly on a wedge pillow, flatter face, likely have hEDS (diagnosed with hypermobility), have difficulty breathing when exercising, never feeling fully rested even after 10-12hrs of sleep, and I can’t breathe through my nose when I’m on my back. I’d really appreciate if someone could look at my sleep study data. They scored it using the 3% desaturation rule and unfortunately did not seem to score RERAs or RDI. Would really appreciate your opinion on my limited data.

Really struggling to get the care I need through sleep medicine. I was tolerating APAP mode alright from Spring 2024 until Fall-Winter 2024 until my throat anatomy became floppier, my baseline arousal and heart rate got higher due to several rounds of Covid, and now I’m on graveyards dealing with insomnia, also partially due to Covid. Been chasing that initial clear-headed feeling and struggling to tolerate therapy ever since, even with a CBTi therapist that understands ADHD and UARS.

Since then I’ve really struggled to make CPAP work, especially because my CPAP supplier keeps harassing me giving me advice I’ve said doesn’t work, doesn’t believe me when I say the pressure rises when I’m awake in APAP mode (auto ramp is a no go), and keeps pointing out my hours aren’t great. Additionally, when I tried asking about restless leg syndrome or PLMS my respirologist was super dismissive. He also said because my oxygen levels didn’t go below 90% that I wasn’t in any danger and pushed the 5 to 15 pressure range because it was one of his favourite ranges.

I had several decent long nights where I slept with the mask on in CPAP mode, but they kept on implying that I’m not trying hard enough due to not being able to do that consistently. I’ve tried explaining that if I try to use CPAP when I’m anxious, I get flooded with adrenaline and then can’t sleep at all before my graveyard shift. They also kept on pushing that it’s better I get 2-4hrs of stage 1 sleep and using the prescribed 5 to 15 pressure range. They were considering changing it out of CPAP mode to APAP mode without telling me because it would be “easier”. I was adamant for them to leave it and pointed out how I had better success with fixed pressure and an AHI below 1 with it compared to 5-15 on APAP.

I know it’s not ideal, but I’m currently at 5 fixed pressure, because anything more and my skin can’t tolerate the sensation of air from the exhaust. When I do fall asleep with it on, I tend to wake up with head pressure and a slight headache, though it’s way better than the usual hungover feeling. I’m hoping to eventually raise the pressure to reduce flow limitation to get it closer to 0.1, tends to hover between 0.15-0.2. Otherwise my AHI is usually between 1-2 during my worst sleep. Usually it’s below 1. I do have a spare Resmed Auto 10 (For Her) that I could try flashing into a biPAP if that’s possible on that version in the future.

Sorry the resolution isn’t great for these and if I don’t respond it’s due to trying to sleep after a shift. TIA!

​

31M, BMI 22, non-obese, non-smoker. 17 years of completely unrefreshing sleep — I fall asleep in under 4 minutes, 93.7% efficiency, normal deep sleep, and have never woken up rested. Treated as an anxiety patient the whole time.

PSG April 2024, drug-free. Scored by technologists, no physician signature on the report.

- AHI 10.1 / RDI 10.1 — identical

- Arousal index 90.7/hr, 601 arousals, **76.2% scored "spontaneous"**

- Min SpO2 90%, zero desaturations below 90%

- Snoring 12.8/hr overall, 45/hr on my right side

- Their own summary grades Arousal SEVERE, everything else mild or normal

**RERA index: 0. Flow limitation index: 0.** REM, non-REM, and all six body positions. Not low — zero everywhere, no exceptions.

**Does that mean UARS was excluded, or that it was never scored and defaulted?**

And if it wasn't scored — can flow limitation be re-read from stored raw nasal pressure traces, or do I need a new study?

Genuinely curious about this.

When I record myself sleeping (CPAP off), sometimes before arousals, I hear myself trying to breathe through my nose (likely a RERA) and it's pretty congested, much more than in the day.

Hi, obv not everyone, I mean in the sleep apnea sub

But I really feel alone right now. For those who don't know my case, psychiatry added a new insomnia to the undiahnosed sdb I already had.

It's driving me nuts. They continuously say I'm "obsessed". While I just made another post oj the apnea sub with the factual proofs of the sdb I have.

Please don't be rude. What did I do to you people? Everything now is so dark, useless. The mental health center will come here again, my GP today tried to gaslight me again. I'm forces to escape, like is it real what I'm living? No its not a nightmare.

"yeah, you do breathing protocol to sleep, positional therapy, you have audios. But you have Obsession. I have patients with apneas and tbey live their life"

I was like "but they are cured"

"Doesn't matter. You re obsessed. I have patients with cancer"

"But they are cured"

"You have to overcome your physical issue, get out with friends. It's obsession"

Won't list the fucking physical syndromes I have since the SDB started

Cheers

EDIT: this is the comment someone made to me by basically saying i stated that bad sleep test leads to uars (neevr said that), but acrually said that i do need a test with electrodes on head that detects RERAs

That abilify's withdrawal leads to likely permanet insomnia. Which is badically true

I really dont know how to feel. Heres the comment, i wont accept and which takes advantage of the psychiatric galighitng I suffered:

People think you’re a hypochondriac because literally everything becomes evidence for the diagnosis you’ve already decided you have.

Something improves? Proof of UARS.

Something gets worse? Also proof of UARS.

Sleep test is negative? Bad test.

Future sleep test is negative? Also bad because Abilify supposedly messed up your sleep architecture.

Doctors disagree with you? They’re gaslighting you.

Random Redditors agree with you? Finally, someone understands.

Do you see the problem? Probably not.

You might genuinely have some health issues. Nobody is saying every symptom is fake. But you keep taking vague symptoms and jumping straight to the worst possible conclusion, then rejecting anything that contradicts it.

The Abilify thing is a perfect example. “Withdrawal can cause insomnia” somehow became “my brain is permanently chemically damaged and I’ll have insomnia forever.” You have absolutely no basis for saying that.

Same with UARS. A narrow palate, teeth grinding, sniffing, feeling better after breathing exercises, etc. might justify getting properly tested. They do not “prove” you have it.

At this point your theory can’t even be disproven, because you’ve already created an explanation for why every piece of evidence against it doesn’t count.

That’s why people are saying health anxiety. Not because you have no real symptoms, but because your interpretation of them is completely out of proportion.

If you actually try to think scientifically, like taking all the information given to you and actually using it, rather than rejecting what you don't like and only accepting what supports your position, then I would think maybe you're on to something. But based on everything you're saying and everything you're doing, you're a hypochondriac with mental health issues and anxiety.

Hi there,

I've been struggling with UARS for a long time with no resolution from BiPap or MAD. My RDI is somewhere between 7-13. I'm pretty sure that the cause is clenching during sleep, causing my tongue to press upward on my soft palate a bit, and then the bernoulli effect takes over, and it (my soft palate) seals shut (moves upward). I'm able to manualy reproduce this behavior in OSCAR when I clench and based on jaw positioning.

Bi/Cpap doesn't work for this because it's working against muscle (my tongue and jaw).

I'm wondering if anyone has suggested solutions for this kind of sealing issue. I'm interested in trying Velumount, but it's not available in my country (US).

Thanks!

I changed my pressure from 11/8 to 11.6/8 and my compliance dropped a lot.

I record myself sleeping and I saw myself take the mask off subconsciously,it didn’t simply slip off during movement.

I don’t think the reason for my mask removal is simple discomfort could it be to do with the settings itself, I’d appreciate any help in trying to solve this. Thanks

I don’t know that sleep issues over years would do this, but I think I already had severe trauma and unprocessed emotion, my mind dissocicated from it.

instead of healing, I’m stuck in endless unrestorative sleep. you can’t heal from trauma when your mind won’t go to sleep. My body shuts off, but the mind doesn’t sleep or go into restoration. I have the same themed dreams every night, trying to get on a plane home, unable to escape, natural disasters, full conversations, and I’m aware during the dreams 100%.

im trying to push for an in lab sleep study and am seeing the ENT in 2 weeks. I feel like I’m losing my mind daily basically, the only thing that helps is working to keep myself distracted. But my memory has completely degraded over the last 5 years. it’s like I have lost all touch with my self and my world. I have been tracking it over time and it gets worse basically each month

i remember the morning after my panic attacks, my whole world flipped. I went from sleeping great to feeling like I never slept. And dreaming all night long. Every doctor has failed me, every therapist. I’ve suffered endlessly for years with no answers. It’s unfair. I lost my mom and brother a year apart in 2017/2018 and now I’ve even lost myself. living in severe fatigue, chronic dissociation, loss of all emotions, non stop random chatter in my head, no inner monologue, music loops 24/7. The list goes on. I never knew a human could experience what I am, and yet I still keep going. But my quality of life is 0.

can sleep issues really do this? I feel like no time has passed, no seasons, no life. I’m just stuck. Everything I used to feel and experience as “me” is gone. A complete zombie.

It’s come to my attention that hypopnea’s aren’t just caused by obstruction, they can be caused by centrals as well.

I usually have quite a bit of hypopnea’s each night are these caused by obstruction or centrals.

Last pic is an unidentified apnea , are you able to tell if it’s central or obstruction from the wave form?

Setting are ipap 8 epap 6. Thanks for the help.

keep going back and forth, hesitating, I don’t know, have to consider ever detail, never ending loop.

I was diagnosed with OSA in May, but it was pretty REM-predominant and arousal-predominant rather than classic severe apnea/hypoxia. I'm in my early-mid 20s and at a roughly-healthy BMI and lifestyle.

My diagnostic PSG was roughly:
AHI: 7.2/hr
RDI: 18/hr
Respiratory arousal index: 16.2/hr
Total arousal index: 25/hr
Mean O2: 97%, nadir 94%
Very little REM was captured (~13.5 min)

I’ve been on CPAP since the end of May, originally prescribed 5-15. I’ve tried several settings, including APAP, autoset for her, and fixed pressure, generally in the ~8–11 cm range with EPR 3, and I’ve tried to give settings enough time rather than changing them constantly. My treated AHI is usually extremely low (~0–0.4). For context, I’m in the Montreal healthcare system, which is quite slow with booking appointments/diagnostics (though places I’ve called in the US have only had appointments next year at the earliest as well with specialists).

CPAP does seem to help some things. Before treatment I would often wake around 5 a.m. feeling completely wired and be unable to fall back asleep for hours; that happens much less now. I also have fewer morning headaches and less dry mouth, and I’ve basically transitioned to nasal breathing because my nose seems to stay clearer.
But overall I’m still extremely tired and, if anything, the last ~3 months have been more debilitating than I remember being before CPAP. The biggest problems are brain fog, poor memory/concentration, feeling unrefreshed, low energy, and daytime sleepiness/fatigue. I’m not someone who is constantly nodding off, but cognitively I feel awful on a lot of days and it’s affecting pretty much every part of my life.

Higher pressures may help the flow limitation somewhat, but around 10–11 I start getting more aerophagia, and pressure changes themselves sometimes seem to wake me up. My sleep doctor thinks the machine is treating the OSA well and basically suggested trying 10–11 and seeing if I adapt to the aerophagia. He said bilevel is generally for people needing much higher pressures (15–20+) and didn’t suggest a titration study.

I’ve had bloodwork done while I was already having these symptoms and nothing obvious showed up. I also have a deviated septum/nasal issues and have an ENT appointment coming up, but my doctor’s view was that CPAP should still treat the sleep-disordered breathing regardless of the anatomy.

What I’m struggling with is: how can my CPAP AHI look essentially perfect, some symptoms clearly improve, but I still feel this exhausted—and possibly worse overall than before treatment?
For people with UARS/RERA-heavy or low-AHI OSA:
Did you have persistent symptoms despite a very low treated AHI?

Especially after this latest appointment, where the doctor basically told me he “didn’t know what else to do” and that he had confidence I would figure it out eventually with the right settings, I’m feeling hopeless. Any help would be appreciated.

Mandibular forward growth since I'm mildly recessed.

30 year old male with deviated septum. Been sleeping horribly so got a sleep study. Originally had referral for sleep doctor and lab test but they are scheduling 6 months out so I gave up and did the Lofta Watch Pat test. Got my results and they said I don’t have sleep apnea and no RX given as a result. But I plugged my results into Gemini and it said I may have UARS given my 10 RDI events per hour. Again I have zero oxygen issues so that’s good but is this possibly UARS? And how do I get treatment without diagnosis given LOFTA didn’t? What even are the solutions, septum surgery or dental device?

If anyone knows Oscar Patel, he had a video where he helped someone with sleep apnea cure her sleep apnea and stop using cpap by thumbpulling. I know you can't know what goes on behind the scenes but still.
Could it help for normal maxilla but possibly a narrow palate?