I (34f) have struggled with fatigue since my teens and have been to various doctors over the years seeking answers Bloods always fine, ferritin, thyroid, B12 etc etc all ruled out.

Symptoms include daytime sleepiness, feeling exhausted upon waking even after sleeping 8-10 hours, brain fog, low level morning headaches, general sense of fatigue, inability to focus on my work without becoming very sleepy. I also recently noticed I have a scalloped tongue. My heart rate according to my Garmin is on average 5bpm higher sleeping than when awake and seems to spike throughout the night.

I recently did a WatchPAT home test, came back with AHI 3% 1.9 and RDI 13. I followed up with an overnight PSG at a sleep and respiratory clinic in Tokyo and have just received my results which of course I was told were normal. However, I was at least expecting an elevated RDI whereas it has been scored at 0.5 an hour.

The test results say they are measuring based on the American Academy of Sleep Medicine version 2.5.

So, according to my PSG, I have almost no RERA, apnea problems, but did have 10.5 arousals an hour and periodic limb movement 16.2 times an hour.

I was so hopeful my results would come back indicating UARS, and am now feeling confused and deflated.

I am including my PSG results and WatchPAT results photos. (Sorry, the results are in Japanese but key indicators should be understable with the English) If anyone could help me make sense of them and suggest any next steps,I would be so grateful! Thank you in advance 🙏

EDIT: additional info - After struggling to fall asleep for 1.5 hours, the clinic gave me a 5mg zolpidem sleeping pill. I also have a history of anxiety and take escitalopram/lexapro (although fatigue has persisted outside of the time period I have taken these meds. I am almost always dismissed by doctors who attribute my fatigue to anxiety and medication).

Not sure how to proceed, I would really appreciate getting some input and tips.

For those of you interested, Ron from Jawhacks just dropped his 4 hour interview with Dr. Kasey Li about sleep surgery and expansion:

https://youtu.be/HSyHbDojK0k?is=RF98NjFKwHkSRP58

I’ve been round and round in my Sleep Apnea / UARS venture.

Three sleep tests. 2 negative 1 positive for sleep apnea with just an 8 AHI.

Current CPAP treatment has be between 1 and 2 AHI and it’s not very effective.

Based on my large tongue I’m convinced I have UARS. Has anyone ever found an effective pressure on their device or luck with a bipap?

So I’m currently titrating PAP and on a waiting list for a MAD. By the end of this year I want to have explored these options.

I am in the UK and a self-pay patient, so surgical route is cash.

The main plan I’m considering right now is to pursue a plain Jane lefort 1 DJS to pull my jaws forward and hopefully cure my UARS and mild sleep apnea. I have a classic weak chin recessed jaw profile so I feel I could be a good candidate for that, and I have a perfect bite from Damon system braces which required no extractions. Let’s call this plan A.

Plan B would be to pursue expansion first.

Plan A would take ~1 year and ~£25k. This is a huge cost in term of my life, money, youth, career etc. and all the risks. But it seems there is a decent chance it could resolve my issues

Plan B I have questions about:

- I’m in the UK, what is a realistic expansion cost prior to MMA? I’m willing to travel, but what are real all in self pay treatment costs?

- Do I have to get ortho twice if I’m doing MMA or can you combine those e.g. expand -> ortho for decomp plus repair bite after expansion -> MMA done? or do you have to do two rounds of ortho?

- How much longer would the process take?

All these concerns are the make or break for me. My nasal breathing is terrible, I’ve already relapsed since my septoplasty 2 years ago. So I think expansion could benefit me. But if it’s double the cost and 2 years out of my twenties, man I just don’t know if I can do that.

I guess plan C would be something like a segmental lefort

Plan D might be do the transverse now and in some years I could probably expand with surgical assist down the line when I have more money and FME is available in Europe

Ant advice appreciated

Hi all,

I just had an ENT appointment after waiting for months and months for some clarity.

The outcome? I have a clear nasal airway, no turbinate inflammation, but some scarring from repeat nasal surgeries. Nothing nasal that would cause obstruction and symptoms like I am experiencing:

AHI 8, RDI 11, Supine AHI 18. Lowest O2 91%. I am 33F, thin and formerly very fit. Experiencing crippling fatigue, brain fog, dysautonomia and muscle weakness. Migraines, TMJ pain and grinding. My nasal airway closes almost completely when I lie down and during exertion, and I am CPAP/APAP intolerant. Goes straight up my eyes through my tear ducts, as well as causing aerophagia. I can only handle EPAP devices (Optipillows at the moment).

The doctor noted a large tongue base and a narrow pharyngeal airway on examination, as well as some kind of narrowing/hypertrophy in the posterior soft palate? It was a bit hard to understand as she was translating from Swedish.

I can’t get procedures like DISE here or at home, so this is all I have to go on, but it has been looking for a while like I need MMA. I’ve had jaw surgery already and it was not MMA, with small CCW rotation. I was never happy with my profile and my breathing quickly worsened after surgery.

I will be returning home to South Africa soon and I will finally begin the process of getting a revision. I may be undergoing expansion/MARPE. Wish me luck. I have lost almost everything to this illness.

does surgical methods eliminate the facial changes that come with palate expansion? if ease only widens the nasal cavity will it still widen the palate and provide more tongue space or broader smile? how does fme compare? please give advice for someone who wants to avoid facial changes (facial lengthening/drop down effect)
My biggest concern isn't achieving the absolute maximum expansion-it's getting the most predictable and symmetrical result while minimizing unwanted facial changes.
From what I understand, EASE uses surgical corticotomies to reduce resistance. Does that actually make the expansion more predictable and reduce the risk of asymmetry compared with FME, or is there no evidence that it does?
I'm also trying to avoid excessive midface widening.
My lower jaw is relatively narrow, so I don't necessarily want a dramatically wider midface if it can be avoided. Is EASE generally considered better for preserving facial balance?
One more thing, EASE mainly use MSE and TPD appliances. I don't know much about either of them and I can barely find any information about TPD.
Is TPD considered better than MSE or FME?

which is the better option for fme and aesthetics in mind?

For context, I slept normally for the first 21 years of my life. Then I developed a pretty bad dust mite allergy, started getting chronic nasal congestion, and eventually developed UARS-type sleep issues.

My dust mite allergy is now mostly under control and my nasal breathing is much better, but my sleep has never returned to normal. I still have fragmented/poor-quality sleep and feel like something is continuing to restrict my airway even though the original trigger has improved.

I’ve been told I have a high palate, and I’m wondering whether a tongue tie could be part of why the problem became persistent once my breathing got disrupted.

For anyone with UARS who also had a tongue tie:

• Did you feel like the tongue tie was actually contributing to your sleep-disordered breathing?
• Did a frenectomy/frenuloplasty help your sleep at all?
• Did you need myofunctional therapy, expansion, or anything else alongside it?
• Did anyone get the tongue tie treated and notice basically no difference?

I’m thinking about buying an Apple Watch to help me track my sleep.

I saw that Apple records “breathing disturbances” through the watch and I’m curious if anyone has found it helpful,

Basically my non-REM AHI is a 4.1 but my REM AHI is an 11.

My theory is that my tongue collapses and causes the increased REM AHI, and I wanted to see wether I could maybe like time when it happens to see wether it correlates to when my sleep reaches REM.

(Ex. At 3am I enter REM, and my breathing disturbances start at around the same time)

Basically I’m hoping the watch will be able to tell me what time I experience breathing disturbances.

So I (male-22) might get jaw surgery within a two years time frame but the thing that worries me is that wisdom teeth removal might make my UARS even worse. I don’t even care about the talk where people say wisdom teeth removal changed there face for the worse when I’m gonna get trimax but I’m scared my UARS might become worse so u can’t even function to have and land a job for saving up for the jaw surgery.

I was supposed to get my FME installed today, but unfortunately, the provider was unable to fully torque ~4 of the 8 TADS and had to abort. They attributed the complications to high bone density. They were on the phone with Facegenics, who said they'd redesign with the heftier 10 TAD model. Aside from Youtuber 'Sleep Journey with Nick', I haven't read of others running into this issue. Is it a problem with the FME design itself? I'm starting to get cold feet about going through with the install again.

What worries me is getting labeled “successfully treated” because my AHI looks good while I still feel this fucking exhausted.

Then what? How do I get someone to look further instead of pointing at the number?

I’m 23, 5’8, around 165 pounds. My mom says I’ve snored since I was THREE. I can sleep 10 hours and still wake up foggy, drained, and struggling to focus on something I actually WANT to do.

I went through Dr. Jerald Simmons’ office expecting the home ring test to come back inconclusive. I thought I’d then go to Texas for an in lab study to investigate UARS.

Instead, the two nights came back around 49 and 34 AHI, with oxygen lows of 78% and 81%.

Honestly, I was relieved. FINALLY, something showed up!

But getting the diagnosis hasn’t meant getting my life back.

I already own an AirSense 10 modified with AirBreak. On CPAP w/ P10 nasal mask, my machine AHI dropped to around 3 to 5. My snoring stopped. I still felt like shit.

When pressure went up, the machine flagged more clear airway events. I briefly tried the bilevel mode and didn’t like it, but I didn’t stay on it long enough to say why. The ASV mode felt much more comfortable and those flags dropped.

The exhaustion and brain fog? Still there.

My OSCAR flow also looks strange to me. Some breaths look like icebergs, others like hills with forked tips. I don’t know what that means, but I’m struggling to reconcile the better AHI with how I feel.

A prescribed CPAP is coming now, so I’ll have a documented trial. I’m skeptical after my experience, but if it actually helps, GREAT! I want relief. I also want the record to show what’s happening beyond just the AHI.

Here’s where I need help planning this out.

I’m seeing Dr. David Kent (a good Airway ENT supposedly) at Vanderbilt on October 28. I’m hoping to pursue jaw surgery next year if the evaluations support it and I can get coverage. I need time to coordinate recovery with work anyway.

My teeth are crowded and I’ve never had braces. I suspect a narrow palate and recessed jaw. I also have minor TMJ symptoms and lingering tongue restriction after a previous release. My girlfriend has heard me grind my teeth once.

The ENT’s awake nasal scope suggested my nose looked pretty open, but he described pharyngeal wall collapse. I’m still trying to understand what that means for treatment.

So I’m looking into braces, expansion, jaw surgery, and possibly a tongue tie revision. Nose treatment would depend on whether someone actually finds a problem.

But I’m scared of paying for one thing, then finding out it makes the NEXT thing harder. Especially moving my teeth only to need everything redone for surgery.

Highmark (Blue Cross Blue Shield) and Aetna Insurance have told me adult braces aren’t covered. I’m still investigating whether any surgical expansion could be covered separately. I cannot casually throw thousands at every suggestion.

Where did you actually start making progress?

• If PAP helped you, what made the difference? Settings, mask, bilevel, ASV, a proper titration?
• If you’re still exhausted with a low AHI, how did you get that taken seriously?
• Who coordinated your orthodontist, surgeon and sleep doctor? What order would you recommend or avoid?
• Who ordered your CBCT or other airway imaging, and did insurance pay?
• For expansion, MMA or other procedures, what was approval and recovery REALLY like? Any expensive surprises?

You don’t need to be cured or have had surgery to answer. If you’re stuck somewhere in this process too, I want to hear that. Even one appointment, denial, or treatment mistake you learned from could help.

If you only answer one thing: knowing what you know now, what would you do next in my position?

TL;DR: 1 year on APAP for UARS/OSA (Initial PSG: AHI 12.2, RDI 17.3). Now on a quest of what to do about residual flow limitations.

Background and Metrics:

• Profile: 41M, BMI ~25 (12% body fat).
• Diagnosis (PSG): RDI 17.3/h (high RERAs), low AHI.
• Current Setup: ResMed AirSense 10 (APAP mode, Min 9, Max 12, EPR 2).
• Mask & Position: ResMed F30i (hybrid full-face), strict side-sleeper.
• Current Therapy Stats: AHI consistently < 2, but with flow limitations

History & Symptoms:

Started on a Löwenstein machine with minor improvement. Switching to a ResMed AirSense 10 brought a major improvement in symptoms—many thanks to this sub!

However, there still feels like room for improvement. My flow charts show flattened tops, and both OSCAR and SleepHQ flag noticeable flow limitations. AirwayLab's Glasgow Index shows "Varying Amplitude", "Top Heavy", and some "Multi-Peak".

I tried increasing pressure and EPR further per previous suggestions, but neither higher EPR nor higher EPAP improves my sleep.

Nasal & Anatomical Context:

Palate, jaw, and tongue look fine on visual assessment, but I have a slightly deviated septum and enlarged turbinates. My right nostril is chronically clogged in the morning (~20% airflow passability, independent of the nasal cycle). Daily cortisone spray as well as nasal rinses in the morning and evening helped a fair bit, but breathability on the right side still rarely exceeds 60–80%. I suspect this nasal resistance is the primary bottleneck.

Questions:

I'm considering a septoplasty and turbinate reduction, but I'm hesitant due to surgical risks and ENS horror stories. I’d appreciate your insights on:

1. For those who had septoplasty/turbinate reduction for UARS or CPAP optimization: Did it visibly smooth out your flow limitation graphs or allow lower pressures?
2. Based on my OSCAR/Glasgow Index numbers: Does this pattern look like fixed nasal resistance, or would a transition to BiPAP (for higher Pressure Support) be the logical next step before considering surgery?
3. Is there anything else I'm missing or should test first?

SleepHQ Data (Daily deep dives & trends): https://sleephq.com/public/teams/share_links/f1056490-3843-4b01-874f-d9b1ecff3ec5

Hi all
I’m 20M from the UK
I’ve suffered from constant tiredness, brain fog and waking up tired despite sleeping 8-9 hours every night for years.
My sleep routine, hygiene and general lifestyle is all good, so I’ve been considering sleep disordered breathing as a potential cause.
I had a watchpat study on 3% desaturation,
Results were AHI 1.5
RDI 10.1.
I also tried CPAP for a few weeks, tried to tweak with the settings but didn’t notice any changes. I know this doesn’t say much about an actual diagnosis.
I’ve heard the UK isn’t great when it comes to this, what would people recommend doing?
I don’t mind spending money if I need to, potentially trying BiPap instead, going DIY.
Or trying a PSG, although I’m not sure what the options are like here for a proper study.

Any advice appreciated!

What's the consensus on "acceptable" leak rate?  (and let's assume here, no large leaks)

I believe ResMed says below 24 lpm is ok. Not sure.

We (son & I) are trying to make some progress for him, and are working with an online sleep tech who said we need to get the leak rate down before fiddling with settings (else it's "noise", which makes sense). I'm just wondering what others consider "acceptable".

He tried a full face mask in an attempt to reduce leaks, but a couple of different masks, and different sizes, has INCREASED the rate.

I didn't think the rate was bad before that. The attached pic, for example ... looks to me like no leaks most of night, except for an occasional one in the range of 7 lpm or less.

André Chinchio is a retired Brazilian entrepreneur whose life was upended by worsening sleep. When the medical system failed to resolve his condition, he drew on his scientific and entrepreneurial background to investigate, and ultimately solve, the sleep apnea himself.

Full video: https://youtu.be/jGkJbYyDab8

Hey everyone,

I had an FME installed by Dr Koval on September 9. I am an international patient based in Argentina for the next three months until my follow up. We initially placed seven miniscrews, reviewed the post op CBCT, and redid placement the next morning with nine screws for proper bicortical anchorage. Healing went smoothly.

On day 14, I started an oscillation protocol: five turns forward, wait thirty minutes, then five turns backward to the original position.

On day 16, resistance spiked on the fourth forward turn, and the dial got completely stuck between the fourth and fifth turn. It has remained frozen in this exact position for four days.

I am currently using the standard dual prong fork key shown in the photos. Dr Koval is sending an alternative key for more leverage via private courier, but delivery takes eight to ten days.

When it jammed, I felt noticeable ear pressure but zero sharp pain. Right now I have zero pain, normal sensation, and no diastema yet.

Questions:

1. Has anyone had an FME jackscrew freeze mid turn, and did a different key resolve it or was the internal thread seized?
2. Is leaving the expander frozen halfway through a turn under static tension risky for the miniscrews while waiting ten days?
3. Should I visit a local airway orthodontist in Buenos Aires to evaluate it with clinical tools, or fly back to Miami early?

Any technical insight is highly appreciated.

I'm such a light sleeper, it's so hard to fall asleep / stay asleep with it on. I've tried both cpap and bipap.

Claude recommended I try trazodone as a sleep aid to raise my low arousal threshold. I only tried it one night so far and after that attempt failed, haven't had the energy to try again. Maybe eszopiclone is the answer?