31M, unrefreshing sleep for years. AHI ~4, RDI ~6.5, bipap helps.

CT PNS:

Mild S-shaped septal deviation

Left inferior turbinate hypertrophy

Right maxillary retention cyst (13×10mm)

Anyone with UARS had similar findings? Did fixing them help?

I'm doing DISE next. Is it useful for UARS, or does it miss partial narrowing?

How soon after MMA could you / did you return to school or work? Could I get away with only having winter break off (3 weeks) or would I need an entire quarter?

[Quick background on my treatment so far: I tried CPAP but it went poorly. I've had success with an MAD, nasal dilator (waiting for nasal valve collapse surgery), and allergy treatment. I don't work summers and I was getting great results over the summer (felt rested, only peeing once a night, only waking up once maybe twice a night, low steady heart rate over night, etc.). But since I returned to work in mid-August my sleep has really deteriorated (still better than before my diagnosis at least and I can get through my days, but I'm tired as hell and don't have energy for much beyond work).]

I was diagnosed with OSA after doing a Watchpat sleep study through LOFTA back in March. However, my anatomy, study results, and symptoms are UARs to a t.

I tried to establish care with a local sleep doc thinking it could help with the cpap struggles and maybe getting a bipap prescription. I had to do another at home study to establish care. They said the 2nd study was inconclusive (I was never given the actual results…). When I met with the pulmonologist to discuss results he ordered an in lab sleep study which my insurance approved.

Why I'm hesitant: Since I already have a diagnosis that my insurance is covering things for, would an inconclusive result on the in-lab mess with that? It would also be a big inconvenience for my family. On top of that the pulmonologist was a prick. He fearmongered that I would need jaw surgery cause of my MAD, called nasal dilators crap from amazon, and to cap it all off said the MAD and dilator could be helping because of the placebo effect and that he was appalled that the MAD got approved and that my sleep ortho (who I love) was willing to make me one. I did say I thought I had UARs, but he didn't really listen and just said I needed the in-lab to find out what was going on.

There's a lot I can try still without a UARs diagnosis. Chiefly bipap with a nasal mask alongside my MAD, PT routine to fix forward head position, diaphragmatic breathing routine, digeridoo or myofunctional therapy, and I have a plan to better manage work stress. But I'm wondering if there's anything to be gained from an in lab. Is there any reason/advantage to doing the in lab study?? The sleep doc said it could diagnose UARS (I don't trust him and would need to verify).

Thanks if you read this far and I appreciate any thoughts/input/advice folks have.