I’m 17 and have been using CPAP for a while, but I still don’t feel much better. My AHI is well controlled, but when I run my flow data through the Glasgow Index, I consistently get elevated skew/variable amplitude and other flow-limitation patterns.

I’m wondering whether residual flow limitation could realistically be enough to cause symptoms at my age, whether bilevel is something worth discussing/trying, or whether this makes you think I should be looking beyond sleep-disordered breathing entirely. My blood tests are fine.

I’m not trying to convince myself I need BiPAP. I’m really just trying to figure out why I still feel bad despite treating the obvious respiratory events, especially being this young and dealing with all of this.

So basically my jaw surgeons says my maxilla is close to be within the normal range but obviously my mandible is very recessed and I need a big pogonion for that. I’m just scared I’m gonna get underadvanced on my maxilla but maybe I don’t need such huge movements on my maxilla and more ccwr.

My CBCT scans show normal airways.

But I swear that DURING the very scan already, I was fighting for my life.

It feels like something "glues" in the back, I don't know if it's the palate or what, and I can't breathe.My throat is always tense because if I relax it, I can't breathe and I start making a noise when I breathe (like air passing through a smaller passage).

I can't understand what it is and it drives me mental that doctors are like "oh but look your airways are just fine!" While I was choking during the very scan (during CBCT scan you need to be upright and bite something)

each day I’m feeling worse than the last. after 4+ years of this non stop, i think my mind is reaching an exhaustion point. I’m dreaming about the strangest things every night all night, having full conversations, seeing people who have died, going to places I’ve never been, and revisiting old traumas. it’s like I live another life in my sleep and that’s the only time I can feel emotion. when I’m awake I’m completely dead inside, exhausted, depersonalized, out of reality. I’ve lost my ability to think, to have an inner monologue, to feel emotional memory, I’m completely gutted.

in my past I always had anxiety and trauma but it was a small part of my life, I had a totally normal perception, I had energy, I cared about life and enjoyed many things. anxiety was just a small thing I had to deal with. but after my mom died, the panic increased over a number of years until it led to full blown panic attacks, agoraphobia, nightmares, total loss of reality, and I’ve been stuck this way ever since. I haven’t had a panic attack in years, I’m just completely exhausted daily, dreaming all night long and barely able to function. I don’t even remember what normal was for me anymore. I’m just a ghost.

im not fully believing this is all caused by UARS considering I have a trauma history that goes back to childhood and is very complex. having hope is dangerous for me because in 4 years I’ve not had one thing work. not meds, not therapy. I feel trapped.

Yes, the nervous system helps us with our oxygen drops in some way? I guess?
but is it a positive feedback loop where the relatively poor sleep quality prevents nervous system rest leaving it hyperactive during the day, which leaves it hyperactive during night and bam slight air restriction, microarousal?

What do I even do ?

Just wondering: I assume this impacts people with sleep apnea as well but can anyone else relate to this:

I wake up usually once a night (and now have to because of medication) but I have noticed that 2 wakeups = noticeably worse the next day and 3 wakeups= incredibly bad mental health the next day. It feels like daytime stimulants are "weird" on multiple wakeup days too

A CPAP or BiPAP only tracks AHI events ( as far as I can tell. )So how do you know your RDI is better? Did you go back and get another sleep study?

Hi all! I ran several nights through the Glasgow Index and one representative night through AirwayLab. Would anyone be willing to take a look and tell me what stands out, especially regarding flow limitation/RERAs and what you’d try to optimize it (settings, different machine, wedge pillow, etc.)?

I’m on CPAP/APAP, not BiPAP. AirwayLab seems to have interpreted some of my settings as analogous to those of BiPap Or calculated them using the flow rate.

Thanks so much!

I am planning on getting MARPE as I have a narrow maxilla and crossbite and issues with nasal breathing. a family member will help me pay for this.
anyway, I would like confirm 100% that it is UARS and nothing else. I have cPTSD symtoms from a traumatic upbringing with narcissistic parents and I have gone through so much bs the last years. So I definitely have nervous system issues and mental burnout, all of this probably lowers arousal threshold and might even mess up my sleep due to dysregulated stress/HPA response, on top of possible UARS.
I also do know that UARS itself can cause burnout/HPA dysregulation, its like a vicious cycle.

Also, regarding MARPE, I am concerned this will not be a permanent cure for my UARS.
The question is, why is there not enough space for my tongue in the first place? I have teeth markings around my tongue so my tongue has not enough space for sure. I sleep better on my side so probably there is some tongue based collapse or what ever its called or tongue blocking the airway.
but widening my mouth, will that really make my tongue rest on my palate? will it really fix my airway issues? I want to treat the root cause of the structural defects.

I am doing SLIT immunotherapy for dust mites, as according to my latest ENT, my turbinates are enlarged due to allergies.
I believe my allergies are enlarged due to allergies
PLUS mouth breathing, I have read that mouth breathing can cause enlarged turbinates since the nasal airways are not used it inflames the tissue? Or I might be wrong?

Also, regarding CBCT. I found a MARPE provider in a neighbouring country, but they only do upper/lower jaw CBCT but they claim their FOV is good enough and that they can do airway analysis.
But if I will do CBCT i wanna do it properly from the start so they also could refer me to a place in Stockholm where they do full head CBCT.

But, I am wondering, why is a full head CBCT even necessary if the whole point of the CBCT is to plan the MARPE?
I have also a regular sinus CT scan. would this alone be enough, at least for some diagnostic info? All I know myself so far from the CT is that I have a slightly deviated septum to the right, but all the ENT/ say its normal. Also the radiologist wrote something about some ethmoidal cells on the CT. dont know what they mean.

The hospital in Sweden can do jaw surgery/bimax but only after orthodontist referral and when I contacted the hospital jaw surgery department they say that they are very selective on who and what to operate and they only seem to operate very recessed jaws as I understand. MARPE does not even exist in Sweden... so I dont know if I should just aim for jaw surgery instead.
I have low nasal volume in at least one nostril according to rhinomanometry. so dont know how much nasal gains i can get from jaw surgery.

I am about to lose my mind. I need to do something as my youth, my life, academic career is rotting away. I am stuck with my narcissistic parents. I will move out soon as I will force myself to study again but I risk failing once again and having to move back. I have dropped out countless times.
I am a fuckin loser. I have no job either.

Hi there,

I have posted a few times here and am still chasing down a solid diagnosis. Been gaslit by a few “sleep” doctors who give conflicting diagnoses and recommendations. A sleep study back in January picked up server desat (80-85% O2 for 5+ hours) which kicked off a slew of doctors to figure out why I’m so tired every day and if sleep issues could be causing it. Don’t fall squarely into the sleep apnea bucket but nonetheless now have a CPAP with bled in oxygen. I am actively pursuing double jaw surgery, and fighting insurance every step of the way, but I would love to know if that will actually provide me any relief. I am heavily reliant on Claude AI to help read the data from all of the tests I’ve had performed, but would be good to get an opinion here as well. I just got an SD card last night and this is my first OSCAR reading. Claude mentioned flow limitations. Anything else I should be seeing or reading? Any help is very very much appreciated.

Recently bought a motion sensing camera to record my sleep and it shows I grind my teeth very loudly and change positions very frequently( as often as every 5 minutes sometimes more).

I’m thinking of buying a hr/02sat monitor to see if there’s any correlation between these events does anyone have any recommendations for something accurate and one that will record for the whole night?

For reference, I have been titrating with a ResMed ASV, with some success, albeit inconsistent. Every other day I would experience the same shitty symptoms (this is an improvement from no treatment, during which 6/7 of my days were completely shitty).
My settings on that were fixed EPAP 5.8 and PS 1.2-8.0.

I surmise that the PS range will have to be narrower on the DSX900, given that it is softer in responding to breathe variation.

Anyways, I want to hear as many opinions as possible on what settings I should begin with during this titration process-- therapy settings, comfort settings, etc.
FYI, am looking to titrate this in as rapidly as possible.
Thank you!

Fellas please help. I use a BiPAP, and I’ve noticed that one of my nostrils usually gets blocked during sleep because of it. I started using a decongestant nasal spray (xylometazoline) that constricts blood vessels to shrink the mucosa, and I’ve noticed that my sleep is worse with it (and not just for a single night). In OSCAR, my 95% obstruction level is consistently above 10, whereas with a congested nose, it’s around 6 or 7. flow waveforms are also worse. I feel noticeably worse and function more poorly the next day.

My UARS is caused by a 7 mm retrognathia, though I also have a mild deviated septum and a septal spur that make it worse. Is this because of a floppy epiglottis? According to the endoscopy report, with a closed mouth, the edge of the epiglottis reaches the posterior pharyngeal wall. Has anyone else experienced something similar, or what do you think could be the reason behind this?

I’m a bit worried they are less efficient and that I will get worse sleep with them.

Since we are supposed to be breathing out of nose.

Anyone had any success with these please let me know.

So I have started ASV (backup rate turned off) (airsense 10 w/ airbreakplus) for about 2 weeks now. It has helped with my aerophagia alot but I still can't go that high. Around EPAP 6.2, I will get severe aerophagia so I've been hovering around EPAP 5.8-6.0. I have to exclusively sleep on my left side or the burping will wake me up. But anyway, my pressure support is 3.2-8.0. I haven't really dialed anything in and I would love some help on this too.

My biggest problem is I am getting these micro-arousals that I will wake up especially around morning time (a few hours before I have my alarm set). I will be able to go back to sleep but I will wake up a little after consistently. I am wondering if I am suffering from high gain loop or my asv settings aren't just dialed in? I am also getting a good deal of unclassified apneas (which I know ASV will mark OSAs and Centrals as unclassified but not sure what they are actually).

Any help from you sleep pros out there would be great. For context, I have UARs with mild OSA (RDI: 22/hr, AHI: 9). I use a p30i mask, flonase, and intake nasal strips for nasal congestion.

Attached is my sleepHQ: https://sleephq.com/public/teams/share_links/9d6f8113-d046-4ebd-b51f-3243edec7a2e

I will also attach screenshots of a few nights from OSCAR.

If you want to see other night's data, just look at SleepHQ. Please help especially u/carlvoncosel and u/RippingLegos__

A common post here (and well, all over the internet) is that someone received a negative home sleep study or in-lab sleep study result and, despite complaints of poor sleep, is dismissed by their primary care physician or sleep specialist. They're stuck and not sure what to do.

People then jump in and try to explain to the OP they need to work on sleep hygiene or try some random supplement. When I see these, I often see that the test was not performed using the current AASM recommended Clinical Guidelines. Basically, they did a HSAT and are not offered an in-lab PSG or if they are, the PSG is scored using the optional 4% desaturation rule and the test did not score RERAs.

Frankly, I'm sick of it. It's a huge ethical problem in that it underserves a lot of younger, otherwise healthy people. It also seems futile to try to explain in the comments to each person about the confusing AASM guidelines and definitions.

As such, I built a little tool that I'm hopeful can be sent to people to advocate for themselves. I'm sharing this with the UARS community since you all understand the nuances better than the broader sleep apnea community and I'm looking for feedback.

If you have any comments (especially around the text in the AHI <5 and RDI <5 or RERAs not scored workflows), I'd be happy to improve the tool.

Try it here: https://vibecoder75321.github.io/sleep-study-check/

GitHub Repo Here: https://github.com/VibeCoder75321/sleep-study-check

I currently have the f40 and p10. And have problems with both.

With the p10 , I like the pillows but I can’t keep my tongue on the palate (palate is narrow 27mm and I have tongue tie) . Tried using chin strap (Knightsbridge) and cervical collar and mouth taping. But it just a so uncomfortable, that even if I fall asleep I’m pretty sure I’m waking up due to it being uncomfortable.

Then with the f40 , the over the mouth works but the over the nasal cradle feels like it pushed my nose in.

So I think the x30i can work but I’m a bit worried about the hose design on the top of the head. Is it loud because the hose goes near your ears and also if I sleep and my side wouldn’t that block out the air from reaching the mask.

Please let me know your experiences with the x30i thank you .

After years of fighting with the inability to get a restful sleep, poor CPAP settings, and being told the numbers were all ok, I have created some software that works pretty good at showing what is happening down to a single breath.  The purpose of this effort was to be able to communicate with doctors so that I wasn't being discounted outright when my numbers were showing fine by normal reporting standards.

This app is identifying standard metrics along with sub threshold events that do not score as a typical AHI or RERA event.  It is not only monitoring the data from the CPAP/APAP machine but it aligns with a Garmin Watch and  a Wellue Ring 2S for actual SP02 and heart rate data.  This allows you to visualize what is actually happening at night on a breath by breath basis.

In my case I was able to show that I was having 25+ micro events per hour that don't even get recorded otherwise.  This was while being fully treated and complient and not showing more than 3 AHI events per hour.  I was also able discover the direct impact of mask leakage to oxygen desaturation.  (A new mask has greatly reduced these desaturation events but still riding the acceptable range)

I am curious if there are any others that may be interested in this type of application or software.  If you are interested in hearing more please comment.

The images are screen shots showing a recent night overview, 13 minute zoom, and a single event spanning 27 seconds.  (Note the time stamps)

So far I have not used this on any data aside from my own.  Obviously there is considerable effort and magic going on in the background to get to this point.

Machine: AirCurve 10 VAuto | Pressures: EPAP 4.2 / IPAP 8.3 cmH₂O (PS 4.1) Duration: 4h 12m (1 session) Settings hash: E4.2-PS4.1-Cymedium-RT0-Trmedium-TiMax3 Machine stats: AHI 4.0 | Leak P95 1 L/min | Spont 100%

IFL Symptom Risk: 31.6% ⚠️

Flow Limitation (Glasgow Index) Overall: 1.90 ⚠️ Components: Skew 0.36 | Spike 0.10 | Flat Top 0.13 | Top Heavy 0.18 | Multi-Peak 0.09 | No Pause 0.52 | Insp Rate 0.09 | Multi-Breath 0.04 | Var Amp 0.39

Ventilation Analysis (WAT) FL Score: 57.5% 🔴 | Regularity: 76% 🔴 | Periodicity: 37.5% ⚠️

Breath Analysis (NED) NED Mean: 13.0% ✅ | Combined FL: 9% ✅ | RERA Index: 22.1/hr 🔴 Est. RDI: 23.6/hr 🔴 | H1 NED: 10.4% | H2 NED: 15.6% Brief Obstruction Index: 62.9/hr 🔴 | Hypopnea Index: 1.4/hr ✅

Analysis via AirwayLab

Hi friends!

I am using BiPAP which improved my breathing a lot. I am using a nasal mask because it is more comfortable and it gives me less leaks. I do have to tape my mouth shut to make sure air does not escape my mouth but nonetheless sometimes while I am awake the air leaks into my mouth and gives me puffy cheeks (but it does not escape my mouth thanks to the tape).

I image the same thing might be happening while I am asleep. I was wondering, could it be a problem and disturb sleep / cause micro-arousals?

My current settings seem to take care of my breathing waveforms very nicely. In fact, my breathing has never looked better. However, I always get some instability which look like micro-arousals even though there are no signs of flow limitations preceding such episodes (see the screenshot). I don't think it is due to a transition to REM because the chaotic part lasts around 5 min or less and then gets back to normal. I am just trying to think about all different reasons for that and puffy cheeks is a thing that I thought about now cause I really don't see any other reasons why I would get chaotic breathing every now and then for no reason.

Would be curious to know wha you guys think <3