UARS

[TooNew]

Thanks to Pugsy I do believe UARS is what I have. Based on some research of it, A) untreated it WILL turn into full blown OSA and B) I would probably already have full blown OSA if I was overweight.

Now for decisions - do I put off CPAP until it becomes OSA? Just start taking OTC sleep aids? I know the doctor won't prescribe anything good

Do I "attempt" CPAP and hope it staves off full blown OSA? Will it stop the progression?

I will be scheduling an EKG and an appointment with an ENT to see if there is anything out of whack.

Can I still be part of this "in" crowd even though I'm not officially diagnosed with OSA? LOL

Any comments or suggestions are welcome.

Thanks,

[Pugsy]

Can I still be part of this "in" crowd even though I'm not officially diagnosed with OSA? LOL

Of course.

This is a cpap help forum....not an OSA forum. You don't even have to use a cpap I suppose but it's nice when we can all talk about the same stuff and we understand from first hand experience.

I will share this. If you do decide to try the cpap you will have to go to the store and find a big box of patience and buy several.
The data from the machines may not be able to aid you all that much in finding the right pressures to help because you will have to go more on how you feel and it's not usually a quick fix. I won't sugar coat it. The feeling good part with the good numbers is elusive for a lot of people (and I am willing to bet you drew that unlucky short straw too) and you are starting off with "good" numbers as it is except for the arousals.

Damn doctors...they never want to give us the good drugs.

[jnk...]

First of all, you are more than welcome to be here. Some docs consider UARS to be a form of OSA; others consider it to be, in some aspects, the polar opposite of OSA. But as patients at cpaptalk.com, we consider you welcome here either way. Some here do not use PAP at all. A few have no diagnosis whatsoever related to sleep-breathing problems but learn from broad sleep-related subjects discussed here.

My understanding (as a nonprofessional) is that UARS as a designation is fully embraced by some researchers and clinicians but is resisted by others. It is more of a description than a diagnosis, since insurance people have a hard time digesting its significance.

From my point of view, which has been influenced by a few clinicians I have interacted with who take a unique position, the question is not "what do I have" so much as "what will help." PAP helps many with sleep-breathing problems who do not fit the standard diagnosis of OSA. Whether or not UARS always progresses to OSA is not a primary issue either, since UARS can be just as disruptive to good sleep as OSA, and fixing sleep is the goal no matter what is happening technically.

Remember that strict medical definitions are more useful to insurance payers than to patients. Skillful application of PAP is worth the full shot to see if that helps how you feel in the mornings, but an overly sensitive airway that wakes you up or disturbs your sleep on other levels is often accompanied by an overly sensitive body in general that will have to be babied a bit. Little things like the nature of your sheets, the temperature of the room, how noisy your location is at night, and what other medical conditions affect your sleep may all need to be given full consideration as you find the absolutely perfect mask and PAP approach for YOU. These things matter less to many of us with full-blown moderate-to-severe OSA, since our problem is often more a lack of sensitivity than being overly sensitive.

If I were facing UARS-type issues, I can think of nowhere better to learn about sleep than right here and could think of nobody better than Pugsy to help me experiment with possible solutions. As for doctors, I would suggest working with one who has experience being successful helping people with UARS-type issues. It takes a sort of patience that many docs lack when they don't enjoy the challenge of it.

As for further education, Dr. Park and Dr. Krakow both have helpful things to say based on actual treatment of patients. I consider them cutting-edge as clinicians, but personally I tend to temper their observations with a good dose of reading the theories of lab researchers too, since the anecdotal can cloud the opinions of even the very best of clinicians.

Just my opinion as a fellow patient.

I wish you all the best with this. I hope you find total success and stick around to help others do the same. Judging by your attitude in your post, I would consider that a likely outcome.

[TooNew]

I will share this. If you do decide to try the cpap you will have to go to the store and find a big box of patience and buy several.

I can't afford enough boxes...

[/quote] Damn doctors...they never want to give us the good drugs.[/quote]

I know, it's quite frustrating.

I just noticed you were in the same state as myself - east, west or central? I would have my location in my profile - if I could get approved so I could create a profile...

First of all, you are more than welcome to be here.
I wish you all the best with this. I hope you find total success and stick around to help others do the same. Judging by your attitude in your post, I would consider that a likely outcome.

Thanks, I'm sure this community will be helpful no matter what my issues end up being...

[jnk...]

. . . in the same state as myself . . .

Speaking of patience . . .

"There's no need to worry
I ain't in no hurry
Missouri loves company"

https://www.youtube.com/watch?v=-W0nR4MwoK8



Hadn't thought of Ringo in a long time.

[Pugsy]

I am down in the SW corner area. About half way between Springfield and Joplin. Live out in the country and on a clear night I can hear I 44 traffic which is about 3 or 4 miles south of me. Where are you ?

[TooNew]

I am down in the SW corner area. About half way between Springfield and Joplin. Live out in the country and on a clear night I can hear I 44 traffic which is about 3 or 4 miles south of me. Where are you ?

37 miles north of the capitol. Not in the country unfortunately - not yet anyway. Will be looking at property as retirement draws near.

[TooNew]

==========

ekg is not useful in this context
you need an IHT to check for apnea and hypop levels

The EKG I want has nothing to do with my sleep disorder. Heart abnormalities were detected during the sleep study and I want to make sure the old ticker is going to keep on ticking.

UA can become full OSA but that generally results from the throat collapsing not the UA congestion
cpap should stop OSA and improve the UA issues

Apparently I can just put on weight and change it to OSA, or allow time, age, and damage to progress to OSA. I read an article by Dr. Krakow who highly recommends ASV for UARS.

I am still wondering if I have true UARS or am in between it and OSA. UARS presents as having difficulty getting to sleep and OSA doesn't. My sleep onset was 30 seconds for my sleep study. Also, UARS does not typically have any apneas. I know mine were very low, but still...

I'll see how that flies with the VA tonight...

[Pugsy]

There is a device that can be used during a sleep study to help figure out if for sure UARS is the culprit.

PES esophageal measurement

http://www.sleepmedicinecenters.com/Sle ... ceSyndrome

Not many sleep labs utilize it. Most often UARS is a "rule out" diagnosis...rule out this and rule out that and this is what is left..type of thing.

Good luck tonight. I will cross my fingers that the cpap works a miracle and you get some answers to your questions right away.

[robysue]

UA can become full OSA but that generally results from the throat collapsing not the UA congestion

Upper airway resistance syndrome (UARS) is NOT caused by congestion in the nasal passages.

UARS is caused by frequent narrowing (i.e. partial collapse) of the upper airway that leads to EEG arousals during sleep. The narrowing of the airway is not severe enough to meet the criteria for a hypopnea. In other words, the airflow might not drop by at least 50%. Or the airflow might drop by 50% or more, but the reduced airflow only lasts 5-8 seconds instead of 10+ seconds.

[TooNew]

My UARS is not congestion related. The only time I have any congestion is when I'm ill - no allergies or sinus problems.

What is CA?

What is PSG?

At least I don't have to fight insurance companies - only the VA - and so far they have been wonderful, so I will be surprised if I need to "fight" for ASV if that's the best option. They really do want to treat people and not have them return for the same issue.

[robysue]

UARs has hypops
they count in the AHi index to decide if you need treatment
they lower your spo2 and can be as bad as short apneas when the hypops are longer

No. In UARS, the respiratory related events that matter are RERAs---respiratory effort related arousals rather than hypopneas or apneas. A typical UARS patient has NO O2 desats because they arouse (wake up) before the respiratory events turn into full-fledged hypopneas or apneas with desats. And because they wake up/arouse as soon as their airway starts to narrow, UARS patients usually have diagnostic AHI that are very, very low---as in well below the normal cutoff of 5.0 for diagnosing mild sleep apnea.

And it's important to realize that a RERA does not meet the standards for a hypopnea, so RERAs are NOT part of the AHI, although they ARE part of the RDI:

• In a hypopnea with arousal, the airflow MUST drop by at least 50% for at least 10 seconds AND end with an EEG arousal.
• In a hypopnea with desat, the airflow MUST drop by at least 50% for at least 10 seconds AND have a corresponding 3% or greater drop in O2.
• In a RERA, there must be evidence of flow limitation (i.e. distorted inhalations with our without any reduction in airflow) that end with an EEG arousal and a return to normal breathing.

ASV is good but hard to get as it is meant for CA and other less usual problems than OSA and UARs

There is no way that an insurance company is going to pay for an ASV machine for someone with UARS.

if all you have is the OSA and UA then an auto bipap should work well and costs insurance less

Most insurance companies will not pay for an auto bipap for someone with simple OSA or UARS until CPAP/APAP has been tried and the person could either not tolerate it (like me) OR the pressures could not be set to properly control the OSA on an CPAP/APAP.

if you also have CA or it is caused by bipap pressures then you would need an ASV
for that last you should have a full PSG in a sleep lab

The OP does NOT have CA. Home studies do have ways to determine CA vs OA.

[robysue]

My UARS is not congestion related. The only time I have any congestion is when I'm ill - no allergies or sinus problems.

xxyzx is confused. UARS is NEVER caused by simple congestion.

What is CA?

A CA is a central apnea. A central apnea occurs when you stop breathing, but the airway is NOT compromised. Essentially your brain "forgets" to send the signal to the lungs and diaphragm to Breathe NOW. Central sleep apnea is a somewhat rare, and not well understood problem.

What is PSG?

Polysomnograph---i.e. an in-lab sleep test where you are hooked up to a bunch of sensors and a technician monitors all the data all night long.

At least I don't have to fight insurance companies - only the VA - and so far they have been wonderful, so I will be surprised if I need to "fight" for ASV if that's the best option. They really do want to treat people and not have them return for the same issue.

You don't need an ASV to treat UARS.

[Pugsy]

CA...central apnea..the airway is open but no air is moving. Hold your breath for 10 seconds ..that's pretty much what a central apnea is.

PSG polysomnography...sleep study

Unless you develop a bunch of centrals with the cpap pressure tonight during the titration sleep study central apnea isn't a factor in your situation.
A random central here and there is normal and no big deal.

[TooNew]

You don't need an ASV to treat UARS.[/quote]

That is not the opinion of Dr Krakow, and I thought he was pretty well renowned...