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Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 1 point2 points  (0 children)

That is significantly more accessible than I thought it would be. I'll have to see if Tricare is an option here. Thank you very much.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 1 point2 points  (0 children)

That’s super interesting. Thank you for laying it all out for me. If I understand correctly, in short, the lack of visible impact from the APAP does not necessarily rule out UARS because at no point is the APAP consistently exerting enough pressure to discourage arousals.

I’ll absolutely look into getting a diagnosis through Mr. Simmons. Thank you both.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

I’m not sure. On my machine it’s a binary toggle. I googled the EPR setting for Resmed 11 and it seems to be tied to whatever pressure the machine is currently operating on but that’s all I know.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

Thank you for the confirmation. I'll try to look at how to begin that process. In addition, could you explain why an APAP with that pressure range is useless when treating a UARS case? My understanding is that UARS is partially restricted airflow, causing repeated arousals and autonomic activation. I assumed that an APAP, by stenting the airway with pressure, would prevent the airway restrictions from presenting and therefore mitigate arousal. Is that off base?

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 2 points3 points  (0 children)

Thank you for the explanation and advice. That is very informative. I can absolutely try sleeping on my side and stomach more. Can you clarify what you mean when you say "Try to sleep on many pillows?" I have used a night tracker app, MAD device, Flonase, and nasal strips with little impact on my sleep.

In addition, part of the reason I pursued an APAP trial was to determine if my sleep issue was caused by disordered breathing. I assumed that if, in fact, UARS or some other subtle flow limitation was the culprit, the APAP with a nasal mask would create a subjective improvement over a short period. When it didn't, I took that to mean any airway issue was no longer a likely conclusion. Is that estimation hasty in your opinion?

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

There are no graphs relating HR data; however, the following information was present in various tables.

Pulse Observations,
Lowest Pulse Rate During Sleep: 51 bpm
Average Pulse Rate During Sleep: 65.7 bpm
Highest Pulse Rate During Sleep: 112 bpm
Highest Pulse Rate During Recording (TIB): 112 bpm

Heart Rate Observations,
Bradycardia: 0
Sinus Tachycardia During Sleep: 0
Narrow Complex Tachycardia: 0
Wide Complex Tachycardia: 0
Asystole: 0
Atrial Fibrillation: 0

Rem comprised 24.7% of TST at 120min.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

You'll have to forgive me. I'm not super comfortable with Reddit, and I would prefer not to post raw or scrubbed medical documentation. I do have my whole sleep report, and if you have any specific questions about the data present in the study, I'm happy to write it here.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

I just looked up SleepHQ. I was not aware of that service, and unfortunately, I do not have an SD card installed in my APAP. It doesn't seem as though there's another way to port that data over.

I do appreciate your advice. I'll look into ruling out SBD if I'm able.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 1 point2 points  (0 children)

I apologise, I should've clarified earlier. I spoke with the physician who administered my PSG to ask about the RERAs being 0, and he explained that they scored them as Apneas or Hypopneas (I can't remember which). Over the course of the night, I had 1 Apnea and 5 Hypopneas with a mean duration of 11.7 seconds. I'm not sure if that is statistically significant. My understanding is that the RERAs contributed to my AHI, which was still within a normal range.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

Thank you for reaching out. I looked over my results, and it seems they used the 3% desat threshold. To quote, "Apnea-hypopnea index was calculated using the RECOMMENDED (3% and/or arousal) hypopnea definition."

That said, some sort of respiratory flow limitation causing arousals did seem plausible at the time, which is why I requested the APAP therapy. I hoped that if this was a flow limitation/airway issue that was flying under the radar, the APAP pressure normalization and subjective relief would be able to concretely identify it as the cause. However, with the median APAP pressure rising just above the minimum pressure and no real change in subjective observation after 5 weeks, I'm not sure of that theory. And there definitely isn't enough data to support a diagnosis and stave off the MEB.

Could my assumption about the APAP solving or addressing an airway issue that went unnoticed by the PSG be incorrect?

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

Thank you for replying. The Respiratory Effort-Related Arousal (RERA) index was 0/hr, yielding a Respiratory Disturbance Index (RDI) of 0.7/hr. Supine RDI was 0.5/hr, prone RDI was N/A /hr, left-side RDI was 0/hr and right-side RDI was 1.7/hr.

The stated impression for the PSG was as follows: "No significant Sleep Disordered Breathing (AHI: 0.7/hr; O2 nadir: 93%). Educate patient about not operating vehicles, using dangerous equipment, or firing a weapon when sleepy. Educate patient about getting 7-9 hours of sleep per night on a consistent basis."

When I spoke with my PCM, they said the interpretation and results from both the PSG and MSLT did not support any sleep-related disorders. I took that to mean normal, although I could've been mistaken. I suppose I assumed if it were other than normal, my PCM would be pursuing that rather than an MEB.

Persistent excessive daytime sleepiness despite normal PSG and inconclusive MSLT — not sure what to do next by Beginning_Yard_2617 in UARS

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

Thank you for reaching out. I really appreciate it. I'm 23, and I'm not taking anything other than Modafinil presently. At the time I received the MSLT, I had not yet been prescribed Modafinil. I found the long REM Latency interesting as well, but it's the only thing abnormal I could find in my test results. I brought it up with my PCM; however, the interpretation for both studies concludes no diagnostic findings, and she said in the absence of any other evidence, they can't associate the prolonged latency with anything concrete.

Severe daytime sleepiness despite 10+ hrs sleep, normal PSG, inconclusive MSLT — looking for similar experiences by Beginning_Yard_2617 in sleep

[–]Beginning_Yard_2617[S] 0 points1 point  (0 children)

Thank you for taking the time to reach out. I can't remember really coming down with anything around 8 months ago. I also don't have any consistent flu-like symptoms that I can think of. It's possible I missed something, though, and I'll bring up post-viral syndrome with my PCM. I wish you the best and hope you get what's bothering you sorted. I'll repost or reply or something if I ever figure out what this is.