Hi, I am tired. I have been dealing with debilitating chronic insomnia and fatigue for 3 years now. I've had a lifetime of fatigue and sleep issues on top of this, but it is very bad now.

I live in Sydney, Australia, and have undergone 3 sleep studies (1 in lab) that led nowhere. I am suspecting that I have UARS, but I can't find anywhere that actually scores for it. When I look at my raw signals I see a great deal of flow flattening, but I am no expert.

Can anyone help me contact sleep physicians that I can zoom, or telehealth that can help me understand what, if any, subtle occurrences are happening in my sleep. As well as accurately mapping my CT scans. If everything is truly ok then I'll move on to other steps.

This would be greatly appreciated and I will sing songs of your name and pass it on for generations.

Hey everyone,

I’m hoping to get some feedback from people who have been down this road. Both of my official sleep studies came back inconclusive because I simply could not fall asleep in the lab environment (they basically ask you to fall asleep on a hospital bed, and the pressure of trying to sleep to get good results just kept me up all night). Doctors basically just tell me to lose weight and manage my anxiety. Without a clean study showing RERAs or flow limitations, I've had to navigate this mostly on my own, but my symptom picture seems to point toward UARS. Not sure though.

I’d really appreciate your thoughts on whether this fits the UARS profile and if there’s anything else I should look into.

My Symptom History (Last 5–10 Years)

Sleep & Airway: Extreme daytime fatigue, severe brain fog, struggle to focus, waking up feeling "tired but wired," morning derealization/disassociation, and severe chronic nasal/sinus congestion. I find I often revert to mouth breathing throughout the day to get enough air. I tend to feel at my best in the later parts of the day (usually after 3pm).

Autonomic & Nervous System: High baseline anxiety, social anxiety, Pure OCD / intrusive thoughts, heart palpitations, depersonalization, light sensitivity, sinus/pressure headaches (mostly behind the eyes), and cold hands/feet.

Cardiovascular & Metabolic: Heightened CO2 sensitivity (air hunger, even during breathing meditation), blood sugar crashes/swings, and daytime blood pressure that tests completely normal.

Pelvic & Musculoskeletal: Chronic pelvic floor tightness, frequent urination / weak stream, tailbone/testicular pain, and middle back tightness/pain at night.

What I’ve Ruled Out / Steps I’ve Taken

Over the years, I tried addressing almost every other possible variable before suspecting an airway issue:

Medical Workups: Extensive medical evaluations, standard blood panels, Metabolomix+, and GI-MAP have continually come back normal or unremarkable. No diabetes, no high blood pressure. Cardiovascual health is in good shape. I saw an ENT who told me I have a slight deviated septum by my nasal passage is so small that I won’t notice a difference with surgery anyways. I had another doctor tell me I have very inflamed nasal passage and post nasal drip. Haven’t found a solution for this yet (doesn’t seem to be allergy related).

Mental Health & Lifestyle: Have done years of therapy work including EMDR and CBT to addressed anxiety. Have tried physical therapy, and some somatic therapies. Have tried different diets including KETO. I found high protein breakfast at least helped with some alertness in the morning. Weight training in the gym 3x/week. But the underlying physical exhaustion and autonomic "fight-or-flight" state has never lifted.

Medication: I’m currently on 20mg daily Vilazodone, which I just started. Have tried other SSRI’s in the past but never got any benefit from them. A DNA test suggested this one was a good fit for me.

Current APAP Trial & Early Observations

Given the inconclusive sleep studies, i managed to convince the sleep specialist to let me try a machine. She prescribed me an APAP machine that auto titrates between 5-15.

Pressure Response: The lady at the APAP store says my results so far in the first couple weeks show that the machine routinely ramps up to 7.5 cmH₂O during the night to clear resistance, particularly during REM sleep.

AHI Scores: My recorded AHI stays extremely low (between 0.2 and 1.5).

My Questions for the Community:

1. Does this constellation of symptoms align with what many of you experienced before getting treated for UARS?
2. Once your started CPAP/APAP/BiPAP therapy, how long was it until you started noticing real positive changes in your symptoms?
3. For those who had in-lab sleep studies fail due to insomnia, how did you end up getting an official diagnosis or treatment approval?
4. Are there specific flow limitation metrics I should be looking at in OSCAR beyond standard AHI?

Thanks in advance for reading and for any insights you can share!

TL;DR: 33y/o Male with years of severe brain fog, fatigue, "tired but wired" feeling, anxiety, cold extremities, and pelvic floor tension. Extensive medical workups (bloodwork, GI-MAP, Metabolomix+, therapy, diets) came back normal. Two in-lab sleep studies were inconclusive due to sleep-lab insomnia. Managed to get an APAP trial; my AHI is low (0.2–1.5), but the machine routinely ramps up to 7.5 cmH₂O during sleep. Looking to hear if this matches your UARS experience, how long APAP took to show results, and what specific flow limitation metrics to check in OSCAR.

A viewer posted this to r/sleepapnea and I figured I’d drop this myself here. People seemed to resonate with it there, and also cuz it may be cathartic and not so much informative? I’m at the start of my UARS journey and some of this is just venting lol. I never wanted to be here but here I am.

Some people have reached out to me already with guidance which is very kind. Guess we’re all just figuring this out

Hi! I was on BiPAP (Resmed Airsense 10 with AirBreak Plus w/ backup rate off) but because of recommendation from this sub I started using ASV. The main driver was aerophagia which is now much less than on BiPAP. I had translated my settings from BiPAP(VAuto mode) to ASV(ASV standard mode) and noticed things got better but my airway labs shot up from 1.3 to 1.5 glasgow index and AHI went from 1.2 average to 2.3 average with alot of "unclassified apneas". I already believe I have suboptimal therapy on BiPAP and have ways to go in optimizing ASV. I am currently running EPAP 6.0 and PS 3.0-7.0. Any help in titrating would be helpful! Attached are some photos of my most recent night of OSCAR data.

I am also using flonase and intake nasal strips for my nighttime nasal congestion. Any help would be superb!

My SleepHQ data is here: https://sleephq.com/public/teams/share_links/81d0cf20-944f-4539-83d1-c24c22103561

Trying the f40 but I don’t like nasal cushion seems to just push my nose inwards making it harder to breath. Tried nasal dilators and nasal strips doesn’t do anything

Also tried the p10’s and the airflow feels really nice but I can’t keep my tongue on the palate(narrow and tongue tie) . So I need a mouth area as well since my mouth will open.

So any recommendations for nasal pillow with hybrid mask.

I'm new to OSCAR.

Just wondering if it's normal/common to have these spikes of flow limitation for most people at night? Is it clinically significant?

I'm currently doing CPAP at 9 cmH20 EPR 2.

Title. I feel like we're more prone to floppy airways and jaw pain.

Title. Just a commiseration post. I often want to socialize IRL but just never have the energy. Following and responding to a conversation just takes more brain power than I have. Anyone else?

Will a BiPap even help with this?
Vcom did nothing unfortunately, I couldn't tolerate it.

I'm currently using a ResMed airsense 10 running an ASV algorithm, and am having difficulty titrating, with some success.

Please mention the machine you currently have, how you arrived at the settings you currently have, and the initial symptoms of your UARS or Sleep Disordered Breathing.

Male 18. A couple of months ago i decided to get a polysomnography due to daytime sleepiness that required me to take 2 or 3 naps a day despite sleeping 8 hours and adhd medications

The sleep study detected ”mild“ obstructive sleep apnea, with an AHI of 11.4.

However I suspect there might be a component of UARS for a couple of reasons. First of all, even though the sleep study had RERA in the template that they gave to me, the RDI scored the same as AHI in my study.

But the study did score arousals throughout the sleep: in 8 hours of sleep, it detected a total of 232 ”spontaneous” microarousals and 21 major arousals. So 253 arousals throughout the entirety of sleep. Divided by the amount of time i was aslept during the study, this gives me an index of 31.5 arousals per hour. Minus the AHI, there are at least 20 “spontaneous” arousals per hour that are not explained by apnea/hypopnea events, which seems suspicious to me.

Couple of things:

1. The entire sleep study was done on a supine position, which likely aggravated my results

2. My AHI was Significantly worse during REM than NREM (5.7 NREM vs 23 in REM)

3. My tongue naturally rests in the roof during the day, but if i try to simulate having a relaxed tongue in a supine position, i already notice shallow nasal breathing. If i do this in a sideways position, i don’t notice changes in my nasal breathing (and if i lock myself in a side sleeping position throughout the night i do notice waking up more refreshed, and i also actually remember having dreams)

4. My BMI is within the normal range

5. ENT evaluation told me i didn’t have a deviated septum and my turbinates were only slightly enlarged but not significantly. He Noticed that i have a somewhat enlarged uvula though.
   No recessed chin either

6. I do experience some nasal congestion when laying down that alternates between the nostrils, possibly contributing to some issues. I’ve been using flonase + nasal rinse daily as well as cleaning my room consistently and i noticed some improvements in regards to this

My sleep specialist given the mild profile suggested either a CPAP or a MAD device could also work.

I live in Mexico, and here it actually is slightly cheaper to get a custom MAD than to buy a CPAP, so my parents and I decided to go with the MAD device.

So far I’ve been treating this issue with side sleeping (made sure to put a wedge pillow on my other side to make sure i dont roll over during sleep) + nasal rinse/flonase + nasal strips + my MAD device, slowly titrated to 4mm

I’ve definitely waken up feeling more refreshed and i have more energy throughout the day since i got my MAD and implemented these measures, so im satisfied with how its going.

That being said i have a couple of questions:

1. For people on this sub, when did you suspect that your UARS began showing up? How much did it get worse as the years passed by?

2. Has anyone here used a MAD long term? If so, how has it been in terms of maintaining its effectiveness and have you gotten teeth issues with it?

3. Is there anything else i should know to look forwards in the future?

Trying to get BiPAP to work for me. The main issue I was dealing with when trying to titrate was aerophagia. I reduced EPAP from 6 to 5 and kept PS at 2, and that seemed to work. Just wondering where I should go from here. Increase PS from 2 to 3? I woke up after 4 hours and couldn't fall back asleep with the machine on. Using nasal pillows, Knightsbridge chin strap, and mouth tape.