Quick background: I am a 31M that is not overweight. I have had trouble sleeping for a very long time. I have also suffered from mild to occasionally severe anxiety for an equally long time. As we all know, anxiety and sleep issues feed off of each other bidirectionally in a cruel cycle, creating a self-propagating flame of symptoms.

Unfortunately, I had a physical and emotional trauma about a year ago (which involved fainting and hitting my head on the ground), which in my opinion basically was like pouring gasoline onto the flame that was already there, turning it into an inferno and making everything 100x worse. It was a nightmare and I won’t get into the details of it here, but it involved severe worsening of both my sleep, my mood, and my anxiety.

I was hoping some people in the community could help me with a couple questions. I have also included OSCAR screenshots below.

Based on symptoms and OSCAR data, is it worth demanding to try BiPAP from my doctor? He hasn’t mentioned it yet.

Is it worth trying an oral appliance due to issues I feel with my tongue and jaw (below)?

What types of doctors should I see about this?

Is there anything else I am missing?

Is this mild OSA or REM-specific OSA or UARS or all of them? Are they treated differently?

Is there anything in my data I should specifically bring to the attention of my Dr?

  • Symptoms
    • 3 – 6 (maybe more not conscious of) wake ups during the night, every night, without exception. They are much more frequent in the second half of the night, and are always after dreaming.
    • Anxiety, mood, cognition issues (which were severe and debilitating last summer, needing me to go on disability insurance, especially heightened after a poor night of sleep.
    • Used to have very weird twilight dreams where I was half awake and could hear myself struggling to breathe. Used to have other weird things including frequent lucid dreams. I think CPAP helps with these.
    • Trouble getting my jaw and tongue in a comfortable enough position to sleep. Feeling like I have to clench my jaw a bit to prevent saliva from building up. Hard to swallow saliva due to post nasal drip congestion that continues despite saline sprays, antihistamines, and neti. Dry mouth on awakening.
    • Wake-ups are the problem 100% of the time, but have sleep onset insomnia sometimes too, usually because it feels like I stop breathing right when I fall asleep, waking me up.
    • Sleep disproportionately more difficult when it is only slightly hotter in the room.
    • Mallampati grade between 3 and 4, scalloped tongue, droopy uvula
    • At home sleep study showed mild OSA with 12.7 AHI (16 supine, 6 non-supine), BUT I had a head cold with congestion that night and I’m 95% sure I did not sleep at all. So who knows what my real stats are, but at least this got me my CPAP prescribed. In-lab study pending till July (but I need to make improvements before then, it’s just too long to wait).
    • Adherence to CPAP therapy for at least 2 or 3 months. Can sleep with the mask on fine, kind of even like it. Has maybe made symptoms slightly better but hard to tell. But sleep is getting worse again, seemingly due to it getting hotter (can that affect the airway?), which is why I’m posting here.
    • Started at 7 – 12 auto cpap, then tried 10 – 15 auto cpap, but got very bad stomach cramps the next day, right now have been doing 8 fixed cpap with flex on 3.
  • OSCAR data
    • Here is the data: https://imgur.com/a/BMRgmgk
    • The first thing I noticed about my data is that my AHI always spikes in the second half of the night, often going above 10, even 11. This pattern is pretty consistent. There is an illustrative example there.
    • I initially started on 7 – 12 auto CPAP, then went to 8 fixed pressure CPAP. It looks like I have enough data to pretty clearly see the first one kept me at a lower AHI, so the plan right now is to switch to 8-10 auto. Fingers crossed for that.
    • My events are very predominantly hypopneas, with some obstructives on nights of particularly high AHI (4 or 5).
    • As my sleep has gotten worse in the past week, I’ve noticed increases in periodic breathing, whatever that means.
    • Let me know if any other data would be helpful to look at
    • Thanks so much

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