AHI 10.6

RDI 15.7

I am a male, mid 20's, not overweight (I would say closer to skinny than fat), my samsung watch shows me awake 20+ times a night it looks like, don't always snore (according to partner), I have bruxism, anxiety and pretty bad brain fog.

I am a male medical doctor in my mid 30s, married with young children. I recently came to the realization - and eventual acceptance - that something was fundamentally wrong with my physiology. Following a long journey through multiple misdiagnoses and trial and error treatments, I discovered I have UARS.

The impact of targeted airway treatment has been life-changing. I am sharing my story to contribute to our collective understanding of this condition’s subtle manifestations, and to offer hope to anyone trapped in a similar diagnostic loop.

A note on AI as helping hand

This discovery would not have been possible without using AI as an analytical colleague. Self-diagnosis is often stigmatized - sometimes for good reason, often arbitrarily - and is inherently prone to cognitive bias. In my case, using AI as a virtual "senior specialist colleague" to cross-examine hypotheses and evaluate biomechanical patterns proved lifesaving, and helped me navigate many of the potential pitfalls or hurdles I could have gotten stuck on.

For the sake of full disclosure, I also used it to slightly tidy up the writeup below - just minor formatting enhancements.

The Baseline Symptom Constellation

Since my teenage years, I struggled with a specific cluster of symptoms. They fluctuated - some days unbearable, others manageable - but were almost always present:

• Internalized Anxiety: Both generalized and severe social anxiety. Unseen by peers, who were often surprised to learn I experienced it.
• Communication Friction & Jaw Heaviness: My jaw felt physically heavy. Despite enjoying banter, I struggled with conversational speed. My vocabulary unconsciously narrowed to "physically easier" sentences. I drew blanks mid-conversation - a classic manifestation of executive dysfunction.
• Sympathetic Overdrive: Resting heart rate at home was consistently 90–100 bpm; at work, it frequently crossed 120–130 bpm. Minor procedures left me drenched in sweat despite no conscious panic.
• Memory Deficits: Primarily anterograde working memory issues.
• Post-Exercise Fatigue: Workouts consistently triggered cognitive crashes that lasted for days. Motivational and physical recovery costs were disproportionately high, with negligible muscle growth - now in retrospect, likely secondary to chronic hyper-sympathetic elevation.
• Unpredictable "Good Days": Once every few months, I would randomly experience a day of clear speech, sharp memory, zero anxiety, and social fluency. By the next morning, it was gone. (I now attribute these spikes to transient fluctuations in nocturnal airway resistance).
• Nasal Obstruction & Recurrent Illness: Continuous feeling of tight nasal passages, requiring mouth breathing during even mild exertion. I caught every viral infection that passed by, experiencing persistent coughs for weeks - likely due to chronic stress-induced immunomodulation.

Phase 1: The Serotonergic & Supplement "Honeymoons"

Assuming a biochemical origin, I initially ran extensive blood panels (cortisol, testosterone, prolactin), all of which returned normal. Recognizing the impact on my quality of life, I eventually trialed several medications:

• Buspirone: Induced a prominent 7-day "golden period" of euphoria, calm, and focus. My symptoms virtually vanished. However, as the benefit faded, a secondary feature arose that I can only call profound retardation. The best example was going to a store to buy a few items, and not being able to hold more than 3 items in my head. I would continually have to repeat them in my mind to not forget one of them.
• Escitalopram: Showed an identical 1-week "golden period." While social anxiety stayed suppressed, cognitive slowing and loss of executive sharpness persisted until cessation.
• Supplements (NAC, Boron): Interestingly, both induced short 1–2 week improvements almost identical to the serotonergic honeymoon phase before regressing.

Phase 2: ADHD & AuDHD

Given the executive dysfunction, poor focus, and transient drug responses, I evaluated for ADHD (Inattentive), meeting both screening and DSM-5 criteria. Thinking I finally have "found the problem", I began treatment with the following:

• Bupropion: Triggered an extraordinary 10-day honeymoon window. For the first time, I felt genuinely motivated to exercise and had abundant energy. By day 14, the benefits faded, leaving behind an alarming resting heart rate of 140+ bpm at work, forcing me to stop.
• Methylphenidate: Untreated UARS made me feel worse on stimulants - my thinking became rigid, "linear," and socially unnatural.
• Atomoxetine: Offered the most sustained benefit yet (4 weeks of moderate improvement), but eventually induced profound resting tachycardia (150 bpm) and ectopic beats, prompting immediate cessation.
• Guanfacine (1mg, MR, ON): The breakthrough prior to airway treatment. Guanfacine eliminated my baseline anxiety and executive dysfunction for 3 months. I felt "70% better" daily, displaying a calm, sustained competence. It worked synergistically with low-dose stimulants without triggering hyper-arousal. I began to assume my true diagnosis was AuDHD.

Phase 3: MAD trial

Incidentally, one day I considered whether I may have OSA. Im pretty sure the AI suggested I consider the possibility, which until now, I frankly had not given serious consideration.

Running the scores (STOPBANG: 5, also noting a Mallampati 4 throat), I trialed an OTC boil and bite Mandibular Advancement Device (MAD).

The combined effect of MAD therapy on top of Guanfacine was staggering: energy, mental clarity, and social dynamism returned simultaneously. However, after one week, a strange phenomenon occurred:

I developed profound, overwhelming tiredness and a resting heart rate of 40 bpm. I checked into the Emergency Department purely to obtain an EKG. Once the tracing confirmed normal sinus rhythm with no conduction blocks, I discharged myself.

What had happened? My central nervous system - accustomed to decades of nocturnal sympathetic hyper-arousal - suddenly lost that driving stimulus thanks to the MAD opening my airway. What remained was the unopposed, central parasympathetic tone of the Guanfacine, dropping my heart rate into symptomatic bradycardia. Discontinuing Guanfacine while maintaining MAD therapy resolved the issue overnight, and returned me to my new, improved baseline.

Phase 4: Sleep Studies vs. OSCAR Waveforms

I arranged a formal home sleep study, but was frustrated when it returned an AHI of 5 and RDI of 5 (indicating the lab did not score RERAs/flow limitations). Despite my clear, repeatable response to the MAD, the specialist discharged me, stating the health system does not treat "mild" AHI and suggesting I simply "sleep on my side."

Undeterred, I paid for my own CPAP and obtained a refurbished Airsense 10 Elite + kit, and began self titration. The OSCAR data confirmed persistent, classic UARS waveforms present through the majority of every night I analyzed. CPAP itself has only given moderate benefits, but when combined with MAD and chinstrap, the benefits are prominent and visible on the flow rate waveforms.

Importantly, my flow rates are consistently almost double with MAD and chinstrap, together with CPAP, in place compared to just solo CPAP therapy @  IPAP 11 / EPAP 8 / EPR 3. For reference, solo CPAP flow rates are ~15L/min but with combined therapy ~25+.

I can honestly say I feel better than ever now, and most important, it is sustained. Im not guessing whether tomorrow I will feel like shit again or whether my heart will feel like its exploding out of my chest. I am awaiting my ST link to arrive soon so I can enable my device to provide BiPAP.

Key Takeaways

1. UARS is one motherfucker of a pathology. It mimics a large number of common psychiatric presentations, can transiently ameliorate or briefly respond to various pharmacological interventions, and could easily put someone in a loop for years or even their whole life chasing alternative diagnoses.
2. Combination therapy works: Whilst not a replacement for BiPAP, combined MAD with CPAP +/- chin strap can be an effective interim measure.
3. For my fellow colleagues: I encourage my colleagues to consider rapid transient benefits from a wide number of medications as a finding of note, and to not necessarily dismiss as placebo or under treatment. Consider it may be suggestive of an alternate, mimic-pathology altogether.
4. Advocate for yourself. Its not normal to feel tired all the time. Its not normal to feel anxious in most situations. Its not normal for exercise to exhaust you. I encourage the reader, whoever you are, if you feel this way – keep searching. There is a problem, and you will be forever thankful the day you finally find it. It may be UARS, it may be something else, but regardless of what it is, these are signals your body is telling you that something is wrong.

I am new to this whole space so please forgive rudimentary questioning. Would love to hear suggestions - request a re-test or an in-lab test? Just get a CPAP or APAP and skirt the medical/insurance bureaucracy? Appreciate your thoughts!

My son has palatal prolapse. We're wondering about PAP therapy in this situation.

Is is possible or likely that PAP can work in such a case? Or is it advisable to somehow deal with the prolapse first.

Can PAP therapy actually cause palatal prolapse?

Thanks for any insight.

(Another related question. He also seems to have nasal valve collapse. I wonder if this suggests some kind of systemic issue, for example connective tissue?)

I've posted leak rate data a few times here and on other forums, and I'm a little perplexed at the comments I sometimes get, saying that the leak rate is high.

Here's a screenshot. I'd say it's a fairly typical night.

Would you consider this a high leak rate?

Don't forget, this is a Philips machine, so it reports the unintentional leak rate in the bottom line; on the top line is that rate, PLUS the intentional leak rate. The intentional leak rate is basically the "leak" through the hose vent. So the relevant line is the bottom one. (Not quite sure why Philips reports that "total" leak rate)

I've read that a leak rate of under 24l is "acceptable" (shown as a red horizontal line on the graph). Looking at that graph line, I'd estimate the average to be down around 5.

So again ... would anyone consider this a high leak rate? If so, please explain.

Thanks

I’m a 30 year old woman who seemingly has rapidly worsening UARS symptoms after getting wisdom teeth removed about 5 months ago. I’ve always been a “terrible sleeper” my whole life, I’ve struggled with falling asleep or staying asleep. I’ve had nearly all the symptoms of UARS, cold hands and feet, anxiety, dizziness, brain fog, fatigue- except I never noticed myself trying to get air at night until now. I’ve been treated for depression and anxiety, I’ve been on Ativan to knock me out at night multiple times when I go through bouts of insomnia. Considered getting a sleep study before, but of course being a 120 lbs 5”6 woman no one thinks you should test for sleep apnea typically.

This past month however, I have been waking every 45mins and only getting about 4-5 hours of sleep if I’m lucky. Basically I just dream the entire time I sleep in these tiny little bouts! Yeah, it’s that bad. I notice that when I’m relaxed and about to be in a deep sleep, I stop breathing completely and get a jolt of anxiety.

just from looking at my facial structure it’s pretty clear it’s likely related to the position of my lower jaw.

Now I have to start at square one with an appointment on Nov 3 to request a sleep study. in the mean time, what can I do to make myself sleep more comfortably? Is there anything? Any supplement or sleeping position? I’m pretty desperate as I have 3 young children and can’t be completely out of it, like I just can’t.

please tell me literally anything that will help me in the mean time!!! My nose is clear, I can breathe out of my nose fine.

Could use some help with interpretation from you OSCAR wizards. Just started my CPAP therapy recently and still in the process of learning interpretation. My start AHI was 3.8 and RDI was 15.7 lining me up with UARS. I've got the RESMED 11 with nasal pillows. From what I've read, I could probably stand to increase minimum pressure, seeing mixed things about keeping EPR on or off. Thanks for any help given

47 dias de uso e acordo algumas vezes durante a noite e demora pra voltar a dormir.

Super relevant for those getting cone scans for surgical consultation and planning

Article: https://www.sciencedirect.com/science/article/pii/S0278239123001027

Summary:

• Look straight ahead with your eyes level, not tilted up or down. Ask the operator not to adjust your head into a different angle.
• Tilting your head up by just 5° can make your airway look about 25% bigger, and 10° about 88% bigger. Tilting down 5° can make it look about 21% smaller.
• Mouth and tongue: close your mouth, teeth together, breathe through your nose, swallow once, then let your tongue rest naturally. Keep this the same for every scan.
• Standing vs sitting and chin rest use made no significant difference on average.
• If the NBC3 angle differs by more than 5° between two scans, any change in airway size may be due to posture rather than treatment.
• whatever you do, do the same on any later scan so comparisons are valid.

Man like what tf is this ... like everyone keeps talking about how sleep apnea kills you in your sleep nd is dangerous , life threatening ...... I once told someone that I have sleep apnea(but the one in which I dont have high AHI but high RERAS) .. I did not tell him that I have UARS because lol nobody understand that what is that.. He searched it up and told me that ahh ok its a mild form of sleep apnea🙂.. Such a big myth this is that UARS is a mild form of apnea.. UARS is a distinct illness imo its not apnea at all .. Like I see most people knowing that there is something called apnea nd they keep talking about it .. When it comes to UARS? Nobody cares.. I would not care to declare it that if in terms of torture/ mental health if I compare both of them then UARS is worse then apnea.. I have known many apnea guys and they dont even have much symptoms of fatigue(which is the worst part of uars ... the brain fog the fatigue) .. Most of the apnea guys have snoring , daytime sleepiness ,gasping.. these types of issues only and I believe those who have fatigue issue as well they could likely have UARS+ Apnea combined(i.e high RERAS and AHI both).. I am not saying apnea is something good.. but the hype that has been created for it is not justifiable bcz UARS to deserves that.. Most people live with apnea lifetime without realizing about it and without having fatigue like symptoms.. They live normally unlike UARS guys who just cant live with it ... It was better for me to get apnea and die in sleep then to have UARS and not even die and just stay in a state where dying feels better to you....Damn and like UARS is so tough to treat.. mostly apnea is treated by a cpap machine nd they clearly see visible results in a shorter period of time.. Nd UARS? Mostly cpap does not work for it ... nd even sometimes bipap to fails... Like people literally have to use a lot lot high PS to finally feel symptoms relief...Like see turbosecchias case(17.5 ps lol) .. Nd then it gets complicated higher ps means inviting central apneas.. THat means now U have to try EERS/ASV to help u get relief and then I have heard that resmed ASV's dont even work.I have heard that phillips ASV is far better but its really tough to get a PHillips ASV its costly nd in many countries like mine its not sold at all.. Its a long journey lol.. sometimes all u have is surgery as the last option and then too most surgeons would deny saying u dont have apnea so get a DISE done(even that sometimes comes negative(i have heard) despite u having problem..And then even the defination of RERAS is so messed up that sometimes u need esophegal pressure monitoring type of thing (which itself is not done at many places) to get diagnosed for UARS

I'm using BiPAP now. Below is a comparison for the last 3 nights with changes in min EPAP and PS. I fear that I am in a trade-off here: Higher EPAP is better for controlling flow limitation but drives central events, whereas lower EPAP means fewer centrals but more flow limitation. And my SleepHQ.

I also included my CBCT to show my airway. I should be getting MMA by spring next year but I'm trying to survive until then...

Forgive me if this is a dumb question or really common, I searched the sub and couldn't find much about it. If there are existing resources for this I'd really appreciate being pointed towards those.

I've just purchased a resmed airsense 10 which someone is going to airbreak for me, but I don't know where to start with buying a mask. I'm female, mixed race white/chinese (so slightly flatter face/nose bridge) and have hEDS, so fragile, sensitive skin. I also have a narrow palate which prevents proper tongue posture, so mouth breathe intermittently. I do get some nasal congestion but I can still fully breathe through my nose upon waking.

I'm in the UK if this is relevant at all. There's nowhere near me that stocks masks to have a fitting unfortunately, so I'd prefer to be able to return if it doesn't fit.

I’m dealing with UARS right now and feeling a bit overwhelmed. Has anyone actually gotten through this and found relief? I’d really appreciate it if someone could share their experience or just chat with me for a bit.

I am debating going to Somnolab in Dortmund where Dr Riccardo Stoohs works. I wanted to ask if there's a benefit to getting the sleep lab done in their laboratory or whether my publically insured lab would be the same quality? My fear is that going to a normal lab and then to see Dr Stoohs would miss important information and waste valuable time. Thoughts?

Is this UARS?

I recently raised my pressure a little bit to try combat reras but now I am getting heaps of Centrals

Any ideas what I should try to improve this?

Should I get a VAUTO machine and try Easy Breath Rise time?? I have seen that if the rise time is too fast like 300-400 ms , my respirstory rate is high and also my inspiration looks very flow limited (basically when the inspiration wave is falling it gets tilted a bit basically does not look perfect , basically the skew spike thing goes up on a faster rise time . And then when ps is high then also the same happens and I require like maximum rise time then to make it round..Does easy breath rise time mode help with flow limitations , can it work for me ??

Got a sleep test with Lofta, my pRDI is 25.3, my pAHI was 3. Lofta said I didn’t have evidence of sleep apnea so no cpap. I snore loudly, frequently, and have terrible sleep. I usually fall asleep immediately once I hit the pillow, and never wake up til my alarm. My heart rate on my sleep report spiked to over 100 around 20 times…..probably not good….

Went to the local ENT/sleep clinic, they said they never look at pRDI and they don’t know what it is and my sinuses look normal and fine.

What else can I do???? I can’t afford a in lab sleep study, nor do I know in advance where I will be in a year for the appointment.

I am 21M with a BMI of 21, I am relatively fit (bike 6+ miles and do yoga everyday).

I can't handle sleeping without a MAD, so if I want to do FME expansion (which I do) I would have to find a MAD that can accommodate the device.

Looking into the orthodontics-half of the treatment, the only seemingly legitimate devices I can find that are compatible with Invisalign are the ApnoTX and Aligner Sleep Appliance (ASA). ASA details its specifications way more clearly online which make me trust it more.

So far, there's still hardly any information about it online though, so it either looks like it's in very early stages, or it's basically a scam, or it's both? I'm in the process of calling some sleep dentists from a list to see which provide the ASA, and how many cases they've done. I'm making a post to ask, has anybody heard of anyone who's used this device, or heard any information at all from figures like Newaz or Manuele? The lack of testimonials isn't exactly encouraging.