Hi, does anyone know how long roughly or a range of how many months you have FME in your mouth once it's actually installed? What's the total length of time once it's in your mouth and when it's taken out please?

I hear some people argue that nervous system activation in UARS is primarily compensatory and any dysfunction of the nervous sytstem is driven by it being over-activated in a compensatory manner. So, to explain lower arousal thresholds, maybe one could argue the nervous system is primed rather than being independently dysfunctional. On this view, it seems that correcting for the airway would allow the nervous system to re-adapt afterwards. Recently, though, I've been seeing people argue that the nervous system is dysfunctional in a manner distinct from airway instability—that dysautonomia is an independent factor. I'd be interested in seeing what the different perspectives are here and why.

I have had significant benefit of a smart watch optimizing my UARS therapy. I am on Android, so Apple Watch is not an option (well, maybe it will be after the deprecation of Fitbit app), but I tried Huawei, Garmin, several Fitbit's and currently on my absolute favorite Google Pixel Watch 3 (combined with Fitbit premium). I "calibrated" against PSG (3x) and a Contec 50 based finger pulse oximeter.

Why this thread? Because of the upcoming enshittification of the Fitbit app to Google Health. I will loose several KPI's important to me (I tried Google Health yesterday). No more SHR (sleeping heart rate), no more SpO2 variation during sleep, no more heart-rate-per-1 minute-during-sleep, no more "% below resting heart rate), no more indication of awakes during sleep .....

During my search for improved UARS therapy I found the following KPI's to be helpful to identify improvement yes/no when trying for 1-2 weeks:

HRV
Sleeping Heart Rate (SHR) and % below Resting Heart Rate (RHR)
SpO2 variation (the absolute SpO2 number has never helped me)
Awakes (#/hr) with time stamp (Oscar analysis, SpO2/HR analysis)
Respiration Rate (RR)
Restlessness Detection during sleep

Fitbit Premium (required to get all the KPI's I discuss) with Google Pixel Watch 3 helped me a lot, because I have per-1-minute sleeping heart rate with SpO2 variation, a nice overall Sleeping Heart Rate, sleep HRV and an near perfect "awake detector" (my Dr., and myself, were surprised I predicted all spontaneous arousals of my in-lab PSG). I verified increasing HRV, reducing SHR, increasing SHR below RHR, reducing SpO2 variation, reducing RR with therapies that subjectively gave me better sleep. Often, if not always, the numbers showed the therapy performance before the subjective feeling verified it. Important note: in the end subjective feeling always wins. For example, # awakes does not match (for me) with best therapy, and my current favorite therapy still has some SpO2 variations. This is how I ended up with alternative, non-prescribed, UARS therapies and I stopped listening to Dr's.

As said, my KPI's are mainly getting killed on Google Health. I am going to miss my KPI's......

So, what to do? I could go for finger pulse oximeter (reliable average sleeping heart rate + SpO2 variations) + snore/RR detection app + HRV (basically available on any decent smart watch). But I am not a fan of sleeping with a finger pulse oximeter (bulky and the Contec app is crap and Windows only so I need to run Parallels on my Mac). I loved doing a quick check each morning, log it, and live. I still need the data as I am titrating at the moment. Edit: a smart ring could do the job as well, but then I still "need" a smart watch for plain smart watch stuff (plenty of choices there).

Besides ranting about yet another Google enshittification (pressure reduction valve), I am wondering if people can share their favorite smart watch for UARS therapy and why it is their favorite. Also very interested in hearing about Apple Watch users, as I plan to upgrade my almost 5 year old Android phone end of this year. Personally, budget is not a constraint, I am looking for a setup that can help me to improve my therapy i.c.w. enough comfort.

i'm interested in getting FME through a separate provider before MMA, while doing my pre surgery orthodontics through my oral surgeon (rutgers). Has anyone done a split provider approach like this before? how did the coordination work between your providers? were they okay with it?

Also interested in hearing from anyone who got FME specifically in the tristate nj/nyc area, Who did you see and how was your experience? Looking for providers, I know the obvious answer is probably Newaz, but just looking at my options for budgeting.

Hey all. Long post but wanted to share my case properly and get input on whether pursuing the Airbreak firmware flash for VAuto mode is worth it given my data so far.

Background and suspected cause

I'm a 30 year old male based in the UK. My suspected UARS origin is a specific traumatic event - at around 14-15 I took a hockey stick directly to the face during PE, bad enough to go to A&E. I was offered surgical correction of the septum on the spot and declined because I was a scared teenager. That decision has probably cost me 15+ years of decent sleep.

Around the same time, I had four teeth removed to create space for wisdom teeth, which may have contributed to reduced posterior airway space on top of the structural nasal damage. Interestingly my palate doesn't appear narrowed despite this - my tongue can sit fully on the roof of my mouth with the tip only lightly touching the back of my upper front teeth, suggesting palatal expansion is likely not indicated.

The resulting picture is a confirmed deviated septum with bilateral nasal valve collapse (strongly positive Cottle manoeuvre bilaterally, right worse than left), mild mandibular retrognathia, and chronic mouth breathing secondary to nasal obstruction. The subjective sensation when replicating my snoring while awake is a vacuum pulling soft tissue into the airway - classic Starling resistor dynamic.

I trialled a MAD which resolved snoring completely but caused jaw discomfort and tooth mobility so discontinued. Home oximetry normal - no OSA diagnosis - consistent with UARS where RERAs resolve before oxygen drops. No access to in-lab PSG or RERA scoring so everything below is inferred from OSCAR data only.

Current self-treatment

ResMed AirSense 10 AutoSet, AirFit N30 nasal cradle, EPR Full Time Level 3, pressure range 4–15 cmH₂O. 14 AutoSet nights of OSCAR data.

OSCAR data — AutoSet nights

Key trends

• FL 95th percentile essentially eliminated - 0.00–0.03 across 13 of 14 nights from night 2 onward. The primary UARS therapy target is being consistently met.
• FL 99.5th percentile stubbornly persistent - consistently 0.12–0.23 across all nights regardless of how clean the rest of the session is. Almost certainly concentrated in late REM where the machine pushes to 7–9 cmH₂O. I'm waking consistently around 6am - one cycle short of ideal - which I suspect is this REM-phase challenge cutting the final cycle.
• AHI below 0.75 on undisturbed nights - elevated nights (1.16–2.26) all correlate with higher CA counts and median pressure, pointing to congestion as the driver.
• Median pressure 4.22–4.88 - airway needs very little support for most of the night. Over-pressure on the Elite (fixed 7.0) was likely driving much of my exhale anxiety and CA sensitivity early on.
• CA events settled at 2–4 on good nights - adaptation complete.

Airbreak question

Firmware SX567-0401, SD card flashable, no warranty on refurb unit. Rationale: the persistent 99.5th percentile FL and late-REM pressure peaks suggest a true bilevel PS gap might convert flow-limited breaths in that window without requiring IPAP to climb as high - potentially reducing the arousal cutting my final REM cycle short.

Aware of TECSA risk given CA sensitivity - planning to start at PS 2 and monitor closely. Firmware is reversible so happy to revert to AutoSet if CAs climb and don't settle.

Questions: is this worth doing given this data? What PS gap would you recommend given the CA sensitivity? And has anyone seen the 99.5th percentile FL pattern resolve with bilevel where APAP couldn't get it?

Happy to share OSCAR screenshots if helpful, and thanks in advance for any help or guidance - your time is really appreciated in helping combat this insidious problem.

As per a comment suggestion, here is a cut of my flow rate from the most recent night.

https://preview.redd.it/029wsvws0b2h1.jpg?width=1988&format=pjpg&auto=webp&s=02e89345127ca5dcecab5ce3370a810105ca5fad

I live in Houston and originally my plan was to go with Dr. Newaz of course, but now Houston has an in city FME provider. It's also much cheaper to go to as well compared to Newaz's clinic and will just be easier for me overall. Do you think it's a good idea to stay local with a potentially less experienced provider, or should I stick to my original plan? Thanks.

For those of you that use an ASV with a flow limitation algorithm: I am curious to know how much your pressure changes in different sleep stages and does this pressure also increase as the night progresses?

I have just got my report back from the DISE I had last week. Here are some excerpts.

I have multilevel obstruction of grade III Croft Pringle classification, significant collapse of the oropharynx with the tonsils almost meeting in the mid-line and palatal vibration was seen too. My tongue base was pushing the epiglottis back towards the larynx. Jaw thrust did have some improvement but this was rather difficult to sustain.

My Dr wants to do a tonsillectomy and radiofrequency ablation of the uvula, tongue base, soft palate and potentially turbinates.

My preferred treatment would be jaw surgery and/or expansion but I need some immediate relief now, NHS jaw/expansion options could take over 18 months. Has anyone had success with soft tissue surgery in the view of getting jaw/expansion treatment later?

I have mild/moderate sleep apnea, with almost complete tongue base collapse onto epiglottis + partial intermittent soft palate collapse with snoring seen during sleep endoscopy.

Full CBCT playthrough:
https://youtu.be/5WrhYvWUqUo

CBCT Screenshots:
https://imgur.com/a/i1bllro

https://preview.redd.it/qkybxz5xwx1h1.png?width=1996&format=png&auto=webp&s=b8549db0ab5ce2f55f325fdc9cc6252f5bb49654

https://preview.redd.it/es9zc26xwx1h1.png?width=1994&format=png&auto=webp&s=a2662f4adeb9403dd41630c7aceec45bf4d6bfc4

Basically the title. I have frequently been trying to help others for over 10 years as I consider myself partially improved by a few things (not cured, but some things helped me in that time).

I just find the amount of nasty and sarcastic people in these UARS groups (FB, here, others) to make me never want to share a cure if/once I figure it out.

I get it. We sleep bad. So do I. I don't need to be nasty though just because I am fatigued or suffer.

It seems even a kind comment trying to help someone with my experience gets met with sarcasm or nasty replies about "Obviously I did that already" or "you're just saying what my doctor said" or "you think I never tried that?" Or "you're making this about my weight and minimizing my sleep issue like doctors do, what's your issue???" when someone talks about being super obese and I kindly and sensitively share my story of gaining 25 pounds and that screwing up my sleep leading to me being riddled with anxiety and bedbound, in an effort to help them realise that weight can definitely worsen sleep (because many people genuinely do not know or consider it) and might be the key to their issue getting so much worse in the first place.

Because all this time I have just wanted to help myself and everyone else get out of sleep disordered breathing hell.

I just get nasty sarcastic replies so often I actually quit posting here and FB until today, when I came to check something and I shared an experience for the first time in a year and got another nasty reply in minutes.

So honestly...think before you write. I have seen so many people asking for success stories, and I have known a few people who also refused to share their success here. I used to think they were being extreme until I saw how people act towards me. Your attitude and need to get offended or mad over everything could impact your future and your health and life if someone figures out something that works and doesn't come back to tell you about it, because I certainly won't. What if that person you snapped at today, finds a solution that also could've helped you and doesn't come back to ever share it?

https://preview.redd.it/9wn3js9w2q1h1.png?width=1740&format=png&auto=webp&s=d20ece8c8f74c6577fa03a0dc52dcb4af63a1e5e

https://preview.redd.it/ftfoxxdx2q1h1.png?width=1724&format=png&auto=webp&s=91b7917d48758875e8aa11c5b71977f0727c9207

https://imgur.com/a/Mo5NaMB

I could use some validation from the community on whether this is worth looking into further or not.

I went to a private orthodontist in my country, one of the few who deals with expansions like marpe and all that. He looked at my palate and felt the teeth, and said that 4mm is the most I'll get out of MARPE, before it causes bite problems.

He recommended SARPE instead. Does this sound about right? I haven't done a CBCT scan yet, but can they generally estimate how much room you have for expansion without the scans?

28M

(Male-21) If i have insomnia what is the best type of medication i can use Long term for like a year or two years Max? The reason im asking is cuz i stand in situation where I live at Home and i have to work to get Money for my DJS(and MARPE) for my UARS but the vocational Education in thinking about I have to sake up at 6am for it every morning. I also live at Home so i can save all the Money up i earn from the vocational Education. But yeah I feel like my life stands by right now cuz it would be a bad idea to start on the Education now before I have found insomnia meds that work for me. Hope someone can help me cuz im mad depressed over this. Anyways have a good day and sry if my writing is really bad.

Hi all,

I am currently 6 months post-op from MMA/DJS + genio. For the first time in 6–7 years of battling UARS, I’m actually waking up some mornings feeling refreshed and energized — a very foreign feeling for me. It’s not every morning, but generally, if I’m able to get my sinus congestion under control, my sleep quality is pretty good.

Overall, I would say my symptoms have improved by roughly 70%. I went from being a complete vegetable to being fairly functional in life again. I’m hoping that as I continue to heal and the inflammation/congestion improves, the results will become more consistent.

I had a 9.5 mm upper/lower advancement with a 5 mm genio. Before surgery, my sleep test showed:

• Non-REM RDI: 10, AHI: 4
• REM RDI: 26, AHI: 9

Things I tried before surgery:

• Extensive sinus surgery to remove large cysts and polyps, along with septoplasty, turbinate reduction, and FESS. This significantly improved my nasal breathing but probably only improved my UARS symptoms by around 20%. I had this done almost a year prior to MMA.
• CPAP — this worked decently for several years. I never woke up feeling refreshed, but it at least kept me functional.
• Custom MAD — this actually worked great for about 8 months. I had full remission of symptoms, but I developed severe TMJ issues and had to discontinue treatment.
• ExciteOSA — this improved symptoms somewhat, but in my opinion, it wasn’t worth the price. I would recommend myofunctional therapy or other cheaper tongue-training options instead.
• Positional therapy — helped to some extent, but I struggled to find a comfortable way to consistently apply it.
• Cognitive Behavioral Therapy — this actually helped a lot, and I would recommend it.

What has changed 6 months post-MMA:

• Waking up feeling refreshed some mornings
• Overall better energy levels — I’m able to spend time with friends and family without feeling crippling fatigue 24/7
• Better sex drive
• Improvements in depression and anxiety
• Less brain fog and better cognitive function

Recommendations:

• Nasal breathing is incredibly important and needs to be addressed, either through expansion and/or sinus work. The nights I sleep well now are usually the nights when my congestion is minimal.
• Get as many opinions from OMFS surgeons, orthodontists, ENTs, and sleep doctors as possible. Had I not done this, I could have easily gone down the wrong path with surgery or treatment. Every doctor will try to sell you a procedure or treatment, whether or not you actually need it.
• If you end up having MMA, make sure you prepare thoroughly. Have your meals and medical equipment ready beforehand, and have family or friends available to help during the first few weeks. Recovery is no joke.
• Don’t give up. Getting relief from UARS takes a massive amount of resilience, both physically and mentally.