By the way, I proposed the most recent two research topics currently at the top of the "Research" page of this website. Please take a look and consider voting for my proposed research topics. Thanks!
I have not excluded hyper-arousal with any test, I just meant to say that I do not feel hyper-aroused. I do not experience any sensations like muscle tension or a "running mind" when I am awake at night. I feel comfortable, relaxed, and tired. But for me, strong enough sleepiness to put me to sleep seems to come and go in waves, so sometimes I just don't have it during the night when I need it. Then a strong wave of sleepiness will sometimes come over me during the day when it is not wanted. I am considering getting cognitive behavioral therapy for insomnia (CBT-I), but I wanted to make some progress on treating my sleep apnea first because doing CBT-I with untreated sleep apnea seems like it would feel like torture.
My sleep study does not report flattening or flow limitation, just apneas, hyponeas, and RERAs. Sorry I can't help with that.
It is very good news that Stanford is willing to consider you case remotely! Hopefully they will be able to provide you with helpful guidance.
It does seem that our experiences have a lot of similarities, but there is one thing that is very different between them. In my case, I am having a lot of insomnia. On a typical night I wake up spontaneously in the middle of the night and remain awake for several hours before I can fall back to sleep. It does not feel like I am hyper-aroused; it just feels like my sleep drive is too week. My sleep doctor thinks that my OSA/UARS may be causing my insomnia, as this can sometimes happen in UARS cases, and there is no other likely cause to explain why I have insomnia. So, in my case, I don't have a really large number of respiratory events, but they do seem to cause me a lot of sleep loss because of my inability to fall back to sleep quickly. In your case it sounds like you have a lot more arousals, but you fall back to sleep very quickly after each one, so your problem is sleep fragmentation, not insomnia. In my case, it is not yet clear whether my fatigue and cognitive symptoms are primarily caused by OSA/UARS or by insomnia. If I succeed at correcting my breathing with CPAP and my symptoms go away, then that would make it clear that my primary problem was OSA/UARS.
If you suspect enlarged nasal turbinates, I would suggest seeking a consultation with an ear, nose, and throat doctor to get confirmation of this. If it is true that you have enlarged nasal turbinates, then you could ask the doctor whether radio-frequency ablation of the turbinates would be right for you. This procedure reduces the size of the turbinates and is not very invasive. Also, have you tried any product like Breath Right Nasal Strips or Max-Air Nose Cones to hold the nostrils wider open?
I am a patient recently diagnosed with UARS. My symptoms include insomnia, fatigue, and cognitive impairments (slow processing speed and reaction time, poor memory and concentration). I also occasionally have waves of sleepiness. I have had these symptoms for about 25 years (since adolescence) and, like you, my career, and other important parts of my life, have been substantially hampered by this situation. The first time I had a sleep study done, my AHI was 3 and so I was not diagnosed with sleep apnea. I recently had a second sleep study done at Stanford with esophageal manometry and my AHI including RERAs was 11, so I received a diagnosis of obstructive sleep apnea (the UARS type), which is thought to be due to a little bit of maxillary deficiency in my case. I am currently in the process of learning to use CPAP. I have not yet gained relief from my symptoms, but I am hopeful that I will once I have figured out how to get the CPAP adjusted right and the mask comfortable. I am also receiving myofunctional therapy, but the expected benefits of this are limited because of my age in mid-adulthood.
As for the question of whether insomnia or daytime sleepiness is necessary to suspect UARS, I am not sure. It does seem unusual for UARS to present without either of these symptoms. But the 40 EEG arousals per hour that were detected in your sleep study suggest that your sleep is very fragmented. To me it seems quite plausible that this sleep fragmentation could be the cause of your cognitive symptoms.
Also, have you tried posting a note about your situation on the sleep apnea forum at cpaptalk.com? That forum is more active than this one, and there are a number of users on that forum who are familiar with UARS. It might be a good place to gather ideas.
Also, even without a definitive diagnosis of UARS, you could talk to an ear, nose, and throat doctor about the cause of your breathing problems and snoring. If there is a way of correcting your breathing, it is always possible that it will also help relieve your sleep fragmentation and cognitive symptoms.
