Alaxo Hybrid Stent with CPAP - Therapy Thread

[G. Szabo]

 I start this thread to help those in similar situations and obtain suggestions for improvements.

Preamble 
Result of the sleep study without CPAP (no stent): Apnea index 8.4, AHI Index 10.8. Oxygen saturation nadir 89%. 70% of the sleep was in a supine position. 
Result of the sleep study with CPAP (no stent): The CPAP titration with a full face mask showed that the optimal level of CPAP was 12 cm H2O with 95% oxygen saturation and AHI =0. 
Conclusion: Mild Obstructive Sleep Apnea. 
My experience without stent: After the initial success, the AHI gradually increased and reached 5-8 over several years, even when introducing an Auto CPAP allowing its maximum pressure setting.   
Current Achievements without stent: 
Enforcing side sleep with a homemade device that makes supine sleep impossible  
Switching to Philips DreamWear nasal-cushion combined with full face mask to support side sleep, also using a CPAP pillow 
Using mouth tape and cervical collar
Start pressure 4 cm
Min pressure 6 cm
Max pressure 12 cm H2O
Full time EPR 3 
With the above alterations, the AHI went below 1. Also, the instrument reported pressure decreased from 14 to 9-10 cm H2O.        
Nevertheless, OSCAR indicated palatal prolapses for multiple periods during the night for 1-30 minutes. 
My objectives: Reducing further the treatment pressure with the Alaxo Hybrid Stent because PAP causes or worsens glaucoma.

I will thank and appreciate suggestions from experts during my journey

[G. Szabo]

Alaxo Hybrid Stent, 4.9" long:
This short stent cannot support the tongue base but can mitigate palatal prolapse. Nota bene, the 6" stent supports the tongue base and mitigates palatal prolapse, too, but it is not available. However, this short stent can be easily incorporated into a nasal mask. 
Experience: 
It took about two to three weeks to be able to insert the envelop tube fully. I tried and rejected a Novocaine nose spray because you want to feel where to insert the tube. But a salt-containing nose spray was helpful in lubrication. You should find a path where the movement of the tube is not painful, although it is highly annoying. It caused tears and mucus production, which decreased over several weeks. 
It took another three weeks to deploy and tolerate the stent over 5-7 hours of sleep. The stent causes pain when I swallow. Initially, the pain was persistent during the daytime, too.
Hence, I could not sleep well during the first few nights, but the pressure was surprisingly low (probably because of no REM sleep). However, when I tolerated the stent better, the pressure and the appearance of REM periods increased. 
On the positive side, the palatal prolapses disappeared.
On the negative side, the pressure was not noticeably reduced. 
I will upload some OSCAR charts to illustrate inhalation resistance (I guess).

[CPAPfriend]

Just curious what literature you're citing when you say PAP causes / worsens glaucoma. I'm interested.

I made a post recently asking for personal experiences with the alaxo stents, because I intend to make a video about them, so I'll add this to the information I'll use. Do you intend to keep using them? Do you recommend them? Anything else you can share?

[G. Szabo]

Just curious what literature you're citing when you say PAP causes / worsens glaucoma. I'm interested.

Any optometrist can confirm that sleep apnea is one of the risk factors for glaucoma. You can also see it in the following paper: Oman J Ophthalmol. 2016 Sep-Dec; 9(3): 125–134. Glaucoma and its association with obstructive sleep apnea: A narrative review. They conclude: "Obstructive sleep apnea (OSA) is one of the systemic risk factors for glaucoma ...". Quite a few papers have the same conclusion.

Now, let us consider the way such risk factors are established. These are based on statistical correlations over large databases of patients. Hence, they must have found a positive correlation between OSA and Glaucoma. But correlation is not causation. Because OSA is mainly treated with CPAP, you also must have a positive correlation between glaucoma and CPAP treatment. The only way to positively verify the CPAP vs. glaucoma issue is to organize a clinical trial in which the OSA patients with glaucoma are divided into a first (control) group with no CPAP treatment and a second group in which CPAP treatment is provided. Then, we compare the progression of glaucoma in the two groups. Because the glaucoma progression is slow, this trial would take years. However, it is unethical not to treat the control group with CPAP for years. Hence, we will not know the precise answer for a long time.  

However, the primary medication for glaucoma patients is intraocular pressure (IOP) reducing drugs. Now, you can consider the fact that CPAP treatment increases IOP. See, for instance, in the following paper:  Continuous Positive Airway Pressure Therapy Is Associated with an Increase in Intraocular Pressure in Obstructive Sleep Apnea. Stefan Kiekens; Veva De Groot; Tanja Coeckelbergh; Marie-José Tassignon ; Paul van de Heyning; Wilfried De Backer; Johan Verbraecken. Investigative Ophthalmology & Visual Science March 2008, Vol.49, 934-940. doi:https://doi.org/10.1167/iovs.06-1418 .

Therefore, the conclusion is unavoidable. If you use CPAP and are lucky enough to have a long lifespan, you will develop glaucoma.  

See also the "CPAP & INTRAOCULAR PRESSURE - CONSENSUS OF OPINION" posted on the Main Apnea Board forum.

[G. Szabo]

 Do you intend to keep using them? Do you recommend them? Anything else you can share?

I am not interested in posting it on social media. You can use them if you remove all my personal info, i.e., my user ID, country, email, etc. I will eventually disclose my additional experience/observations in this Therapy Thread.

[G. Szabo]

  CPAP STENT001.pdf (Size: 209.65 KB / Downloads: 16)
  CPAP STENT003.pdf (Size: 136.01 KB / Downloads: 12)
  CPAP STENT002.pdf (Size: 125.8 KB / Downloads: 10)

Hi experts, 

I request some help to improve my treatment because I still have daytime sleepiness and fall asleep while sitting. 
I put my finger on some issues I cannot figure out myself.
(i) Should I be concerned about my high (0.9) I:E ratio?
(ii) Can I do something to change the sharp V-shaped expiration pattern to a more sinusoidal one? Or should I ignore it? 
(iii) Most importantly, I need clarification on why the instrument increased treatment pressure. Initially, I thought that it addressed the inspiratory limitation. However, you can see that the inspiration volume has a similar plateau at low and high pressures. So, what triggers the pressure increase? 

The attached OSCAR plots result from a single night. The first session is with the stent. You can ignore the second session because I could not sleep due to the high mucus production. The third session is without the stent.  

Further details:
Enforced strict side sleep.  
Philips DreamWear nasal-cushion combined with a full face mask.
Using a CPAP pillow, mouth tape, and cervical collar.
Start pressure 4 cm
Min pressure 6 cm
Max pressure 12 cm H2O
Full time EPR 3    

I would appreciate your comments.  
Document 001: whole night
Document 002: the initial low-pressure flow rate at 0:42 (first session with stent) 
Document 003: high-pressure flow rate at 2:02 (first session with stent)
Document 004: low-pressure flow rate at 2:32 (first session with stent) 
Document 005: 7:45 (second session without stent)

[G. Szabo]

  CPAP STENT005.pdf (Size: 123.5 KB / Downloads: 13)
  CPAP STENT004.pdf (Size: 129.57 KB / Downloads: 12)

[G. Szabo]

Correction: Document 005 belongs to the third session.

[G. Szabo]

Progress report:

I need to insert the stent entirely to ensure the elimination of palatal prolapse. It means that I cannot even see its tip in my nose. If I move it out with about five to ten mm, the characteristic exhalation flow limit (see the previously uploaded 005 document) reappears. Hence, this shorter hybrid stent might not do the trick if you have a large head. 

I am still annoyed with the pain, and I woke up because of the increased mucus production. However, I can insert the stent within about two minutes now. 

Those with a nickel allergy might have some difficulties because the stent is a nickel composite.
 
As for the cleaning solution:  When you buy it from Alaxo, it costs about CN$ 27.0/100 ml. But you can buy a "wound irrigation solution" on Amazon.ca that has the same additives and boils down to CN$ 14.0/100 ml. It is sold in a 350 ml container for CN$ 50.0. The policy of this forum prevents me from disclosing its brand name, but I can send it to you in a private message if you need it.

[BKeeper]

CPAPfriend,

Like, G.Szabo, I am not interested in you posting my comments on social media. As he has stated, you can use my comments if you remove all my personal info, i.e., my user ID, country, email, etc.

That said, I wish you the best in your test of the Alaxo stents. The stent was a total game-changer for me and I wish the company the best.