Alaxo Hybrid Stent with CPAP - Therapy Thread

[BKeeper]

G.Szabo, 
I can not offer comments on your Oscar charts other than to say that I do see the palatial prolapse evidence in the flow pattern.

I am surprised that you have to insert the stent so far to be able to prop open your soft palate. What do you see in the mirror when the stent is fully inserted?

For me, titrating CPAP pressures using the stent was confusing. If my pressures were too high, my apnea events increased, and at some point would go cyclic. It appeared to me the same as when my pressures were too low without the stent, except that I did not have the palatial prolapse pattern. If I set a wide range of CPAP pressure, the machine would raise to the higher limit. I eventually narrowed my pressure range to only 1 and turned off EPR, and then worked my way down in pressure. Even then, it was confusing because it took a while for my system to relax into the new setting, and for the apnea event frequency to drop. I am now running my machine at a fixed CPAP pressure, and EPR on 1 to reduce flow limits a bit. Gratefully for me, sleep is now usually blissful.

So my only suggestion would be to test a narrower and lower range of pressure. 

Hopefully the scratchy throat will subside. I frankly do not remember how long the scratchy throat lasted with me. I had started with the nasal stents, so by the time I got to the soft palate stent, my nasal passages were "broken in".

[G. Szabo]

Thank you, BKeeper, for sharing your experience.

Your story and titration are fascinating, and I am happy that you can run your instrument at such low pressure, which is my primary goal. But I am not there yet. Like you, I tried to set the minimum pressure to 4, but it made no difference because Auto quickly raised it to over 6. And its maximum goes to 11 because of the inspiratory flow limit (see below); hence I am not ready to limit the max pressure yet.  

As for your question about the insertion depth of the stent,  When I insert it fully, i.e., when its brass tip is almost not visible, I can see its other end in the mirror. About 2-3 mm visible. Hence, I need to insert it deeply, even though it hurts more.

I figured that a high moisture setting on the device somewhat mitigates mucus production. Nevertheless, I need to get up after 4 hours of sleep to clean it up (because it is suffocating) and reinsert the stent. I trust it will be more tolerable in time.    

I concluded From the OSCAR charts that I have inspiratory and expiratory flow limitations. The stent took care of the latter, and I am trying to deal with the inspiratory limit, which is probably caused by my tongue. Currently, I am experimenting with different cervical collars, a nasal mask (instead of full-face ones), and a tongue retaining device. I will post the outcomes here.

I posted about my homemade device, which significantly dropped my AHI. See the  "Side sleep enforcer for positional apnea."

[BKeeper]

G.Szabo, sounds like you have done an admirable deep dive into using the Alaxo stent. I understand from your view in the mirror that you are propping open your soft palate, but with very little help on your tongue. I offer the following as possible insight, but in no way intending to discount your work and observations.

I'll clarify that I did not just drop my CPAP pressure to 4. I started at about 12, as I remember, and very slowly worked my way down, since I had no idea where the bottom was. I had fairly high flow limitations which confounded things. I assume that for this reason, the machine would rise fairly quickly to the top of my APAP pressure range. I was quite confused and frustrated. So I figured I had little to lose, and narrowed my APAP range to about 1 and set EPR to 0, and then slowly worked my way down in pressures. It took a while to get better results. And with less than optimal sleep while doing this experimenting.

All of which to say, even with flow limitations, you might be able to run at a lower pressure since you have at least eliminated the trap-door operation of your soft palate with the stent.

I hope you can home in an a good solution for you. I'll be interested in how it goes.

[CPAPfriend]

G. Szabo

I think the evidence to support the hypothesis is strong, but I wouldn't say it's a certainty as you put it. Let's take what you said / showed supporting evidence for:

OSA is risk factor for glaucoma
OSA is treated often with CPAP
Assumption, CPAP use is also a risk factor for glaucoma
CPAP increases IOP
Glaucoma treated with IOP-reducing drugs

put differently,

If OSA, then glaucoma.
If CPAP, then IOP.
If glaucoma, then -IOP drugs.

Assumption: If OSA, then CPAP.
Assumption: If CPAP, then glaucoma.

It's a strong case, and I appreciate the strength of it, but I don't think it's absolute. Assumptions are required and confounding variables are ignored. For example, threshold of pressure, pressure-to-obstruction ratio threshold, other comorbities that correlate with both OSA and CPAP usage (which there are many). What other causes are there of IOP?

I won't include any personal identifiers if I decide to use any of your guys' information, no worries.

G. Szabo
you have some peaks in the top of your waveforms. I:E should be 1:2, normally. I'm not sure what you're asking with iii. Pressure increases on the airsense autoset are driven by snoring, flow limitation, or obstuctive events. The machine will evaluate which of these is responsible and the respond with the lowest appropriate pressure increase. You can really observe that palatal prolapse without the stent.

Just a random thought, and not sure what the medical considerations are here, but in the context of the details you share, I wonder if using OTC nasal steroids to dry the nose would help at all.

[G. Szabo]

Thank you, CPAPfriend, for your comments on CPAP vs. glaucoma.

I agree with the outcome of your formal logic analyses. You are correct that my conclusion was not based on undebatable evidence like some clinical trials, which would be unethical, as I explained. Therefore, I wrote, " Hence, we will not know the precise answer for a long time. " Nevertheless, caution is strongly recommended.

Let me illuminate this with an example. A long list of chemicals, including food additives, is classified as suspected human carcinogens. This means we have some evidence, mostly on animals, which led to this classification. Here comes the question: Would you welcome such additives in your family's food until 100% of the evidence is presented?

As for glaucoma. There are several types. The most common is the high-tension one. In this case, high eye pressure (IOP) causes the deterioration of the optic nerve. However, it is not based on 100% undisputable evidence because nobody increased the IOP intentionally to test this hypothesis. But this is the explanation most doctors accept. They even suggest not bending and/or elevating the top of your bed to avoid increased IOP. Based on this explanation, IOP-reducing eye drop is prescribed. If it is not effectively reducing the IOP, then IOP-reducing surgeries are performed. The clinical outcome of these two interventions is the reduced progression of glaucoma.

Do you consider the current practice reasonable? Someone applies IOP-reducing eye drops every evening, puts the CPAP mask on and goes to sleep knowing that it will increase the eye pressure.

Therefore, consider my warning carefully and responsibly until we have solid proof, which is rare in medical sciences.

Thank you for your suggestions about my treatment. I will address them in a separate message.

I genuinely appreciate your feedback and thoughts.
IP Address: Logged

[Crimson Nape]

G. Szabo - Your post used a white color font, thus making it unreadable. Please do not use a formatting editor to create your posts. Only use a plain text editor if you don't use the built-in editors here on the board.

- Red

[G. Szabo]

 Only use a plain text editor if you don't use the built-in editors here on the board.

- Red

Thanks for the warning. I will repost my message.

[G. Szabo]

I will repost my message.

Thank you, CPAPfriend, for your comments on CPAP vs. glaucoma.

I agree with the outcome of your formal logic analyses. You are correct that my conclusion was not based on undebatable evidence like some clinical trials, which would be unethical, as I explained. Therefore, I wrote, " Hence, we will not know the precise answer for a long time. " Nevertheless, caution is strongly recommended.

Let me illuminate this with an example. A long list of chemicals, including food additives, is classified as suspected human carcinogens. This means we have some evidence, mostly on animals, which led to this classification. Here comes the question: Would you welcome such additives in your family's food until 100% of the evidence is presented?

There are several types of glaucoma. The most common is the high-tension one. In this case, high eye pressure (IOP) causes the deterioration of the optic nerve. However, it is not based on 100% undisputable evidence because nobody increased the IOP intentionally to test this hypothesis. But this is the explanation most doctors accept. They even suggest not bending and/or elevating the top of your bed to avoid increased IOP. Based on this explanation, IOP-reducing eye drops are prescribed. If it is not effectively reducing the IOP, then IOP-reducing surgeries are performed. The clinical outcome of these two interventions is the reduced progression of glaucoma.

Do you consider the current practice reasonable? Someone applies IOP-reducing eye drops every evening, puts the CPAP mask on and goes to sleep, knowing that it will increase the eye pressure.

Therefore, consider my warning carefully and responsibly until we have solid proof, which is rare in medical sciences.

Thank you for your suggestions about my treatment. I will address them in a separate message.

I genuinely appreciate your feedback and thoughts.

[CPAPfriend]

We're on the same page. My reservation was simply with what I perceive as a strong statement "Therefore, the conclusion is unavoidable. If you use CPAP and are lucky enough to have a long lifespan, you will develop glaucoma."

Such a statement could drive a patient away from the therapy that they would otherwise benefit from.

"A long list of chemicals, including food additives, is classified as suspected human carcinogens. This means we have some evidence, mostly on animals, which led to this classification. Here comes the question: Would you welcome such additives in your family's food until 100% of the evidence is presented?"

There's nuance. A fairer question would be, "would you welcome CPAP for your family members who suffer from OSA given such glaucoma evidence?". If the decision is food with additives versus no food at all, that's different from food with additives versus food without.

I'm not trivializing the associations you're highlighting between these variables, but just contesting your statement above. The relationship between PAP and glaucoma is a good discussion / potential consequence that's worth consideration.

[G. Szabo]

Indeed, we are on the same page, CPAPfriend. Every treatment has side effects, and you decide which one you are comfortable with:  having a good sleep and reducing the risk of dementia, high blood pressure, diabetes, among other things, or increaseing the risk of vision loss.     

Therefore, my objective remains the same: I want to reduce the CPAP pressure as much as I can. Especially in light of the post of MrIvanDrago , "High Pressures - Inflammation of the CV system?"   

Thanks for your considerations