Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
I’m now 8 years into CPAP use. Mid-70s male; 5’6” 155#; Mallompati score of 4. Pretty healthy for my age. For most of my life I was a belly-sleeper and would exhale through my mouth while sleeping. About 20 yrs ago, hip and shoulder issues prompted me to sleep on my back. Thus, sleep apnea became apparent. I held off on a sleep study for some time, but finally gave in and found I had moderate sleep apnea, needing a CPAP pressure of ~16 to treat.
I was fortunate to have a DME provider who suggested the P-10 nasal mask even though I am a mouth breather at night. I had good early results, but within a few months I started exhaling through my mouth, deteriorating the results. It was obvious from my early treatment results that treating my sleep apnea was crucial to my health, so I dug in. A friend told me about Sleepyhead software, and I found this forum. I struggled with finding a mask that worked. I could find no full-face mask that really worked. And boy, did I have leaks! I found I had to mouth tape very securely to keep from blowing air out my mouth on exhale.
It has seemed through much of my CPAP treatment that I was on the upper end of tolerable pressures for me. I was at the upper end of where I could tape well enough to keep leaks from causing arousals or deteriorating the therapy. I also felt exposed to some risk by being so thoroughly taped up. And I had some issues with bloating from the higher pressure. I suspected early on that palatial prolapse might be an issue for me since I had such issues with taping to prevent mouth exhales.
I caught wind of Alaxo before it was approved for use in the US and inquired as to traveling to Europe to purchase. I was discouraged from doing so for several reasons. When approved in the US, I purchased the 6” Alaxo Stent in March of 2020. I was frustrated at this point in that I could not figure a way to titrate cpap pressures with my P-10 mask and the stent. Titrating with the FF masks that I could tolerate just did not seem to work.
Then I saw mention of the Bleep mask. This seemed a potential solution to leak issues, plus possibly a way to titrate the AlaxoStent. I was in the process of adapting to the Bleep when I saw SleepyCPAPs threads. His treatment thread showed pressure flow graphs of palatial prolapse which mirrored many of my apnea events. I was quite inspired, and proceeded to slowly titrate CPAP pressures with the Bleep mask and the Alaxo 6” stent.
I found that stenting my soft palate allowed me to drop cpap pressure from 16-18 down to about 11-12. By inserting the stent more deeply – about 20mm lower than my soft palate which is about 10mm below by uvula – I get AHI of 1-3 at pressures of 4-5 cm H2O. This IS a game changer for me! Sleeping seems so much more natural at these lower pressures. I still need to tape, but on the corners of my mouth, with an inch or so open in the middle. Almost zero leaks.
The 2 screenshots below show a good day before the AlaxoStent. The detail shows the flow pattern of palatial prolapse - a sharp downward spike of an exhale. This occurs when the soft palate closes against the back of the throat. SleepyCPAP's threads show this well, and confirmed my suspicions that part of my issues were thusly caused. Note the leaks - even on good days I had a fair amout of leaks from the nasal mask.
The attached overview shows the most recent 2 years. I started using the Bleep mask in Feb '22. Not how leaks drop markedly afterwards. I started using the Alaxo 6" stent in late May '22 and slowly titrated down. Note the marked decrease in necessary pressures.
The attached screenshots are of 22 April 2023 at a pressure of 6.0-6.4 cm H2O. This was a point early in my pressure titrations. I ended up running at 6.0-6.8 for most of the period 7 August 22 - 15 April 2023. An area of concern for me at lower pressures is a sort of "surging" pressure pattern, shown on the detail here.
I've recently titrated down to 4.0 pressure. The results are comparable, though there are more and deeper flow limits, and the "surging" flow pattern I see sometimes are more pronounced. The attached screenshots show my last night's results. I still feel rested, though I feel just a bit better at pressures between 5 and 6. I am considering a home sleep test both with and without CPAP. I would love to camp and travel without the CPAP.
The AlaxoStent and Bleep have truly been game changers for me. And I am quite thankful for this forum; for SleepyCPAP in particular; for Sleepyhead and then OSCAR software; and for many, many tips and ideas I have gleaned from the members of this community.
I'm curious as to comments re the "surging" flow patterns I see roughly at pressures below 6.0.
Thanks for posting this! With the bleep mask, do you use the bleep tape around the nostrils to hold the stent in place or do you put the bleep nostril tape on then insert the stent then use other tape for the stent. I'm not sure how that works. Can you provide more details on that. Thanks again!
Because I had to tape so thoroughly before the Alaxo stent, and because I have old skin, I have a favorite tape. 3M Micropore S tape. It’s blue, and I buy it by the 12-pack.
So I apply the Bleep dreamport over the tail of the Alaxo stent. Then I apply a strip of the Micropore tape such that it covers a bit of the Bleep port, and continues on to cover the stent, including the end piece. I seldom get leaks around the Bleep port using this method. I also apply small pieces of tape on the corners of my mouth, since I still want to exhale through my mouth - even with a chinstrap.
The blue Micropore tape feels like it holds the “tail” of the stent securely. This gives me comfort, in that it makes me a bit nervous sleeping with the stent inserted so far into my throat.
Thanks for the information. I'm starting to realize that the stent I've been putting in isn't going back far enough so I tried to get it to the back of the throat so that I can just see it in the mirror when I open my mouth. No matter how hard I tried, I can't get it to curve down to the throat to the correct position. I get it as far back in the sinus horizontally but it seems blocked from curving down. Have you ever heard of this? Did you have any issues getting the stent further down so that it's more effective? I think it's back further than before but there's still at least 3" inches coming out of the nostril. Anyway I am small boned and have a small face but not sure if the insertion tube diameter is too large to go back far enough? I'm hoping to get this to work for me. It feels like it ends at the back of the roof of my mouth.
I do sometimes hit the back of my throat. Occasionally that is because I’m in the upper turbinate and I back out and try a bit lower. But most times I can tip my head back a bit and the insertion tube then slides on down my throat. Occasionally I have to both tip my head back, and sort or raise the tube up a bit in front of my face and then it slides down.
Practically, if the tube won’t slide down after a couple of tries, I go to the other nostril. I’ve always been successful this way.
I can tell that my nasal passages sometimes get irritated and swollen and I have more difficulty inserting the stent.
Please keep the questions coming - I want you to be successful :-). SleepyCPAP should also be an excellent resource.
Thank you so much for all of your help. I am hoping to get the kind of results you both have been getting. I'm not giving up yet; maybe it was in the upper turbinate. I haven't had anyone contact me from Alaxo but I hear they are supposed to provide support as well. I may try calling them if I still have difficulty. I really appreciate your willingness to provide support .
The night before last, I tried it with my CPAP machine using a dreamwear nasal pillow mask with a slit (instead of the nasal inserts). I taped it a bit but still had some leakage. I think I can do a better job of preventing the leakage. When reviewing the report on OSCAR it still looked like wave patterns consistent with palatal prolapse in some areas so I think correct positioning of the stent will alleviate this.
I provided a screenshot to show the stent with CPAP from the night of 7/3... Obviously the stent was not back far enough to prevent prolapse.
. 