obstruction in the exhale cycle, a year later

[sleepyzzz]

hello all,

this is an update and request for advice as well.
i have posted before that using a cpap/bilevel did not stop me from continuous arousal at night ( see previous threads) 
i have been to huge number of doctors ( ENTs. sleep specialists, neurologists, pulmonologists  ) they all look at my throat and say it looks normal.
i had 3 sleep endoscopies and depending on the interpretation of the doctor, which one of them was Steven Park, i had a modified UPPP on may 2019, he removed my uvula, part of epiglottis, and did upper expansion of the sphincter.
 
it did not work!

what happens is i still feel something "closing" i call it the "bite" in my throat and as soon as it happens, i get a signal in my brain to wake up, and i find my self awake. sometimes this comes with an involuntary "RERA" or a gasp for air, sometimes i just wake up . sometimes i hear the "bite" sometimes not. 
it happens sometimes when i am drifting to sleep, then after 2-3 hrs at night then increases through the night until it happens like each 30-20 mns in the last hours of sleep. 

in each time there is an arousal and after these arousals i go back to sleep right away, but when i wake up i'm in a zombie state because of the number of arousals i had through the night.

3 months later i tried a MAD device and it did not do anything.

In September 2019 after another sleep endoscopy, i had a partial glossectomy where the doctor removed around 15mm of the base of the tongue.

a month and half later and i'm still having the arousals, the ONLY thing that changed is instead of a "zombie" state through the day i now get a headache in the back of my neck ( it's better than zombie state which was horrible) but i'm still not sleeping ok. 

i audio recorded my breathing at night and i am uploading few recordings here, where i noticed that the obstruction happens in the EXHALE CYCLE. you could hear the "bite" then me gasping for air and arousal. other times you could hear a groaning noise then an arousal. other times just the arousal. 
but it's always in the exhale breath not the inhale breath, then my brain gets the signal to wake up. 

i have read about palate prolapse here in the forum but i do not see the matching flow rate in sleepyhead ( i am posting some nights of SH after the tongue base surgery ) 

the only way i could find out it's an exhale obstruction is from the audio recordings.

i let ALL my doctors hear the audio recordings but hey have no idea what it could be. 
i also checked with laryngologists if i had any vocal cords spasm and they said i don't have none.

i think that something collapse when i am exhaling and as soon as it does i wake right away before the 10 secs of apnea and this is more often in REM cycle.

my initial sleep study before the surgeries was that i had an AHI of 17 in NREM and an AHI of 40 in REM. 

increasing the min EPAP did not resolve it for me, and going over 10PSI start to give me aerophagia and chipmunk cheeks. i use a dreamwear nasal mask and tape my mouth. i also tried dreamwear FFM with pressure of 12-13 and still was having the arousals.

i don't know if changing cycle sensitivity or trigger sensitivity or any of the time of breath would make a difference
i have an aircurve 10 Vauto .

my doctor will do another sleep endoscopy by end of the month but i don;'t have any high hopes. i just need to be able to sleep . 

thanks

link to audio recordings:
https://drive.google.com/drive/folders/1...F2iLVh-vLD


screenshots of sleepyhead different nights before waking up:

[Sleep2Snore]

Listening to you breathing #3 you appear to take a small breath before your throat closer (or appears to) then you appear to clear it by expelling air, then breath again. I noticed the same on another recording, but it was not so clear. The fact you wake up clearing your throat by expelling air may give you the impression it is closing when you breath out, this is in fact when you clear it. Listen carefully yourself. I think you need a bit more pressure when you breath in. But it is hard to tell just on the recordings. There is something creepy about listening to someone breathing, then stopping! It is just a thought, I will wait for others for their opinion.

[Sleeprider]

Did anyone ever discuss "palatal prolapse"? http://www.apneaboard.com/wiki/index.php...l_Prolapse

[sleepyzzz]

Did anyone ever discuss "palatal prolapse"? http://www.apneaboard.com/wiki/index.php...l_Prolapse

This is from my post:

"i have read about palate prolapse here in the forum but i do not see the matching flow rate graph in sleepyhead ( i am posting some nights of SH after the tongue base surgery ) "

[sleepyzzz]

Listening to you breathing #3 you appear to take a small breath before your throat closer (or appears to) then you appear to clear it by expelling air, then breath again.  I noticed the same on another recording, but it was not so clear.  The fact you wake up clearing your throat by expelling air may give you the impression it is closing when you breath out, this is in fact when you clear it.  Listen carefully yourself.  I think you need a bit more pressure when you breath in.  But it is hard to tell just on the recordings.  There is something creepy about listening to someone breathing, then stopping!  It is just a thought, I will wait for others for their opinion.

Thanks for taking the time to listen to the recording. And you are right, they sound creepy even to me !

I heard what you said, I don't know if you heard all of them, but many others you would hear a groaning noise or the clicking (bite) then I wake up immediately.

What I could think of is maybe there is a a collapse or narrowing that happens and as soon as it happens right at the voice box? So airflow is narrowed it make that groaning voice or that clicking noise as a side effect of the actual collapse and then I wake up ?

I am not sure because in other recordings my inhale sounds normal just before the (bite) or groaning noise. 
Also looking at the flow rate graphs, sometimes you see the inhale curve little less sometimes it is normal before there is smaller exhale curve. ( I am looking right before I take of the mask)