Does this look like palatal prolapse?

[Unkikonki]

For a long time, I've suspected that my soft palate is the main cause of my sleep apnea. After contracting Covid for the first time and experiencing a worsening of symptoms to the point where I couldn't even fall asleep a couple of months ago, my suspicions have grown stronger.

Recently, I read about palatal prolapse, also known as Expiratory Palatal Obstruction (EPO), Expiratory Retrograde Palatal Prolapse, or Retropalatal Airway Closure. I suspect this condition might be affecting me.

Would anyone here be able to help determine if this is the case by reviewing my Oscar data?

The Flow Rate looks very similar to the examples of Palatal Prolapse seen in sites like Palatal Prolapse: diagnosis & treatment and Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnoea | European Respiratory Society

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Below is a data sample from last night, during which I used two different settings:

SETTING A: From the beginning until 6:40 am.

Mode: ASV Auto
EPAP MIN: 11.0
EPAP MAX: 12.0
PS MIN: 3.0
PS MAX: 8.0

SETTING B: From 6.40 am onwards.

Mode: CPAP
Pressure: 11.0

The reason I switched from ASV to CPAP mode is that ASV makes it impossible for me to sleep once I reach REM-predominant sleep, as it causes 'chipmunk cheeks.' I suspect this might be due to my soft palate not allowing enough airflow through the nasopharynx, forcing the air back into my mouth.

Yes, I’m already using a chin strap (Knightsbridge Dual Band) and a soft cervical collar. However, keeping my mouth shut and chin in place hasn’t solved the issue.

Notes: I’m fully aware of the difference in AHI between the two modes. Most events while using CPAP are central apneas, which is exactly why I switched to ASV in the first place. I am not sure why OSCAR is classifying them as "Unidentified Apneas" since there clear is no flow limitation during these events.

FULL NIGHT

ASV - Deep Sleep (Normally no events during this sleep stage)

ASV - Minutes before waking up. Possibly REM

CPAP - Minutes before event cluster

CPAP - Event Cluster - Central Apneas

[G. Szabo]

I do not belive that you have palatal prolapse.

[Unkikonki]

I do not belive that you have palatal prolapse.

Why not? The flow rate curve clearly flattens at the transition between exhalation and inspiration, especially during REM sleep. When using a nasal pillow, I can hear a whistling sound coming from the upper back of my throat when exhaling—definitely not from my nose. It definitely feels like something is obstructing the airway there.

Does the flow rate look normal to you?

[G. Szabo]

Does the flow rate look normal to you?

I am not a medical doctor, but I can compare it with my case, which is a textbook pattern. 
What you can see is the normal exponential decay at the end of the exhalation period. When you have a PP, the flow abruptly changes to horizontal because the soft plate suddenly closes the airway fully or partially. 

You have some bumps, though, on some of your exhalation curves, which can be frequently seen in many cases. They indicate some flow disturbance but not a fully developed PP.

[Unkikonki]

I am not a medical doctor, but I can compare it with my case, which is a textbook pattern. 
What you can see is the normal exponential decay at the end of the exhalation period. When you have a PP, the flow abruptly changes to horizontal because the soft plate suddenly closes the airway fully or partially. 

You have some bumps, though, on some of your exhalation curves, which can be frequently seen in many cases. They indicate some flow disturbance but not a fully developed PP.

Right, I understand. So probably not PP, but the soft palate could still be involved in obstructing the airway. It really feels like it to me.

Btw, what have you done to address your issue? Just ASV? Have you considered surgical options?

[Crimson Nape]

Unkikonki - I never saw where you state your normal or predominant sleeping position. Are you avoiding sleeping on your back?
- Red

[Unkikonki]

Unkikonki - I never saw where you state your normal or predominant sleeping position.  Are you avoiding sleeping on your back?
- Red

Yes, I sleep on my left side at all times. It is impossible for me to sleep on my back, I get awaken right away.

[G. Szabo]

Yes, I sleep on my left side at all times. It is impossible for me to sleep on my back, I get awaken right away.

Sleeping on your back is the worst position for PP.  

[G. Szabo]

Btw, what have you done to address your issue? Just ASV? Have you considered surgical options?

I do want want a surgery because sometimes makes the situation worse. 
Instead, I used nasal stent and positional therapy: 
Alaxo Hybrid Stent with CPAP - Therapy Thread ( 1 2 3 4 )
Palatal prolapse mitigated with positional therapy.

[Unkikonki]

I do want want a surgery because sometimes makes the situation worse. 
Instead, I used nasal stent and positional therapy: 
Alaxo Hybrid Stent with CPAP - Therapy Thread ( 1 2 3 4 )
Palatal prolapse mitigated with positional therapy.

Thanks, I'll make sure to go through your journal to learn more about Alaxo Stent; it may be worth trying before considering surgery.

I am aware UPPP or modified UPPP is highly ineffective, even if performed on the right person. What about other options such as Expansion Pharyngoplasty? Are there no effective surgeries for soft-palate-based sleep apnea? I've made appointments with 3 different ENTs to start exploring surgical options because I'm sick of how unreliable and inconsistent CPAP/ASV therapy is.