[Diagnosis] BiPAP and MAD not working, please help

[got2bedaniel]

Hi everyone,

Two years ago, I underwent a second septo- and rhinoplasty, and since then, I've been experiencing various sleep-related symptoms (red eyes, impotence, fatigue, headaches, and so on). Recently, I had a DISE, which indicated a 100% blockage of my throat caused by my tongue.

Unfortunately, despite using both my Mandibular Advancement Device (MAD) and BiPAP for a year, they haven't been effective. My symptoms remain the same. 

Could anyone help me interpret my sleep data? I’m trying to determine if this truly appears to be a tongue-based issue or if my nose could also be involved. Or if it is even a breathing-related issue?

Thank you very much.

Best, 
Daniel

[SarcasticDave94]

I myself would not be able to determine what causes your airway blockage.

I do see 2 things you need to change for success. One, your leak rate is high. You need to try getting the mask to seal better, which does not include making the mask tighter. If the mask doesn't keep leaks down with moderate tension, then it's a poor choice for you.

Second, your settings are not ideal. The Min pressure of 4 is too low for adults typically. I'd go to about 6 or 7. Also Max pressure probably needs to go up about 3. Then PS should be raised to about 3.

I'm thinking the pressure was edited down to prevent leaks, and that's the wrong way to fix it. Leaks just need addressed, while using proper therapy settings.

[Jay51]

Here are some tips for mask leaks as well:   Mask Primer             

• Mask leak solutions
  

[got2bedaniel]

Thank you very much for the advice. I seem to have solved most of the leak issue with my current mask, while I wait for a new one. 

However, I still don't feel much better, and I have previously also used these settings for six months, while having a low leak rate, without feeling much better. 

Do you have any idea why this could be?