I'm using AlaxoStent with PAP therapy to fix Palatal Prolapse

[SleepyCPAP]

My SleepyCPAP treatment thread now shows results of adding the 6" AlaxoStent to my PAP therapy.

The first night the positioning of the stent brought AHI down to 0.3, with just a handful of Palatal Prolapse events (I didn't bother posting snapshots). 
The second night I put the stent down lower, so that it was more visible at the back of my throat, and my AHI was 0.0, and no Palatal Prolapse.

I use a ResMed VAuto and Bleep Mask.  It is tricky to tape down the tip of the stent where it comes out of my nostril, and make the Bleep Dreamport seal, but I did get it to work with KT Tape and patience.

I've started this separate thread in case of questions about the stent.  This is still early stages for me but I'm glad to share my experience.

- SleepyCPAP

[BKeeper]

Very cool. I recently picked up a Bleep setup and was going to self titrate with first the nasal stents and then the longer stent. I’ve tried unsuccessfully to do this with a FFM, but had issues due to my high pressures and perhaps odd face shape. So I will be very curious how this goes for you.

Question - how did you determine your obstructions were at the soft palate?
Also, have you found that with the AlaxoStent, your effective pressure is lower?

Dick

[BKeeper]

Ah, I see your first thread, which I assume will answer my questions. I was just excited to see you were on a similar quest as my latest 
Thanks for posting.
Dick

[SleepyCPAP]

BKeeper asked “Question - how did you determine your obstructions were at the soft palate?
Also, have you found that with the AlaxoStent, your effective pressure is lower?”

I looked at the breath waveforms I was experiencing and found people here talking about Palatal Prolapse.  There wasn’t much question in my mind once I saw what others had figured out, and I figured the AlaxoStent (6”) would work for that.  

But it was months before I could go through the system of asking my doctor, asking a sleep doctor, getting a referral for ENT doctor - and I finally got the company-referred ENT in a virtual visit, which gave me the script to get the stent.  

I am starting to decrease my pressure. See my SleepyCPAP Therapy Thread for more updates.  I’m guessing this will go smoothly.  I doubt that it is just my palate that is giving me problems, so I’ll still need PAP therapy to help hold open the rest of the airway.  If the soft palate was part of the problem 11 years ago then my pressure needs will go down, and if not then I’ll end up in the pressure range that worked for me before the summertime emergence of Palatal Prolapse (maybe with some variations due to the VAuto and PS 4.4 too).
http://www.apneaboard.com/forums/Thread-SleepyCPAP’s-Treatment-Thread-Palatal-Prolapse-AlaxoStent?pid=426051#pid426051

I like the AlaxoStent, I’m getting used to it very quickly and the effect on my nighttime breathing is exactly as I hoped.  

[BKeeper]

Thanks for the reply, Sleepy. I went through your treatment thread - very informative. I recognize the waveforms and can see that I have partial collapse, which is no big surprise, since I must seriously tape to have effective treatment. I became interested in the Alaxo stents some time ago, even considering traveling to Germany. When they became available here, I convinced my doc to prescribe. I started with nasal stents and worked up to the longer stent propping open the soft palate. I found the stents initially eye wateringly hard to insert, but soon enough no big deal. But I was trying to titrate with a FFM, which I just do not tolerate. So I just could not evaluate then. I very much look forward to titrating with the Bleep setup. I am now awaiting an appointment with my dermatologist to treat a little spot on my nose that I don't want to tape over. I am pretty sure that the Alaxo stent will only partially treat my apneas. But with the high pressures I run, that will be big.

Thanks so much for your postings.

With respect specifically to the stents, I find the shorter AlaxoLito stents to be relatively easy to deal with, despite the initial few insertions. If they help, I will happily use them. With the longer Alaxo stent, I found it would slip down in my throat pretty easily. If this stent is effective, I will have to come to a solution that I feel is foolproof to insure that it doesn't slip down (I'm almost 74, so if I tape it really, really well, I will lose skin in the morning). Do you feel you have a solution in that with the Bleep, the protruding tail is very firmly anchored?

I have to add - I, also, had no gag reflex with the longer stent. This surprised me. I did have a real scratchy feeling the first few times, but pretty easy to get used to.

[SleepyCPAP]

Hi BKeeper,
Glad to hear from another person using the 6" AlaxoStent!

I find the 6" stent does have to be taped well to keep in place. I do note that there is a sweet spot for me, where it shows 1/2" below my palate when I first put it in. I've marked my clear insertion tube with a sharpie to show the approximate place to stop inserting into my nostril. Your throat is likely different, but if I get it too much lower than the sweet spot it has a tendency to want to swallow down lower (it has hit my epiglottis once or twice when the tape wasn't holding - that was the 3M tape they supply). And if I start with it too high, it "bunches" up over time and rises above the soft palate which is less effective for my treatment).

I don't find the 3M Micropore tape resistant to nose drips, so it lets go and then the stent can move. I don't use it anymore. I use KT Tape (original - cotton), and make sure I've used a tissue to remove any moisture on the stent braid or my skin before applying. Mostly my nose (and eyes) don't water anymore, after doing this for over 10 nights. I cut a 1/4" to 1/3" wide strip of the KT Tape and tape the end of the stent to the area above my lip, or pull it more sideways to slant towards my cheek. Think of the KT Tape being a mustache, that does not quite reach the skin below the nose where the Bleep Dreamports would stick. Once I have my dreamports in place I then do a 3" swath of KT Tape across my mouth, over the first bit of tape and stent end, and overlapping with the Bleep Dreamport lower edge. I have lip leak issues so taping is something I've done a very long time anyway. I test the Bleep mask with my thumbs to check for leaks... it is an art to get the leaks gone with that stent coming out. Sometimes I'll add more KT Tape in strategic spots. My personal preference is to put blue painters tape over the cloth tape, as an air seal, but others probably wouldn't bother.

I don't know if KT Tape will be too much for your skin. I suppose some of it's strength could be reduced by taping your palm first and then moving it to your upper lip/cheek area. I've found it still holds through the night even if I've had to pull it off to open my mouth, and then pat it back down again.

Of course if you have a mustache you only have the option of pulling the end of the stent sideways out of the bottom of the nostril and taping to your cheek.

[BKeeper]

Sleepy, I'm very happy to get your feedback. Thank you.

I have thought for some time that palatial prolapse and/or nasal constrictions were the cause of my persistent mouth breathing. I will be interested if, over time, you find that your needs for mouth taping reduce, and you can run lower pressures. That is my hope.

Your comment re hitting your epiglotis makes me wonder - were you all taped up (nose and mouth) at the time? How did this work out? This is the scenario of concern for me. (I have hit my epiglotis once when I tried running the stent deeper in an attempt to prop up my lower tongue. I found I could raise just above the epiglotis and tape in place. I just did not have a way to titrate at the time, so have no idea as to the effect though I did run a night that way.)

[SleepyCPAP]

Hi BKeeper,

When the epiglottis was touched, the first time it was just the way I’d inserted it.  Another time I had put the stent in while waiting a couple hours before bed.  I was doing some tasks around the house and didn’t notice the tape had come loose. When I started talking with my wife the stent touched the epiglottis.  I was not mouth taped yet.

It is possible my mouth taping will go away if my body is confident it can inhale and exhale normally. We’ll see.

I continue to bring my min-EPAP down, about 1cm each week, and so far I’m still getting 0.0 AHI (or close to that) so I have not found the bottom pressure yet. (Was min-EPAP 6.4cm when I started, now min-EPAP 4.4cm, in a few days I’ll start to try 3.4cm)

Placing and removing the stent is becoming routine, two weeks into this.

- SleepyCPAP

[BKeeper]

Good results! I'll monitor your treatment thread! Hopefully you get to no tape :-)

[yankees123]

Sleepycpap, I just read about your adventures with pp.  would you mind looking at my posts from today, I would like to hear what you think.