Palatal prolapse, something else? What's going on here?

[fsc321]

Thanks for taking the time to look at this thread.  

The problem: 

Low AHI but still very poor sleep quality.  Lots of arousals, very tired and brain foggy often, noticeable issues like increased hunger and heart palpitations due to poor sleep.

What I've tried:

Deviated septum surgery and turbinate reduction.  This greatly improved my ability to breath through my nose.
Full face masks, nasal masks, mouth taping, wedge pillows, adjusting pressure, steady pressure, high pressure, low pressure, epr on 3, no epr, dreamstation vs airsense, etc.

I've been wearing a pulse oximeter at night as well that is showing an improvement in blood oxygen to the point of really no issue there, but often still big spikes in heart rate and a lot of arousals.

What I think is going on:

I've noticed when I wake up from apnea events that I'm having what feels like palatal prolapse.  I can breath in just fine, but I cannot breath out...or at least it can be very labored to do so.  It feels like a one way valve that gets closed on exhale and I can feel it as I wake up and keep replicating it at will.  I am scheduled to have a variation of UPPP surgery.  Examination revealed I do have a narrow airway largely due to the soft palate.  

Looking at my wave forms I don't often see what looks exactly like the examples of PP that I've seen on here.  I'm not sure if its totally blocked or perhaps I'm having some sort of UARS issue where I'm breathing, but it's labored, throughout the night.  

Images:

These are all using nasal mask.

Here is the other night:
https://pasteboard.co/Wwf5sLIhEqQO.png

Closeup of waveform:
https://pasteboard.co/3s3oRX3i8DJp.png

An example from another night that looks like something of a PP event, maybe not fully but a rather quick drop?:
https://pasteboard.co/ReNoOcb5LdB4.png

Another closeup of a normal period during that night:
https://pasteboard.co/OwfwcgYUdl8E.png

A period of erratic sleep:
https://pasteboard.co/BA7yz8v4RbC0.png

Another quick drop off:
https://pasteboard.co/QQJI2D4VT6tu.png

Any help or thoughts would be greatly appreciated.

I've attached as many below as possible as well.

[fsc321]

PingInc this thread so hopefully someone can see it

[Sleeprider]

I don't see any evidence of palatal prolapes in any of your charts or images. Our textbook on PP is SleepyCPAP's thread https://www.apneaboard.com/forums/Thread...AlaxoStent I see evidence of inspiratory flow limitation with flattened or double inspiratory peaks indicating obstruction at peak flow. This is common with some loose palatal tissue, but is much different from the prolapse which is during the expiratory cycle. The best solution to your issue would be some pressure support that increases pressure with your inspiratory effort. The Resmed Airsense 10 and 11 CPAPs and all bilevel machines have this capability, but your dreamstation does not help with this. Resmed CPAPs offer up to 3-cm difference between inhale and exhale pressure using exhale pressure support (EPR), and this works much differently than the Flex options on Philips machines. The Resmed is a real bilevel and would likely be a great help to you.

You are using CPAP pressure at 12.0 with a ramp from 4.0 cm. I think you might want to try C-Flex at setting 2 to see if that feels any better.

[fsc321]

Thank you sleeprider. I was hoping I’d hear from you! I have a Resmed 10 and have tried it several times but when I use the pressure support it makes me feel like I’m hyperventilating. It’s hard to explain but it breaks up my natural breathing cycle because it starts pushing air pressure back before I’m ready to breath. Ive found it almost impossible to actually fall asleep because it makes me feel like I’m going to have a panic attack. Does anyone else have this issue? The flex on 3 slob the Phillips seems to work pretty well and I’ve felt a bit better the last two nights.

[Sleeprider]

I personally preferred the Flex settings at 1 or 2 when I used a Philips machine long ago. I live in the town where Philips Respironics is manufactured, but I'll never go back.