SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent

[SleepyCPAP]

No Charts to share.  It would be a waste of my allocated attachment usage limit on AB.  

The Oracle oral mask is usable but leads to me being non-functional.  It breaks up my sleep, leaving me exhausted by the time I get to the late afternoon.  I took a nap after work so that I’d be safe driving to my evening activity, and overslept so I could not participate.  The next night using the Oracle mask my sleep was broken up again, and I didn’t get back to sleep until I went back to my Bleep mask in the morning, sleeping in long enough that I missed being able to cook breakfast and was 10 minutes late to work.

Sure, there was no Palatal Prolapse, and no leaks (other than steady vent), and sometimes stretches of sessions that looked ok, but I’m not celebrating that “success.” My AHI during use of the mask was as high as 6 AHI during one session each from the last two nights when zoomed to just those particular Oracle-wearing sessions.  And as I said, I wasn’t functioning in life the next day.  And I was up for a stretch in the middle of the night trying to let the air out of my belly. No need to show OSCAR charts, I’m not going to try “tweaking” this lousy experience.

A 2003 study of the mask (study supported by F&P, manufacturer of the Oracle mask) found that average AHI was 5 points higher with the Oracle mask compared to nasal, and arousal index was 3 points higher for Oracle. Only 57% of patients used CPAP for at least 3 hours per night with Oracle mask, vs 62% of patients for nasal mask patients.  
[“A Randomized Crossover Efficacy Trial of Oral CPAP (Oracle) Compared with Nasal CPAP in the Management of Obstructive Sleep Apnea”
Fiona E Anderson, Bsc Hons; Ruth N Kingshott, PhD; D Robin Taylor, MD; David R Jones, RPSGT; Lewis R Kline, MD; Kenneth F Whyte, MD]

My real life nights concur with the study.  My Bleep mask rescued me, as much as it could in the time remaining in the night, when I ditched the Oracle.  Even with me leaking through the multiple layers of tape over my lips when wearing the Bleep mask, I was getting better therapy (AHI 0.40 during the 2.5 hour session with Bleep towards morning, due to a single Hypopnea scored during a short stint of Palatal Prolapse).

The past two nights are a blemish on my otherwise very good 10+ year history with CPAP (not counting my first week or two).

I’m not going to solve Palatal Prolapse and leaks at the expense of AHI and daytime non-functioning.

Was the F&P Oracle worth a try - yes.  It was a lot cheaper (and reversible) than trying surgery, implants or stents.   And it is worth keeping around if I get my nose broken or major sinus congestion (easier to fit than my hybrid full-face mask on my shelf).  I hope that night never comes though.

[SleepyCPAP]

Better night last night.  Bleep mask only, 3M tape (three layers, still wouldn’t hold, leaks got big but the machine didn’t register any Large Leak time periods). This was the last night of the 3-night Auto-trial on the PRS1 460 (10cm-12cm), no Flex.

First night of O2Ring.  I like my old CMSD50+ and it’s 1-second sampling rate, but it is nearly impossible to get OSCAR to accept the download completely.  The O2Ring loads easily in OSCAR after downloading the binary files, does multiple sessions, and it’s low and high SpO2 in the charts is correct in OSCAR screenshots.  Sample rate not as detailed (4 seconds) but I don’t seem to have issues that need that much detail.  (I had to do a -1:46+ adjustment to OSCAR to compensate for clock drift of the PRS1 so the SpO2 would match).

Hooray about making it without multiple bathroom trips last night.  I did try getting back to sleep at 6am this morning, but never did sleep. 

Only a hint of Palatal Prolapse last night.  I’ll include that in the next reply.

Whole Night
   

Obstructive Apnea
   

One of the Hypopneas (the other wasn’t real - it was a mini-awakening due to drop of pressure)
   

[SleepyCPAP]

Some breathing examples from last night:

   

Barely any Palatal Prolapse last night on the PRS1 (no Flex):
   

I don’t know if Palatal Prolapse will return tomorrow night when I go back to the ResMed, especially if I put EPR on to deal with flow restrictions.  

- SleepyCPAP

[SleepyCPAP]

Another decent night, although I feel I woke to early (could not get back to sleep after bathroom trip in a.m.).

Bleep mask, 3M tape (2 layers plus vertical bits at corners of mouth) plus first attempt at using denture cream on lips. I remember leaking, but it isn’t showing, perhaps it was too gentle and steady to be logged as leak.

Long stretches of Palatal Prolapse.  7-12 minutes for example. Not much SpO2 desat, except for the first ones at beginning of night (one being marked as OA).  This breath pattern is far more likely on the ResMed, especially with EPR (it was 3 last night).

I don’t know why OSCAR does not put the Maximum Flow Limitation on the left columns.  OSCAR says .10 Max, but the closeup look at events shows the max was .24.  Not that I’m upset about the low Flow Limitation last night, just that I don’t trust the reporting.

It is so much easier to use the O2Ring, and it does report correctly in the columns with Max and Min.  Unlike the literal and figurative pain of the CMSD50+, I could wear the O2Ring every night. 

Some screen shots:
Whole night, just one event early in the sleep time
   

Close up of OA, implicating Palatal Prolapse
   

Flow limit maximum, which didn’t show in the columns, but was enough to bump the pressure:
   

Any feedback?  

I’ll post two different types of breathing next.

[SleepyCPAP]

Here is some Palatal Prolapse, and some “normal” breathing in the night, in case they are helpful for analysis:
   

   

[SleepyCPAP]

Help please…
I’m being referred to a (new) Sleep/Lung center by my Primary physician.  I’d appreciate it if you look at this thread to suggest what I might bring up, or what I should provide the doctor in advance.  I’ll include two new screenshots too, if it helps (and doesn’t make you shy of comments). What should I talk about?  I have only had one opportunity in all my years of CPAP to talk to a sleep doctor about my CPAP use (also a referral).  At that visit he told me I was doing better than all the patients who come to his practice regularly - which has not motivated me to _ever_ go back to a sleep doctor. (And _thanks all_ because I’d read many posts which helped me be better at treating my sleep apnea - and better than what he was used to achieving for patients in his practice).

But the reason I was referred this time is because things are bad.  The Palatal Prolapse on expiration is new, as I said.  Then, I had the worst night _ever_ a few nights ago. In just the first 3.66 hour stretch (before my brain frantically called time out for a bathroom break to get me up and rescue me) I had 51 obstructive events scored, plus hypopneas (also a CA). Evidence of unscored moments of breath problems too.  My body was exhausted but did _not_ want to go to sleep again (pretty smart brain to avoid sleep after such a nasty stretch).  I did finally get to bed early in the morning.  Added a few more scored events, but overall AHI came down for that night, from the start of 14.79 AHI for the first 3.66hours, to 8.32 AHI.  
ResMed Airsense 10 AutoSet on “soft” 10-12cm, Bleep Mask. OSCAR 1.2.0 on my Mac says no EPR but I believe it had been on EPR3 for that session, since flow, inspiration/expiration time balance, and tidal volume were so good (turned EPR off later in the night, realizing it could be making the problem worse, so that may be reason why it shows “off” in the stats). No ramp. I was wearing my O2Ring oximeter, averaging 91 SpO2, with low of 86. Here is a sample of three minutes of breathing misery:
   

Since that night I tried adjusting the way my head is positioned.  I got a wedge pillow.  That by itself doesn’t eliminate Palatal Prolapse entirely, but I get pretty close if I make sure my head is way up at the top, with a regular bed pillow over the wedge but just coming up to the neck (so my head tilts back slightly up there).  Maybe this has nothing to do with it, but I’ve had better nights since then.  I also checked for biological things which might have swollen my palate:  I don’t have RSV, Strep, Flu, or COVID (all tests negative).
For example, last night (Bleep Mask, wedge pillow, lips taped so just small leaks through tape, head positioned correctly, no EPR, no ramp, 10-12cm) was a huge improvement:
   

So, again, any advice on what to bring up with sleep doctor (whenever that referral gets on the calendar)?  I know sometimes folks don’t reply, but I hope this time you are less shy.  Thank you!

-SleepyCPAP

[SarcasticDave94]

With regards to what to discuss, everything you've posted here. EVERYTHING! It appears PAP machines can sometimes be helpful, and other times not even close to being helpful. The variable Palatal Prolapse makes things even more difficult and again the descriptor variable comes up.

I think it's going to be pretty hard to help with PAP when the Palatal Prolapse messes therapy up frequently.

[cathyf]

I don’t know why OSCAR does not put the Maximum Flow Limitation on the left columns.  OSCAR says .10 Max, but the closeup look at events shows the max was .24.  Not that I’m upset about the low Flow Limitation last night, just that I don’t trust the reporting.

In the case of flow limits, the number that gets reported as "max" is actually the 99th percentile not the max. (The table is very compact, and that sort of thing is in the weeds.)

Your "worst night ever" sounds like positional apnea -- my positional apnea total sh**-show I fell asleep without a collar and had 46 minutes with 47 OAs, one H, spent 20 minutes of the 46 freaking not breathing...
https://www.dropbox.com/s/7zcg4igm95mwic...t.png?dl=0
https://www.dropbox.com/s/k6kf0gboy8lchn...e.png?dl=0

The point for me is that this is a totally different kind of apnea than I have most of the time. It can only be fixed with a cervical collar keeping my chin from tucking. If it weren't for the people here I wouldn't have understood what was happening, and I didn't understand what was happening for the first 6-1/2 years of CPAP therapy because it didn't happen very often and I didn't know to ask and sleep doctors are idiots.

[SleepyCPAP]

Thanks SarcasticDave for pointing out what I’ve said here should be conveyed to the sleep doctor.  So far I haven’t been contacted by the doctor’s office.  In the meantime I can go through these posts and figure out how to create a handout for the doc.

Cathyf, I wondered if there was a way to keep my head right.  I don’t remember having this problem before, which again points to some change in my throat.  It may be things were more tolerant of various positions in the past.  A cervical collar seems like a logical thing to try, though I don’t have a clue which one to start with.  Too many choices!

Last night I remember waking several times.  Once I had the impression that circulation had been cut off for my scalp in back (or it had “gone to sleep”), maybe because I’m trying to hang my head back at an angle at the top of the pillow.  I’m wondering if a cervical collar might do that too. I don’t like the feeling.

Numbers last night were great for AHI (one hypopnea), I didn’t see any trace of expiratory PP, not so great for leak (machine was a smiley face, but OSCAR had the grey bars), and I remember waking a few times.

- SleepyCPAP

[SarcasticDave94]

My opinion, be proactive, call the doc. Don't wait for them to call.