SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent

[SleepyCPAP]

Posted by SarcasticDave94:
“My opinion, be proactive, call the doc. Don't wait for them to call.”

I called my Primary Care office yesterday and let them know I was not hearing back from the Sleep and Lung specialists.  They double checked and said the referral had gone through.  I’ll give Sleep and Lung a call this afternoon.

I’ve finished typing up my summary sheet based on this thread, so it is ready to go!

[SarcasticDave94]

Ok good. I'm not trying to be pushy, but I'm conveying what I've learned about my own doctor, DME, insurance interactions. If I don't call and keep the ball rolling, eventually momentum stops and I'm waiting and waiting. My calling kept reminding them to make progress.

[SleepyCPAP]

Update:  I got to see the new sleep doctor last month, after a couple months waiting for an opening.  Recommendation was to increase range to 11-13cm, and try pressure relief, and come back in a month.  Plus get a new titration study... but there isn't an opening in the schedule until later. Doctor suspects I need a different type of machine.  I've not heard of a PAP mode that can deal with Palatal Prolapse.

I'm heading back to the sleep doctor.  It is clear that Palatal Prolapse is still messing with my sleep.  But it is also clear that bringing pressure up and using pressure relief is eliminating the flow limitations.  I would like advice to dial this in better.

I have tried EPR 3 on my For Her machine.  I use that mode because it isn't supposed to chase apneas over 12cm unless flow limitation is there - this limit can sometimes work to not make Palatal Prolapse worse.  But flow limitations are still there at EPR 3.
I have tried PS 4 on my other machine.  VAuto allows that. It seemed to be too high though, as I was starting to get CA's.

So... should I be fiddling with PS (maybe 3.6?) in VAuto, or cm pressure on the For Her machine... or something else?  How would you suggest I talk with my doctor about this?

Overview of last night on For Her machine
   

Close up of sleep breathing on EPR 3:
   

Compare to breaths in VAuto mode on other machine, PS 4:
   

I have also mentioned Alaxo Stent to my sleep doctor, as an added device on top of CPAP.

Other relevant info: I use the Bleep mask, tape my mouth, use a wedge pillow and a cervical collar.  I've eliminated leaks so these two nights don't have any leak confounding the data.  These nights are about the best I get lately, and AHI has been over 5, 6 and 7 on nights in this past month (compare to average 0.7 AHI before the Palatal Prolapse started this summer).  I've mentioned to my doctor that almost a quarter of all the Obstructive Apneas I've had since starting treatment in 2010 have been in the past 2.5 months, because of expiratory Palatal Prolapse (some stretches get scored as apneas).

-SleepyCPAP

[Gideon]

IMHO VAuto at 4. See how rounded you breath form is. That is ideal breathing, MUCH better than at EPR=3. Watch you CAs because they are mostly in the early part of the night and you may have been awake. Besides that is not enough to worry about and since they just came on they most likel;y will disapate over time (stock answer is 2-3 months).

[SleepyCPAP]

   

IMHO VAuto at 4. See how rounded you breath form is.  ...since they [CA's] just came on they most likel;y will disapate over time (stock answer is 2-3 months).

Thanks Gideon,

Yes, I very much like the rounded breath forms.  I like how the cardioballistic artifacts are nearly gone too.

It took months at my start of CPAP (in 2010) for the CAs to go away, back in 2010.  After titration showing mixed apneas the tech said he expected to see me back, but I took to CPAP well enough to deal with the CAs in the mix until they disappeared.

I stayed at PS 4 for six nights, the last night having the worst AHI of 4.3, divided evenly between CAs and OAs.  I think that is why I went back to For Her, trying EPR 3. 

What if I back off 4 slightly, to 3.6 or so, if that lower pressure relief causes fewer CAs, and builds a tolerance at the same time. Then go to 4? Would that method work too? Or would I be better going the weeks before titration at a solid 4 (or even higher) to make it easy for the tech?

Here is the VAuto closeup for those who need it:

[Gideon]

What are you getting out of the titration? What exactly is being titrated?
Feel free to back off the 4 if you wish. I like the idea that 4 looks real good and knowing that the CAs will diminish over time and do it a bit easier if you have a few of them.
I do not like the look of the EPR=3 chart.

[Gideon]

Assuming the titration is for Palatal Prolapse make sure that both the sleep clinic and your doctor understand both what it is and how to treat it. Your doc said a different machine, get a specific answer of what he is thinking and how he thinks it would work. I don't think there are many out there that understand Palatal Prolapse

[SleepyCPAP]

What are you getting out of the titration?  What exactly is being titrated?

Gideon,
I think the titration is because the Doctor suspects I will need a VAuto machine permanently.  Or maybe ASV.  Seems to be "standard operating procedure".  I have the sense from my first meeting last month that nothing I show my Doctor from OSCAR registers as "real".  I will turn that into a renewed question for my doctor "why am I doing titration?, what will it tell us that is different from what we know?"

The correct approach to Palatal Prolapse is endoscopy, but the sleep doctor won't refer me until the titration report is back.  At the speed all this is going (I asked for the sleep doctor appointment in August when my AHI exceeded 10, it took until October), I'm guessing endoscopy will be in the new insurance year (Jan 2022).

In the meantime, as I may have said in another thread, I had a heart attack and the Cardiologist says I should not be stressing my heart at night and wants my apnea controlled.  My heart will just have to keep at this level of unaddressed nighttime breathing problems until standard operating procedure catches up.


Or I suppose I could find a new sleep doctor further away, again not likely to be fit into someone's schedule until after the holidays.

In the meantime I am doing what I have available to me to do.

- SleepyCPAP

[Gideon]

IMHO the VAuto is a good choice for you.

[Sleeprider]

I know you were concerned about the emergence of CA at PS 4. The Vauto has the setting for trigger sensitivity. If you set that to high, it will probably eliminate the CA events by triggering IPAP sooner, with less inspiratory flow needed to get the inspiratory pressure. Works for me.