Help Interpreting Charts to ID Potential Palatal Prolapse - Deep Sleep Issue

[reedro287]

I've been using CPAP/APAP for over 10 years after being diagnosed with severe sleep apnea. I'm 100% compliant and use even during naps which are frequent. For the past 5+ years, I've experienced bad daytime sleepiness. Oftentimes, I "have" to nap at least once per day and often 2 or 3x per day ( I work from home). A number of other symptoms - poor memory, focus, mood etc. I didn't think my sleep was the issue because my AHI levels are typically less than 5. After talking to several specialists chasing other possibilities, I ordered an in-home sleep study using Watchpat which is supposedly 98% accurate. According to the sleep study with Watchpat, my AHI was 23 (moderate sleep apnea), but my ResMed data said 4.8 for that same night. Additionally, my deep sleep was 20 minutes vs. 1.6-1.8 hrs which I've read is "normal." So, that's a huge difference between my Resmed data and the Watchpat. I found a study, though, that compared the accuracy of CPAP machines to the Watchpat and they found nearly 50% of CPAP users' AHI event data is understated by their CPAP machines. Using a Apple Watch app the past week, it also says my deep sleep is only 20-30 minutes with only 11 minutes last night. From other symptoms experienced during sleep, I'm wondering if palatal prolapse could be causing the difference in the AHI's identified? Any thoughts, insights or suggestions on possible palatal prolapse, my settings, etc. would be greatly appreciated. I've posted the sleep study data vs. the Resmed/Oscar data from the same night. Thanks!

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Adding two other images from sleep study...

[G. Szabo]

Indeed, palatal prolapse (PP) can cause the symptoms you report.

According to the experts on this forum, palatal prolapse is not marked on your report. Hence, it would be best if you scanned your flow curves to catch them. I do it every morning. In my case, PP is often followed by hypopnea. You can find example curves for the exhalation limitations caused by PP in Wikipedia. If you find PPs, post them, and then we can discuss mitigation options. I cannot see PP in your chart above.

[40plus]

       
I belive i have palatal prolapse too. Sometimes i snore on exhale and i think i can clearly see the prolapse in Oscar. I have good AHI, between 0.0 - 2.5. Im not trying to high jack your post, just providing pictures of how mine looks so you can compare with yours.

One image of the whole night shows the proplapse on exhale. The thinner streches are where the exhale collapse. The close in pic is of my breaths showing normal inspiratory but abnormal expiratory.

[BigWing]

The close in pic is of my breaths showing normal inspiratory but abnormal expiratory.

I often get that exact same pattern too! I attach an example of mine (a worst case one).




It shows a normal inhale pattern on every cycle, but then exhale briefly starts and immediately stops - there is essentially NO exhale (or just a tiny constant bit?). I see it called "Expiratory Mouth Breathing" and is indeed supposedly a symptom of "Palatal Prolapse",

What I cannot fathom is this....

I can quite understand why the waveform measured by the CPAP machine would appear that way if you are wearing a nasal pillow, because any breaths in or out via your mouth are simply not being monitored by the CPAP machine.

But if you are wearing a Full Face Mask - as I sometimes do and I see you are doing - why doesn't the CPAP machine see those exhales and display the waveform just like normal ones, where exhale is from the nose?

[40plus]

Yepp this is very strange. I also used moth tape when i had nose pillows and still Oscar would show that i pretty much dont exhale at all. Which i obviously do unless i fart out every single breath. I also never had any issues with aerophagia so the exhale air must go somewhere.

It must be exhaled but i guess the limitations of the machine means that the waveform we see seems to show no or almost no exhale even if the exact same voulme of air that was inhaled is also exhaled. I also have this wierd breaths for a long time, up to 60 min straight sometimes.

I need around 13-14 pressure to be apnea free but i get these proplapse above 10. So full epr helps but isnt enough. I will try and get a bipap machine. That should help the issue i hope.

[G. Szabo]

...But if you are wearing a Full Face Mask - as I sometimes do and I see you are doing - why doesn't the CPAP machine see those exhales and display the waveform just like normal ones, where exhale is from the nose?

This is the precise question I have been pondering, too. I figure exhaling through your mouth is easier and quicker, and it presents as a huge negative peak followed by a close-to-zero line. 

So why could we not solve the palatal prolapse by switching from nasal to full-face mask to allow mouth breathing? We can't do that because mouth breathing is associated with obstructive events, so it is better to avoid it by mouth taping, chin strapping, and collar. 

Nevertheless, I would appreciate feedback from our expert on this full-face mask for palatal prolapse suggestion.

Thanks,
G.