yankees123 - Therapy Thread

[Rubicon]

1.  Full-face mask.

2.  EENT surgeon

3.  Hit up SleepyCPAP for a couple of his Alaxo Stents.

[yankees123]

Rubicon, why is a full face recommended?  I use a nasal mask with taping and I get zero leaks?
Is surgery my only option?  Is using my apap not a good thing to use with this condition?   I finally have reduced my ahi and controlled my leaks and now I have this problem?

[Rubicon]

The palate often occludes the airway, resulting in an expiratory flow limitation (EFL) ranging from not so bad to severe.  In severe case wearing a FFM may allow exhalation through the mouth and preventing arousals.  See these expiratory limbs demonstrating severe EFL.  Flat is bad, should be as least as gradual as the 10th and 11th breaths from the end:



You can blow these up to ~1 minute to get a better view.

The EENT guy can do a sleep nasopharyngoscopy to determine the extent of occlusion and predicted success of surgery.

Might end up getting rid of CPAP.

OTOH might end up blowing milk out your nose when you swallow.

Search SleepyCPAP's success with the Alaxo Stent.  Should be a sticky around here somewhere.

[Rubicon]

IMO those leaks were actually mouth exhalations--  the breath needs to go somewhere.

In the images you presented, the one without leaks shows EFL terminated by arousal followed by disappearance (temporarily) of EFL:



You'd have to wade through a whole night and count up the arousals.  The #rules for AHI also apply to arousals (cause they're really one and the same).

Arguably, the image with the leaks seems to show better sleep than those without (but obviously not a pattern you'd want).

[yankees123]

Thanks Rubicon for your response.  I am still trying to understand this, would it be a good idea to wear a full  face masks a few nights and post my results?

[Rubicon]

Sure!  It's cheap, easy and non-invasive.

Or maybe like an Oracle or DreamWear type of thing.

I'm sure Alaxo 6″ Airway Stent would work but it's $974.00, so after FFM experiments the options are going to take a big jump.

OTOH, if the stents last 18 months then

it's still $974!!

[yankees123]

Ok, I have a dreamwear full face mask, will use it a few days then post.  Will be nice not having to tape my mouth. Do you think since I wear a cervical collar that this might contribute to this problem?

[Rubicon]

Negative.

[yankees123]

I was just reading about palatal prolapse and wondering if this is true. “Bi-Level PAP reinforces the expiratory flow, pushing the palate like a sail in the wind and is likely to worsen the prolaps”.  Does this mean that straight cpap constant pressure is better?  I am just trying to understand this problem and try to see if anything could be done to alleviate the problem.  Thanks 

[Rubicon]

A poster on "the other site" wrote that. IDK if it's true or not.