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+--- Thread: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent (/Thread-SleepyCPAP%E2%80%99s-Treatment-Thread-Palatal-Prolapse-AlaxoStent)
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse Alexo Stent - Sleeprider - 12-20-2021
I am very impressed with the outcome of using the Aircurve Vauto in combination with the AlexoStent. I have changed the title of this thread to include the key-words Palatal Prolapse and AlexoStent so that this thread will surface in future searches of those terms.
I wonder if you would be willing to post some comparison Oscar charts of your flow rate and therapy before and after implementing these changes?
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 12-21-2021
SleepRider,
I think post #2 has the first image with classic Palatal Prolapse in the flow wave chart, zoomed in. Post #3 shows the form that plagued me: long-term breathing with spikes. Later images show the awful cycle of Palatal Prolapse being identified as OA’s, one after another (post #16). One of the more recent posts (with AlaxoStent in place) shows a hint that those might have occurred if it were not for the stent (some exhale spikes hinted in image shown in post #46). Rather than repeat similar images, I think the more “at a glance” contrast is in my one-week overview screenshot from OSCAR this morning.
[attachment=38207]
I’ve emphasized the AHI chart and the pressure chart. The beginning of the week I was not using the AlaxoStent. AHI is about 7, then I had a better night but still higher than what I’d expect (before Palatal Prolapse took hold, my average AHI for July was 0.7). The VAuto was using a greater range of pressures at the beginning, needlessly trying to rid me of those scored OA’s that were really bad Palatal Prolapse lockup, and the pressure could make the bad pattern continue. Uselessly, because pressure wasn’t going to solve it, the VAuto was bumping against the 14cm upper limit (IPAP is not shown on OSCAR VAuto charts, unlike APAP charts), which you can tell by looking at the upper (9.5cm) line Dec. 14, which is 99.5% EPAP (which with 4.4cm Pressure Support adds up to 14cm IPAP limit with rounding error).
You can tell when I start using AlaxoStent: on the third night. AHI drops below 0.5, and has been 0.0 AHI or as close as possible to that since then. (Exception being the one wake/junk CA scored just as I was stirring this morning).
Other things to note on this screenshot:
Respiratory Rate calms down with AlexoStent. The 99.5% rate was 23 at the start of the week, and 18 at the end. I attribute this to fewer panicked recovery breaths upping the score. Similarly, but not shown on the chart, my median pulse rate was 72 BPM at the start of the week, 65 BPM at the end. Thus, according to my O2Ring stats, my heart is much less stressed now that I’m using the AlaxoStent. I’d guess blood pressure would be similarly more calm with the stent use.
The VAuto is handling Flow Limitations like a champ. I’m guessing the slight FL bump on the first night of the AlaxoStent (Dec. 16) is due to the stent being completely filled with gooey mucus as my nose was not used to it. So it was taking up breathing room that night. That’s not an issue by the end of the week.
Mask leaks are harder to control with the braided end of the stent sticking out a nostril. I’m guessing any nasal pillows mask would have trouble with that little bump. The Bleep Dreamports have the ability to stick well, so long as things are dry, but there can still be tiny seepage, even with extra tape over that leaky spot. Mostly the leak is too small for the VAuto to notice, but it did register on Dec. 19, briefly. I think I woke and pressed the tape down harder and it stopped. No effect on treatment, but the seepage/disturbance is something I want to get rid of with better taping so that I don’t have awakenings.
I’m going to give it another couple nights at this same VAuto pressure range, enjoying the 0.0 AHI, and then start bringing the min EPAP down.
-SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 12-23-2021
End of first week with AlaxoStent. I didn't end on 0.0, but I'm very satisfied with 0.22 AHI. One obstructive in first sleep session, one CA in the second session after I'd been up to the bathroom, for a total of less than 30 seconds in apnea for the night. I note that the CA resulted in a SpO2 drop of only 2% so might not have met official scoring standards.
It seems as if expiratory Palatal Prolapse was almost going to happen starting 22:51:20 through 22:59:23. That eight minute period had hints of a sharp point on exhale, or snore jaggies at that exhale point. So I'm guessing the stent was challenged, but held, and the soft palate did not fully collapse the airway. I note that this is about the same time of sleep that I'd had clusters of Palatal Prolapse OA's in the past, so it may relate to a sleep stage where the soft palate relaxes most.
Bleep Mask. KT Tape as base and blue tape on top for solid air seal, with 1.5 Poligrip strips sealing my lips (helps with drool, which unsticks the blue tape). Some seepage/leak but it is not picked up by the machine (but seepage was noisier in morning, similar to vent hitting a sheet). It is still an art to try to tape effectively around the end of the stent coming out of the nostril. I don't like the airflow noise disturbance, so will keep practicing tape technique.
Wedge pillow and cervical collar.
Trouble going back to sleep after 4:00 bathroom break, lots of sleep/wake junk. Remembered to put on O2Ring in this session after bathroom break, but not in first half of night (I was so wiped out at bed time). Glad I went back to sleep because my body needed the extra time.
Upon AlaxoStent withdrawal this morning, I saw a spot of blood on the stent (on the 40mm expanded portion at the end that positions in my throat behind the soft palate). It rinsed off with the mucus. I did not taste or smell blood, and had no nose bleed. I note that my blood thinner medications may be too high at the moment and are also causing bruises so may be a contributing factor in this blood drop.
Overall night. Note cluster of snores where I'd often experience Palatal Prolapse with OA's, and VAuto responding.
[attachment=38274]
Close up at end of that 8-minute period of "almost" Palatal Prolapse, where snores occurred instead of complete palate collapse in airway (stent working).
[attachment=38275]
Tonight I will experiment by setting min-EPAP down 1cm (and ramp* down to 5cm). We'll see over the next few nights if the stent is doing enough of the work to allow this lower pressure.
*Remember the only reason I use the 10min ramp is so the machine doesn't score sleep/wake junk, I still review the wave forms to check for issues. I may drop ramp altogether again in the future, I don't need it for comfort.
-SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 12-25-2021
9th successful night using AlaxoStent with VAuto.
I had one CA in the night which lasted 13 seconds and caused a dip in SpO2 from 97% to 95% for an instant. Would that even count on a sleep study, since it is only 2%?
Pressure stayed at or near set minimum all night. When it did budge, the VAuto was responding to the rare Flow Limitation breath. This might as well be straight CPAP, except that I like the PS 4.4cm.
I've adjusted to the stent so easily. Maybe I'm feeling so good because I didn't have any seepage last night and so no noises disturbed me. My only twinge of sorrow is I was up late last night so didn't get more than seven hours sleep.
There were no hints of Palatal Prolapse breaths anywhere in the night. I don't see any other way to tweak my therapy, except to keep going down on min-EPAP, which I will after another night or two at this pressure. (PS 4.4 over 5.4-14cm).
The "nothing to see here folks" night:
[attachment=38362]
The SpO2 worst desaturation of the night, close up. Not a problem. This is so much better than looking at closeups from just 10 days ago, before the 9" AlaxoStent arrived.
[attachment=38363]
- SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - Sleeprider - 12-25-2021
We have seen a lot of misery from PP from members in the past, and never had a first-hand experience with a member using the Alaxo-Stent. Amazing results. With palatal prolapse being recognized as a real medical condition, it seems insurance is behind the ball in recognizing this therapy. The stent is surly less expensive than the surgeries which don't have a good record of success.
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 12-28-2021
Again last night I used the AlaxoStent just by itself (not masked up too) while first going to bed and cuddling with wife. Much easier to kiss and lay with my cheek on her. No bulk or vent issues that way. SpO2 shows I stayed above 92% during that period, which is about the same as when treated with PAP, but stent alone keeps me more below 95% than above. In other words, the bar graph is flipped, with around 20% of my time above 95% with the stent alone, rather than at least 80% of my time above 95% with PAP alone or PAP/AlaxoStent Combo. This leads me to trust that the AlaxoStent is doing a great deal to control Apneas, and I can trust it to do so for brief periods or naps, but maybe not eliminating hypopneas or FL issues. I'm still better off with combined stent/PAP therapy for overall oxygenation, but I like this compromise of stent alone for closeness with my wife in that key first-to-bed period.
After an hour and 10 minutes on the stent alone, I woke up to put on Bleep mask and taped well (no leaks).
Things are still so successful that I'm confident this will be my last night at PS 4.4 over 5.4-14. The VAuto had almost no work to do, mostly staying at that base setting and only rising to 10.24cm max IPAP (around 5.8 EPAP) for some rare FL (mostly when I was awake from 5:00am until getting up). As I noted before in this thread, I might as well have a straight CPAP pressure (with EPR), except for the fact that I like the 4.4PS and the VAuto's quick response to the rare FL.
I saw a three minute time where my breath waves had just the tiniest hint of a spike at exhalation. That's it. So again I assume this is the soft palate collapsing but not overcoming the AlaxoStent. Excellent!
I will reduce min-EPAP to 4.4cm starting tonight, and (for the first time) reduce max IPAP slightly so the change is more visible on my overview charts. The VAuto has not been above 13.5cm since using the AlaxoStent, and that high point was only on the first night when I didn't quite have the stent in the best position.
- SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 12-29-2021
First night at this new lowered pressure of PA 4.4 over 4.4 to 13.6 cm. Using 6" AlaxoStent and ResMed Aircurve 10 VAuto combined.
[attachment=38459]
The VAuto had little to do. Slight pressure rises near 12:40am, 1:50am and 2:18 am due to flow limitations detected by the machine. SpO2 looks slightly better during that 12:40-3:00am elevated pressure span.
[attachment=38461]
Another tiny FL happened just before 4:00am with pressure bump matches with a movement tag registered by the O2Ring and followed by recovery breaths which may have led to full awakening to get to bathroom. A good question for me to ponder is: Was it the tiny pressure change or the underlying bladder signal that got me up?
Also, I'm going to keep an eye on the waveforms this week. It seems to me that cardioballistic artifacts are showing up a tiny bit more at this lower pressure, but overall curve is preserved.
[attachment=38460]
For AHI purposes this 1cm reduction to min-EPAP 4.4cm is still excellent, due to the stent doing much of the work in my throat. I don't know if the next days will give me longer sleep (I never did go back to sleep after the bathroom break, and I am tired this morning). There are other issues that may be affecting my sleep, including stresses that keep my mind running, so not everything is about PAP therapy.
Other: Bleep Mask, KT Taped mouth with blue tape over and Poligrip strip on lips (no seepage last night). Cervical Collar and Wedge Pillow.
Ramp at min-EPAP for 10 minutes to avoid machine responses to sleep/wake junk.
- SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 01-04-2022
Please,
I’d like advice on my next move.
I’m the second night into a reduction to PS 4 over 4-13.4cm on the VAuto, combined with AlaxoStent. I was intending to go below 4cm because I thought VAutos were supposed to go down to 3cm, but it appears I can’t set mine to lower min-EPAP, so 4cm is what I could do (had been min-EPAP 4.4cm last step).
Here is what I’m imagining I could change after a few more successful nights at this pressure:
1. I could bring PS down to 3cm, so it would be VAuto PS 3 over 4 to whatever cm. With IPAP headroom this still allows auto response to any rare FL or Snore.
2. I could switch to “S” mode which allows me to set min-EPAP to 3cm, and set IPAP to 7 (same as PS 4). Just let FL or snore flags in OSCAR show me how it is doing, without the machine responding. Remember I did very well on straight CPAP without the distraction of pressure changes, so this might be good.
3. I could leave settings as-is for the moment and take away my wedge pillow or my cervical collar to see what that does. I had added them in recent months to get rid of Palatal Prolapse, but maybe they aren’t doing anything anymore because the stent is doing the work.
4. Some combination of option 3 and either 1 or 2.
Here are some screen shots from last night (my second night at this setting), if it helps you to give advice.
Yeah, a perfect night overall. AHI 0.0, Flow Limit. 0, Snore 0, leak 0, and SpO2 never below 95%. The VAuto had nothing to do, the AlaxoStent is doing all the major work. Can’t see it here, but zoomed-in I note I didn’t even have sleep/wake junk during ramp. I’m sorry I had to get up to the bathroom in the night, but otherwise had 7 good hours of sleep.
[attachment=38628]
Here is where I might have had Palatal Prolapse if it hadn’t been for the 6” AlaxoStent preventing collapse of the soft palate (note jaggies and spike on exhale). Worst SpO2 desaturation, which only went down to 95%. Very Very Pleased!!
[attachment=38629]
Typical breathing last night still looks really good to me, I think it shows room for any of the above options for changing my therapy:
[attachment=38630]
Thanks for reading. If you have any opinions of where I go next, please chime in.
- SleepyCPAP
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - Sleeprider - 01-04-2022
You are already using the the equivalent of fixed, low pressure at 8.0/4.0 with no variation through the night. This is actually a pretty unusual result for a Vauto in Vauto mode as it will respond to any hint of flow limitation to raise pressure. You have NONE! The desire to reduce pressure to 7.0/3.0 is fine, and I was not even aware that was possible in S-mode. Option 1 is a matter of comfort and efficacy. We have not seen what your minimum requirement for PS is with the stent. You can try PS 3, or for that matter, any PS between 3 and 4 in 0.2 cm increments. Option 2 is to lower EPAP min. Again, you have no obstruction or flow limitation, so from a therapeutic standpoint that looks like a possibility. Like PS, you can likely select increments of 0.2 cm between 3 and 4 cm. I'm not sure what your comfort motive is for lower pressure, or whether you would prefer changes to PS or EPAP, but I would choose only one at a time. I like option 3 if you don't need it for comfort or to treat an issue like PP or GERD. I actually think that is a good starting place to get away from using wedges. Option 4 is combinations of changes, and I don't favor that. Your therapy and comfort are as close to perfection as I have ever seen. It makes no sense to throw more than one change at a time into the mix.
JMHO, YMMV. You have done some innovative things to achieve an amazing level of efficacy and I should probably be looking to you for recommendations.
RE: SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent - SleepyCPAP - 01-05-2022
Thank you Sleeprider,
You asked “I'm not sure what your comfort motive is for lower pressure, or whether you would prefer changes to PS or EPAP, but I would choose only one at a time.”
I agree one change at a time.
I’ve been comfortable. If my treatment needs are at this pressure, so be it. But I suspect the stent will continue to be doing what’s necessary even at lower pressures. I thought about what I can learn most in my next step: If I bring PS down next, to 3cm, and it works (even if not perfect like now) then I’m not only learning if 7cm total is doing ok, but also open up the idea that my Aircurve 10 AutoSet is a workable backup solution (since EPR only goes to 3).
Last night was not as perfect, but still magnificent. AHI 0.0. SpO2 was above 95% for “only” 99% of the night (ranged from 92%-98%, Median and 95%tile were both 97%), and pulse rate was averaging a mild 64BPM. No leaks (I’m finding it easier to overcome any seepage at this lower pressure, I don’t need the blue tape over the KT Tape anymore). The 99.5%tile readings for FL and Snore were each 0.02. Pressure once jumped to 8.62 after a rare FL, came back down, and then went up a lower amount later in the night, but the median for the night was the set 4-8cm range.
If I keep going down I may eventually realize I don’t need PAP therapy as long as I’m using the AlaxoStent. But there are several cm reduction between now and then, and I may find my perfect streak ends before I get there.
- SleepyCPAP