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Can Palatal Prolapse be treated with CPAP
RE: Can Palatal Prolapse be treated with CPAP
I have read about the Alaxo Stent and mentioned it to my Primary Care doctor. I plan to make another appt. with my sleep doctor in the near future and take some of my sleepyhead reports to discuss with him. I really like the Alaxo Stent, and even though it may seem disgusting, I’d be willing to try if it will help my prolapse issues. I really don’t want to undergo the knife as I’ve seen mixed results and at least the Alaxo Stent could be thrown in the trash if it doesn’t work and isn’t such a permanent choice. If insurance could help pay for it that would be a plus, but with our government insurance, my deductibles are in the thousands. I’m back to wearing my Dreamwear Full Face mask and received an adjustable mouth guard from Amazon today to see if it will help hold the tissue forward in my mouth. Couldn’t hurt to try. I’m still waiting on my O2 wrist monitor from China. I want to see how my oxygen levels are affected during these periods. I’ll keep you guys posted, but I’m steadily going downhill.
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RE: Can Palatal Prolapse be treated with CPAP
I have indeed posted on palatal prolapse. These waveforms sometime resolve to normal breathing, sometimes end in short arousal (from the flow + documented on IR camera) and sometimes wake me up completely. I had experiemented extensively with the AirCurve 10 with various pressures and pressure support 6/9...9/17...11/11...15/18 and many more in between without any clear change in the resulting palatal prolapse waveforms or frequency. It may still be possible that even higher EPAP would solve this but I did not see any improvment from EPAP=7 to EPAP=15 and it was already quite hard to sleep with 15.

The waveforms in the article is Palatal prolapse as a signature of expiratory flow limitation and inspiratory palatal collapse in patients with obstructive sleep apnea look very similar to mine, see recent flows attached with zero leaks (mouth is always taped shut) but without natural sleep endoscopy we can't be 100% positive this is indeed palatal prolapse.

For that reason alone performing any non-reversible palate surgery may not be advised, even before considering these frequently fail.
The AlexoStent or Pillar procedure (both unavailable in my country) make sense trying out as the AlexoStent is non-surgical and the Pillar procedure is easily reversed.

Very interested to hear of your experience!


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RE: Can Palatal Prolapse be treated with CPAP
I don't think it's surprising (I mean it makes sense to me) that my flows with the longish pointy exhales like those are almost always, maybe always, accompanied by lip leaks (I can't tape due to facial hair). I'm very interested to learn of peoples' experience with alexostent and pillar procedure.
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RE: Can Palatal Prolapse be treated with CPAP
Just thought about this - palatal prolapse will not happen the same with a full face mask as the flow will go out the mouth. This isn't great but better than the alternative of going nowhere with a taped (or closed) mouth. The soft palate touching the velopharynx may still cause an arousal though.

I had tried full face masks before but could not adjust. Will try again.
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RE: Can Palatal Prolapse be treated with CPAP
I had further experienced with high (20cm) pressure with DreamWear pillows mask & taped mouth:

[Image: 2QdPzYt.png]

and full face F20 mask, no taped mouth, with hard collar to control neck movement and mask leaks:

[Image: RcKYck7.png]

neither was a success... In fact the first one seems to be worse than lower pressures where I rarely have such long apneas. Possibly the pressure is opening up the flow making the soft palate blow harder? or expanding the retropalatel area making the soft palate seal even better? don't know.
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RE: Can Palatal Prolapse be treated with CPAP
I think I have palatal prolapse as well (for 10+ years) and thanks to this post and another one over at the [[ Auto Word Filter: links to DME-owned sites not allowed ]] forums, I was finally able to identify my issue as palatal prolapse. Other terms I've come across during my research are:

* Expiratory palatal obstruction (EPO) (This is what Dr. Steven Park refers to on his blog. He has an article about it and I encourage you to read it, very insightful stuff.)
* Expiratory velopharyngeal obstruction

* Soft-palatal / palatal obstruction
* Obstructive palatal prolapse

Needless to say, that after a decade of insomnia, I'm eager to find a solution and wanted to let you guys know, that I have created a WhatsApp group for this purpose.

Unfortunately I am not allowed to post links as a new member, but I'll give you two tips. 1: Cuttly (this is an URL shortening service) and 2: ZrVxQ60  :-)

I made a list of possible solutions (which I have gathered from different forums and sites):

CPAP therapy: Some people have found that enabling the expiratory pressure relief (EPR) (C-Flex on Philips) setting on your CPAP machine makes things worse for EPO. This makes sense, since pressure is the thing that is keeping your excess tissue in place upon exhalation. Unfortunately that means, that people that suffer from EPO cannot use this setting. Obviously CPAP relies on a closed loop system and this only works if you can keep a good seal. If you are using a nasal mask and your mouth keeps opening, look into mouth-taping. I'm not sure yet, if a full face mask will do good for EPO, but I remain skeptical, because you'd want the pressure behind your velum / tongue area and not in front of it for it to stay out of the nasopharynx. APAP, BiPAP, ASV are probably not a good solution because of the same problem (like EPR), but that's just my personal opinion. I have not experimented with these.

Nasal stents: AlaxoStent / Nastent. Not tried 'em yet.

MAT Body positioning system / Massage table with face cradle - not tried, either. Might be worth a try.

Mandibular advancement devices - Haven't tried one, but if I move my lower jaw forward, I can still very reliably reproduce the EPO - so I suspect it's of no good use for this special problem.

Velumount / Ronchex: These are basically clips made of wire in silicone tubing that are supposed to stabilizing your velum and uvula during sleep - currently looking into this!

Shifting your sleep position: Sleeping on your side (lateral position) seems to be better. This makes sense to me, because gravity will not additionally pull your uvula/velum back into your throat (like in subpine position). I have never been able to fall asleep in subpine position.

Playing Didgeridoo (combined with 'circular breathing') is said to help as this trains muscles in the respective areas. Might look into this.

Surgery options: Radiofrequency treatment of the soft palate and uvula (uvulopalatopharyngoplasty (UPPP)), also the "pillar Procedure". Both very promising - pillar procedure seems to be reversible, even.

Please let me know, if you have found something that works for you or if I have forgotten something which I could add to this list.

I have a sleep study due in march and hope that I get more insight as to what I might do about it. My sleep has been really bad the last few months and it sure as hell can't stay that way. Now that I finally understand what the problem is, I'll put every energy I can raise towards finding a solution. Please help and consider joining my WhatsApp group. Let's science the sh*t out of this!

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RE: Can Palatal Prolapse be treated with CPAP
I suspect more than a few folks are interested in what you learn. effective solutions seem to be remote. thanks for the summary.
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RE: Can Palatal Prolapse be treated with CPAP
(02-17-2020, 09:43 AM)NightVigil Wrote: * Expiratory palatal obstruction (EPO) (This is what Dr. Steven Park refers to on his blog. He has an article about it and I encourage you to read it, very insightful stuff.)
* Expiratory velopharyngeal obstruction

Thanks for writing! I was not aware Dr. Steven Park was looking into this too.
Here is the article you mentioned.

the silicon wires
are also new to me! and very promising!

Personally, no pressure modality on the AirCurve 10 helped: if anything, high pressure caused long expiratory apneas.
Neither did pillow/full masks with/out mouth taping.
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RE: Can Palatal Prolapse be treated with CPAP
NightVigil your experiences confirmed some of my thoughts on this (had posted them in a previous thread on this topic).

I have minor signs of palatal prolapse, I don't think it is enough to be a real issue but I see the odd signs of it in OSCAR data and my Mallampati score CT scan help indicate palate is probably one of my issues.

As far as CPAP goes I definitely see EPR/PS as being counterproductive. You want slower flow and less pressure differential during exhalation to try and maintain an open airway. Think of it like a fan blowing against a partially closed door, the harder the fan blows the more likely the door is going to close.

I often sleep on my side with head near edge of pillow which allows for head to be pointed slightly downward. I am guessing this is one of the better positions for this issue. I had been doing this before I even started CPAP so maybe it is something my mind/body had figured out without me realizing why.

One idea that is probably a bad one for most people but would avoid the palate prolapse issue would be to use an oral CPAP mask. This obviously requires you to breath efficiently through your mouth though.
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RE: Can Palatal Prolapse be treated with CPAP
This is sounding awfully relevant to my case. 

The CPAP and EPR seems to be doing nothing, and possibly just making it worse. I had some waveforms that looked similar to this in my charts, and the ENT observed a shallow velophayrnx. I have pretty much all the symptoms and experiences outlined by NightVigil. 

I’ve even noticed the last couple nights that my mouth was repeatedly dry and I had to drink water a few times which I haven’t had to do for the last couple months that I’ve been mouth taping without CPAP...and my mouth tape was almost coming off, as though the CPAP air was trying to escape through my mouth. Without the CPAP my taped mouth is always pretty well sealed and moist all night. I wonder if that’s because the air is trying to escape through my mouth because my soft palate is too narrow. 

This is kind of scary to consider since it doesn’t sound like there are any solid treatment options and this will probably be even less understood by doctors than UARS. 

I wonder if my plan to get a DNA appliance to widen my palate and move my jaw forward would help to correct this problem. They have a fair bit of research suggesting the airway increases in size after treatment. Like around 23:45 in this video https://youtu.be/vHRTuY4s3eY
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