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Sleep doc's reply to my question about palatal prolapse.
Doc:
Greetings I have not encountered this condition in my practice. I do know a very competent otolaryngologist who can help though, I can make a referral if you want.
H
Me:
Thank you, Dr. A. I will ask for the referral when I know more. Best, Harv
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
Awakened an hour early by intensely loud tinnitus.
Has influenced how I feel: not great.
Graphs for 3/21:
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
Your AHI looks better at these recent settings but to me your breathing looks worse with more restriction and more palatal prolapse. In that hour of data you posted from last night half of it has palatal prolapse/restriction.
It doesn't surprise me that your doctor hasn't heard that term before as they don't usually look at this level of detail in data and this isn't that common of a condition. Without a doubt he is aware of palate restriction which is why he offered an ENT referral.
From adjusting these settings we appear to have figured out that you have less obstructive apnea with pressures over 10 cm. EPR doesn't seem to have a big difference but maybe contributed to central apnea a couple nights, I would say either 1 or 2 is probably the best EPR setting.
I want to try APAP mode again now to see if the varying pressure helps combat varying levels of restriction. I am thinking min 10, max 16, EPR 2. This is almost identical to what you used back in February (8-16 and 11-16) when AHI was its lowest so hopefully we will see similar results again.
Did you notice that he didn’t answer one question. He just said he hadn’t seen a patient with it in his practice. A search would have told him the other names for the condition. But yeah, it’s way below the level of detail he’s concerned with.
Will try those settings tonight.
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
He did offer an ENT referral to see if anatomy is an issue, most would have thought you were crazy.
I assume if the ENT agreed palate causes restricted that the options would be the same we already discussed (UPPP or a stent).
I only have a couple more tests I have been thinking about. If you feel more progress is required then you might have to look into other options like these.
If by “more progress” you mean a consistently good
night’s sleep, then yes, I’d like more progress.
It sounds like you don’t have many more tests to try.
Talking to Medicare about paying for surgery or a stent
should be a very interesting experience.
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
Here's 3/22 chart. Lots of leaks, but none called Large.
Expiratory pressure mirrors inspiratory, but always below it,
again evidence of palatal prolapse.
Any expansions you'd like to see?
Feel okay, but not really sharp.
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
Lots of palate prolapse in that data and it translates into low minute ventilation (4.5 compared to previous high of 7) and low tidal volume (280 compared to previous high of 400).
Try this for one more night to see if ahi stays the same and then try a night without the mouth tape. We have been using similar settings as back in Feb but ahi has been higher since we improved leaks with mouth tape. I don't think the mouth tape is creating a problem but I would like to confirm it is the reason ahi has been higher. What I believe happens is that you have the same restriction/obstruction regardless of tape but when you don't have tape open/breath out mouth and apnea don't end up getting scored (mouth opening may even be allowing the palate prolapse to fix itself).
The idea that mouth breathing may fix the palatal prolapse
is intriguing.
Thanks to everyone who helps us get a better night's sleep. Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor. An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies. Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.
It doesn't fix it per say and the bigger issue with palatal prolapse is the initial close rather than being reopened in a shorter time frame. If your mouth is taped and you are trying to exhale the exhalation pressure has to overcome cpap pressure. If your mouth is not taped and you open mouth when exhaling then you exhale against atmosphere while the CPAP pressure blows on closed palate. So with mouth tape pressure is roughly equal on both sides of palate(actually slightly higher inside mouht) whereas without mouth tape pressure is only on the CPAP side which helps push the palate back open.
Your data prior to mouth tape showed signs of palatal prolapse as well, I am just trying to understand why AHI is higher with mouth tape and this is the only plausible theory I can come up with. Only other theory is that something changed positionally allowing apnea to occur now that didn't occur before.
