Palate still closing on exhale

[terriergal]

There are numerous anatomical features in the airway involved in sleep apnea.

Don't get too focused on just one structure in your airway. The fact is that your airway is closing and the best therapy is CPAP.

Surgery is a last resort.

No. In my case there is the palate. That is all. It flaps around against my adenoids when inhaling (snoring loudly). It flaps completely shut when exhaling.  I don't have any other issues in my throat causing a problem.
 CPAP at lowest pressure fixes all inhalation issues.
CPAP at much higher pressure doesn't do anything for my exhalation issues. I tried up to 13 and endured many nights of air filled stomach since that's the only place my exhalation could go since mouth exhalation is counter indicated while on CPAP.

I do get stuffy noses often, so yes, turbinate reduction is in my future too.  But it isn't my main issue. It's also temporarily fixed with nasal sprays (obviously can't use them too much or they lose effectiveness).

[terriergal]

Terriergal, something I forgot about, and someone coincidentally started a thread.  http://www.apneaboard.com/forums/Thread-...asal-stent

This is a nasal stent that patients apply themselves, and while it looks radical, you have the opportunity to ask a user about the Alaxo Stent.  This would bypass the soft palate and potentially eliminate your problem, not just when sleeping, but whenever you have a need.

This is the manufacturer information and is an allowed link. http://www.alaxo.com/alaxostent_eng.html

I just got a reply from them the other day and sent a note off to my physician to look into it.  I would definitely prefer this to the machine. Absolutely. Even if not covered by insurance.

[terriergal]

Sure I didn't mean to completely cut it out, but to go under the blade. I had expiratory flow limitations in two places, at the palate and at the base of the tongue, after UPPP they removed the small tonsils under the tongue and remodeled my palate, solving both of the problems. I had regurgitation into my nasal cavity for about a month, but the freedom of breathing was indescribable.

Where do you get someone to look into expiratory flow limitations??  The P.A. I just saw was sure it was something they couldn't deal with and suggested and ENT but I've seen two different ones who just kinda shrugged me off like I was talking a different language....  Maybe if i use the term "expiratory flow limitation" they'd understand??   Anyway I'm going to call one of them tomorrow. The one who offered me turbinate reduction (nasal swelling is a very frequent but not continual problem and is also fixed at least temporarily by sprays, which I try to avoid if at all possible).

Oh another thing - I found a better nasal pillow that might actually stay on so I can stop using a nasal mask. Fisher and Paykel's nasal pillows have a kind of protective housing that allows air flow but keep it from being dislodged too easily. They have two different ones that both seem to use the same kind of design. Next mask I try is going to be one of those.

[Sleeprider]

Terriergal, something I forgot about, and someone coincidentally started a thread.  http://www.apneaboard.com/forums/Thread-...asal-stent

This is a nasal stent that patients apply themselves, and while it looks radical, you have the opportunity to ask a user about the Alaxo Stent.  This would bypass the soft palate and potentially eliminate your problem, not just when sleeping, but whenever you have a need.

This is the manufacturer information and is an allowed link. http://www.alaxo.com/alaxostent_eng.html

I just got a reply from them the other day and sent a note off to my physician to look into it.  I would definitely prefer this to the machine. Absolutely. Even if not covered by insurance.

Keep me advised where this goes. It sounds promising for someone with minimal inspiratory apnea and your palate prolapse issue.  With regard to the failed titration study, we have a problem that "sleep studies" are really just test protocols with limited ability to interpret and respond to events that are not commonly encountered. Very few are problem solvers with the knowledge or freedom to actually diagnose or move outside the protocol to find solutions.

[terriergal]

I really think your best odds for success may be finding a collar that provides the fit and support to be both comfortable and effective.  The inflatable Trac Collar just looks like it would cause constriction, and I'm sure a different device could solve much of this. I'll leave specific suggestions to others, because we have many members that have resolved severe positional obstruction using collars.  Although your Palatal Prolapse is a variation on positional apnea, it shou,d respond to the right device.

Yes, i agree, it should respond to the right device. The problem is the right device is not CPAP.  It does nothing for my exhalation.

The Traccollar i would not inflate to use for sleep, but it's still too much vertically. I have never been able to stand anything snug around my neck for as long as I can remember. Gives me terrible headaches if done too long (but I do use them sometimes for pain, because I have little option at that point). 

Every other cervical collar I've tried presses on the front of my throat or just isn't supportive enough.  I have tried so many already due to my neck and migraine issues, attempting to find something comfortable I can rest in, with no luck (besides the traccollar which has no bladder on the front to press on the trachea, only on the sides and they inflate more vertically than side pressure)

Besides, keeping my mouth shut isn't the problem.  Keeping my mouth shut (which I do naturally most of the night, even on my back) only further prevents my being able to exhale.

[terriergal]

I find your post interesting as I feel that I am suffering from the same symptoms.  I also have disc degeneration in my neck as well as all down my spine.  I've posted my charts several times that show little to no exhale, and have gotten the response that I am mouth breathing.  I wear a full face mask now and still experience this breathing pattern most of the night.  Last night I woke myself up to some sort of blockage, snoring sounds, that I can recreate somewhat even when awake.  My mouth is not open, and I never seem to have slipped my lip below the mask, so I am still searching for an answer.  I had surgery several years ago to stretch my esophagus because of choking episodes while eating.  I am also overweight.  I would be interested to know how you sleep on your stomach with a neck roll as this would seem to hurt your neck.  I've read that stomach sleeping is actually a good position for those with back problems.  It has helped me on occasion to loosen back spasms, but I can't stay in this position for long as I'm having to hold my head to the side to breath.  I wish you luck with solving this dilemma and will be following to hopefully solve my own.

Sorry I missed this post before.  You're right the neck roll with my chin propped on it is not great. I did it once and it seemed great.  But the more I do it the worse it gets and the pain and discomfort makes it hard to sleep, once again.

I should clarify. With the full face mask I tried several months ago, I had it loose enough so that the air can actually get out of my mouth into the mask, then I get leaks.  In my titer test they put one on snugger than that.  But if I have it snug enough not to get leaks, the air can't get from my trachea into the mask on exhale. 

When I exhale, my natural preference would be through my nose.  My mouth doesn't really open when I am asleep, much if at all.  So when the palate snaps shut, air is forced into my cheeks and out the corner(s) of my mouth.  This happens without the machine on sometimes but it's not enough to wake me up unless I am on the machine. I've observed the same thing in my husband sometimes, who doesn't snore much at all, but occasionally on exhale has air escape out through his cheeks to the side of his mouth.

If I have a full face mask on, the pressure from the edge of the mask causes that route to be cut off so my cheeks puff out and I end up waking up having to open my airway consciously anyway.  When I had the machine pressure turned up, the exhalation would be forced down my esophagus a lot of the time too.

Apparently some people are having trouble understanding this explanation when I have given it.  But be that as it may, this is an accurate description of what is happening.  It happened during my titer test and the sleep tech that put it on me thought it was great that it stopped my mouth breathing. Yeah, it did, because it stopped my breathing/my ability to sleep at all.  

[ardenum]

Sure I didn't mean to completely cut it out, but to go under the blade. I had expiratory flow limitations in two places, at the palate and at the base of the tongue, after UPPP they removed the small tonsils under the tongue and remodeled my palate, solving both of the problems. I had regurgitation into my nasal cavity for about a month, but the freedom of breathing was indescribable.

Where do you get someone to look into expiratory flow limitations??  The P.A. I just saw was sure it was something they couldn't deal with and suggested and ENT but I've seen two different ones who just kinda shrugged me off like I was talking a different language....  Maybe if i use the term "expiratory flow limitation" they'd understand??   Anyway I'm going to call one of them tomorrow. The one who offered me turbinate reduction (nasal swelling is a very frequent but not continual problem and is also fixed at least temporarily by sprays, which I try to avoid if at all possible).

Oh another thing - I found a better nasal pillow that might actually stay on so I can stop using a nasal mask.  Fisher and Paykel's nasal pillows have a kind of protective housing that allows air flow but keep it from being dislodged too easily.  They have two different ones that both seem to use the same kind of design.  Next mask I try is going to be one of those.

I went to my sleep apnea doc and told her I want to get a surgery, she wrote me a document and I went to the nearest sleep apnea hospital where they do UPPP. Before doing the surgery they had to know where to cut so they did a sleep endoscopy a week before the surgery. During the drug induced sleep they meassured in some internal code the severity of obstruction in each part, palate, tongue, tonsils, under the tongue, vocal cord. The next week they did a modified-UPPP. The point is this type of study is only done, as I understand, before surgery. So you gotta go tell them you want the surgery and after they do this study you can say you changed your mind if you don't want any surgeries.

[ajack]

My exhale breath also blocks, I fixed it by raising the min pressure till the air splint kept my throat open. Currently I need 12cm. I don't know if this will work for you, but it might be worth trying

[terriergal]

Keep me advised where this goes. It sounds promising for someone with minimal inspiratory apnea and your palate prolapse issue.  With regard to the failed titration study, we have a problem that "sleep studies" are really just test protocols with limited ability to interpret and respond to events that are not commonly encountered. Very few are problem solvers with the knowledge or freedom to actually diagnose or move outside the protocol to find solutions.

Yeah, i figured re the sleep studies. I just hate wasting time and money doing that when I knew it wasn't going to go anywhere.

My doctor just told me she would not be willing to prescribe it and I would have to find an ENT. The ENT here in town is really not someone I find particularly inspiring... but then I didn't get much better results from a snore specialist ENT in the larger metro area nearby who recommended the turbinate reduction and maybe the pillar procedure.

As far as the INSPIRE implant I think someone recommended, does that help with exhalation issues as well as inhalation?

[Sleeprider]

I originally raised the Alexo Stent and INSPIRE as an alternatives that might be applicable to your situation. The Alexo Stent ( nasal airway stent) is very rare in the U.S. and hopefully the company that wants to market this will use your case to expand their acceptance.  None of us have actual experience with this approach, but it seems like it should work to stent your prolapsing palate.  Inspire is more targeted to conventional obstructive apnea and uses an electrical stimulation to tighten the muscles when an apnea is detected.  Does it even work for expiratory apnea? Big question that has not been addressed in any studies I'm aware of.