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[Pressure] Weight loss but cpap pressure has rised
#1
Weight loss but cpap pressure has rised
I'm 49y male and I was diagnosed 2017 with AHI 57 (severe) - values were when lying prone - unable to sleep at all on supine (still the same - palatal prolapse). I have lost weight on "well formulated" keto during past 13 months 45kg (99lbs) BMI 39-->27. Average pressure has rised steadily month to month from 7 to 8.5. 95% pressure rised from 9.5 to 11 during last 13 months. Before that pressures were the same 4 years even weight fluctuated significantly. I have turbinate hypertrofy and ENT shrank them with RFA on jan 2018. I have DISH and there are 1cm osteophytes protrudingfrom spine towards my throat. I think DISH and nasal congestion were the main causes for my sleep apnea and now with this weight loss it seems more certain. It could be that nasal turbinates have regrown and throat osteophytes have grown even bigger - but the timing exactly month to month with weight loss seems odd.

But does anybody else have same kind of experience with pressure rise. Could it be that throat gets "loose" like what my lower belly skin looks right now. I tought I could get rif of cpap but when you have severe OSA it seems it's not going to happen anymore.
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#2
RE: Weight loss but cpap pressure has rised
You mentioned my first thought, excess (flabby) skin because of weight loss. Based off of various articles I have read, it takes time for the skin to contract.
Crimson Nape
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#3
RE: Weight loss but cpap pressure has rised
You mentioned palatal prolapse, and we have a very good thread by "SleepyCPAP" on using an AlaxoStent to address that problem http://www.apneaboard.com/forums/Thread-...l-Prolapse What we have found is that this physical problem is not fully resolved by increasing pressure or pressure support, because the airway unpredictably slams shut on exhale and causes the obstruction and arousals you are well aware of. The stent is an alternative to surgical options to stiffen or trim the anterior palate, and has been found effective by at least one of our members, and saves submitting to much more invasive surgery. SleepyCPAP continues to treat his obstructive sleep apnea, but with much lower pressure that in combination with the stent seems to be working well.

Consider the above linked thread, and if you want to investigate your problem, we should move on to look at some charts and perhaps some close-ups of the respiratory wave to see what your obstruction looks like and verify obstruction occurring in the expiratory cycle. We can experiment with pressures and pressure support (EPR) to see if the problem can be mitigated.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Weight loss but cpap pressure has rised
I saw ENT last friday (1 hour appointment even though 30min was reserved) and complained all these issues with no results. My sleep apnea appears to be unrelated to my weight which was over ~40kg higher at the time of diagnosis. So weight loss didn't cure it. He said that multiple "small" things about my neck/throat anatomy apears to cause of my sleep apnea. I have swallowing difficulties (not esophagus related) but everything except liquid seem to get stuck in my throat. If I extend my lower jaw outwards then I can swallow perfectly. Otherwise it feels like my throats "elevator movement during swallowing process" seem to get stuck. He also measured my face that maxillomandibular advancement surgery wouldn't fit me because I have normal jaw line and the result would look very odd in my facial structure. There is little space in my throat but advancement is not recommended. He said that I will never ever get rid of cpap.

He did endoscopy through my nose and said that cervical osteophytes can clearly be seen in my troat as a bulges but they are not that bad. There is still enough space even he said it is quite narrow. He offered RFA treament to my turbinate area but not where things bother me: palatal area and base of tongue. Outer turbinastes are open and it gets tighter further down the nasal canal. So I declined. Toncills seem to got smaller because of the weight loss - I guess? - so no need of surgery to them anymore - 10y ago ENT suggested it.

They did CT to my sinuses prior that mornng and it didn't reach low enough to visualize my throat area. I thought they would do it to my throat. Waist of resources and unnecessary load of radiation to me - Never ever had any sinus problmes - although there 1cm cyst on the left side. He said that pulmonologists (sleepapnea is treated here) usually refer patients to ENTs with nasal stuffiness even they all complain about throat. He said that it is now annoyingly common - same hospital!!! I especially complained about my throat and as a side note said "when he insisted repeatedly" there is nasal problem / stuffiness behind palate. They could as well did a CT to my left knees meniscus - would have been more usefull.

I asked about my palatal prolapse and the ENT dismissed it totally "I've seen it once..." It is definitely on of the main reason to my symptoms. It is difficult to even to blow my nose because "valve shuts with a bang". I forgot to ask him about palatal threads to stiffen the area. I asked about alaxostent and he had never heard of it - but he googled it then and said "I think no one can use throse because of the irritation".

I asked him about my tuba aperta - opened eustachian tube which is new symptom and only happens when I exercise biking/walk/run. That seem to be caused by losing weight. I asked if cpap pressure has anything to do with it - apparently not. Very annoying problem: ear pops constantly by every breath and hearing as well.

So I had to pay two specialists with no results and it took time to get these appointments. Public heathcare is great... sometimes. I have appointment with pain management doc (anesthesiologist) about my DISH disease in 3 weeks so I ask him about rescanning my throat area of the osteophyte growth progression.

I use Vicks nasal spray and the only ingredient that helps in it is the camphor. There are two versions and both contain oxymetazoline as the main effective igredient but the one with camphor is the only one thats helps to clear my nose - really opens it. I have multiple nasal corticosteroids sprays that have no effect to my swollen nasal membranes except camphor. Flow limitation 95% is 0.15-0.2 without camphor and with camphor averages 0.06. Huge difference how easily air flows with it. The problem is that I can't use it too many nights in a row.
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