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SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent
#31
RE: SleepyCPAP’s Treatment Thread
The use of the VAuto again, this time at PS 3.6, worked very well.  I know this is only one night, and perhaps AHI would have looked good on the For Her machine at EPR 3 too, but I do agree these wave forms are so much better using bilevel PS levels beyond 3.

   

   

I also believe the Palatal Prolapse is fading in recent days.  Since most OA's were really Palatal Prolapse stretches, that makes a difference in the AHI (and my sleep quality).  Tonight's sleep had a couple other times of Palatal Prolapse (which didn't trigger an OA score), but no long stretches which is unlike the past - and the jump to near 14cm didn't set off that soft palate to lock up.  I've lost some of my COVID-19 lockdown weight since my heart attack, so maybe that has a role.

-SleepyCPAP
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#32
RE: SleepyCPAP’s Treatment Thread
Your upcoming BiLevel titration will start at PS of 4 starting. I'd increase the PS to decrease CA events at 4. Why? As a minimum you want a BiLevel VAuto unless your PP is better treated with another model.
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#33
RE: SleepyCPAP’s Treatment Thread
If my Palatal Prolapse continues to recede, I can increase Pressure Support.  Back in August when I tried EPR the Palatal Prolapse would just get worse - it was moving the soft palate back to the stuck place.  I'm pleased that I'm able to get bilevel to work, as it is doing well for my sleep breathing otherwise!

I will bring the images I've shared here to show my doctor.  If the sleep doctor the titration is just to please insurance, perhaps we can skip that step if I do a cash purchase with a new prescription.  And/or have temporary access to VAuto more.

- SleepyCPAP
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#34
RE: SleepyCPAP’s Treatment Thread
Generally, insurance could give a rip about titration unless it is to demonstrate a medical need for a particular therapy. Your detailed data from the machine should be sufficient for the doctor to make that case, however it is also a conflict of interest if he is making income from the test and/or analysis. All you need to do is make the case that bilevel is much more comfortable, and increases efficacy, much as you have done in thinks thread. I don't know of any insurance company that wants more than a PSG diagnostic test that demonstrates the need for CPAP or bilevel. Beyond that the titration test is more for your doctor to prescribe a pressure range.
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#35
RE: SleepyCPAP’s Treatment Thread
Yes! I have a new prescription for VAuto from my sleep doctor!  This will allow me to continue with what's working (since now I just have a temporary VAuto solution).  Supplier #2 is sending me a low-hours machine, which was cheaper than the local cash price for new. (I couldn't get one locally due to waiting lists with no time estimates anyway).

And we're going to skip the titration study, instead I have a referral to an ENT doctor to see about the Palatal Prolapse.
My sleep doctor was reluctant to believe the data I had from my machines, but since I'm also using an oximeter every night, and provided some closeup printouts of breathing (with the improvement with VAuto that you've seen here in this therapy thread), it was convincing enough.  This is good, it is expedient and should save me some out of pocket cash too.

The doctor asked me to increase pressures, and use PS 4cm.  I set the max IPAP as directed (15cm, and it never got there last night), and moved the min EPAP to 8 (Doctor wants 9cm, thinking higher EPAP will eliminate Palatal Prolapse because of a theory in a paper).  I don't know if it makes any difference to put EPAP higher, from reading on this forum, but I will step up to that 9cm eventually. (remember I'd been on straight CPAP for over 10 years, around 10cm, so I'm trying not to get air in my belly at the current 8+4=12cm+ IPAP).

A good night, except for the fact I stayed up to late so didn't get at least 6 hours sleep. So I'm tired, but not from the AHI which was 1.19 (I spent less than 2 minutes total in apneas last night). I spent less than 4 seconds under SpO2 90 (a quick dip to 89, as the machine was responding to one of the rare Flow Limitations marked in the middle of the night).  I would have slept longer but needed the bathroom -and once I'm up, there is no use going back when it is so close to my wake-up time.

Here are OSCAR snapshots from last night with VAuto set to PS 4, EPAP min 8, IPAP max 15:
   

Longest stretch of Palatal Prolapse, a miracle that these are down to under a minute, compared to this summer when it seemed to go on forever some nights:
   

If it were not for the first 15 minutes of my night, my AHI would have been under one. Sleep Wake Junk?  The first one in this snapshot didn't even meet the SpO2 desat criteria to be scored (same for the one just before it). Screenshot showing part of the cluster of CA's and an OA just 10-15 minutes after going to bed:
   

- SleepyCPAP
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#36
RE: SleepyCPAP’s Treatment Thread
Awesome.

For your ENT
Put together several charts showing the worst of your PP and show it in a typical current chart.

The only reason you needed a titration study was proof for your doc. He accepted your OSCAR charts, great. Other than not being unfamiliar whit OSCAR and your CPAP not being certified as accurate there is usually no need for titration studies for anyone that is actively using OSCAR.
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#37
RE: SleepyCPAP’s Treatment Thread
Yeah, you were definitely in a sleep-wake junk area for those two close-ups. You seem to have it covered. Enjoy!

QAL
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#38
RE: SleepyCPAP’s Treatment Thread
This is me spitballing here, and could be all wrong -- because I don't really understand what's going on with me, and what I've got going on is clearly not exactly the same, but maybe this will trigger an "aha!" moment for you?

I've got a thread about my own kind of weird flow rate curves:
    http://www.apneaboard.com/forums/Thread-...-your-data
Clearly this looks weird in a different way than you, but I'm wondering if any of this is variations on a theme. In no particular order, here are things I've observed which might matter

  1. This weird breathing pattern started after I had been on CPAP for about 15 months. I started therapy at 267 lbs, and started losing weight 4 months later, and lost 130lbs total. My jaggy breathing pattern started at the same time as I hit ~165 lbs on the way down.
  2. I think that it's positional.
    -- There's always one of those characteristic patterns of movement breathing at the beginning and end.-- It doesn't happen if I'm wearing a cervical collar effectively -- it's what happens during some of the in-between periods between clusters of positional apnea when I've got clusters going on.So I'm thinking there's one position that causes apnea clusters, and a different position causes the jaggies, and the collar prevents both positions.
  3. EPR on the autoset doesn't matter. (I have an original 2014 autoset, not the "for her".) With or without EPR, it's just as bad.
  4. PS on the vauto completely eliminates it -- but not if the trigger sensitivity is set above medium. (I have concluded that the autoset EPR algorithm is using a trigger value of VeryHigh. If I'm right, the ResMed engineers are freaking morons. Why would they hard-wire the EPR function to something that's other than the default vauto settings? ResMed has engineers who know how to build a biPAP, but apparently they can't talk to the autoset engineers who were implementing EPR!)
  5. When I've got either EPR or PS-with-very-high-trigger going, the Mask Pressure graph takes a wild crazy ride during this -- the PAP gets utterly confused as to whether I'm inhaling or exhaling and ties itself in knots trying to keep up. Dialing the trigger back to "medium" somehow cleans up it up.
So this is really perplexing, until I figured out the explanation that while the PAP doesn't cause this, a well-tuned pressure support flow can damp it. But a too-high trigger sabotages the ability to damp it down.

My working hypothesis is that there is some bad position I get into where there is some sort of resonance frequency in my airway. (Think of the Tacoma Narrows Bridge oscillating wildly.) With the trigger set to medium, the pressure support doesn't react to the vibrations (probably part of the code which keeps the pressure from responding to cardioballistic artifacts) and acts as a damp to the oscillations.

So where am I going with this? I wonder if the palatal prolapse is the same sort of animal -- where the oscillations of pressure support aren't causing the prolapse, but with the right tweaks to the vauto the pressure support can damp down the mess to keep it from running away wildly.

(I spent one really really ugly night with trigger set to VeryHigh. The flow rate waveforms looked just like the autoset -- it was a train wreck. It is more like being strangled than being suffocated!)

So far, you seem to be zigging-and-zagging into a similar place as me -- where it's not that the autoset breaks things, but that the vauto can push back in the right way -- when tweaked just right -- and the autoset can't be tweaked and doesn't help.
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#39
RE: SleepyCPAP’s Treatment Thread
(11-05-2021, 05:56 PM)cathyf Wrote:
  1. …When I've got either EPR or PS-with-very-high-trigger going, the Mask Pressure graph takes a wild crazy ride during this -- the PAP gets utterly confused as to whether I'm inhaling or exhaling and ties itself in knots trying to keep up. Dialing the trigger back to "medium" somehow cleans up it up.
So this is really perplexing, until I figured out the explanation that while the PAP doesn't cause this, a well-tuned pressure support flow can damp it. But a too-high trigger sabotages the ability to damp it down…

…So where am I going with this? I wonder if the palatal prolapse is the same sort of animal -- where the oscillations of pressure support aren't causing the prolapse, but with the right tweaks to the vauto the pressure support can damp down the mess to keep it from running away wildly…

Hi cathyf,

I’ll check out your thread.  My sleep doctor said that as long as I’m not out of sync with the bilevel machine, it will be comfortable.  I find that ResMed EPR is fine (though for some reason I didn’t like “2” when I tried it). And PS is fine in bilevel. What you are describing sounds like my breathing patterns on a Philips Respironics machine with CFlex (I could never get used to it, it was always a little off from when I wanted to breathe, and it showed up as a mess in the breath forms). I went without pressure relief all those years on my PRS1 CPAP.

The prolapse came on strong when I started with the Autoset.  That machine may have just the wrong waver to it.  Even without EPR.  But it also turns out there was a lot going on inside me - I didn’t know I was weeks away from a heart attack.  I have no clue if Palatal Prolapse was due to a related body effect, exacerbated by something about the machine.  The fact that it is fading confuses me too, does it mean Cardio Rehab is working, or my weight loss, or something I’ve not even considered?  Anyway, my pondering won’t help.  I’ll head over to your thread.  Thanks.

- SleepyCPAP
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#40
RE: SleepyCPAP’s Treatment Thread
@ pineman, I think the experts will want you to have your OWN therapy thread, so as not to confuse your data and situation with SleepyCPAP's data and situation. Perhaps the mods will remove the post and insert it into a new thread named "pineman therapy thread" or something similar. And I believe they will encourage your to keep all your stuff in ONE thread so that they don't have to search hither and thither to find your background.
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