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SleepyCPAP’s Treatment Thread - Palatal Prolapse AlaxoStent
#41
RE: SleepyCPAP’s Treatment Thread
pineman,
I moved your post and started a new thread for you.
Find it here:

http://www.apneaboard.com/forums/Thread-...apy-thread
OpalRose
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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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#42
RE: SleepyCPAP’s Treatment Thread
I won't bother with pictures today, just a quick typed interim update.
I continued with VAuto PS 4 EPAP Min 8 and IPAP max 15.

AHI was 3.99 for the whole night, but close examination leads me to be less alarmed at the jump from the night before:
1) Sleep Wake Junk - a set of CA's in the first 8 minutes of putting on the mask.  To "solve" this I may now set ramp on, but to .2 less than regular starting pressure for 10 minutes so that this stuff doesn't get into my AHI results.
2) The few OA's which were flagged within minute-long stretches of expiratory Palatal Prolapse.  Until Palatal Prolapse is diagnosed by an ENT, there isn't a therapy available to me (not through dial turning on PAP machines anyway).  So nothing to do here.
3) Constant Sleep Wake Junk when I came back to bed in the early morning.  I was just light dozing, in and out of sleep the whole time, and I could tell when the machine was checking (FOT) each and every one of these.  23 CA's in around three hours, so >8 AHI for that stretch.  

Side note:  Median IPAP pressure 12.32, 95% 13.64, 99.5% 14.20 (at one moment of the night for less than 2 minutes). Makes me think going up another cm on the minimum end isn't going to be hugely helpful, but I will get there eventually and show my doctor.  I had to have lots of air coming out of me when I woke, so I'm not eager to keep going up.
SpO2 was 92%-98%, with the median being 97%.  no problem there!  The Sleep Wake Junk CA's don't pull down much in their brief appearance, I think the worst CA had a desat down to 95% (that's a fine awake reading, let alone a sleep reading).

-SleepyCPAP
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#43
RE: SleepyCPAP’s Treatment Thread
I can barely get awake sp stats to read 98, 40 seconds, a couple in a row.  Otherwise, 99 or 100.  But, can really desat with my apnea.

QAL
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#44
RE: SleepyCPAP’s Treatment Thread
New VAuto arrived, nice low-hours machine, and its first night happened to be a very very good AHI night (0.0).  

Settings were PS 4, 6.4-12.6cm (so 10.4-12.6 IPAP).  I set the trigger to high and cycle to high. Ti Max 2.0s (default) (actual was 1.3s for this night when I looked at the screen) and TiMin 0.3s (default).  I had ramp set to 10 minutes starting at EPAP 6 (so only .4 below full pressure) to see if that helped me avoid sleep/wake junk.  

The screen said I had “Spont Cyc 98%” last night, whatever that means.

There were eight times of expiratory Palatal Prolapse.  I’m glad the machine did not go pressure chasing these, as PAP does no good for this condition.  

The only flow limitations showed up during the final hour session when I was trying (unsuccessfully) to get back to sleep.  I did not get enough hours of sleep and am tired today.

No leaks (Bleep mask, and I tape my mouth with KT Tape + blue painters tape over that, and a Polygrip strip between my lips).  A few singular snores marked in the night, statistically insignificant.

When I turned on custom user event flagging in OSCAR, two of the eight Palatal Prolapse events came up.  They must have been just under the time limit or volume to get a regular (H, OA) flag.  They both had significant SpO2 drops (each was five points), though the duration was short. Pulse rate jumped for both.

I’ll include a minute close-up of normal sleep breathing.  Looking pretty good, but perhaps there could be tweaks.
I notice that Vt was 460, which sometimes had been slightly higher.  Also uneven 1:2.1 I:E ratio - I thought that would be more even at PS4. 

The whole night overview shown here, mostly showing the night stayed at the base IPAP 10.4cm since it didn’t chase the Palatal Prolapse, and Flow Limitations were mild (these FLs were while I was not sleeping):
   

Palatal Prolapse with 6% SpO2 desaturation (this was not one of the custom user flagged events)
   

Close up of typical breathing in night:
   

-SleepyCPAP
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#45
RE: SleepyCPAP’s Treatment Thread
My 6” AlaxoStent arrived.  

I practiced with putting the 6” stent in on the first day for short periods, and left it in while watching shows, I did not sleep with it the first night.  Last night I put it in after dinner, gave my nose time to stop dripping (mostly) while I streamed a movie, and then put on my Bleep Dreamports, taped my mouth and slept with the stent in my throat down to just behind my soft palate.  I’m going to keep trying the combination of BiLevel PAP and Alaxo Stent at the same time for the next few nights.

Proof of concert:  Yes, nasal pillows (at least Bleep) can be used even while the end of the wire stent mesh is sticking out and taped to my cheek.  

They provide micropore tape, but I felt it was too weak (and susceptible to runny nose) so I used small bits of KT Tape instead (what I use to tape my mouth).  The Bleep Dreamport does not seal right on that side, so bits of extra tape over the edges of that too.  Blue tape then over everything.  I believe it still leaked very lightly all night, but the machine didn’t record any leak (I could hear it, and if it got loud I woke several times and would push down on the tape).

Last night reminded me of my first nights (weeks?) on CPAP 11 years ago.  Each leak would disturb me.  The feelings of having stuff attached to me disturbed me (this time, feeling it in my throat and nose). And I didn’t get more than about 5 hours of sleep time though I tried for more.  I’m tired today.

As I get used to it I will publish treatment results.  Last night was pretty good for AHI (0.39 for the part I was really sleeping, 0.34 with the extra time I’d come back to bed but was awake).  I still had Palatal Prolapse but not long stretches (one example from last night looked almost identical to the image I posted last time).  Maybe the stent saved me from worse?  I may have to place the stent lower than the palate to get the best effect, instead of just behind it.

-SleepyCPAP
Bleep Mask, KT Tape & Blue Tape & Poligrip to seal mouth, ResMed VAuto PS 4.4 over 6.4-14cm. Wedge pillow & cervical collar.  AlexoStent (6”)
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#46
RE: SleepyCPAP’s Treatment Thread AlaxoStent
Second night of 6" AlaxoStent and VAuto together.  AHI 0.0
I tolerated it much better last night, and my nose had stopped running before bed so I could tape and make my Bleep Dreamports leak-free.  I'd put the stent in a couple hours before bedtime and streamed a movie to keep me occupied while waiting for dripping to stop.

I was comfortable with the stent in place all night.  I would have liked to have slept in more than the 7.5 hours, but my bladder disagreed. I knew I wasn't going to go back to sleep so just stayed up after the bathroom break.

I'd put the stent a fraction lower into my throat, so that it went just beyond my soft palate and I could see it at the back of my throat.  This seemed to eliminate all Palatal Prolapse.  The first night I'd put the stent so it was just behind the soft Palate and not visible.

I thought this would eliminate any rare flow limitations but there were still a handful.  The VAuto raised pressure a minuscule amount in response.  I believe the stent reduces breathing area slightly, at least at this stage of early adoption, because it fills to become a column of thick moist mucus (from my nose still not being quite used to having an object in the sinus).

If this night can be a blueprint for all future nights I will be very pleased with the investment in the 6" AlaxoStent.

As always, Bleep mask, KT Tape on mouth (also Poligrip strip between lips, and blue tape over the KT Tape), no leaks.
Cervical collar and wedge pillow.  VAuto currently set to PS 4.4 over 6.4-14cm. (last night it went no higher than 11.38cm, snapshot below).

Overall view of the night of Zero AHI:
   

I believe this would have been Palatal Prolapse if the stent hadn't been there:
   

Highest pressure for night, in response to one of the rare Flow Limitation moments:
   

- SleepyCPAP
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#47
RE: SleepyCPAP’s Treatment Thread
Many people complain of a strong gag reflex with the stent. How was your experience. I always thought the AlexoStent mith5 p4of3 3rr3d5if3 in Palatal prolapse, but they are not widely available, and many are hesitant to try. I think my first awareness of PP was about 4-years ago. Good to see some positive progress.
Sleeprider
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#48
RE: SleepyCPAP’s Treatment Thread
Hi Sleeprider,

Part of your sentence is garbled, but I'll answer no.  I'm not having a gag reflex. 

The insertion of the tube (clear plastic tube with stent tucked inside) sometimes bumps something in the sinuses or back of my throat (still learning to navigate the passage!) but I'm going slowly so no pain or gagging.  Withdrawl of that tube is still clumsy for me and my eyes water a little from the irritation of me inadvertently tugging the expanded stent in the process.  On a scale of 1 to 10 irritation, maybe moments of 3, and I'm getting better at it so it is only for brief instants. Pulling the stent out in the morning is done in its expanded shape, and feels as if I'm pulling a feather gently through my nose.

The only thing close to a gag reflex was a trial run I did my first day right out of the box and I went too deep and touched my epiglottis.  I quickly pulled back and never did that again! My correct position is down to the soft palate.

I'm finding it slightly scratchy when I drink water at night while it is in place.  That's it, and that's not bad! 

Last night was another night of 0.0 AHI, and about 7.5 hours sleep.  This is exactly what I needed. Pressure barely moved in the night (all adjustments by my VAuto were within a 0.4cm range).  Flow Limitations chart has less than a handful of tiny insignificant marks (99.5% reads 0.01 in OSCAR for FL).  

   
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#49
RE: SleepyCPAP’s Treatment Thread
Thanks for this as well!
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#50
RE: SleepyCPAP’s Treatment Thread with AlaxoStent
Yet another night of Zero AHI using the AlaxoStent with my VAuto (Bleep mask).

I did have one point in the night when the VAuto noticed some leak around the tape and Bleep Dreamport where the end of the AlexoStent comes out of the nostril.  That put the 99.5% leak rate at a small 2.40.  Usually I have zero leaks (since I tape my mouth and the Bleep mask is good at preventing leaks).

Rather than show a boring OSCAR shot of a night with nothing bad on it, I’ll share a snapshot of my O2Ring report. This was the first night ever that I had a perfect 10 score.  No O2 drops of 3% or more the entire 7 hours of sleep.  Lowest SpO2 reading was 93%, but the average was a very decent (for me) 96% for the night, with a 98% max.  Pulse rate was nice and relaxed too.
   

My nose is getting more used to the AlaxoStent too.  Much less mucus on the stent when I took it out this morning.
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