yankees123 - Therapy Thread

[Gideon]

I would say to confirm it with an ENT familiar with PP. And scroll thru your charts and document how extensive it is.
Call Alexostent and see if they know of any doctors using it in your area.

[yankees123]

Thanks guys, will look into it.

[yankees123]

A question I have is with this prolapse problem wouldn’t you expect me to have problems with flow limitations?  Usually my 95 percentile is very low.

[Rubicon]

PP is absolutely a flow limitation problem, up until the point of total occlusion.

However, xPAP machines only measure inspiratory flow limitation (IFL)(stuff above the -0- line). PP is largely expiratory flow limitation (EFL)(stuff below -0-) which the machine does not.

[yankees123]

Thanks Rubicon, are there any pap devices that do measure expiratory flow limitations?

[Rubicon]

No.  IMO that's something you need to go over section by section.  "The Number" and "SkyLab View" are of no help.

Even section by section examination is limited in information.

[Gideon]

PP can be a bit different than standard flow limitations in that it often acts like a check valve with no problem breathing in but when you breath out a lot of resistance, fortunately this isn't happening all the time.

From what you have shown us it is significant enough to to have it checked out by a doctor that has the proper equipment to visualize this anomaly and possibly a stent to hold it open at night.

[yankees123]

Thanks Gideon, was hoping to resolve my osa with cpap and not with something invasive.  Will have to look for a doctor familiar with this.

[Gideon]

That is our wish as well. Most users we have seen with PP have found that CPAP helped little with the PP. One of the goals of seeing an ENT is to see if PP is in fact the issue here.

I've asked about the extent of your PP so I could ask the follow up question, is this a livable condition for you, one that you can safely tolerate.

[SleepyCPAP]

Hi yankees123,
I saw your note to come look at your thread.
The first thing I tried was turning off EPR (or bi-level), next I tried a different mask (instead of nasal pillows) so that I could breathe through my mouth.  Then I added a wedge pillow, to see if a different angle would prevent the palate from locking up on exhale.  No luck with those, so I asked to get the 6” AlaxoStent.

I used the company referred doctor for a virtual visit to start the order on the stent, as my wait to get into an ENT doctor in my region was looking like it was going to be forever.  I did finally get to see a local ENT, who scoped down through my nose to see (while awake and sitting up).  That didn’t show any problem, which (in my view) eliminated something scarier (such as tumor).  But really, if I didn’t have the stent on order already (just hadn’t been shipped), I would have requested that I be scoped laying down under medication, so that my throat would be relaxed as if I was sleeping… that would have confirmed the soft palate was an issue. 

But once I had the stent in, it improved both inhale and exhale.  It was worth trying, because it worked, and worked better than I had imagined (see SleepyCPAP Therapy Thread, all the way through my follow up sleep study with the stent).  When I combine it with my VAuto, I get night after night of 0.0 AHI, at lower pressures than before, and 99.5% Flow Limitations around 0.02.  I was a perfect candidate for it.  YMMV.

If you have access to an ENT doctor willing to scope you while you are drugged asleep, you might learn if the palate is doing what we suspect from reading your OSCAR reports.

As for cost, the company said a particular submission code worked for someone (or a few) insurance.  It didn’t work with mine.  I was willing to pay full price, and am glad it was fully worth it in the result.