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Palate still closing on exhale
#11
RE: Palate still closing on exhale
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
Sleeprider
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#12
RE: Palate still closing on exhale
Palate makes problems? Cut him out!
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#13
RE: Palate still closing on exhale
(12-12-2018, 04:12 AM)crowtor Wrote: Palate makes problems? Cut him out!

Just kidding, or having a bad day?  The soft palate is responsible for closing off the nasal passages during the act of swallowing, and also for closing off the airway. During sneezing, it protects the nasal passage by diverting a portion of the excreted substance to the mouth. It is also functional in some speech sounds. If you use nasal CPAP therapy, it would be impossible without a functional soft palate. It is often modified in UPPP or excision of the uvula, but "cut it out" is disabling mutilation. I'm sure Terriergal has consulted on surgical options and already has an opinion on that.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#14
RE: Palate still closing on exhale
(12-12-2018, 09:08 AM)Sleeprider Wrote:
(12-12-2018, 04:12 AM)crowtor Wrote: Palate makes problems? Cut him out!

Just kidding, or having a bad day?  The soft palate is responsible for closing off the nasal passages during the act of swallowing, and also for closing off the airway. During sneezing, it protects the nasal passage by diverting a portion of the excreted substance to the mouth.  It is also functional in some speech sounds.  If you use nasal CPAP therapy, it would be impossible without a functional soft palate.  It is often modified in UPPP or excision of the uvula, but "cut it out" is disabling mutilation. I'm sure Terriergal has consulted on surgical options and already has an opinion on that.

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.
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#15
RE: Palate still closing on exhale
(12-12-2018, 12:49 PM)crowtor Wrote:
(12-12-2018, 09:08 AM)Sleeprider Wrote:
(12-12-2018, 04:12 AM)crowtor Wrote: Palate makes problems? Cut him out!

Just kidding, or having a bad day?  The soft palate is responsible for closing off the nasal passages during the act of swallowing, and also for closing off the airway. During sneezing, it protects the nasal passage by diverting a portion of the excreted substance to the mouth.  It is also functional in some speech sounds.  If you use nasal CPAP therapy, it would be impossible without a functional soft palate.  It is often modified in UPPP or excision of the uvula, but "cut it out" is disabling mutilation. I'm sure Terriergal has consulted on surgical options and already has an opinion on that.

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.

much better answer
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#16
RE: Palate still closing on exhale
(12-11-2018, 06:24 PM)Sleeprider Wrote: This description helps, and I have seen this profile in Sleepyhead flow graphs a number of times.  In the past we have simply considered it oral expiration, but apparently it is the signature of expiratory flow limitation by palatal prolapse (pp).  Have you also seen this in your Sleepyhead flow charts?

[Image: nihms959132f1.jpg]
I don't know - husband has been so busy he hasn't had time to look at the charts.

The thing is my apnea was mild. I get great relief from the snoring and associated headaches and adenoidal irritation when I use the machine but I sleep slightly better I think without the machine a lot of the times.  :-(  because without the machine i can at least have my mouth open to let air out when my palate closes. i tried a full face mask too, it's really hard to keep a seal around my mouth.  Jaw just falls back and breaks it.

(12-11-2018, 08:50 PM)Sleeprider Wrote: 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.

I don't have to inflate it for that purpose.  I did try it, and woke up with horrible neck pain because of my disc issues.

Every other collar i have tried is either painful or gives more pressure on the front of my throat than i can stand, or is too short. Or any combination of the three.
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#17
RE: Palate still closing on exhale
(12-11-2018, 06:24 PM)Sleeprider Wrote: This description helps, and I have seen this profile in Sleepyhead flow graphs a number of times.  In the past we have simply considered it oral expiration, but apparently it is the signature of expiratory flow limitation by palatal prolapse (pp).  Have you also seen this in your Sleepyhead flow charts?

[Image: nihms959132f1.jpg]
I don't know - husband has been so busy he hasn't had time to look at the charts.

The thing is my apnea was mild. I get great relief from the snoring and associated headaches and adenoidal irritation when I use the machine but I sleep slightly better I think without the machine a lot of the times.  :-(  because without the machine i can at least have my mouth open to let air out when my palate closes. i tried a full face mask too, it's really hard to keep a seal around my mouth.  Jaw just falls back and breaks it.

(12-12-2018, 09:08 AM)Sleeprider Wrote:
(12-12-2018, 04:12 AM)crowtor Wrote: Palate makes problems? Cut him out!

Just kidding, or having a bad day?  The soft palate is responsible for closing off the nasal passages during the act of swallowing, and also for closing off the airway. During sneezing, it protects the nasal passage by diverting a portion of the excreted substance to the mouth.  It is also functional in some speech sounds.  If you use nasal CPAP therapy, it would be impossible without a functional soft palate.  It is often modified in UPPP or excision of the uvula, but "cut it out" is disabling mutilation. I'm sure Terriergal has consulted on surgical options and already has an opinion on that.

I honestly would rather do this if it would work.

But yeah I realize it's a permanent thing and what if it is done badly?  Scares me.  But since my apnea is mild why did I need a machine?  However now that I know my snoring was causing a lot of irritation, sleep deprivation, and headaches, I want that fixed.  I would much rather be without a machine though.

I talked to a person who had the UPPP or whatever it's called and he said it worked for a few months and then it stopped working.
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#18
RE: Palate still closing on exhale
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.
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#19
RE: Palate still closing on exhale
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.
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#20
RE: Palate still closing on exhale
(12-11-2018, 06:24 PM)Sleeprider Wrote: This description helps, and I have seen this profile in Sleepyhead flow graphs a number of times.  In the past we have simply considered it oral expiration, but apparently it is the signature of expiratory flow limitation by palatal prolapse (pp).  Have you also seen this in your Sleepyhead flow charts?

[Image: nihms959132f1.jpg]

I'll have my husband respond since he's been doing the computer side of things on this. 

I had my titer test. It was a bust. I found a nicer nasal mask I might try.  (Fisher Paykel nasal pillows - i prefer nasal pillows but with other brands I can't keep them in place very well - the design of the FP pillows has enough support to keep it where it's supposed to be.

They also decided I was mouth breathing too much so they put a FFM on me.  INSTANTLY WORSE. TERRIBLE AWFUL. I hated it. But I laid there dutifully trying to make it work.  Just kind of a 'hoop jumping' exercise to demonstrate the futility of this machine for my current problem.

This is what happened.  The problem with not being able to exhale was not solved.  However with a nasal mask or pillows and no chin strap the exhalation will start to leak out through my cheek to the corner of my mouth and escape.  

With a FFM the pressure on my cheek from the mask makes that impossible.  The prolapsed palate closes off exhalation possibilities through my nose.  But the mask edge itself, pressed against my cheek, closes off the exhalation that would escape through my cheek to the corner of my mouth.  My tongue is always pressed forward pretty solidly against my teeth. My jaw is normally closed when sleeping, even when on my back.

 (I've tried chin straps too, very uncomfortable and the whole point of them is to keep air from leaking out your mouth which is the only way I can exhale in some positions anyway, so it isn't fixing the problem).

BUT Sleep tech said it "fixed my mouth breathing" yeah because i couldn't sleep / couldn't exhale at all with my throat relaxed.  No mouth breathing = no breathing. Yay.  Annoyed-and-disappointed

I went home and switched my machine to the lowest setting. It's great.  Works just as well as on higher setting and is more comfortable.  EPR on 3 (the highest setting of 1-3).   No air being forced down my esophagus.  Still only works on inhalation, not exhalation, but at least if air leaks out from the exhalation palate closing problem it's not such a loud shock. I may get a few minutes more sleep before waking.

However the followup I talked to the sleep doctor's P.A. and she finally understood what I was trying to say.  Yes palatal prolapse, I'm pretty sure just by looking at the waveform you shared here that that is what mine will look like.  (I was a med tech major in college, and biology/medicine/veterinary medicine is still a hobby interest although I never finished school - got married and had kids instead.  :-)  )

I also saw that study online about "expiratory flow limitation by palatal prolapse."  But I am unable to find any resources for how this is treated other than someone mentioning on some forum a product called "Alaxostent" which is pretty darn hard to find. (looking into that however,  I would definitely prefer that to the machine. I would prefer surgery to the machine!  I did have turbinate reduction recommended (covered by insurance) and am going to call about that, and ask also about the stent (not likely covered by insurance) and possibly pillar procedure (not covered by insurance). But I am getting pretty desperate for a decent sleep.  as it is now I wake up at 4 or 5 and take the darn thing off because I can't get comfortable anymore on my side, and if I leave it on or take it off I'm awake more than asleep for the rest of the night because I need to sleep on my back and can't.

Incidentally I noticed my husband also breathes like this occasionally but he doesn't have the same snoring/inhalation constriction that I have so he doesn't hardly snore at all.  Sometimes his palate closes, I think, and a little puff comes out his mouth on each exhale.  No big deal. If only I could sleep that way.  But I had to fix the constant snoring which was giving me constant nasal/adenoid irritation and headaches. I already have enough headache issues.
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