Mystery solved! ever heard of "palatal prolapse" (new article)?

When I had my jaw broken several years ago, I was told by my doctor to carry a small pair of scissors with me at all times in case I got choked, I could clip the bands. I carried those things for six weeks.

Okie bipap wrote: ↑

Sun Mar 17, 2019 2:46 pm

When I had my jaw broken several years ago, I was told by my doctor to carry a small pair of scissors with me at all times in case I got choked, I could clip the bands. I carried those things for six weeks.

Well I was in middle school which was probably why they didn't give me my own scissors. hmm come to think of it that makes the surgery longer than the 30 years ago I was saying.

Cynmatthes wrote: ↑

Sun Mar 17, 2019 2:51 pm

Okie bipap wrote: ↑

Sun Mar 17, 2019 2:46 pm

When I had my jaw broken several years ago, I was told by my doctor to carry a small pair of scissors with me at all times in case I got choked, I could clip the bands. I carried those things for six weeks.

Well I was in middle school which was probably why they didn't give me my own scissors. hmm come to think of it that makes the surgery longer than the 30 years ago I was saying.

obligatory aside, I've got a friend who says her spirit name is "Runs with scissors".

Further updates,
1) Many of my early-morning arousals are preceded & likely caused by palatal prolapse.
2) High-pressure CPAP modality: 17/17.4, 20/20.4 is even worse than lower pressures, causing long apneas. With the better flow, the soft palate blows more in the stronger wind?
3) Although one would expect the mouth to open during palatal prolapse, breathing with a full face mask and untaped mouth did not resolve the issue.
4) Using a hard cervical collar did control the neck position and full face mask leaks, but did nothing to stop the palatal prolapse.

Having tried all that air pressure can offer and still not sleeping well -especially early mornings wakeups, I'm starting to think about surgery.
Even then it's not clear what the appropriate surgery would be.

20/20.4, pillows mask & taped mouth, Apnea:


17/17.4, pillows mask & taped mouth, Apnea:


20/20.4, pillows mask & taped mouth, Palatal prolapse casuing arousal:


12.0/12.0, F20 mask un-taped mouth, Palatal prolapse:

Thanks to NightVigil, here is an interesting article from Dr. Steven Park, "Two Things That Go Flop In the Night, Making You Wake Up":
https://doctorstevenpark.com/2things

Curious if anyone has tried Provent for palatal prolapse? I'd try it myself but it's not available in my area. I'm guessing no one has tried a nasal splint either?

Check mine out!!

I'm thinking of raising my EPAP by bringing my EPR down. Perhaps more pressure down the nanopharynx will keep the palate from flopping up? Right now I'm at 15 cmH2O with an EPR of 3. Will try 15 cmH2O with an EPR of 2 tonight and reporting back.

I have a consult with my ENT (at my sleep dentist's strong suggestion) to have a drug-induced sleep endoscopy done. That should show the obstructions at all points in my airway. I'll bring up the research article you posted with him and see his thoughts on it!

My former dentist (now retired) had trimming done on his uvula for apnea.
and ended up unable to talk while eating. Everything went up his nose. (Ick)
He still has to use a bilevel machine

nee wrote: ↑

Thu Feb 20, 2020 11:20 pm

Check mine out!!
I'm thinking of raising my EPAP by bringing my EPR down. Perhaps more pressure down the nanopharynx will keep the palate from flopping up? Right now I'm at 15 cmH2O with an EPR of 3. Will try 15 cmH2O with an EPR of 2 tonight and reporting back.

Yes, it looks like palatal prolapse.
Pressure may help if it inflates enough the area, not likely but worth the try.
EPR is actually be a problem as it makes the expiratory flow stronger, pushing more on the soft palate. Think a sail in the wind.
I'm now testing an adjustable bed with the head elevated which is promising so far.
Also, posted a summary of everything I found out at the first thread message.

yrnkrn wrote: ↑

Fri Feb 21, 2020 3:07 am

nee wrote: ↑

Thu Feb 20, 2020 11:20 pm

Check mine out!!
I'm thinking of raising my EPAP by bringing my EPR down. Perhaps more pressure down the nanopharynx will keep the palate from flopping up? Right now I'm at 15 cmH2O with an EPR of 3. Will try 15 cmH2O with an EPR of 2 tonight and reporting back.

Yes, it looks like palatal prolapse.
Pressure may help if it inflates enough the area, not likely but worth the try.
EPR is actually be a problem as it makes the expiratory flow stronger, pushing more on the soft palate. Think a sail in the wind.
I'm now testing an adjustable bed with the head elevated which is promising so far.
Also, posted a summary of everything I found out at the first thread message.

What you're saying is that having EPR off could help resolve palatal prolapse, correct? That the CPAP pressure on the soft palate counteracts the exhalation pressure on the soft palate? This makes sense to me.

As far as last night... an EPAP of 13 cmH2O (15 cmH2O w/ 2 EPR) last night resulted in no >10 second obstructive events at all. First time this has happened for me, which is encouraging.

I set a custom flag for Oscar: Flag all >20% flow restrictions for >5 seconds and for >4 seconds. Thought it would give me some interesting data, and lo and behold it did.

>5 second flag:


>4 second flag:


Close-up of >4 second flag events:


I gotta say it's interesting seeing these events preceding big gulps of air. I have a good amount of leakage still and I'm getting the F30i FFM today, so I'm pretty stoked to try it out and report back tomorrow.

nee wrote: ↑

Fri Feb 21, 2020 9:22 am

I set a custom flag for Oscar: Flag all >20% flow restrictions for >5 seconds and for >4 seconds. Thought it would give me some interesting data, and lo and behold it did.

Sometimes flow limitation precedes a problem but sometimes it's benign. Flow limitation could be lowered using higher EPR or pressure support on Bi-Levels but then palatal prolapse may get worse. Try various pressure configurations to see what's best for you while keeping the same pressures for a week at least due to night to night variability.
The leaks are not bothering you?

yrnkrn wrote: ↑

Sat Feb 22, 2020 2:06 pm

nee wrote: ↑

Fri Feb 21, 2020 9:22 am

I set a custom flag for Oscar: Flag all >20% flow restrictions for >5 seconds and for >4 seconds. Thought it would give me some interesting data, and lo and behold it did.

Sometimes flow limitation precedes a problem but sometimes it's benign. Flow limitation could be lowered using higher EPR or pressure support on Bi-Levels but then palatal prolapse may get worse. Try various pressure configurations to see what's best for you while keeping the same pressures for a week at least due to night to night variability.
The leaks are not bothering you?

They bother me sometimes. I just got an F30i in the mail so I'll try it tonight and see if I can eliminate leaks.

I tried an EPR of 1 (EPAP 14 cmH2O) last night and I tolerated it very well. However I woke up in the middle of the night and took the mask off because the leaks were bothering me. Unfortunately, I think my nose skin is very stretchy and balloons up with pressure, which makes the Bleep come off.

Just an FYI, but if anyone else was looking to try the nasal stent device (nastent), looks like the product company SevenDreamers filed for bankruptcy. I was struggling to find a way to get a starter pack in the U.S. but ran across their bankruptcy filing instead. I did however send an email to the distributor in France just to see if they had any shipping options for the U.S. and I'll post their response when I hear back.

imposterdroids, any news about SevenDreamers?

yrnkrn wrote: ↑

Mon Mar 09, 2020 3:53 pm

imposterdroids, any news about SevenDreamers?

I'm in contact with a seller from the UK called, CORINIUM MEDICAL EQUIPMENT LIMITED. I'm told they will deliver to the U.S., but the options they've given me so far haven't allowed me to make a purchase.

Direct from the email I received from them:

Option 1

You can order the product via Amazon using the link below

https://www.amazon.co.uk/Nastent%C2%AE- ... NrPXRydWU=

I'll update as I hear back. FYI though, I'm not sure how long the option will remain viable as I'm not sure the product is still being made. And the cost of shipping from another seller was prohibitive (for me at least). Around $70 for the product itself and then nearly $40 for shipping.