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

[chunkyfrog]

That sounds "hinkey".
Very, very hinkey.

[imposterdroids]

That sounds "hinkey".
Very, very hinkey.

I don't disagree with you. I've asked for more options and a shipping cost, as well as info on future availability. But good luck finding another supplier who will even ship to the U.S.

[ChicagoGranny]

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.

Assuming you have a checking account, it looks very easy to order direct from the supplier.

[Shaare]

Well, 13 years later...
I have palatal prolapse. With an ASV machine, an F1B full face mask from BMC (50$ aliexpress), I have much better sleep than CPAP. I'm looking into getting a barbed pharyngoplasty https://www.youtube.com/watch?v=s4DhudXwQbUsince it looks to be the ticket for people with CCC level 2 (complete concentric collapse) which is (I think) what palatal prolapse is.

I tried pretty much all the masks, my pressure goes up to 20 and so that mask is the best I've found for high pressure.
About the nasal stents like the Alaxo... I have the six inch and unless you don't have a gag reflex forget it... when it passes say around four inches in you start gagging and coughing and there's no getting used to that. No amount of will can void your natural reflexes. You literally have to not have a gag reflex to live with that.

I tried medical glue and tape with the mask and it'll help a little but it'll leak anyway and it's a lot of hassle.

Hoping this helps and that others can contribute what surgeries they've had or looking into.

Cheers,

Antoine

[ChicagoGranny]

Here is a review of the literature:

Conclusion
Barbed reposition pharyngoplasty has proven to be an easy to learn, quick, safe and effective new palatopharyngeal procedure, that can be used in a single level surgery or as a part of multilevel procedures. Patients affected by severe OSA may benefit from this surgery with more significant reduction of AHI values. In our opinion, this valid technique should be included within the surgical armamentarium of a sleep surgeon.

Last but not least, BRP was popularized in Italy since 2017 and then it

https://www.sciencedirect.com/science/a ... 0921002982

[vandownbytheriver]

(snip)
Hoping this helps and that others can contribute what surgeries they've had or looking into.
(snip)

I replied to another thread... just read this whole thread with interest. I found through experimentation that my palatal prolapse (thanks rubicon) was being set off by EPR 3. Positional dependent, supine worst, left side some, right side minimal. Reducing EPR lessened it... turning off EPR I have not had a recurrence. This solution was actually suggested two pages back here. Went to see an ENT, he didn't even look at the graphs I'd brought, gave me the old 'say ah' and called it 'tongue'. This did not evince without CPAP EPR 2/3.

If you feel like your face is being slapped from inside, I think that's palatal.

[cvelee]

Hi @Shaare, thanks for reviving the old thread.

I found your reply quite interesting and have a few questions. I also have classic PP. If I let CPAP, my pressures could sometimes go up to 15 without resolving some OA events. That being said, I am somewhat unsatisfied with CPAP. How is that ASV is better in this regard?

For me "no EPR" is mandatory. With EPR of only 1, I can experience palate "flipping" even when awake with mask on. To cut long story short, with my dual chin strap that stops jaw dropping in REM and with pressures of ~6.6:9.6 I can keep AHI ~5 with acceptable incidence of leaks and aerophagia (and subsequently induced GERD/LPR). That is point of diminished return for me - because increasing pressures really increase aerophagia/LPR and I don't want to go there.

Moreover, I also have Alaxo 6". Guiding it through nasal passages is piece of cake, trying to unsheathe it is totally different story - ineffable feeling really Regarding barbed wire pharyngoplasty, I find it interesting because it is easily found in my vicinity (Rome/Italy), but having in mind that I still have side effects from somnoplasty, I would rather skip additional surgeries.

Thanks again and please elaborate a bit on ASV for PP. I'm willing to go that route if it seems reasonable.
Cvelee

[tiredNorlando]

Hi everyone,

I’ve been on CPAP for nearly 8 years now (mostly APAP mode), and despite consistently low AHI numbers—usually under 2—I’ve never really felt great on therapy. I’m tired all the time, and some days are worse than others. It’s been frustrating, especially when the data looks “good,” but I still feel awful.

Recently, I started using an AirCurve 10 VAuto, and surprisingly, I felt better for a few nights—even though the charts didn’t look ideal. Someone on another forum pointed out signs of palatal prolapse, and when I looked closer, I realized I’ve likely had this issue all along. I can even replicate the same obstruction while awake, lying on my back with the machine on.

I’ve done extensive research on PP, but there’s almost no definitive guidance. Some people say to use BiPAP, others say don’t. Some recommend lowering EPAP, raising IPAP, decreasing PS, increasing PS—it’s all over the place.

The last few nights have been rough again—waking up feeling like I haven’t slept, needing naps during the day, just dragging. I’ve tried everything I can think of to avoid sleeping on my back (SomnoPose app, physical gadgets, etc.), but nothing seems to stick. Supine sleeping definitely makes things worse, but I can't fully avoid it.

My main concern: I’m only having obstructions on exhale, which no machine really addresses. That has me wondering if I even need CPAP or BiPAP at all—or if it’s doing more harm than good in my case.

I’d really appreciate any advice on:

Whether I should continue with VAuto or go back to APAP

Ideal starting points for IPAP/EPAP/PS settings to minimize PP

Whether fixed BiPAP (S-mode) might offer more stability

How to truly confirm PP

What others have done if dealing with expiratory collapse, not classic OSA

Here’s a [SleepHQ chart link] for reference (happy to upload more data or specific nights if helpful).

https://sleephq.com/public/3fa8fc71-ab8 ... 628404d9c0

Thank you

[Pugsy]

I’d really appreciate any advice on:

You probably should be starting a topic/thread of your own about this particular issue because it is going to get lost in this thread of 4 plus pages and well over a year old. Just copy/paste what you wrote above in a new thread.

Then look for forum member Nocibur and try to get him to participate....he knows how to spot palatal prolapse and may have an idea what to do about it.

[tiredNorlando]

Thanks Pugsy