Palatal Prolapse Help

[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/0093b605-79c ... efde568d46

Thank you

[Nocibur]

How to truly confirm PP

That's easy! Find you an ENT guy and do a DISE (Drug-Induced Sleep Endoscopy).

[Nocibur]

I’ve never really felt great on therapy.

This seems to contradict your early claims that initially, it did.

That has me wondering if I even need CPAP or BiPAP at all

You've got 2 sleep studies that say you don't.

I’ve done extensive research on PP, but there’s almost no definitive guidance.

Sure there is, allow me to offer a metaphor to help explain:

You can't bang in a nail with a banana.

If what you're saying is you've run out of bananas, you might investigate nasal stents. Alaxo and Nastent are options.

That said, IMO using nasal stents is kinda like getting a Covid test with a fork.