I’m using AlaxoStent with PAP therapy for Palatal Prolapse

[ChicagoGranny]

That's good news about the stent and a short nap. If you ever try the stent sans CPAP for an entire night, I hope you will update this thread. If you try it and wake up in the middle of the night in distress, please start CPAP.

Thinking of my own case, an entire night might put me in danger, particularly in REM stage, where my OSA is most severe.

BTW, you make no mentions of the difficulty/ease of inserting the stent nor the comfort/discomfort of sleeping with it.

[SleepyCPAP]

ChicagoGranny points out I didn’t talk much about the wearing of the stent. Here is an excerpt of a product review I did on another forum:

What I like: small travel case holds all I need. This protective case could fit in the outer pocket of my roll-on case in the over-seat bin on the airplane. Except for the small part taped outside the nostril there are no masks, straps (or morning marks), or things to get in the way if I want to kiss my wife. I could put this in and sleep on the plane, and nobody would know under my COVID mask. I like that it targets the one area that is causing my sleep problems - the soft palate - without surgery.

What I’m learning gets better, but not so great the first couple days: Inserting the delivery tube through the middle sinus passage and then the quick bend down the throat took a couple day’s practice, and I realize I’m still learning to be better at it my fourth night of using it. Note: this was less of a difficulty than my first attempts at getting a leak-free mask fit with CPAP, but had some small discomfort for me the first couple tries.

Downside, but seems to be going away: My nose was dripping for a long time the first times I put it in (I started by putting it in 2 hours before sleep, so it was not dripping when I put my Bleep Dreamports on my nostrils just before sleep). That dripping period is already starting to be shorter, and less of an amount, and perhaps will go away as my body gets used to this object in there. (No, I have not experienced any nosebleeds, saline spray is recommended if you have dry passages, I tried it once but I find I don’t need it.).

What is still a downside: Takes a little time to put in correctly, must be done in front of a mirror (comparable to my Bleep mask) and since I use it with my PAP machine and mask it means more taping so as to have no (or low) pressure seepage around the part that comes out the nostril. Also takes a few minutes longer in the morning (compared to typical mask morning routine) to wash out the mucus on the stent, and do the rinse/disinfect, rinse/disinfect process before setting it out to dry.

Also feels a little scratchy at the back of my throat when I swallow. I don’t notice it when sleeping, but I do when I’m awake.

Overall I’ve adjusted quickly to the AlaxoStent.

There are videos on YouTube showing people putting in the stents. Note that the 6” stent must be taped to the lip or cheek when done, unlike their shorter 2” and 3” sinus stents (which are shaped differently to stay in the nose).

- SleepyCPAP

[SleepyCPAP]

Still using the AlaxoStent with VAuto, eight nights now. Last night I set lowered pressure of PS4.4 over 5.4-14cm (min-EPAP down 1cm from before). Overall AHI was 0.22 (one CA and one H in the morning)

A stretch of machine-scored snores perhaps would have been Palatal Prolapse without stent, but with the 6" AlaxoStent in place the soft palate didn't lock closed! My wife has not mentioned me snoring.

80-85% of the night I was above 95% SpO2 according to my O2Ring (96% average, and nothing below 91%).

Still using Bleep mask. KT Tape over lips and area of stent coming out of nostril. Blue tape over top. Poligrip strip between lips to reduce drool. Not any full-on leaks according to the machine (and OSCAR), but I noticed there was air seepage. The noise woke me a few times - I pressed tape down again but didn't last. This taping of the exposed end of the stent is an art, and I've only had it perfect a couple nights. The noise from seepage is disturbing my sleep, much as struggling with mask leaks did in my first days with CPAP over 11 years ago. I'll either get used to it or be more experienced in getting the tape just right.

I continue to use the wedge pillow and cervical collar. But, in an unusual experiment, one part of night I slept on my side (instead of all night on my back).

I rate this night as a great success, and it would have been perfect if I hadn't needed to use the bathroom in the middle of the night. Even with that bathroom trip I was still able to get back to sleep so the total sleep for the night was 8.5 hours.

- SleepyCPAP

[squid13]

These stents sure cost a lot $974 for the 6" stent. https://alaxousa.com/products/

[SleepyCPAP]

These stents sure cost a lot $974 for the 6" stent.

I agree, Yes, the cost is significant. It is still worth it to me, and I'm glad I'm in a position to make the choices in my budget to get the stent.

I just now looked over my stats for the first 15 days of this month (no AlaxoStent use, just VAuto), and compared to the last 15 days (with AlaxoStent combined with my VAuto). I am so glad OSCAR can export CSV files. According to OSCAR, I had 315 OA's scored in the first 15 days, compared to 3 OA's since I started using the stent (also 15 days). It took me less than a half hour of the very first night of the month to get to 3 OA's (no stent), whereas it was a week to get there with the stent in place (and two of the three were on the first night when I didn't get the AlaxoStent placed quite right). I have not had any OA's since Dec. 22 (in that first week of stent use). If I multiply how many OA's I'd get over 18 months, with stent use, I'd guess 108 based on these 3 in the first 15 days. If I multiply the OA's estimated over 18 months without the stent, I'd guess 11,340 based on the 315 in the 15 days this month without stent. So over the manufacturer's projected lifespan of the stent, the $974 reduces my OA count by 11,232. Also, in terms of time in Apnea, my OA's brought me 1 minute 10 seconds of time in apnea over these 15 days, and this is done even though my pressure is down 2cm (so far, and I'm still slowly reducing). I'm also averaging a half hour more sleep per night now that I'm using the 6" AlaxoStent. Again, worth it to me, I'd even say priceless.

In comparison, the online price for a ResMed Airsense 10 AUTO is $1249.00 at our host's online store. Yikes, all prices of Obstructive Sleep Apnea treatment look like they cost alot.

[ChicagoGranny]

That's good to hear!

I’ve been masking up for 11 years now, usually averaging <1 AHI, but PAP doesn’t fix this new-since-summer expiratory Palatal Prolapse which leads to its own apneas.

Any idea what changed?

[SleepyCPAP]

Any idea what changed?

Short answer: I don’t know what caused my expiratory Palatal Prolapse issues to arise this summer.

Longer guesswork stuff: Maybe the tick bite I got in June led to inflammation or something? Maybe an environmental allergen that didn’t affect me before this summer? Maybe the black foam degradation from my PRS1 450 (that I stopped using in June upon recall notification) had irritated things after the fact? Maybe something interrelated to my heart attack coming on (Palatal Prolapse as an early indication of M.I.???). Maybe just being one year older? Maybe not having done enough singing (chorus groups closed for COVID-19) reduced my muscle tone? It definitely got worse when I switched to ResMed, but wasn’t caused by the different CPAP.

Finally saw an ENT Doctor last month before I started using AlaxoStent. Doctor said my palate looked fine when scoped down through my nose (at least when awake, sitting up). Nothing noted that would be explanation (which reassured me it isn’t something like a tumor in there).

In any case, the AlaxoStent is dealing with the soft palate and that’s what matters.

[ChicagoGranny]

Your lawyer says to stick with this ---->

black foam degradation from my PRS1 450

[SleepyCPAP]

It’s been a while since I updated this thread. The AlaxoStent is still working wonderfully. I think I can do without PAP therapy altogether.

I kept turning down my machines’ settings over these past weeks, as an experiment to see if the stent took away the need for pressures that might sometimes cause issues for me (such as air in my belly). I’m at 4cm pressure now, three nights so far, and AHI is always <1 (a few Hypopneas). I take naps without masking up, just the stent, and my O2Ring reports about the same oxygen levels as when I’m masked up along with the stent at nighttime. For example: today’s nap averaged 95% SpO2, range 90%-98%, with the 6” AlaxoStent only (compare to last night, with the AlaxoStent combined with my VAuto set to 4cm, when the average SpO2 was 96%, range 91%-98%).

At this point I’m just wondering how to monitor things (other than O2Ring) without a mask attached to my face. I’ve been tinkering with my old (recalled) PRS1 CPAP, to see if I can get readings by attaching a cannula directly to the internal sensors, so that it is reading my breath waves. I’m having mixed luck but once or twice I got it to do that and load into OSCAR (it is noisy though, as the fan can’t be disconnected). Contec makes the RS01 which has a similar idea, but it can’t load into OSCAR and I have a Mac not PC so I haven’t bought that since I can’t use their software.

I hadn’t intended to work myself out of PAP therapy (I’m very well adjusted to CPAP or BiLevel after all these years), but it looks like I was exactly the patient that the AlaxoStent was designed for, and why it got the FDA approval as a substitute sleep apnea treatment. I may ask my sleep doctor to recommend a sleep study, so we can be sure this is really the solution (my doctor tends not to believe OSCAR, and besides I want to know if I’m getting all the sleep stages).

- SleepyCPAP

[Pugsy]

I may ask my sleep doctor to recommend a sleep study, so we can be sure this is really the solution (my doctor tends not to believe OSCAR, and besides I want to know if I’m getting all the sleep stages).

You know that the only way to know for sure if the AlaxoStent has fixed your OSA issues is with a sleep study.

What you might consider is a home sleep study that does the actual sleep stages data points since you also want to know about your sleep stages. It's a Type 2 home sleep study.
For more information about the various Types of home studies and the data they gather or don't gather you can read here
http://freecpapadvice.com/home-sleep-tests
Type 2 studies are pretty much just like what is done in a sleep lab in terms of data gather. Costs a little more than the Type 3 home study which is more common but it is what I would do if I were in your shoes.
Something to talk to your doctor about for sure.

Much easier to sleep at home than in the foreign environment of a sleep lab so probably a truer test in terms of sleep stages as well. It's not always so easy to sleep in the sleep lab environment.....I have been there and done that and won't be ever trying it again.

[ChicagoGranny]

At this point I’m just wondering how to monitor things (other than O2Ring) without a mask attached to my face.

You might want to keep a diary.

Daytime:
-energy level
-sleepiness

Night:
- awakenings
- nocturia

Always comparing to how you did when using CPAP plus Alaxo.

[SleepyCPAP]

Pugsy, thanks for the link on Jason’s site. I will check with my doctor when I send my monthly report next week and ask for a Type II study at home. If that is not available through my insurance, I’d see if Jason has room in the schedule to ship out his test equipment.

ChicagoGranny, thanks for the suggestion. At this point that’s what I most need to consider - how am I feeling? I’ll have the O2Ring numbers too. OSCAR will allow me to just have the O2Ring on each day’s data, and I can use the note field there.

- SleepyCPAP

[SleepyCPAP]

You know that the only way to know for sure if the AlaxoStent has fixed your OSA issues is with a sleep study.

What you might consider is a home sleep study that does the actual sleep stages data points since you also want to know about your sleep stages. It's a Type 2 home sleep study.

I got my sleep study results back, Type 2 as you noted that gave me the sleep stages. There were no local folks who could do a Type 2 home study, so when my doctor approved the study I went ahead and ordered from Jason (LankyLefty). I also appreciated that he suggested I have a do-over before sending the equipment back to him if my first attempt didn’t go well. In fact I did have a bad first try, I was slow in putting on all the leads and so threw off my bedtime routine and didn’t have a good night. It was wise advice to have saved the electrodes and try again the next night (which was much more typical, so I believe the results).

I had a one-week washout period, using only the stent, leading up to the night(s) of the home sleep study (as per recommended by my doctor). No combined PAP treatment during those nights.

The study showed that the stent reduced my AHI to 2.7 (mostly Hypopneas), and my RDI to 11.7. That’s pretty impressive! I definitely trust using the AlaxoStent alone for naps or an occasional night. The stent brings me down from severe Obstructive Sleep Apnea, down to the “treated” range (or down to mild Sleep Apnea if going by RDI).

This gives me flexibility on my treatment. I don’t think I’m going to do the stent by itself most nights though. I can do better when combining the 6” AlaxoStent with my VAuto. When combined, pretty much every night is 0.0 AHI, and Flow Limitations are reduced to almost nothing. My VAuto pressure stays at or near the settings (PS 3.6 over 4cm EPAP) most of the night, with a tiny temporary bump once or twice if there is a FL detected, then back to settings again. Combined seems to give me better rest than just the stent too (I could tell during the washout week).

I trust the stent alone, and will use it by itself for naps or the occasional night when it is most convenient (power outage, camping, etc.). I don’t trust the VAuto alone (it doesn’t deal with the expiratory Palatal Prolapse, no matter what pressure settings). I’m completely confident of the two combined, and I enjoy the lower pressures I’m using this way (no more soaring to 14cm pressure and getting air in my belly).

- SleepyCPAP

[Denase]

I have one on order! You mentioned insertion of the stent in the middle sinus passage, the product literature states the lower sinus passage.

[Denase]

Viewed the video from Alaxo again they show the middle sinus. Is it easy to tell which one you are in?