Can this be palatal prolapse?

[cvelee]

Hello everyone. First time poster

Since 2000 I've been noisy breather and breath holder. First sleep test in lab in 2000 was negative. Yet because of expiratory night groaning (catathrenia) making my wife lose sleep I had uvuloplasty in 2015 (there was paper claming it helps). It did nothing for me.

In june 2023, profuse night sweats, sleep fragmentation, nightmares, restless legs and hct of 48% made me undergo novel sleep test resulting in AHI of 20. SaO2 nadir was 89% (short time there). 50% of centrals on sleep test but respiratologist was reluctant to call it CA before titration. Now only 10-20% events are CA (as per Airset).

I feel great on cpap, like a new person. All symptoms vanished. I realized how tired and fatigued I was. Yet, I cannot lower AHI past 3-4. I do mouth tape vertically but cheeks puff and air leaks when suction hold/soft mew fails. Low pressures I use are chosen due to these leaks and aerophagia.

During one run session, I noticed that I snorted 6-7 times during forceful expiration. Many times I couldn't blow my nose because forceful expiration blocks nasopharynx. So I looked at flow rate when in OA and it looked like expiratory collapse, interruption that continues in expiration.

I put 11 Oscar screenshots also here:
https://imgur.com/a/GHSgjT1

Is this palatal prolapse? I still do have catathrenia especially when too tired (I feel in lucid dreams e.g., that I hold breath or breathe out slowly with moans).

DISE seems hard to find in my country, but if I were convinced that it is palatal prolapse I would either buy Velumount or Pillar Procedure.

EDIT: Oscar screenshots retaken and graphs reordered

[Julie]

It's important to get the pressure graph in there - yours is sort of stuck at the bottom, not really visible...

[cvelee]

I reordered and scaled graphs a bit.

Nevertheless, major leaks are still there even on such low pressures, so I tried to zoom on parts without leaks so that flow rate has some meaning.

[ChicagoGranny]

I put 11 Oscar screenshots also here:
https://imgur.com/a/GHSgjT1

I would like to see a screenshot of the whole night of September 13 when you were using Auto mode.

The instructions for the standard screenshot are here ----> OSCAR Chart Organization and preparing for Screen Shot/ https://www.apneaboard.com/wiki/index.p ... ganization

[ChicagoGranny]

I do mouth tape vertically but cheeks puff and air leaks

Are you practicing holding the tip of the tongue on the roof of the mouth?

Are the leaks from the mask or between your lips?

[cvelee]

Hello ChicagoGranny.

I attached with this post 13-sept data as per apneaboard.com suggestions.

I do mouth tape vertically but cheeks puff and air leaks

Are you practicing holding the tip of the tongue on the roof of the mouth?

Are the leaks from the mask or between your lips?

Leaks are mostly from the mouth - as soon as I enter REM sleep rear/mid part of my tongue lose seal and even if the tip is still in contact (it usually is), air rushes by the tongue, puffs cheeks and leaks out. I do practice all day long hard mewing (whole tongue on the hard palate, tip behind incisors, low/mid/high force on mid/front part) and soft mewing (with or without suction). I would say that intramolar width is somewhat increased (from 37mm to 39mm now) and that I got some forward growth (I lost some nasolabial folds, but I also did a lot of really extreme thumbpulling/intraoral facepulling). Tongue is much more comfortable inside the mouth now.

Yet, no matter all the tongue exercises, it just fails to seal during REM. Hence, I need to tape really hard, sometimes even 1.5''-2'' wide instead of 1''.

[ChicagoGranny]

A few thoughts.

1. Higher pressures might solve the events-in-the-data problem, but you have the side effects.

2.

Yet, no matter all the tongue exercises, it just fails to seal during REM. Hence, I need to tape really hard, sometimes even 1.5''-2'' wide instead of 1''.

It sounds strange to some, but I tape under a FFM (ResMed AirFit F30i). The FFM helps prevent jaw drop, helps hold the tape, and maintains the pressure when air leaks through my lips. I use two pieces of x-sleep tape, one on each corner of my lips. Air can leak through the center of my lips and this eliminates the cheek/blowfish issue. Most of the night, there is no air leaking between my lips.

3.

I feel great on cpap, like a new person. All symptoms vanished.

Maybe that's it. Forget the data. I was taught to judge my sleep at the end of the day instead of in the morning. Was I energetic during the day? Was there any excess sleepiness? Am I frazzled or tired but relaxed at bedtime?

[cvelee]

Maybe that's it. Forget the data. I was taught to judge my sleep at the end of the day instead of in the morning.

Yes, exactly, thanks for reiterating - better to use it constantly even if undertreated, than to use it sparingly (due to side effects) and feel like a zombie.