Eppiglotic collapse

My sleep endoscopy revealed "lateral and anterior collapse of the eppiglottis." Does anyone know if this type of obstruction would prevent CPAP from being effective?

It is possible--but then it could also be causing your apnea.
If the doctor urges surgery, it could save you from a lot of misery--or worse.
Good luck.

Thank you. I have obstruction in two other areas as well: the soft palate and tongue base. Been using CPAP for 2.5 years and wondering why I'm not benefitting, if it's perhaps the eppiglottis portion of the obstruction responsible.

My sleep doctor insists that I have severe psychiatric issues and that is the reason I am not responding to treatment. He is in the camp that considers UARS a mild form of apnea.

This is what he wrote in response to my eppiglottis question and my ENT's suggestion that eppiglottis obstruction could be what's not allowing me to benefit from CPAP:

"On CPAP, your airflow is normal. So no surgery is going to make that better. Your substantial psychiatric co-morbidities are your best target."

My question then, would the airflow look abnormal if the eppiglottis was causing a problem? If airflow looks normal, do I assume CPAP is fixing all of the obstructions, including the eppiglottis? He didn't respond when I asked him this.

get second or third opinions from a board certified specialist. every one here is guessing at what could or could not be.

Perhaps it's not really known. I had another ENT -- one who specializes in implanting Inspire devices, so he knows DISE procedures very well -- who made no comment on the eppiglottis obstruction and said my multilevel obstruction is normal for what he sees in sleep apnea patients. I tend to think some of the people on here are more helpful than doctors at times.

Okaythen wrote: ↑

Tue Aug 07, 2018 4:59 pm

I tend to think some of the people on here are more helpful than doctors at times.

Very few if any people here on this forum would disagree with you.

Blaming everything on "psychiatric comorbidities" is too d*mned easy.
Bad sleep can turn anyone into a nutcase.
(looking in mirror)
You need a different doctor--one who treats without making excuses.

epiglottis come in different shapes, some are more like Omega shape, some are relatively flat, while the rest might be somewhere in between.

A flat epiglottis is like a door close in one direction, i.e., could be pushed down by airflow and the airway becomes much narrower very quickly. CPAP could be less effective in that case due to the potential epiglottis movement. I found some videos on youtube:

https://www.youtube.com/watch?v=VXgpLooNiGo

https://www.youtube.com/watch?v=G0V9nNobr-I

On the other hand, epiglottis is rarely the only issue. The hyoid bone might drop too close to the posterior pharyngeal wall during back sleep, which means both tongue base and epiglottis are also close and easy to block airway.

Could the epiglottis be the culprit of many CPAP failures? I think it could account for some. My ENT surgeon also mentioned to me that he have seen many CPAP failures cause by large tongues. I think that implies female might respond better to CPAP since women tend to have smaller tongue mass on average.

Are the quotes you are giving us from a copy of your reports? It may be that even with the collapse your air flow wasn't compromised. There should be some answers in black and white on a detailed report. I am like some others here who get a little testy when I feel I'm being brushed off. You have legitimate questions that a doctor should be able to look at the details of your test and give you answers as far as what they saw during the testing period. Getting a doctor to spend that kind of time with you is not easy. It helps to limit your questions and hone them to the fewest possible words. Maybe getting them to the doctor before the appointment could help them prepare to be ready to answer your questions. If a doctor has given you an answer, they should be able to tell you precisely what data that conclusion was based on. I'm sorry you're going through this in search of answers. Even people with mental illnesses have physical health issues. And messed up sleep does not make one feel emotionally sound. Our goal is to reach our capacity for living life with a sense of well being as much as the cards we are dealt in life permit. Hope you get some answers to settle your mind and help you feel better.

musculus wrote: ↑

Tue Aug 07, 2018 7:27 pm

...large tongues...

My tongue shrank in size (no more scalloped edges from teeth impressions) after being on CPAP therapy for while.

Muse-Inc wrote: ↑

Tue Aug 07, 2018 11:44 pm

musculus wrote: ↑

Tue Aug 07, 2018 7:27 pm

...large tongues...

My tongue shrank in size (no more scalloped edges from teeth impressions) after being on CPAP therapy for while.

Mine too.

Kteague, the wording was correspondence via the hospital online message system. He says that currently the airflow looks normal.

Here's an example of a recent message:

Let me preface it by saying that I've been bedridden for 1.5 years from this, with no relief in the 3.5 years since symptoms began. What I have from the severe chronic sleep loss/deprivation is severe exhaustion, high anxiety/panic at times, and suicidal ideation every single day. The sleep deprivation for so long is making me mad.

Me: "I am getting very desperate. My therapist does not feel that the root cause is psychiatric. He thinks the symptoms of anxiety and despair, etc. are secondary to the prolonged poor sleep. Maybe there is another cause.

I found this online. Could this explain what is going on with me regarding CPAP?

'"It is called arousal threshold.
UARS sufferers have a low arousal threshold (ie they wake up or arouse too easily to events that normal subjects would not wake up to). They are typically light sleepers. So while there is a resistance in the airway there is a brain that is doing more than it should and identifying a problem that may not be a problem. This is why for many cpap and dental appliances are very difficult. Brain reacts to these as well."'

Doctor: "Wrong. You are completely going the wrong way to think that somehow the solution lies in your sleep-which is now reflecting your mental health. On PAP your breathing is fine. When on PAP there is no UAR (which by definition cannot exist with adequate PAP)
You need expert psychiatric care. The sleep part just needs to be prevented from amplifying anything."

Meanwhile, I've explored the psych root even though I feel I'm a completely normal guy, albeit a bit sensitive and neurotic ... I had 4 hospitalizations, 2 therapists, 3 psychiatrists, and 18 different medications.

Okaythen wrote: ↑

Wed Aug 08, 2018 7:52 am

...When on PAP there is no UAR (which by definition cannot exist with adequate PAP)...

Many have posted here how difficult it has been for them to deal with UAR while on CPAP therapy.