Does this look like palatal prolapse?

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Unkikonki
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Does this look like palatal prolapse?

Post by Unkikonki » Wed Oct 23, 2024 6:08 pm

For a long time, I've suspected that my soft palate is the main cause of my sleep apnea. After contracting Covid for the first time and experiencing a worsening of symptoms to the point where I couldn't even fall asleep a couple of months ago, my suspicions have grown stronger.

Recently, I read about palatal prolapse, also known as Expiratory Palatal Obstruction (EPO), Expiratory Retrograde Palatal Prolapse, or Retropalatal Airway Closure. I suspect this condition might be affecting me.

Would anyone here be able to help determine if this is the case by reviewing my Oscar data?

The Flow Rate looks very similar to the examples of Palatal Prolapse seen in sites like https://sites.google.com/view/palatal-prolapse/ and https://erj.ersjournals.com/content/51/2/1701419

Below is a data sample from last night, during which I used two different settings:

SETTING A: From the beginning until 6:40 am.

Code: Select all

Mode: ASV Auto
EPAP MIN: 11.0
EPAP MAX: 12.0
PS MIN: 3.0
PS MAX: 8.0
SETTING B: From 6.40 am onwards.

Code: Select all

Mode: CPAP
Pressure: 11.0
The reason I switched from ASV to CPAP mode is that ASV makes it impossible for me to sleep once I reach REM-predominant sleep, as it causes 'chipmunk cheeks.' I suspect this might be due to my soft palate not allowing enough airflow through the nasopharynx, forcing the air back into my mouth.

Yes, I’m already using a chin strap (Knightsbridge Dual Band) and a soft cervical collar. However, keeping my mouth shut and chin in place hasn’t solved the issue.

Notes: I’m fully aware of the difference in AHI between the two modes. Most events while using CPAP are central apneas, which is exactly why I switched to ASV in the first place. I am not sure why OSCAR is classifying them as "Unidentified Apneas" since there clear is no flow limitation during these events.

FULL NIGHT

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ASV - Deep Sleep (Normally no events during this sleep stage)

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ASV - Minutes before waking up. Possibly REM

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CPAP - Minutes before event cluster

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CPAP - Event Cluster - Central Apneas

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Image

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Pugsy
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Re: Does this look like palatal prolapse?

Post by Pugsy » Wed Oct 23, 2024 6:48 pm

ASV model machines do NOT use FOT to figure out if the apnea the machine senses is obstructive or central in nature.
So that's why it uses the "unclassified apnea" flag name. OSCAR doesn't do the naming of anything....the machine does the naming and OSCAR just reports what the machine is reporting.
You don't know if those UAs flagged are central or obstructive apneas. Doesn't matter if you use cpap mode or not....the machine simply doesn't do FOT and ResMed needs FOT results to know if an apnea is central or obstructive.

Sorry...no help with the palatal prolapse question. I have zero experience with it.

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Unkikonki
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Re: Does this look like palatal prolapse?

Post by Unkikonki » Wed Oct 23, 2024 7:38 pm

Pugsy wrote:
Wed Oct 23, 2024 6:48 pm
ASV model machines do NOT use FOT to figure out if the apnea the machine senses is obstructive or central in nature.
So that's why it uses the "unclassified apnea" flag name. OSCAR doesn't do the naming of anything....the machine does the naming and OSCAR just reports what the machine is reporting.
You don't know if those UAs flagged are central or obstructive apneas. Doesn't matter if you use cpap mode or not....the machine simply doesn't do FOT and ResMed needs FOT results to know if an apnea is central or obstructive.

Sorry...no help with the palatal prolapse question. I have zero experience with it.
Right, thanks for sharing. Even if ASV doesn't use FOT, would you agree that a lack of flow limitation during the events + the long continuous flatten curve suggests a Central Apnea event? Besides, I used to get the exact same type of events when using a pure CPAP machine like the ResMed AirSense 10 Auto.

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Pugsy
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Re: Does this look like palatal prolapse?

Post by Pugsy » Wed Oct 23, 2024 8:17 pm

Unkikonki wrote:
Wed Oct 23, 2024 7:38 pm
would you agree that a lack of flow limitation during the events + the long continuous flatten curve suggests a Central Apnea event?
No.
It would be a guess on my part and I don't do guesses very often but this is one of those times.
Unless you know for sure that you ONLY had central sleep apnea and no obstructive apnea.....I won't guess what those UAs might really be.

You may be correct. You also may not be correct and you are seeing what you want to see.

I don't know. My main reason for posting was to explain that it isn't OSCAR that does the naming of events....OSCAR only reports what the machine reports.
Since you had said...
Unkikonki wrote:
Wed Oct 23, 2024 6:08 pm
I am not sure why OSCAR is classifying them as "Unidentified Apneas" since there clear is no flow limitation during these events.

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Unkikonki
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Re: Does this look like palatal prolapse?

Post by Unkikonki » Wed Oct 23, 2024 8:31 pm

Pugsy wrote:
Wed Oct 23, 2024 8:17 pm
Unkikonki wrote:
Wed Oct 23, 2024 7:38 pm
would you agree that a lack of flow limitation during the events + the long continuous flatten curve suggests a Central Apnea event?
No.
It would be a guess on my part and I don't do guesses very often but this is one of those times.
Unless you know for sure that you ONLY had central sleep apnea and no obstructive apnea.....I won't guess what those UAs might really be.

You may be correct. You also may not be correct and you are seeing what you want to see.

I don't know. My main reason for posting was to explain that it isn't OSCAR that does the naming of events....OSCAR only reports what the machine reports.
Since you had said...
Unkikonki wrote:
Wed Oct 23, 2024 6:08 pm
I am not sure why OSCAR is classifying them as "Unidentified Apneas" since there clear is no flow limitation during these events.
I forgot to point out something important. On pure CPAP I was getting the same type of events and the machine did classify them as Central Apneas indeed. I even used an Oximeter which confirmed oxygen levels dropping sharply during those events.

So, what I should've mentioned is that these are TREATMENT-EMERGENT Central Apneas. That is the whole reason why I switched to ASV. Even after 5 months on CPAP, I was still getting plenty of treatment-emergent central apneas that were completely ruining the efficacy of CPAP therapy. Switching to ASV was the right move in that regard, since those centrals completely disappear, although a plethora of new issues arose.

In summary, I don't have central apnea; I have obstructive apnea. However, I do have treatment-emergent central apnea when on CPAP.

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Miss Emerita
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Re: Does this look like palatal prolapse?

Post by Miss Emerita » Thu Oct 24, 2024 11:39 am

I don't myself see a resemblance between your flow-rate traces and the traces in the articles you link to (or in additional images on line). Instead, I see periods of fairly slow and/or shallow breathing, not the shut-offs typical of palatal prolapse.

I don't know how to optimize settings on an ASV. You might start a new thread here (or over on ABF, where I see you are also posting) with something like "optimizing ASV" in the thread title.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

Unkikonki
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Joined: Sat Dec 02, 2023 5:59 pm

Re: Does this look like palatal prolapse?

Post by Unkikonki » Thu Oct 24, 2024 3:00 pm

Miss Emerita wrote:
Thu Oct 24, 2024 11:39 am
I don't myself see a resemblance between your flow-rate traces and the traces in the articles you link to (or in additional images on line). Instead, I see periods of fairly slow and/or shallow breathing, not the shut-offs typical of palatal prolapse.

I don't know how to optimize settings on an ASV. You might start a new thread here (or over on ABF, where I see you are also posting) with something like "optimizing ASV" in the thread title.
Yeah you are right; it doesn't seem to be palatal prolapse, although I still suspect the soft palate is responsible for my apnea.

All right, I'll do what you suggest and start a new thread. Thank you