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Finally I’m cured for Sleep Apnea!
I have today received the result of my in-lab PSG study after my last surgery.
The result shows that I am completely cured for Sleep Apnea. No Apneas or Hypopneas. My sleep pattern and my sleep stages are also perfectly normal.
My Sleep Doctor was surprised (more than myself) and we got a very long talk about what could have been done differently.
It's been a long journey with some severe unfortunate side effects underway.
For 3-4 years ago I was diagnosed with Sleep Apnea in mild to moderate degree. The first 4 months was fantastic and I got it much better. I had no mask problems, no leaks, my AHI was fine and I slept well. At my first follow up, my sleep doctor told me that I was well treated.
Then things went wrong.
I have previously written a long post about my problems.
http://www.sleepguide.com/forum/topics/apnea-pressure-harmful-effects
So I will not write more about this.
But once the solution exists, it is of course much easier to rationalize after.
The key word here is expiratory apnea.
This condition has only received a little attention, although the phenomenon has been known for several years. My own Sleep Doctor knows the phenomenon from several years back, where he participated in a study on this issue. The conclusion then was that the treatment was the same as for ordinary Sleep Apnea (inspiratory).
This is probably also true if there is no other complications.
But in my case there was a series of unfortunate circumstances that made my condition seriously.
With expiratory apnea, you have obstructions in the nose or in the area of the soft palate / uvula, which means that, you can’t exhale (especially when you sleep on your back).
If the CPAP pressure is high enough, this will not cause problems, but for example APAP machines can’t handle this kind of apneas very well.
An expiratory apnea gives a high positive pressure in the esophageal (opposite inspiratory apnea, where there will be a negative pressure). If this pressure can escape through the mouth it will probably not cause problems.
In my case, I closed my mouth when I was asleep, so the pressure could not escape through my mouth.
So the pressure will instead go inward. This creates a condition like weightlifting (Valsalva maneuver).
This condition is much more aggressive on both blood pressures as the intracranial pressure, which can cause serious side effects as I have described in my previous posts.
Back to the question of what could be done differently.
I don't know.
A normal examination of the nose and throat, using Müller's maneuver gives no indications.
A normal PSG study gives no indications.
Only a PSG combined with a Pes measurement can indicate expiratory apneas.
So I'm glad that I had a stubborn ENT Surgeon who insisted that it was my Uvula that was the problem.
I also take this opportunity to thank Dr. Park for his always helpful answers to my questions.
I hope that my story may help others in a similar situation.
Henning
The result shows that I am completely cured for Sleep Apnea. No Apneas or Hypopneas. My sleep pattern and my sleep stages are also perfectly normal.
My Sleep Doctor was surprised (more than myself) and we got a very long talk about what could have been done differently.
It's been a long journey with some severe unfortunate side effects underway.
For 3-4 years ago I was diagnosed with Sleep Apnea in mild to moderate degree. The first 4 months was fantastic and I got it much better. I had no mask problems, no leaks, my AHI was fine and I slept well. At my first follow up, my sleep doctor told me that I was well treated.
Then things went wrong.
I have previously written a long post about my problems.
http://www.sleepguide.com/forum/topics/apnea-pressure-harmful-effects
So I will not write more about this.
But once the solution exists, it is of course much easier to rationalize after.
The key word here is expiratory apnea.
This condition has only received a little attention, although the phenomenon has been known for several years. My own Sleep Doctor knows the phenomenon from several years back, where he participated in a study on this issue. The conclusion then was that the treatment was the same as for ordinary Sleep Apnea (inspiratory).
This is probably also true if there is no other complications.
But in my case there was a series of unfortunate circumstances that made my condition seriously.
With expiratory apnea, you have obstructions in the nose or in the area of the soft palate / uvula, which means that, you can’t exhale (especially when you sleep on your back).
If the CPAP pressure is high enough, this will not cause problems, but for example APAP machines can’t handle this kind of apneas very well.
An expiratory apnea gives a high positive pressure in the esophageal (opposite inspiratory apnea, where there will be a negative pressure). If this pressure can escape through the mouth it will probably not cause problems.
In my case, I closed my mouth when I was asleep, so the pressure could not escape through my mouth.
So the pressure will instead go inward. This creates a condition like weightlifting (Valsalva maneuver).
This condition is much more aggressive on both blood pressures as the intracranial pressure, which can cause serious side effects as I have described in my previous posts.
Back to the question of what could be done differently.
I don't know.
A normal examination of the nose and throat, using Müller's maneuver gives no indications.
A normal PSG study gives no indications.
Only a PSG combined with a Pes measurement can indicate expiratory apneas.
So I'm glad that I had a stubborn ENT Surgeon who insisted that it was my Uvula that was the problem.
I also take this opportunity to thank Dr. Park for his always helpful answers to my questions.
I hope that my story may help others in a similar situation.
Henning
Views: 1724
Replies to This Discussion
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Permalink Reply by Steven Y. Park, MD on
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Congratulations, Henning! I've learned so much from you.
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Permalink Reply by Henning on
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Thank you very much jeff,
IF you have expiratory apneas, as your description suggests, I don't think it's especially good with a bi-level PAP machine.
This has at a lower expiration pressure which is opposite what is necessary. With expiratory apneas, you need a higher pressure at expiration than with inspiration.
So I would suggest you to see an ENT, and have your condition examinated.
As you told me in another post, the Uvula surgery is a mainstream surgery. I agree with this.
But I am sure that most people with expiratory apneas also have inspiratory apneas.
So it is difficult to make any decisions.
Henning
j n k said:Congratulations, Henning. I know you've been through a lot!
My uvula gets stuck during expiration too. It is so bad that I have trouble reclining in a dentist's chair. Fortunately, though, autobilevel in a restricted range, staying off my back, and using an MAD in conjunction with my PAP therapy seems to keep my AHI low and treat my condition well.
I have found your story fascinating. Thank you VERY much for sharing it.
jeff
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Permalink Reply by RockRpsgt on
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Henning congratulations! In reading your post I have seen that this has been quite an ordeal for you.
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Permalink Reply by D. W. Conn on
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interesting to say the least.
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Permalink Reply by sleepycarol on
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Henning, I too, congratulate you on your success. I am just sorry that it had to be such a long journey for you. I found your posts to be beneficial to me when I first came here and hope that you will continue to visit and post as you can.
Thank you for posting your success story!!
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Thanks to all.
I mentioned that the only way to detect expiratory apnea is a PSG with Pes measurement. This is also the official view.
But I think there are some signs that may indicate expiratory apneas.
I am not a doctor, and there are only few studies on this topic, so the following is based on my own experience, what I have read here and there, and my thoughts about this phenomenon.
First and foremost, there is no consensus around the concept of "expiratory apnea". There are a number of articles concerning infants, but with adults you must be searching other terms to find articles.
I found one article which indicated that about. 40% of people with Sleep apnea also have expiratory apnea. But most of these have expiratory apnea in the end of expiration. In this case, this can be compared with inspiratory apnea.
But some (unfortunately I have not a percent on them) have standalone expiratory apnea, where the apnea occurs early in the exhaling. It is this (perhaps small group, but I'm not sure) which is interesting in this context.
Here are my experiences / thoughts about the topic:
No Desaturations:
There are many theories about why some people have great Desaturations, and other has no or very little Desaturations. When an expiratory apnea occurs in early expiration there will be much air into the lungs, and there may be a very long apnea without Desaturations.
Large lung capacity:
I myself have a very large lung capacity. It can hang with me that I at the nights has "trained" me to hold my breath, while there has been a major positive pressure on the lungs. For example, I have always been able to swim underwater for much longer than others, and I still can do that.
Positional sleep apnea:
If we assume that expiratory apnea occurs primarily around the uvula and the soft palate, so it would seem natural that there is a strong positional sleep apnea, where it is worst when you sleep on your back. If this is combined with a very large Uvula it will probably be a strong indication of expiratory apnea.
Valsalva introduced problems:
I have told about what the internal pressure of the Valsalva maneuver can cause.
The following problems may indicate expiratory apnea:
Dizziness and Vertigo.
Problems with pressure in the eye. (Visual disturbance),
Blood pressure which is difficult to treat.
Headache in the mornings.
Henning
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