Blockage during exhale - Uvula/Soft Palate

[Hibernator9]

Mike - hope all is well. Following up to your original post - wanted to ask if you found out more about the soft tissue blockage on exhalation? 

I have the same issue - event went to an ENT that put the camera down my nose during a routine check up. All was normal per the video and he saw nothing out of the ordinary. I made it a point to replicate what happens when I exhale - he saw it on the video and just said “that’s your soft palate”. Now, this is a good ENT and even he was  a bit dismissive. The old - it hurts when I do this / don’t  do it routine. Still looking for answers.

[sheepless]

seems to me that if you can snore on exhale, why should a more complete blockage on exhale be unheard of?

funny this thread popped up again just now. last night I noticed my non-cpap snoring wife exhale through her nose for a second, then I'd hear a thunk of sorts and she'd commence to blow air out through her lips, making pfffting rasberry noises. figured it's a floppy soft palate closing off the airway to the nose. I also became aware of this in my own throat one day a few years ago. I believe I had crossed some weight gain threshold but haven't lost enough weight yet to confirm. age might have something to do with it too. anyway, like others in this thread I can't blow my nose without snorting or completely stopping up the blow. I have the dentist chair issue too. failing weight loss, I agree that pressure is our friend. better if we have some kind of bilevel to adjust inhale and exhale separately but with cpap / apap I think we just have to experiment with raising pressure until obstruction is relieved in both directions. a cervical collar, taller than you might want, should help too.

I should add that lifelong post nasal drip is part of the problem as well.

[yrnkrn]

It may be "Palatal prolapse", see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915321/

[sheepless]

yrnkrn, have you come across any remedies specific to prolatal prolapse?

[yrnkrn]

I've tried whole lot of pressures and pressure supports with not much change in these patterns. Other then surgical options I'm not sure what else could be done. When the palate muscles relaxed it's easy to picture it "flowing in the wind" and shutting down expiration. Luckily this does not happen that much, maybe once per hour and not always terminated by arousal.

Here are several of these breaths terminated by arousal and recovery breaths at pressure 14/15

Sometime they resolve on their own, pressure 10/15

[richb]

Hi yrnkrn. I just happened upon your post which included graphs of wave forms. The upper of the 2 wave forms shows (in my opinion) classic obstructive hypopnea. Obstructive hypopnea shows a period of inhalation terminated by blockage of the airway. This produces the flat top of the wave form. Then after a brief pause you follow through with exhalation. You are not taking a complete breath and are aroused after a number of these breaths. You may need to adjust your pressure to overcome the temporary collapse of your airway. I would re-post your graphs with a request for more suggestions.

Rich B

[yrnkrn]

Hi Rich, thanks for looking into this. 

The flat tops were due to PS=1 in this example. I usually sleep with PS=4..5 and inspiration is quite clean. Maybe 14/15 wasn't the best example, so here are several more waveforms at various pressures, to see the more complete picture. Modality is fixed bi-level.

7/14


8/13


8/16


9/15



9/17


13/16



15.2/18.2



15.2/18.2



15.2/18.2



I sleep with a pillows mask, mouth taped (two layers of 3M micropore) and near zero leaks. Specifically there were zero leaks during these waveforms.
The obstruction happens while exhaling. Some of the waveforms are very similar to the "Palatal prolapse" article.

I didn't see any improvement in these waveforms going from EPAP=7 to 15.2. Maybe even higher EPAP would eliminate them but 15.2/18.2 was as high as I could sleep with.

[allanri]

YrnKrn, are you using an Air Curve 10 ASV? I'm curious, because it's been suggested to me I need such a machine (not by my doctor, unfortunately, but by knowledgeable people on this site). I have similar obstructions when exhaling (along with lots of CAs, which is why an ASV seems indicated), and my hope was that getting an ASV would help these exhale obstructions. It sounds like maybe not?

תודה

[yrnkrn]

I'm using the regular (BiLevel) AirCurve 10. It's very effective in fixing flow limitations while inhaling but does not do much for these kind of obstructions when exhaling.
If the blocking mechanism is indeed "Palatal prolapse" I can't see how any air-based solution (ASV or otherwise) can fix it as the soft palate flips the wrong way and blocks/limits exhalation. If you need ASV for the CAs anyhow do try it and see what it does for your exhale.

[Jodiroo]

I just recently had my first episode where I couldn't exhale.  Really scared me.  I haven't been to the Dr yet,  but one thing I did do is start using my mouth guard for my TMJ. I don't recall what brand I got,  but it was a thicker one that was two in a pack. I haven't had an episode since!  Maybe a cure?!