Blockage during exhale - Uvula/Soft Palate

[rmeadows]

Hello,

I was just recently diagnosed with sleep apnea. During the titration study, I used a nasal mask. I noticed then that when laying on my back, I often couldn't exhale through my nose - my uvula and/or soft palate would close off the nasal pathway.

Unfortunately the study wasn't very good - I only slept for the first two hours, and was awake the rest of the night. I didn't think to mention the problem with exhalation, and they didn't mention it either. But they prescribed me a BiPap machine anyway, which I started using this past Saturday.

Having done a bit of research after the titration study, I decided to go with the Quattro face mask - figuring that would solve the exhalation blockage issue. And it did - I could just breathe through my mouth - but the mask was very uncomfortable - it was a struggle to keep it from leaking all night.

So, yesterday I went and got a nasal pillow (Swift FX). Much more comfortable. However - I keep breathing through my mouth, as I keep getting blockages during exhale when on my back (I'm mostly fine when on my side).

Now, I mentioned my exhalation blockage problem to the DME, and they just gave me a chinstrap to use, to keep my mouth shut. However, I'm a little concerned that it might be a bit dangerous to use it - when I'm on my back, I simply can't exhale out my nose much of the time (with BiPap going). If I wear the chinstrap, I might not be able to breathe, and can only hope that I wake up before suffocating!

I can't find a lot of information about this particular problem - blockage during exhalation. It seems to be confused with 'Catathrenia', which is a moaning/groaning during exhalation, and classified as a parasomnia (as opposed to a physiological problem.)

The only relevant link I could find that was this one (well, I can't post links, so search for the following in quotes):

Dr. Steven Park: "expiratory-apneas-with-or-without-catathrenia-presenting-as-central-apneas"

So - my questions:

1. Anyone else have this problem? What did your doctor tell you? It doesn't seem to be a well documented condition. I'm wondering if surgery might be necessitated to resolve this.

2. Anyone using the 'Oracle' (intra-oral mask) for this purpose? I'm thinking this might be my best option.

For the people that don't like the Oracle mask - why? Does it leak much? Is it comfort regarding the fit, or is the problem more to do with breathing through your mouth? I don't have a problem breathing through my mouth - I've done it for years...I'm used to having a very dry mouth at night.

Thanks for any help...

--Mike

ResMed VPAP S (BiLevel) 11/7 pressure, ramp time 20 mins.

[rmeadows]

Hello,

I was just recently diagnosed with sleep apnea. During the titration study, I used a nasal mask. I noticed then that when laying on my back, I often couldn't exhale through my nose - my uvula and/or soft palate would close off the nasal pathway.

Unfortunately the study wasn't very good - I only slept for the first two hours, and was awake the rest of the night. I didn't think to mention the problem with exhalation, and they didn't mention it either. But they prescribed me a BiPap machine anyway, which I started using this past Saturday.

Having done a bit of research after the titration study, I decided to go with the Quattro face mask - figuring that would solve the exhalation blockage issue. And it did - I could just breathe through my mouth - but the mask was very uncomfortable - it was a struggle to keep it from leaking all night.

So, yesterday I went and got a nasal pillow (Swift FX). Much more comfortable. However - I keep breathing through my mouth, as I keep getting blockages during exhale when on my back (I'm mostly fine when on my side).

Now, I mentioned my exhalation blockage problem to the DME, and they just gave me a chinstrap to use, to keep my mouth shut. However, I'm a little concerned that it might be a bit dangerous to use it - when I'm on my back, I simply can't exhale out my nose much of the time (with BiPap going). If I wear the chinstrap, I might not be able to breathe, and can only hope that I wake up before suffocating!

I can't find a lot of information about this particular problem - blockage during exhalation. It seems to be confused with 'Catathrenia', which is a moaning/groaning during exhalation, and classified as a parasomnia (as opposed to a physiological problem.)

The only relevant link I could find that was this one (well, I can't post links, so search for the following in quotes):

Dr. Steven Park: "expiratory-apneas-with-or-without-catathrenia-presenting-as-central-apneas"

So - my questions:

1. Anyone else have this problem? What did your doctor tell you? It doesn't seem to be a well documented condition. I'm wondering if surgery might be necessitated to resolve this.

2. Anyone using the 'Oracle' (intra-oral mask) for this purpose? I'm thinking this might be my best option.

For the people that don't like the Oracle mask - why? Does it leak much? Is it comfort regarding the fit, or is the problem more to do with breathing through your mouth? I don't have a problem breathing through my mouth - I've done it for years...I'm used to having a very dry mouth at night.

Thanks for any help...

--Mike

I just recently started having the same issues. Me wife says that I puff while awake (getting air out) and moan during sleep and more puffing. I can only exhale out my mouth most of the time and this just recently started. The ENT said I was gaining weight and that was the cause. I know its something else. I snore like hell and now the puffing and moaning sounds that run my wife to the other room.

ResMed VPAP S (BiLevel) 11/7 pressure, ramp time 20 mins.

[PaytonA]

I wonder where all the people are who told me some time ago that obstruction on exhale doesn't happen??

[Sleepster]

I wonder where all the people are who told me some time ago that obstruction on exhale doesn't happen??

I think it happens to me only when I'm flat on my back. And even then the lower EPAP pressure may be enough to keep it from happening. No way to tell without more data.

[FrankNichols]

Thanks for all the replies! I made an appointment with an ENT on Monday. Btw, I'm not sure if CPAP can prevent a blockage on exhale - by definition, the air is flowing in the other direction when you exhale. Maybe if there is some leakage, but in my case, I'm completely blocked on exhale - like a cork was put there...Once it is blocked, the force of my exhale seems to keep it shut against the pressure of the CPAP (well, BiPap in my case), until my mouth blows open. I suppose if the exhale pressure of the BiPap was increased, that might help; but then again, I have to 'beat' the exhale pressure in order to actually exhale...

Anyway - thanks again. This is a very helpful forum.

--Mike

I think CPAP can help in exhale, the idea is not the flow, but the pressure. The blocked airway is inflated (think balloon) and that opens the passage, of course you then have to be able to exhale against that pressure. However, most machines will not go much above 25cm (I think) which is about 2% of normal air pressure at sea level. So, while it is difficult to breath initially, you become used to it and it seems "normal" after a while.

[bklein9104]

Hi Mike,

I'm late to the party but I'm wondering if & how you resolved it. i have the same thing too, my throat closes on the exhale. Please w/b & let me know.

Thanks,
Beverly

[Beej]

I wonder if using radio-frequency to shrink and tighten up the tissue of the uvula and soft palate would help the airflow. It would be somewhat less invasive than surgical removal of the uvula and reduction of the palate

Radio-frequency is being used for a number of interventions these days - debulking tumors, tightening up facial skin, and so forth.

[Sleeprider]

Since the O.P's post was 3-years ago, and he is not an active member, I doubt you'll hear back at this point.

[Johnny Bravo]

Hey

I have this problem too. My Doctor says that's why cpap doesn't work for me, but i'm trying it. I have too many arousals with cpap. Anyone solved this problem? Does cpap work for all of you? I feel sofocated at the end of exhalation with cpap, is it the palatal collapse in exhalation? I supose. How can I set my cpap settings? I don't understand back pressure or pressure support very well. I believe the thing is a matter of enough pressure so the airway doesn't collapse versus not too much exhalation pressure cause of this palatal collapse at exhalation thing, right? Thanks.

John.

[Ghost1958]

Hey

I have this problem too. My Doctor says that's why cpap doesn't work for me, but i'm trying it. I have too many arousals with cpap. Anyone solved this problem? Does cpap work for all of you? I feel sofocated at the end of exhalation with cpap, is it the palatal collapse in exhalation? I supose. How can I set my cpap settings? I don't understand back pressure or pressure support very well. I believe the thing is a matter of enough pressure so the airway doesn't collapse versus not too much exhalation pressure cause of this palatal collapse at exhalation thing, right? Thanks.

John.

It's pretty simple. The min pressure you are exhaling against HAS to be high enough to hold your airway open in any position. Back i,cluded or the problem is likely to happen.
That pressure will likely have to be higher in a :ffm than a nasal.

Just part of the game.