Blockage during exhale - Uvula/Soft Palate

[mikemky]

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.

[PollCat]

, Mike. While I do not know anything about the Oracle mask, I would suggest that you talk with an ENT doc about your exhalation problems. Those people usually have an explanation and a 'cure' for those kinds of problems.

[jgjones1972]

I strongly second the recommendation to see an ENT about it...the sleep tech wasn't qualified to handle your problem, threw the chin strap at you just to get you out the door. ENT should definitely be able to figure out what the problem is. GP or Internist might be able to figure out and fix problem, if not can refer you to a good ENT.

Whatever is going on, I don't think blockage on exhale is a very common problem and it really needs to be addressed/checked out by a good doc.

[DocWils]

The problem isn't new - I have it, a lot of people do, it is a common form of Apnoea - sleeping on your side helps, as does the correct pressure. The ballooning of the uvula or the soft tissue behind the pharyngeal recess is not all that unusual, but it may be necessary to see an ENT in case there is a more profound problem. Normally, though, the correct pressure on the CPAP should be enough to deal with it.

[trish6hundred]

Hi mikemky,
WELCOME! to the forum.!
I've never heard of the condition you mentioned; you might consider getting it checked out by an ENT.
Hang in there for more responses to your post and best of luck to you.

[justMongo]

....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...

I use that mask and love it. It has a soft cushion; and I cinch down the straps 'til I do not get leaks. I am a mouth breather anyway. I get a new mask cushion every 3 months.


FYI, most folks don't get a good night's sleep in the lab -- strange surroundings and all the wires and hoses.

[Sleepster]

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!

You will not suffocate in your sleep. If that was going to happen it would have happened to you a long time ago. I recently calculated that I've had to wake myself up to breathe about 1.3 million times during the 20 or so years that I had untreated OSA.

The chin strap should be adjusted so that it's still comfortable for you to open your mouth, but tight enough that chewing is uncomfortable. Chin straps stop you from mouth-leaking, a situation where the pressurized CPAP air hisses out through your mouth. If you are still mouth breathing with it then you'll have to go to either a full face mask, a hybrid mask, or an oral mask.

The only way to find out is to try them, and the medical providers are set up to allow you to do that because it's a common practice. Most people try several masks before finding one that works for them.

Sewing a tennis ball into the back of an old t-shirt is a good way to keep you from sleeping on your back. My apnea is much worse when I'm on my back. I think I've conditioned myself over the years to instinctively avoid sleeping on my back because it does cause my airway to collapse. I have noticed that, like you, I get a blockage on exhale. It happened during my sleep study.

[PollCat]

Sewing a tennis ball into the back of an old t-shirt is a good way to keep you from sleeping on your back.

Of course this only works if you remember to wear the t-shirt to bed each night; some of us can only sleep 'au naturel'.

[justMongo]

Sewing a tennis ball into the back of an old t-shirt is a good way to keep you from sleeping on your back.

Of course this only works if you remember to wear the t-shirt to bed each night; some of us can only sleep 'au naturel'.

[mikemky]

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