Blockage during exhale - Uvula/Soft Palate

[richb]

Your soft palate which includes your uvula is flipping up and is blocking your nasal exhale. Read above about NOT sleeping on your back.

Rich

[Kujessie]

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.

Hey Mike, I have the exact same issue and am struggling to find a ENT who doesn't dismiss me.  Do you have any developments? Does this have a name or solution? Thanks for any updates. Best, Jessie

[StaphAttack]

I made an account just to reply to this thread.

I have shoulder and back issues that make side sleeping very difficult. When I side sleep I have no issues with my CPAP or soft pallet. In fact, I don't even need a CPAP when I side sleep, but because of the pain when side sleeping, it isn't a solution. If you can side sleep, you most definitely should try it first.

When I sleep on my back, my issue is just as those on this thread have described it. My soft pallet sucks to the back of my throat on my exhale just as I drift off to sleep and it jolts me awake. My CPAP prescription was 6 to 10 (I swallow a lot of air if I go above a 10). When I drift off to sleep the pressure is always at it's lowest, a 6 (and through the night rarely goes about an 8). After reading this thread, I had my script changed to 8 to 10. This did help. At an 8, my exhale blockage became a loud snore when exhaling and drifting off to sleep.

While messing with my CPAP settings I found the flex setting (Philips Respironics). This setting assists you as you exhale by ramping down the pressure. It can be set from a 1 to a 3. By default it is set to a 3. What this means is that my when my pressure was at a 6, this was only for the inhale and my exhale pressure was actually a 3!!! When I set my script to 8 to 10, my exhale pressure was a 5 to 7. If you enter the therapist settings menu, you can turn this feature off. If you set your APAP to classic CPAP mode, it turns this feature off as well.

I ended up setting my machine up as a classic CPAP with the flex setting turned off and I set my pressure to an 8. So now when I fall asleep, my inhale pressure is an 8, and my exhale pressure is an 8. The exhale blockage is now a mild snore, which has allowed me to sleep the last two nights. My AHI is staying below a 3 as well. I'm really excited that this might be finally resolved. I've been dealing with this issue for nearly 6 months. Thank God I found this thread.

I'll give an update in a few weeks and let you know if this sticks. In the meantime, if you a struggling with this issue, try turning flex (philips) or EPR off. Yes it is a little harder to exhale, but it is working for me!

[Sleeprider]

Staphattack, welcome to apnea board and thanks for the feedback. Useful to know that turning off Flex or EPR improves your results.

[Chicapep]

I don’t have sleep apnea, but I do have the breathing out blockage  problem when trying to sleep on my back. I wake up every time I fall asleep on my back where my nose seems to get blocked.  There is kind of a snorting noise when I breathe out And it wakes me up and it’s quite uncomfortable,  I wake up with a sore throat - but it seems to be higher up near my sinuses I’ve been to the Ent and he was unsure of what the problem is.  Like you I have tried googling and I can’t seem to find anything out about it. It seems to be quite rare. I’m wondering if you’ve had any new information on this issue

[tos5899632]

This thread helped me, so I thought I'd share my experience. I have had an issue with breathing at night for a few years now, but only ever on one side at a time. I had a septoplasty and turbinate reduction last year which barely helped. It did reveal that the problem was more on the exhale, though, which led me to this thread. I started doing the exercises posted by Rolan and was shocked at the results- they really did decongest me almost instantly! One note, though, is that on exercise #1, I found that I was able to get the same result simply by moving my arm as if to press on my back, but not actually putting any pressure on it. This told me that it did not have to do with the "pressure point", but rather, the positioning of the arm and shoulder.

I did some research on Thoracic Outlet Syndrome and did a test that I found online (basically, just holding your arms up for three minutes). I found that my arms get a "heavy" feeling and my hands start tingling after about 1 minute, which is an indicator of TOS. I looked up more exercises for TOS and started doing those at home. I am into yoga and started doing heart to earth pose and sphinx pose regularly as these seemed relevant. Initially I was unable to get into heart to earth pose fully because my shoulders were so tight. I had a lot of tightness in the deltoid, the pectoralis, and some muscle on the inside of my upper arm (possibly the coracobrachialis) and found that stretching those out really helped. I believe that I also have had some sort of chronic internal rotation of the shoulders. Adjusting them to be more externally rotated has really made a difference. I also used to get congested all the time when in poses with my head upside down (like downward dog). I've been told this is due to blood rushing to the head, but I actually found that by working to externally rotate the shoulders, the congestion doesn't happen.

Sleeping has been a bit more difficult to fix, but I've found that sleeping on my side has been okay as long as I keep my arms in the right position. I try to keep the bottom arm so that the elbow is at or above shoulder height (this sometimes makes my hand fall asleep, but I prefer that to not breathing). I try to keep the top arm straight down at my side, or slightly behind my back, as that keeps the top shoulder from rotating too far in.

Rolan, if you ever come back to read this thread, thank you so so much. I really don't know what I would have done without your help. My doctors weren't helpful at all.

[Sleeprider]

Readers of this thread may also want to look at the article on Palatal Prolapse in the Optimizing Therapy wiki http://www.apneaboard.com/wiki/index.php...l_Prolapse
Also see the thread by SleepyCPAP who resolved his PP with an AlaxoStent http://www.apneaboard.com/forums/Thread-...AlaxoStent and his review of the AlaxoStent http://www.apneaboard.com/forums/Thread-...A-Approved

[cherylb]

Hi Mike,
I know your post was written quite some time ago.  Have you found any success?  I am having the same exact issues as you were having with exhalations being blocked.  I have used a nasal pillow style mask with cpap for years.  My sleep dr. is trying to get me a bipap machine, but I read on one site that these may actually make the problem worse.
I'm really wondering if I need to see an entirely different type of specialist, like an ENT or pulmonary doctor.

And PattyCarol-it sounds like you have been to a lot of different doctors... Should I go down this rabbithole?

cherylb

[Crimson Nape]

Hi!
Mike's last visit here was 12-20-2013, 12:58 PM. I would suggest that you start your own thread.
- Red