Frustrated with exhalation issue

[Jeff_Snore_No_More]

For the longest time, my BiPAP pressures were 18 inhale and 15 exhale. A new sleep study some months ago warranted changing the exhale to 14. The study showed there were a lot more apneas at 15. A sleep specialist reviewed the sleep study results with me, and transmitted the new prescription to my DME. Beginning at that time, I started doing something very interesting and annoying. On occasion, something in my throat closes as I exhale, opens, closes, opens, closes, etc. It’s kind of like gargling. In one exhale, I might get 10-12 open-close cycles. It’s hard to explain. It doesn’t happen every night, and when it does happen, it doesn’t last all night. But when it happens, it wakes me, and the noise coming from my throat wakes my wife.

So the doctor/sleep specialist changed me from straight BiPAP to auto BiPAP a few months ago. The feedback from my machine shows my inhale hovering around 18, and my exhale around 14. The change from straight to auto has not stopped the throat phenomenon. It’s very annoying when it happens. I saw the doc today. He is not changing me back to straight. He is not putting my exhale back to 15. He suggested the following.

1. Lose weight. Note: I weigh less now than I did when my exhale was at 15 and I never had the gargling problem.
2. See my ENT. What can he do that this doc can’t do? This doc is a pulmonary doc.
3. Start using the humidifier on the machine. I haven’t been using it, but I have my doubts that it will make a difference.
4. He is sending instructions to my DME for a new mask fitting. He said there is a type of full face mask with a valve that shifts from mouth breathing to nose breathing as needed, automatically detected by the mask. I’m currently using a nasal pillows mask, sometimes a regular nasal mask. Anybody familiar with this “valve” mask he’s referring to? I’m not. I told him I’ve never seen it. He made a comment that I couldn’t possibly have seen every one of the hundreds of masks out there.

Anybody else ever experience this throat thing during exhale? Like I said, it’s kind of like gargling, but different. It’s like my throat is opening and closing very quickly during exhale. I’m frustrated. So is my wife.

[Julie]

Hi - reaching a little here, but if you sleep with your head down towards your chest it can block your air flow, and if it does so while exhaling, you might benefit from trying a soft cervical collar that would keep your head up more, airway open and jaw closed. If it fits... maybe worth a try - inhaling is always easier and exhaling more difficult once air is 'trapped' in your system.

[palerider]

For the longest time, my BiPAP pressures were 18 inhale and 15 exhale. A new sleep study some months ago warranted changing the exhale to 14. The study showed there were a lot more apneas at 15.

*highly unlikely*.

Beginning at that time, I started doing something very interesting and annoying. ,,, The change from straight to auto has not stopped the throat phenomenon. It’s very annoying when it happens...I’m frustrated. So is my wife.

Why don't you just try setting the machine back to what worked?

[babydinosnoreless]

I saw the doc today. He is not changing me back to straight. He is not putting my exhale back to 15. He suggested the following.

What I would have done.

#1 tell the doctor to pound sand
#2 change it myself
#3 find a new doctor

[Jeff_Snore_No_More]

Thank you, folks, for your replies. It's nice to know that there are concerned and knowledgeable people here who can be relied upon.

I sleep with only one pillow, not especially thick, so my head is already pretty flat. It's the same pillow I was using before the exhale problem. But I will look into the collar you suggest. Thanks, Julie.

The doc showed me the results and interpretations of the sleep study, and it did show that there were more apneas at exhale pressure at 15 than at 14. However, when the pressure was set at 15, I think I was doing OK. Hard to say, because at that time, my old BiPAP machine didn't give daily visual feedback like my new machine does with the iPhone app. I did in fact set the new machine to 15 myself. A couple days later, my DME called and said they could tell I was changing pressures: the new machine (DreamStation) has a modem of some sort that communicates with the DME via cell signal. So my machine ratted me out! The DME changed it back to 14. I didn't change it again, because I figured the DME would just change it back again. Thank you, Palerider.

I think I will in fact find a new sleep specialist. The doc even asked me what I wanted to do. When I said go back to straight BiPAP with an exhale of 15, he didn't like my answer, so to speak. If he wasn't going to do what I said I wanted to do, why did he ask? Thanks, Babydinosnoreless.