Throat issue that won't go away

[droberts]

Hi All,

I have been a CPAP user for about 8 years now but I have had an ongoing problem that I had hoped would be resolved with some surgery that I have recently undergone (fundoplication). Anyway I don't want to go off on a tangent, so don't focus on the fundoplication.

I posted this question about 4 or 5 years ago on this forum or another (I can't remember which forum) and I didn't really get any helpful feedback. I am hoping now that with CPAP use being more mainstream that someone else may be able to point me in the right direction.

Here goes. I suffer from moderate sleep apnea and use a Resmed S8 Autoset Spirit ANZ Limited Edition machine with a HumidAire 3i humidifier and a Resmed nasal mask. I wish I could tell you the model. I am a mouth breather so use 3M Micropore tape each night. The tape covers my lips from left to right i.e. I don't just put a small piece in the middle.

What happens is that I can use CPAP but after some use, initially it was a couple of weeks of use but now it is about 1 weeks use, I get a sensation in my throat that I can best describe as tightness. If I keep using CPAP it gets progressively worse each night to the point where I have to stop using it. This is what I have been doing now for eight years and it is driving me mad because the benefit I get from CPAP is brilliant.

As stated earlier, I was hoping that the recent surgery I had, fundoplication, would resolve this problem as I have suffered silent reflux for some time. However it now seems that my CPAP problems may not be linked to the silent reflux as this seems to be under control since the surgery however I am still getting the throat tightness when using CPAP.

Throughout the course of trying to get to the bottom of this I have had CT scans on my neck, nasendoscopy, endoscopies. You name it, they've looked at it.

I am thinking now that there is some link between my mouth breathing and pressure that potentially builds up when I subconsciously switch from nose breathing to mouth breathing i.e. when I fall to sleep.

Would really appreciate hearing from anyone who has had a similar experience or who has some recommendations of what to try.

[Julie]

I suggest you give a good try to a few FFMs, properly sized and fitted by someone patient who allows you to lie down somewhere (because faces change when you do that) and give them a decent trial in diff. positions, etc. Often what happens is that people unused to FFMs will 'suit up', lie down and touch nothing, not understanding that it's a good idea once mask is on and air's started, to slightly lift the mask (just a tiny bit) to allow the cushion to inflate - not so much of an issue with nasal masks - and then to maybe pull down (again, just a tiny bit) or wiggle the mask to get it in place better, help seal tiny areas that might otherwise allow air into your eyes, etc.

The reason I suggest that is because you may be onto something with your reasoning about pressure... though I don't actually know. You don't mention a humidifier or setting, and I wonder what part it might play as well.

[library lady]

I was thinking the same thing; try FF mask. I'm a mouth breather, and they didn't want me to even try a nasal mask... this way, whatever my body wants to use for breathing works without losing therapy air; I'm not restricted to just nasal therapy and I'm more comfortable just letting my brain do what it wants to do.

[Sir NoddinOff]

I'd have to agree with the two previous people who recommended FFMs... probably not what you wanted to hear. I used nasal pillows for a year and finally started getting that 'tightness in the throat' feeling, like there was a lump in there when using CPAP. It was sometimes accompanied by a 'catch and release' sort of surge problem. Anyway, it started to drive me crazy, so I made the switch to the Quattro line of masks, first the Mirage and finally the QFX. I won't say it was easy, but now I don't have to worry about those weird throat issues. The only way I could get my Quattro FX to not leak was to make it a bit tighter than recommended plus use a Padacheek liner. Leaks can be a problem but there are ways to address those. Some people have to go thru several masks before they find the one right for them. BTW, have you steered clear of FFMs because of pressure sores or swelling on your nose or face? I used to be the king of pressure sores on the nose, so if I can get used to FFMs (read some of my first posts ), I think just about anybody can. Good luck and let us know how it goes.

[droberts]

Thanks for your responses.

I tried a full face mask some years ago but could not get it to work for me - I just couldn't get to sleep.

I am consciously trying to become a nose breather by breathing through my nose at all times during the day and setting reminders for when I slip into the habit of breathing through my mouth. This is a long term approach and I know it will take months for this to become my normal breathing pattern, even when I sleep.

Has anyone successfully converted from a mouth breather to a nose breather?

[Julie]

How you breathe when awake has no relation to how you do it asleep, nor can you control your asleep breathing however much you would like to think you can. Just because you tried one FFM years ago doesn't mean there aren't 10 others out there now that wouldn't be perfect for you. It seems to be the obvious answer yet you're looking for something that doesn't exist... why not at least give a decent trial to various ones and look at your numbers afterward? By decent trial I mean properly fitted, in your size, lying down (faces change a lot then), over a few days each.

[droberts]

That is a fair point Julie. I am not going to completely discount using a full face mask but would prefer not to go down this path if at all possible. I guess I am a little frustrated to read that there are other mouth breathers who use tape and don't seem to have the problems I have experienced.

[Redonthehead]

Ahh - been searching around the internet and trying to figure out the causes of "throat tightness" and here it is discussed in this cpap thread. I too have come down with a "throat tightness" issue that feels like a lump or someone has their thumb lightly at the base of my windpipe. It may have started earlier in the year when I had mild chest discomfort when taking deep breaths - like when you were a kid and spent all day in the swimming pool. Web sites suggest anxiety, food allergy, acid reflux, infection, etc etc.

I was wondering if it had started when I moved from a FFM to nasal pillows. I do have a deviated septum can't typically breathe that well through my nose, but the pillows/pressure seem to "splint" the passages open like they do the lower airways. But maybe at times during sleep I am having to "work" harder to breathe, causing the issue(?)

Anyway, I don't look forward to doing battle with the Quattro FX again due to leaks at the eyes and the general difficulty sleeping on my side with a torrent of air coming out of the vent holes. A liner didn't help, but maybe I need a new cushion now....

Input appreciated.

EDIT 7/25/2014 Thought I would update this for anyone doing a search. Went to see the NP at the ENT. She slid a scope through my nose and looked down my throat. Tissues around the larynx are inflamed from acid reflux. Laryngopharyngeal Reflux (Silent Reflux) is my problem.

[kteague]

Has anyone successfully converted from a mouth breather to a nose breather?

My early months (years?) of CPAP use I had trouble with any mask pressing on the sides of my nose, so I was committed to making nasal pillows work. I taped, denture creamed, and strapped my chin up tight at night. Old habits die hard. At some point I quit waking up with air blowing through any weak spot. Methodically I stopped using my various props, but kept using the chin strap the longest, more as a reminder. My leak rates stayed the same even after stopping everything. My mouth breathing was not due to nasal deformities or blockage, and my CPAP pressure was not real high, so that was in my favor. Don't know how often it happens, but yes, switching from mouth to nose breathing can happen given the right circumstances.

[archangle]

Have you discussed it with your CPAP doctor? You might ask about trying some pressure changes, especially about increasing your minimum pressure and see if it makes a difference good or bad.

[mobychick]

When you're lying down and ready to go to sleep, try holding your breath briefly so you can press your whole tongue against the roof of your mouth, then swallow. This keeps my tongue in place all night and helps with the problems you describe. If you wake up, just do it again before you settle back down to sleep.

Re the FFM; although you didn't like it when you tried it before, remember you have now had some years to get used to Xpap in general. You may find, if you give it another go, you react to it differently. Especially now there are liners available - I haven't needed to try them but they are well spoken of by those who have.

Good luck!

[mols001]

There are also some newer FULL FACE mask options available.

You may want to look at the Airfit F10 FFM, the Quattro AIR or the SImplus FFM.

The Airfit F10 is a good option to the Quattro FX and seems to work alot better too.