Newbie question about obstructed exhalation

[Lindsley]

Hello all,

I've enjoyed all the info I've been learning the last 2 weeks, but haven't been able to find anything about an issue I have; or maybe I just don't understand the anatomy of OSA. Even before I started CPAP (I've been on 4 months now), I noticed that as I relax, my exhale gets obstructed in such a way that I can't exhale through my nose, only my mouth. This happens even when I am inhaling fine. (This became even more painfully apparent when I tried taping my mouth shut (I use nasal pillows) and woke up unable to inhale because I hadn't exhaled what was already there ) I use a chin strap and a mouth appliance (professionally made) along with my nasal pillows, and it still happens. I awaken every night due to air flow out my mouth, of course. It is worse on my back but happens even when side sleeping. My machine shows no air leaks, however; don't know why...maybe I wake up too quickly?

I've guessed a FFM might help with the mouth exhale, but I wonder if there is something else I could be doing to correct the problem, which actually seems worse than the inhale? Or is this all just part of the usual apnea experience? I've adjusted my machine so there is only 1 cmH20 difference between inhale and exhale. I have failed a FFM trial (not enough bridge on nose, mask slides down and presses on nose/sinus area) and am contemplating getting a Hybrid mask. Am I going in the right direction? My AHI is creeping up all the time, not sure why. Unfortunately, my medical/respiratory support team is almost non-existent.

Any help is appreciated.

[Country4ever]

I can't believe this! I've been asking about this very same problem!
I have deduced that its my soft palate/uvula becoming weak. When I exhale at times, it slams shut like a valve. It even happens during the day.
I recently have changed from swift nasal pillow to a Hybrid full face mask, in hopes of bypassing this problem. I think when it happens, I swallow and it sort of "fixes" the problem for awhile.
It definitely occurs more for me when I'm dry, and maybe have eaten too much salt.
Some people have surgery for this. You might look up the procedure. I've heard it isn't that successful though, and scarring afterwards can make things worse.
I can't believe I finally found someone else with the same problem!!
I used to freak out at the dentist, because it would happen then, and I couldn't breath, since he was working in my mouth.
Are your leak rates real high? I was taping my mouth and it was working out great for 2 years, but since January, my AHI and leak rates are too high.
I'm thinking I obstruct in that nasopharynx area and the air from the pillow just can't go anywhere but back out. And I can't even breath through my mouth either, because of the tape.
Unfortunately, my numbers aren't any better with the full face mask. I'm hoping at least that if my soft palate collapses and air can't make it past that, I'll unconsciously open my mouth and get some air that way, with the full mask.
If its really getting to you, you need to see an ENT and see what he has to say.
But you need to get a full face mask so that you can at least breath through your mouth.
You have my sympathy! Its a very weird problem that we have!
P.S. May I ask your age?

[Julie]

Probably a really dumb question, but are either of you actually using the C-flex feature? At whatever level it might work for you?

[Guest]

I'm 60 years old, have had symptoms of apnea since my late 20's but didn't have my first sleep study until about 7 years ago (and didn't "qualify" even though I had episodes of blood oxygen down to 70%) and didn't start CPAP until 4 months ago. I use the C-flex option and have tried it on 1, 2, and 3, and it doesn't seem to make any difference but I keep it on 1, in case the pressure helps with the exhalation obstruction. No one in the sleep labs or clinics responded when I mentioned this issue, so I didn't know if it was totally irrelevant or they just didn't know how to respond.

Thanks for your resonses!

[Country4ever]

Hi Lindsley,
I asked your age because I am 60 too. I think females, after menopause, can lose alot of their muscle/tissue strength. I think alot of women develop sleep apnea during perimenopause. I think I've had it my whole life too, but it got alot worse during this time.
I think finding a good ENT is the way to go for you.
I've been reading about soft palate exercises that supposedly strengthen that area. You might read up on that too. And as I said earlier, I think you need a full face mask. If you're used to a nasal pillow, you might like the Innomed Hybrid mask.
Its a really weird sensation when it happens, isn't it?
Good luck to you!

[Country4ever]

Hi again Lindsley.........one more question:
Do you find that it slams shut when you blow your nose too? That happens to me. Its like running into a brick wall!

[Lindsley]

Yes, it definitely is a weird sensation, and it does indeed feel like something is "slamming shut", there never seems to be any warning. I've tried to shift my tongue around but of course I can't control that once I'm falling asleep. How did you manage to keep your mouth taped? I was unable to inhale because I couldn't exhale, basically like holding your breath and being unable to breath any more in.

I went to a dentist for my mouth appliance (about a year before I got CPAP), and he said my palate is way small because I had so many teeth removed as a child (this was to avoid braces!), and that this was definitely contributing to my breathing difficulties. I didn't know, and he didn't mention, that there was any surgical remedy for this. And I'll look up the exercises, but how in heavens do you exercise a palate?? In my case, 99% of the time it only happens when I'm lying down and dropping into sleep, so I can't say as it has affected my life much other than for sleep, except for at the dentist, as you've noted. Hey, maybe we could start a club as we seem to be the only 2 people on this forum with this issue!!

Of course, the real question is how is it affecting our sleep? I avoid sleeping on my back because of it, yet my arthritis awakens me when I sleep on my side. My main hope for CPAP had been to be able to sleep on my back, but so far this is not happening. I had already picked out the Hybrid as a possible solution; have you found that is helps with this type of obstruction (I'm assuming it helps with the inhalation obstruction)? My AHI currently is 2.9 but I awaken several times each night, so am not feeling all that rested. My range is 8 to 13, and I go up to anywhere from 9 to 11 on most nights.

[Country4ever]

Hi Lindsley.......yes, lets start a club. We could call it something like "uvula slammers" or "exhale stoppers" or "the soft palate weenies"

I'm curious......you mentioned a mouthguard. What do you use it for? Bruxism?
Very strange that you mentioned you have one, because I got a special kind around the same time my numbers started getting really bad.
Mine is for TMJ. My uvula/soft palate problem also has gotten worse since then. I'm thinking when you bring the mandible forward, maybe it makes the area inside from our nose to our throat even smaller??
The exercises to strengthen the soft palate are things like repeating "Ga Ga Ga, ka, ka, ka, etc. Also, supposedly playing the didgeridoo (sp??) helps. That's a big tube that they play in aboriginal Australia. Do a google search for "exercises for soft palate" and you'll find stuff.

I used to have panic attacks that were caused by feeling like I couldn't breath. But now in retrospect, it was my soft palate being closed. I could still breath through my mouth......but when that soft palate/uvula closes up, you get the feeling that you're suffocating.
When it happens to me, I breathe through my mouth and swallow a few times and it seems to open up. Try not to eat too much salt in your evening meal and be sure to stay well hydrated.
Awhile back, before cpap, I tried that throat spray.....I think its part of the "Breathe Right" stuff. It has some herbs and other natural things in it that make the back of your throat slick. I wonder if that would help you?

I noticed today that when I drink something, I'm hearing a clicking in my throat. Great. Another failing part!

Just in case it would make a difference for you in not waking up so much at night, when I first started using cpap, I used apap. I woke up all night long. When I switched to straight cpap, I could sleep through the night. I think if you're a really light sleeper, the changes in pressure of the apap might wake you up. Just something to keep in mind.

I have arthritis too and usually take 2 tylenol right before bed, and that seems to help with my pain, and I tend to sleep better.
Even when I don't think I have too much pain, I tend to wake up alot.......so be sure your pain is under control.
You have a great AHI, but if your leak rate is high, you can't trust the AHI. I've noticed that when my leak rate is high, my AHI is usually (falsely) low. Make sure that isn't happening. That might be why you are still so tired.

Okay....about this club.....who wants to be president? Who wants to be treasurer? secretary? activities director?

[Lindsley]

My mouthguard is actually for sleep apnea/hypopnea. By moving my mandible forward, I was able to sleep much better, but it has altered my bite so that I cannot chew with my molars any more. It worked less and less as the year went on, which is why I went in for a new sleep study (I got the mouthguard without any study, based on the results of my sleep study 7 years ago). I still use it, because when I don't, the exhalation obstruction (and, I assume, the inhalation obstruction) is worse. I have hoped to get rid of it once I get the CPAP working, so I can go back to chewing food! But so far that has not been possible...

I haven't figured out how to change the settings on my machine yet, to try the CPAP instead of APAP. It does go up every night, and I've wondered if it would help to just start at the higher figure. I think I also need to figure out what software would work with my machine, and see what that tells me. More research on CPAPtalk.com!

[EastPodunk]

I, too, am a member of the club. I've only found a few references to our breathing/anatomical anomaly. It's gotten distinctively worse over the past few years. Sometimes even catching when I speak.

[quote="Country4ever"]Hi Lindsley.......yes, lets start a club. We could call it something like "uvula slammers" or "exhale stoppers" or "the soft palate weenies"

[snnnark]

Another member here (also due to teeth extraction as a kid! ) I "failed" my first sleep test because they tried to make me sleep on my back and I can't breathe out in that position, so I couldn't fall asleep. They diagnose Insomnia!

Prior to CPAP I would use the stop snore remedies, dab Vicks under my nose, saline sprays, drinking something ice cold before sleep etc. The didgerdoo helped, although it's the circular breathing that does the trick and you don't need a didge to practice that!

If you are using Auto PAP then I would say that it's important that your min pressure is the least pressure it takes to keep your palate open. That may mean increasing your min pressure or even switching to straight CPAP.

For me, weight (BMI) is a factor in how soon the palate shuts. And the stickiness of my mucus (yech!) affects the condition too.

Software is available for your machine from CPAP.com (our hosts) for $109, for the card reader and software.

[Country4ever]

Hi snnnark,
You referred to "circular breathing". Could you please explain what that is?

[snnnark]

In musical instruments (usually wind), circular breathing is the ability to sustain a note while taking a breath. The air in ones mouth is squeezed out while a breath is taken in through the nose.

This site explains it far better than I can, and has exercises to teach you how to do it.
http://www.didgeridoostore.com/didgerid ... athing.htm

A study was done in 2005 using didge and there was a reduction in AHI
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/


Plus it's good fun!

[voode]

Hi folks! Although this is an old thread, I ve got to write aline or two. I'm 42 and having this exact weird problem as well. It occurs esp when I'm lying on my back. Indeed something slams shut at the back of my throat and obstruct my exhale. Also, I can't pronounce M properly. It becomes Mbbh..! Help!

[Carmen]

Yep, got the same problem when I try to sleep on my back. I could actually sleep on my back before I got my machine a few weeks ago--although I did snore--but now I can't manage it because as soon as I relax, something slams shut at the back of my throat and I can't exhale. I have an appointment next week and hope the doc can increase the pressure or find another solution because arthritis makes it difficult for me to sleep on my side.