What do exhalation obstructions mean??

I've been having more of these. They are very strange. I wake up, not being able to exhale. I must first inhale, in order to exhale.
Does this mean my pressure isn't high enough to keep the tissues opened for exhalation?
Would these events look different on Sleepyhead, than an inhalation obstruction?
Thanks.

Country4ever wrote: . . . wake up, not being able to exhale. I must first inhale, in order to exhale.
Does this mean my pressure isn't high enough to keep the tissues opened for exhalation? . . .

That anatomical phenomenon is not always well classified or well understood, in my opinion. But yes, I do believe that CPAP usually helps and that an auto that can sense how open the airway is would likely respond to such apneas much the same as it would to standard inhalation-obstruction apneas.

http://doctorstevenpark.com/expiratory- ... ral-apneas

My personal opinion (not really backed up with anything scientific) is that sometimes finding a way to avoid back-sleeping during REM can help that problem a lot, depending on the location of the obstruction.

A second personal opinion is that sometimes a nasal mask is better than full-face when someone has that trouble. (Again, depending on location of obstruction.) No proof. Just partly a hunch and partly my personal experience.

A third personal opinion is that I might be careful with EPR. Maintaining pressure during exhale (instead of reducing exhale pressure with EPR) could be helpful.

If it became a big problem that PAP didn't seem to be addressing, I might choose to have a good ENT (one with a little sleep-breathing knowledge) scope me. I wouldn't fall for the UPPP offer under any circumstances, but I might want to make sure nothing was obviously abnormal in my throat that could easily be corrected.

If you have been heard to groan in your sleep, the problem is more likely about the glottis than about the uvula, I understand. But I guess that is mostly academic in the context of PAP therapy: http://www.foocus.com/pdfs/Articles/Sep ... Regina.pdf

I must first inhale, in order to exhale.

Isn't that the general rule?

Or is it the other way around?

Has your doctor mentioned UARS?
You need to get this ruled out.

I believe that what country4ever is describing is her waking up struggling to breathe out against a complete obstruction that doesn't release when she wakes up, and her remaining unable to breathe out until she takes even more air in.

My understanding is that it may happen near the location of the uvula (if it only happens with mouth closed) or may be happening near the vocal cords, as in closing of the glottis (if it also happens with the mouth open).

For some it is a minor irritation. But for others, it can be a real problem. Some find it increases with a rise of stress in their lives, so it is thought by some docs to have some unknown sort of psychological component that manifests physically. That belief, in my opinion, has prevented the problem's physical aspect from being explored as well as it should be. Such intermittent problems are notoriously hard to study, anyway. And there is the problem of the issue not being well named. After all, many OSA patients have occasional run-of-the-mill exhalation apneas. So when the seriousness of the exhalation issues increase, little is known about what, if anything, to do about it. You can't really scope the throat of a patient while asleep, so the problem is hard to see, unless the patient can reproduce the problem while fully awake. And in the case of the glottis, it would just look like grunting, or the act of pushing/bearing down while holding one's breath. Personally, I can reproduce my uvula exhalation blockage while awake, but have found no need to pursue the issue, since PAP seems to solve my problem completely. If PAP stops doing the trick, though, I'll have to have an ENT take a look-see one day.

Country4ever wrote:I've been having more of these.

"More" is how many?

Thanks everyone.

jnk........thanks for explaining my problem better than I was!

By it happening more, I mean that one night last week I woke up 4 times, being unable to exhale (unless I inhaled again). It's been happening intermittently since then. I did gain about 8# after christmas though. (I've GOT to stop making candy for presents!!)

Maybe by inhaling, there's more pressure to open the closed tissues than there is to exhale.

I've actually been thinking that my apnea problem is a floppy epiglottis........or sagging. I'm 64 and alot of my sleep problems started during perimenopause. I think when women go through this time, alot of their muscles lose their tone. when I was younger, I could plainly see the top of my epiglotis, but now it's nowhere in sight.

Probably my best bet is to lose some weight. (Why didn't I think of that before?? hahha).

And to my next question........would struggling to open up an obstructed exhalation have any particular waveform on Sleepyhead? I suppose if it took long enough to breath, it would just show up as any obstruction...?

Since it is a recent thing, I was just curious. It almost feels (when I first am awakened by it), like I'm really suffocating...........and I'm sooooo glad I can inhale!

I appreciate everyone's feedback.

would struggling to open up an obstructed exhalation have any particular waveform on Sleepyhead

Why don't you take notes of times they happen and try to find them on SH waveform the next day?

My understanding is that with a PSG they look a lot like centrals (based on effort belts) but to a PAP machine they look mostly like regular obstructives. I'm fairly sure someone like Sludge, though, could recognize them from the home-machine flow waveform by noting where in the waveform the breathing stops.

Thanks OhHelpMe and jnk!

Country4ever wrote:Thanks OhHelpMe and jnk!

If you see them in the waveforms, I would appreciate if you post pics in this thread. You have piqued my curiosity.