Obstruction on exhale
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Obstruction on exhale

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Posted by k8e on September 20, 2008 at 14:32:45:

Background: I have a diagnosis of OSA with UARS, unable to tolerate CPAP and getting minimal relief using a sleep apnea dental appliance due to inability to tolerate sufficient protrusion. I was advised by an ENT that I don't have significant excess tissue in my airway and that the obstruction was more likely tongue-base collapse related. Dr. KL apparently agreed and recommended MMA which I'm working on getting arranged now.

This morning I awoke from sleeping on my back with a sense of obstruction in my pharynx area, possibly nasopharynx, blocking my exhale. I've noticed this same obstruction that sometimes prevents me from breathing out through my nose when I dive into water - I thought it was a reflex to putting my face in water, but I can reproduce this obstruction by just closing my mouth and exhaling sharply, even in upright position. Lying on my back, the obstruction occurred spontaneously without any special effort. While still on my back, I was able to reproduce it with a moderately forceful exhale; if I protruded my lower jaw as far as it would comfortably go it became hard to reproduce even with a sharp exhale.

When it occurs, it feels as if some kind of flap is flipping up and blocking off completely the nasal airway as long as I maintain positive exhale pressure. It doesn't seem like the uvula alone is large enough to account for blocking off the nasal airway, but that's the only hangy thing I'm aware of in that area. Does anyone know what is probably happening here and what anatomical structures are involved?

I was under the impression that the "O" in OSA was mainly obstruction of air going in, not out. If this is occurring in my sleep, would the sleep study have indicated whether it was mostly inhale or mostly exhale that was getting obstructed?

On one hand, protruding my jaw seemed to help prevent the flipping-up thing from happening, suggesting MMA should help with that. OTOH, the obstruction does not necessarily clear if I protrude my jaw while having the obstruction, making me think other tissues than just tongue base might be involved.

I'm not even sure if this phenomenon is just normal vs. part of OSA. Can anyone explain, or suggest a theory, what might be happening?

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