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Exhalation Blockage/Catathrenia? Dangerous?
#1
I drift off to sleep fairly quickly but as I approach deep sleep I either grunt or vocalize a sound or occasionally pushing hard to exhale against a nearly total blockage, like I'm intentionally closing my throat.  This problem developed over the last 4 months.  It's a cycle that repeats to the point where I can not get any more than short, light naps.  The times when there is a total blockage to exhalation it causes a burst of anxiety and I can't get relaxed again.  It happens sitting up too.  Frankly, it's scary and I dread going to bed.  CPAP seems to help, but it still happens and my body is being conditioned to not go into deep sleep.  I don't have issues with snoring or inhalation.  Is the blockage dangerous?  Can it result in my not being able to inhale at some point?

The problem I'm facing is having this diagnosed and taken seriously.  I'm a very energetic person.  When I filled out the survey I indicated that I had no problem staying awake all day, which is true.  The doc said insurance wouldn't pay for a sleep study with my responses.

I'm confused as to how to get this resolved.  I'm tired (but active) and scared that something bad is going to happen in the middle of the night.  What words do I need to say to a doctor to get them to take this seriously?  Should I say on the survey that I fall asleep during the day?

Thank you!
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#2
No clue which machine you have but does it record data? Or is it a brick?

Without data, all you have is how you are feeling. And it sounds as if you may be having obstructive events that rouse you from your sleep.

You could try to increase the maximum pressure by a bit. Say go to 8.5. Then wait a week and see what happens.
PaulaO2
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#3
I apologize for leaving out the important details of my cpap  machine.  I have cognitive impairment so I often have poor grammar and leave out pertinent information.

The machine I use is a RemStar Series M with humidifier, Model 1051158.  It does not have any recording ability.  I use nasal pillows (I think that is the term) which are fairly comfortable.  The current setting is 7.5cm.  I've tried higher but it is difficult to exhale at anything above 8.

I asked my doc about a biPap but he said I'd need another sleep study.  He also stated that insurance won't pay for another sleep study because on my survey I indicated that I'm not sleepy during the day.  I can't afford to pay cash for another sleep study so I'm kind of stuck now.  Seems like the best approach is to wait a month and then go back to the doc and complain about daytime drowsiness. 

   
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#4
(04-16-2018, 09:23 AM)ronlecroy Wrote: I apologize for leaving out the important details of my cpap  machine.  I have cognitive impairment so I often have poor grammar and leave out pertinent information.

The machine I use is a RemStar Series M with humidifier, Model 1051158.  It does not have any recording ability.  I use nasal pillows (I think that is the term) which are fairly comfortable.  The current setting is 7.5cm.  I've tried higher but it is difficult to exhale at anything above 8.

I asked my doc about a biPap but he said I'd need another sleep study.  He also stated that insurance won't pay for another sleep study because on my survey I indicated that I'm not sleepy during the day.  I can't afford to pay cash for another sleep study so I'm kind of stuck now.  Seems like the best approach is to wait a month and then go back to the doc and complain about daytime drowsiness. 

That seems to be a very basic fixed pressure machine. On the other hand you are not using a very high pressure and are unlikely to benefit from a BiPAP machine. You could benefit from an Auto CPAP that allows a range of pressure settings, makes data available for SleepyHead analysis, and has an expiry relief pressure feature to make it easier to exhale when the pressure is higher. 

Although a sleep study might be helpful to figure out what is causing your specific issues, it shouldn't be necessary to change to a Auto CPAP from an fixed pressure CPAP. When I told them on the sleep screening questionnaire that I occasionally dozed off when driving, they couldn't get me into a study fast enough...
Helpful Links:
Beginner Guide to SleepyHead - How to download and use SleepyHead to view your detailed CPAP Data
SleepyHead Chart Optimization - How to organize your SleepHead screen to make it more useful to view
Posting SleepyHead Data - How to post your SleepyHead screen shots to get help from others here
Adjust your own CPAP Settings - How to get into the Clinical Menus and adjust your own CPAP pressures and settings
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#5
Don't know your insurance situation but you might want to check into the coverage and see what your deductable is. You may be better off buying a new Auto CPAP online and not have to worry about going through the Doctor.
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#6
Thank you for the reply and good suggestions.  I was hesitant to put anything on the survey about being sleepy while driving.  The concern was that I could be liable in an accident or that my driving would be restricted.  I will be sure to emphasize fatigue as you suggest, but will likely not mention driving issues.

Thank you for the reply.  Is it difficult to set up an auto cpap?  I found a couple websites that sell used/reconditioned units, but I was concerned about difficulty in setting up the machine or having settings that were "locked out", only accessible by medical provider.
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#7
Ron, the CPAP you are using is very outdated. I used the M-Series Auto when I started in 2008, and it was replaced in 2009 by the System One 50 Series, which has been replaced with the 60 series and finally the Dreamstation. You are way overdue for a new CPAP or BPAP. Your doctor's suggestion that you will need a new sleep study, or that if one is required, it will not be covered, is simply false. Call your insurance company to get the real facts about coverage and deductibles.

I think you have a problem with your current machine, and no one can tell you what the nature of that problem is without an analysis of CPAP data or another sleep study. The easiest course would be to request a prescription for a new Auto CPAP like the Resmed Airsense 10 Autoset. The Resmed Autoset machine can provide therapy identical to bilevel with a pressure support up to 3-cm. That could be plenty to resolve your problems, and more important, you would have machine data that could help you to optimized therapy and identify if a problem actually does exist. You are long overdue for replacement. Ask your doctor for a new prescription, then decide if your coverage is the best way to get it. The current price on Amazon is $599, and you won't be asked for a prescription.

If your doctor is not supporting you, then you should not support him. Find another one or use your primary care physician. You need a new machine, and you should not need a new sleep study to get it.
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#8
(04-16-2018, 10:12 AM)ronlecroy Wrote: Thank you for the reply and good suggestions.  I was hesitant to put anything on the survey about being sleepy while driving.  The concern was that I could be liable in an accident or that my driving would be restricted.  I will be sure to emphasize fatigue as you suggest, but will likely not mention driving issues.

Thank you for the reply.  Is it difficult to set up an auto cpap?  I found a couple websites that sell used/reconditioned units, but I was concerned about difficulty in setting up the machine or having settings that were "locked out", only accessible by medical provider.

Hi ronlecroy,
Call your insurance company to confirm your coverage and if they would require a new sleep study.

I think your doctor could have been more helpful with the survey and guided you with responses.  
He’s aware your are using an older Cpap and have already been diagnosed with sleep apnea.  

Your problem with a feeling of your throat closing or being blocked on exhale should be taken seriously.
Have you considered seeing an ENT? (Ear, nose and throat specialist.)
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
Thank you all very much for the replies.  Here is some important background info (it's a mess):

A big part of the problem relates to a terminated in hospital sleep study last year that was ordered by my primary care doc.  I just could not get to sleep and they sent me home at about 1:00am stating that they would not be able to acquire enough data (they said they need 5 hours of data).  It was a distracting facility with a shared bathroom and I was just plain nervous.  Plus I had some family stress occurring.  So, a month later I went to a sleep specialist and he suggested a home sleep study.  That home sleep study did not detect apnea (I have a copy).  I couldn't believe it!  Apparently that night my body decided to behave.

So now I am listed as not having apnea.  The problem I'm having now only developed within the last 4 months.  Coincidentally I have developed overactive bladder.  The sleep specialist and an ENT said that an in hospital/clinic study wouldn't be effective if I had to get up multiple times to use the rest room.  So, I'm stuck in a loop.  It's pretty miserable because between the exhalation and grunting I'm having to get up to use the bathroom many times.

After all your kind and informative responses I've decided to get a new primary care doc and new sleep specialist.  I might change my urologist too.  It is concerning that the overactive bladder issue and the exhalation/grunting have occurred at the same time.  Thinking maybe a neurologist needs to be involved at some point to check for autonomic dysfunction.    Six months ago I was a pretty normal guy.  All of the sudden I'm flopping around in bed, grunting, and peeing all night.  I can't really live a normal life like this.
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#10
Check your local Craigslist for CPAP machines. There tend to be many new model CPAPs and BiPAPs that people don't end up using, and they sell them relatively inexpensively on Craigslist. You will be looking for either a Resmed Airsense 10 Autoset, Philips Respironics Dreamstation Auto CPAP, or Philips Respironics System One Auto CPAP. The Resmed S9 Autoset is also a good one. Get a machine that is modern and at least provides data and we may be able to get a better handle on your situation.

Nocturia is a common complication of sleep disordered breathing, so your bladder may be normal, but without restful sleep you don't produce the enzyme to slow down urine production. Do an internet search for Nocturia.

Grunting, can be a common reaction to obstructive apnea that occurs at the end of exhalation. In order to clear the obstruction and open your airway, you grunt or clear your throat before the next inhale. Again, effective therapy can usually resolve this problem.
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