Throat obstruction when awake

[Velacooks]

Hi everyone,
I've been searching around but this puzzles me. Does it count as Sleep apnea if when lying down awake, you can already feel the throat collapsing ? Is there something else medically that this falls under or is it just regarded as sleep apnea?

Long story short, I've been suffering this since April and it's getting worse. Been to two ENTs and they were so quick to jump to sleep apnea. I've been tested and it shows I have a AHI of 19. That's fine, I am not surprised I have sleep apnea for a while now. I do fit the bill as I am overweight and have a large neck but I don't suffer greatly from other sleep apnea symptoms (slight daytime tiredness, no awakenings in the middle of the night, no headaches etc).

However, it's becoming more apparent that my air passage way is getting more restricted when I am just lying down on my back. Just today I went for a massage and found that I had to unnaturally move my tongue further forward to breathe better while lying down. I even suffered this breathing difficulty while trying to sleep on a plane.


I've been on CPAP for a week and it does help (my events recorded are 1.2 with a pressure set to 4-16) but I can't help but wonder if there's something more serious at play here as the onset of the issue was very sudden and how it is apparent when I am awake.

[ajack]

The muscles relax and the back of the tongue can block the airway. As you know, this can also happen when awake. There may not be a lot you can do there, for now. Putting your chin to your chest can also restrict breathing.

You will need to put an oscar chart up, details at the top of the page.

This video may help a bit.
https://www.youtube.com/watch?v=-gie2dhqP2c

[Velacooks]

I am just starting my journey here and this is very close to what I am experiencing.

I've posted on it before last month, got sleep tested and it shows a AHI of 27.

However my symptoms are a mix of jolts and just calm realization that i am not breathing which I'll manually have to initiate breathing.  I went 25-28 hours of no sleep twice because of this. I've been suffering since April but the issue isn't constant. So far maybe 2-3 days a week this central onset issue will go on a rampage.

I am on CPAP now with it autoset 4-16 but I can't tell whether it's really working as one of the solutions I've done to combat this issue is to wait till the feeling of sleepiness is at it's peak and try to sleep right when it hits which I've been doing pre and post CPAP . This leads to maybe 5 minutes of central episodes and then I am asleep. However if I tried to force sleep, i'll just trigger the centrals thus my sleeping habit is horrible now. I'll be sleeping at 3-4am.

I visited a neurologist specializing in sleep last week for the first time (previously i went to ENTs) and surprisingly the sleep doctor wasn't concerned about the sleep apnea. He said my issue was pro long sleep deprivation due to long term bad sleeping habits and sleep apnea. He gave me melatonin and ambien and said to give it a week and see if it helps. After reading up on ambien, I am very reluctant to try it. My sleeping habits have been horrible since I became a father of twins 3 years ago. Their sleep cycle wasn't synced and they woke up every 2 hours for the first 18 months. It's better now except for 1 child who still wakes up at 4 am no matter what and takes about half an hour to get back to sleep.  

Also from my research, I saw in another forum that the cause was adrenal fatigue but being such a controversial issue, I am not sure how to digest it and where I would go to confirm it. The poster in that thread apparently fixed his issues by targeting adrenal fatigue. If anyone has knowledge on a possible correlation between sleep and adrenal fatigue, I'd really appreciate some info.

[Velacooks]

Yup I know it could happen when awake but the degree I am feeling it leads me to think that it's something more. I can be lying down reading a book and still feel significant obstruction. 

Will try the oscar out, it's just that my RESMED Airsense is on trial now and I don't have access to the app. Can I still upload the data to oscar ? I am abit reluctant to tamper with the machine/sd card if it gets me in trouble.

[Melman]

OSCAR does not write to or remove any files from the SD card.

[ardenum]

Yes totally get the same, i also always lay down with my cpap, i dont do it without it.

[DeepBreathing]

Yes, I occasionally get that collapsing throat feeling as well. I haven't followed up with a doctor, but I wouldn't be surprised if there are exercises you could do to strengthen and tone up those muscles. One theory that was doing the rounds is that playing an instrument like the didgeridoo can be helpful. Probably any of the wind instruments will have some positive effect.

Will try the oscar out, it's just that my RESMED Airsense is on trial now and I don't have access to the app. Can I still upload the data to oscar ? I am abit reluctant to tamper with the machine/sd card if it gets me in trouble.

You can download Oscar here: https://www.sleepfiles.com/OSCAR/

There is no reason not to look at your own data. As mentioned above, Oscar doesn't write anything to the card so your doc doesn't need to know unless you tell him. Personally I tell my doc everything and we work together to optimise my treatment for my many ailments. Not my sleep doc though - I haven't seen him in years!

[Gideon]

just a hunch, are you having any issues/trouble inhaling when you start the night? (yes)  Are you using EPR? (no)

[Velacooks]

just a hunch, are you having any issues/trouble inhaling when you start the night? (yes)  Are you using EPR? (no)


Start the night meaning on cpap or without? No ERP. I don't suffer if my CPAP is on. 

I have troubles randomly. On and off while lying down just using my ipad or like yesterday I was getting a massage and while lying down on the massage table it felt like I was breathing out of a straw. My nose isn't congested. The problem lies somewhere in my throat. The feeling of obstruction is more evident when exhaling. If I stuck my tongue out, it would feel alot better. Then there are times when I am clearly fine. Putting my toddlers to bed and I'll be lying down with them and on most nights it's fine. Is there such a thing as painless inflammation?

[Sleeprider]

Velacooks, I think you might be experiencing the symptoms of what we often refer to as positional obstruction or apnea.  This can occur anytime your airway is not in alignment or there is pressure on the tissues at the back of the jaw or front of your throat.  See the article on Optimizing Therapy in my signature and read the section on Positional Apnea.  

You can verify whether or not this may be a problem.  Just get comfortable and sit and relax in your favorite chair.  As you relax, let you chin drop closer and closer to your chest.  Observe whether you feel restriction in your airway, a snore or more difficulty breathing in or out.  If so, then this explains why sometimes you feel this way when your head is propped on a pillow reading your iPad, or perhaps your head and neck are not aligned on the massage table or the cushions impinge on your throat.  I get the same feelings when falling asleep that my airway is not secure, but for me, that feeling is eliminated with PAP pressure.