Congestion issues with cpap

[Hellcat]

I was diagnosed with sleep apnea late this summer and started treatment then. It's been just over three months, and I seem to be unable to adapt to using cpap. If anything, sticking to the treatment has gotten harder, not easier over time. For weeks now, I seem to be able to use the machine for only 1-3 hrs per night at the most.

My problem is nasal congestion. I am able to fall asleep without issue. However, anywhere from 1-3 hrs later, my nose becomes congested, I feel as though I am suffocating, I awaken, and I remove the mask. I do not always recall removing the mask.

To treat the congestion, my doctor recommended irrigating the nasal passages with a saline solution (I use a neti pot for this). In addition, he has prescribed a nasal spray (Azelastine) for the congestion, and a sleep aid (Lorazepam) to help me stay asleep, although I do not always use the sleep med. Despite these measures, I cannot stay asleep. I have not yet tried a new mask, although I will soon.

I am really at my wit's end. I cannot sleep with the mask, and the sleep I get without it is not restful. I feel like crap all the time, and I'm beginning to dread going to sleep because it does nothing for me. I have a very demanding job, and not being able to sleep is undermining my performance.

Does anyone have any recommendations or suggestions for congestion or new masks? I don't have any sinus issues, so congestion is not something that bothers me at all during the day.

***I should also mention that I have tried different humidity settings on the cpap machine, but nothing I do seems to alleviate the congestion.

[Dazed Indian]

Update your profile, and mention the details of the machine and mask used by you, in text mode

[gasparama]

I've had a horrible time with nasal congestion also. There are a lot of people who have had different experiences, but for me CPAP seemed to make the congestion worse. The saline washes do me little good. But, the thing that has helped me is the use of steroid nasal sprays (I'm not familiar with the spray that you mentioned). I've mostly used Flonase and Nasacort. My doctor told me that I could use more that the recommended amount for short periods of time when I'm going through another sinus infection, and this has saved me. Two squirts in each nostril 4 times a day for about a week gets the job done. After that, normal dosing works for maintenance. Sometimes, the doctor will prescribe an antibiotic to boost the effectiveness of the spray because of the infections, but antibiotics alone are no solution for sinus infections.

[Julie]

Turn down your humidifier - it can be very 'congesting', though if it's already off, or very low, try turning it up because depending on where you live, etc. it can also make a difference.

[nanwilson]

Hi
I have the same problem BUT ONLY WITH PILLOW masks. I turned up the humidity, I turned down the humidity, I tried everything all to no avail. I finally figured out that I can't wear a pillow mask, I'm fine with anything else, just NOT pillows. My thinking is that the pillows blow directly into my nares and cause my sinuses to go nuts. When using the pillows, the next day I sneeze, my nose runs, the whole congested bit, just like I am having a severe allergy attack. I would try a full face mask if I were you and see if that helps you get better. It will take a day or two for your sinuses to settle down, but do give it a try, it might be your solution.
Good luck
Nan

[Hellcat]

Thank you for all your responses!

Dazed Indian: I update my profile at your suggestion. It's a lot easier to read the equipment specs in text.

gasparama: Thanks for the Flonase suggestion. It concerns me that it is a steroid spray. Do you happen to know if there are any side effects with either long or short term usage?

Julie: I've experimented with high, low, moderate, and no humidity. Doesn't seem to make a difference in my case with my current set up, unfortunately.

nanwilson: Thank you for sharing your experience. I'm wondering, if like you, I am just one of those people for whom nasal pillows trigger congestion. Too bad b/c they are comfortable. Anyhow, I think I will try a non-nasal-pillow type nasal mask before I go to the full face mask. Thing is, I just moved so I need to set up an appointment with a new sleep doc and new DME. My current DME is in another state and insists that they can only send me one type of mask (Fisher & Paykel zest nasal mask) because it requires little-to-no measurement or adjustment (which they insist needs to be done in person). In any case, I need to try a new mask ASAP b/c what I have is not working at all.

[KimberlyM]

Thank you for all your responses!

Dazed Indian: I update my profile at your suggestion. It's a lot easier to read the equipment specs in text.

gasparama: Thanks for the Flonase suggestion. It concerns me that it is a steroid spray. Do you happen to know if there are any side effects with either long or short term usage?

Julie: I've experimented with high, low, moderate, and no humidity. Doesn't seem to make a difference in my case with my current set up, unfortunately.

nanwilson: Thank you for sharing your experience. I'm wondering, if like you, I am just one of those people for whom nasal pillows trigger congestion. Too bad b/c they are comfortable. Anyhow, I think I will try a non-nasal-pillow type nasal mask before I go to the full face mask. Thing is, I just moved so I need to set up an appointment with a new sleep doc and new DME. My current DME is in another state and insists that they can only send me one type of mask (Fisher & Paykel zest nasal mask) because it requires little-to-no measurement or adjustment (which they insist needs to be done in person). In any case, I need to try a new mask ASAP b/c what I have is not working at all.

If you want to try a mask very similar to the Zest and that is one-size-fits all, try the Fisher Paykel HC407. I tried the Zest and it didn't fit quite right, so my DME suggested the HC407 because it is just like the Zest, but a little wider. It is my regular mask now. Just an idea.

[gasparama]

Hi
I have the same problem BUT ONLY WITH PILLOW masks. I turned up the humidity, I turned down the humidity, I tried everything all to no avail. I finally figured out that I can't wear a pillow mask, I'm fine with anything else, just NOT pillows. My thinking is that the pillows blow directly into my nares and cause my sinuses to go nuts. When using the pillows, the next day I sneeze, my nose runs, the whole congested bit, just like I am having a severe allergy attack. I would try a full face mask if I were you and see if that helps you get better. It will take a day or two for your sinuses to settle down, but do give it a try, it might be your solution.
Good luck
Nan

Nan, I forgot to mention in my reply that the nasal pillows exasperate the sinus problems. I've tried several models and now have an unused headrest in my mask drawer. The cushion is much less irritating.

[Muse-Inc]

...steroid spray. Do you happen to know if there are any side effects with either long or short term usage?

There is <2% migration of steriod nasal spray from the nasal tissue. That was a huge concern of mine too.

[gasparama]

...steroid spray. Do you happen to know if there are any side effects with either long or short term usage?

There is <2% migration of steriod nasal spray from the nasal tissue. That was a huge concern of mine too.

Well, this is a valid concern. I've spoken with 3 doctors about this issue, and they didn't seem concerned at all. However, because I can't always trust them, I did some googling about this very thing. The only issue that I found is that for a small (it's been quite a while since I looked this us) number of users, there is a possibility of an increase of pressure in the eyes. For me, that has never happened and the ophthalmologist couldn't fine any problems. The only question that I've had is this: How does this not enter the blood stream? When I first started using these sprays, I was concerned about an elevation blood sugar, but with a lot of testing, couldn't find a rise.

[BadThad]

Do you have allergies? How often are you using the neti pot? Do you use right before bed? How are you making your saline?

I use a neti pot at least 2x per day. Morning when I wake and right before bed (and CPAP). How are your filters?

Personally, I can't stand heated humidification. It feels like I'm suffocating, I recommend passive humidification.

[Janknitz]

The only question that I've had is this: How does this not enter the blood stream? When I first started using these sprays, I was concerned about an elevation blood sugar, but with a lot of testing, couldn't find a rise.

I'm sure if you google around you can find the explanation, but the key here is that the steroid is in very small doses and it is delivered directly to where it needs to be--same thing for inhaled steroids used for asthma and COPD. It's a great thing, because I've had to be on oral steroids twice now for asthma and that is NOT nice. I have none of the side effects from the inhaled steroids.

[Big S]

Check out the article below. It talks about nasal passages and the need for humidification to keep them operating to their potential. I recommend it as a good place to start to relieve congestion. Putting these principles to use, I have been able to sleep without congestion about 80% of the time. I have been able to break a 25 year Afrin addiction with nothing replacing it. I am not congested during the day. The Neti Pot as recommended by many others is a great nasal higiene. Avoid solutions with preservatives. It"s best to buy a simple one or make your own. Good luck. The article, I hope, can be found at

http://www.rtmagazine.com/issues/articl ... -06_08.asp