Nasal/Sinus Induced/Aggravated Apnea???

A little over one week of using xPAP and looking through the collected data, I'm beginning to wonder how much nasal/sinus stuff affects or even induces apnea.

I started with a CPAP pressure of 4 cm and consistently recorded values of AHI = 12. When I bumped the IPAP pressure up to 6 cm, but left EPAP at 4 cm, I got AHI = 12 for those two nights as well. When I bumped EPAP up to 6 cm also, I suddenly got AHI = 23, but realized that night that I wasn't able to exhale against the increased pressure very well due to congestion, and so I resorted to mouth breathing.

For the past two nights, I dropped both IPAP and EPAP back to 4 cm and started using a saline nasal rinse which helped some with the congestion. For the two nights, my AHI was recorded as 18 and 19, somewhat higher than I was getting earlier on 4 cm pressure.

Now, I've always been somewhat congested and I'm not aware of being any more congested recently during the day than usual, although the congestion is noticeable when I start trying to breath through the mask at night, despite my attempt at decongesting with the saline solution. (I also kinda think the increased congestion may be caused by the same flu/cold thing that had my wife, daughter and mother-in-law all under-the-weather within the past week or so.)

I'm wondering how congestion generally affects apnea. In my case, the AHI recorded during my sleep study was low, and I can't recall being congested then, even though I'm typically usually congested somewhat, so much so that I'm quite often normally a mouth breather. I also assume that the medical facility air was extremely clean during the sleep study which would likely have minimized any congestion I experienced.

All of which makes me suspect that my main apnea problem may be nasal/sinus related. Does this make sense to anyone here?

Regards,
Bill (looking for some answers)

Funny you mention this. I seem to be noticing a dissproportionate amount of sinus/nasal problems in the OSA world.

I finally got my clogged schnozz fixed with surgery and my AutoPAP range dropped from a 90% at 14cm to 90% at 6cm. And my frustration with CPAP dropped dramatically.

IMHO, if your nose doesn't work, CPAP won't work.

I would NOT say that fixing your nose will CURE OSA though, in my opinion.

I think most people would benefit by seeing a pulmonary sleep doc AND an ENT.

Thanks Snork1,

I've appreciated reading your previous posts on this subject, which I found in the past few days of researching this topic. I believe that you are absolutely correct when you say that CPAP doesn't work unless the nose works.

From the other things I've read, the "experts" haven't been able to prove that nasal congestion is a major contributor to apnea, although there is some "anecdotal" evidence pointing to it in at least some cases.

In my own case, the evidence is mounting. I've only tried simple measures to combat it so far, but there is a definite trend. After wearing a nasal anti-snore clip last night (a wicked device, I might add) Encore Pro reported the apneas dropped markedly from their values over the past week. At the same time reported hypopneas went to the highest value since I started using xPAP, suggesting the possibility that the attempt at correcting congestion converted many would-be apneas into hypopneas instead. This is supported somewhat by the AHI total which while down only slightly from the previous night has been going down as I've progressively attempted to resolve the congestion. I'm greatly encouraged; I'm beginning to feel like I'm close to getting a handle on at least understanding my problem.

One of the more puzzling things to me since I started this therapy has been that my reported hypopneas have been very small compared to reported apneas. By itself this seems to suggest CSA rather than OSA, but that conclusion would be somewhat contradicted by my recent sleep study which recorded only OSA's without any CSA's.

Tonight I'm wearing one of the breathe right adhesive strips on my schnozz. It provides a noticeable difference in relieving congestion during the day, so I'm hoping this will hold true at night as well.

I'm certainly not eager to undergo what you did, Snork1, but at this point I'm open to whatever the evidence points to. If it turns out that a big part of my problem is simply nasal congestion, I'm also gonna be asking myself how I could have been so stupid to not have realized it before. I've always been somewhat of a mouth breather during the day, so why would I keep my mouth shut at night if my nose isn't working? That's why I purchased a full face mask for crying out loud.

Regards,
Bill

Of course now that you have fearfully pondered surgery, let me make a suggestion that may not sound so bad in contrast.

Try saline flushes for opening up your nose. Not just a wimpy spritz up the nose, but a couple of irrigator bulbs full of warm water with some salt in it, then blow out the crud. Gross sounding yes, but very effective at clearing sinuses, and unfortunately most people would rather suffer than try it.

If you do the flushes, make sure to hang your head low a few times to clear out all the solution....etc.

Post surgery, I have done this regularly (twice a day) and so far its really KEEPING the nose clear and greatly reducing duration of colds and allergies.

The nose can be the key to making CPAP work. The strips area good idea to try too, according to several people on the forum.

Try saline flushes for opening up your nose. Not just a wimpy spritz up the nose, but a couple of irrigator bulbs full of warm water with some salt in it, then blow out the crud.

I've kinda been working my way up to trying that, Snork1. I visited the website for "Neti pot", I think it was. Only reason I haven't tried it yet is lack of equipment. I started with a saline rinse which helped only a little.

Anyway, after last night's combination test with the breathe right strip and snore clip in place, a strong trend seems to be in place. My apnea index dropped to AI = 7, the lowest since I started using xPAP, while the hypopnea index rose to HI = 9, the highest. The overall AHI has been dropping steadily since peaking a week ago when I first realized a connection with sinus congestion.

It may not be scientifically conclusive, but I'm just about convinced that a major part of my problem is nasal congestion. I'm considering ordering "nose braces" for the short term to test out the theory. After taking the test at the "nose brace" site, it appears that my congestion is relieved simply by opening up the nostrils.

I'm tempted to just visit an ENT first, but my track record with physician diagnoses has been extremely poor. It seems that unless I can convey exactly what I expect from them, I haven't gotten much.

For the moment though, I'll simply continue to enjoy the best sleep I've had in years

Regards,
Bill

P.S. I'm logged in, so don't blame me if this posts as "guest".

NightHawkeye wrote:
I've kinda been working my way up to trying that, Snork1. I visited the website for "Neti pot", I think it was. Only reason I haven't tried it yet is lack of equipment.

I really think many people make the saline flush WAY to complicated. You CAN make it complicated, I suppose. "Getting the equipment" should not be big issue.

Go to Walgreens or the drugstore of choice, or maybe even the pediatric section of your bigger grocery store. Buy the ubiquitous blue squeeze bulb that is used for babies noses, or comes with some ear wax removal systems, or a bunch of other uses. Cost should be around or under $5.

Combine this exotic item with a some sort of fancy container.... like a cup or tiny tupperware or whatever is laying around and toss a pinch of sea salt into that with some warm water.

Grab the "sea salt" from the "health" section of your store and make sure it does NOT have aluminum in it, which much "regular table salt" does have. I personally do not care if its iodized or not since that is just a nutrient, but aluminum is bad to eat or squirt up up your nose.

OK, whats the difficult part of this equipment to procure?


And I recommend starting out gently. Don't worry about being "effective" at first, just get used to the idea of something going up your nose and out again, which I had MAJOR issues with before starting this.

Go to Walgreens or the drugstore of choice, or maybe even the pediatric section of your bigger grocery store. Buy the ubiquitous blue squeeze bulb that is used for babies noses, or comes with some ear wax removal systems, or a bunch of other uses.

Thanks for the "equipment" recommendation Snork1. I may just try that this evening. If I'm lucky, I'll be able to get the hang of using it before my wife and teenage daughters find out about it and I have to listen to their opinions of just how gross the practice is.

Regards,
Bill