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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
twintrbl
 
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UARS and nasal congestion? Options?

Postby twintrbl on Thu Jan 06, 2011 11:20 am

Hi,

I'm hoping someone in this community might have a little insight for me, as I'm kind of running out of my own...

Basic situation - I have a high RDI (20) with low AHI (<5), which I am told is caused by Upper Airway Resistance. My sleep study with CPAP was a disaster (barely slept at all), and my study with BiPAP not much better. With the BiPAP, my Central Apnea episodes went way up, but I had no diff between RDI and AHI. Since it seemed to eliminate all those UAR episodes, I decided to try the BiPAP machine, but all it's done is give me 5 of my Top 15 Miserable Nights. I'm guessing the increased central apnea episodes are responsible. Either that, or the simple fact that the BiPAP machine doesn't truly adjust to my inhale/exhales. It stops with the "assist" just before I'm finished with the inhale - which is an enormous distraction, making it very, very hard to fall asleep at all even with the "ramp up" feature. And if I woke up (which I did often), getting back to sleep was nearly impossible.

Before I consider trying an Adaptive Servo Ventilator, which is extremely cost prohibitive, I can't help wondering if maybe I'm barking up the wrong tree... You see, my husband (and I, for that matter) can almost always predict my worst nights with one simple test... is my nose congested? If it is, and I use Afrin to open things up, I have a good night. If I don't...

My pulmonologist blew off the possibility that my UAR episodes are caused by nasal congestion. He insists they're caused by my *throat* becoming blocked, not my nose. He said if my nose is congested, I just breathe through my mouth. And the only way to open up the throat is with some sort of assistive-breathing machine. Personally, I think that moment of having to change from nose to mouth is what's disturbing me. It's not enough to cause a drop in oxygen (hence the lack of true apneas), but it's enough to disturb my sleep.

Has anyone else heard of nasal congestion as being a cause of UARs? Should I be headed to an ENT instead of a pulmonologist? I've tried those nasal steroid inhalers, without a lot of effect. And as much as I'd like to, I can't use Afrin every night. I've had CT scans of my sinuses and told that while I do have some evidence of chronic infections, it's not nearly bad enough to consider surgery. And I just don't know of anything else to try. (Forget OTC decongestants. Phenylephrine does nothing, and Pseudoephedrine makes it impossible for me to sleep at all!) But if there *IS* something I can do for the nasal congestion, AND it would also address the sleep issues... Well, it's worth continuing to try to find congestion solutions, no? I really don't want to spend about $150 a month on a ASV machine for the rest of my life if the real cause is nasal congestion (which isn't even a constant occurrence, even though it happens probably 70% of the time).

Insight? Suggestions? Anything is welcome!!

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Tired Linda
 
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Re: UARS and nasal congestion? Options?

Postby Tired Linda on Thu Jan 06, 2011 11:26 am

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KimberlyM
 
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Re: UARS and nasal congestion? Options?

Postby KimberlyM on Thu Jan 06, 2011 11:56 am

I can't really address whether the nasal congestion is the only cause for your UARS because as your doctor stated, usually when someone is starved for oxygen they will breathe through their mouth. However, there are a number of things to do for nasal congestion, such as netti pots, saline rinses and breathe-right strips. I see you have already tried prescription sprays and oral antihistamines. I find that breathe-right strips really help with my treatment and I wear them with my mask. Clearing up nasal congestion is a crucial issue and one thing that makes adapting to treatment much easier, but I can't say that it will replace your need for xpap.

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BusyLyn
 
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Re: UARS and nasal congestion? Options?

Postby BusyLyn on Thu Jan 06, 2011 1:17 pm

Another nasal/sinus sufferer chiming in here...

Afrin and other OTC spray decongestants are quick fixes, but they shouldn't be used for longer than 2 or 3 days in a row because of the very real consequence of rebound congestion, where you have even more severe congestion once you stop using them, so you again reach for the bottle for some relief. It's a vicious cycle, and if your body is used to Afrin you have to be weaned off of it. Steroid nasal sprays aren't an instant fix -- they can take up to 2 weeks or more to really work. Some are stronger than others, so your doctor may have to try several before finding the one that works best for you, and you have to stay away from reaching for the Afrin for the quick fix in the meantime.

Saline sprays, washes and irrigators like the neti pot are much safer to use than Afrin. Some people also get help from Breathe-Right strips.

Your mask is important. If you can't breathe through your nose, you will open your mouth to breathe so you need to use a full face or hybrid mask. You have to make sure that your mask isn't leaking excessively.

I have found that the forced air from my cpap helps somewhat to clear the congestion from my sinuses. I use a neti pot faithfully before bed. Even when I think I have no nasal congestion before rinsing, I find that I can breathe more easily after my use of my neti pot. If I'm really congested I also use Mucinex for a few days to thin the mucus.

Good luck! I hope you find some relief soon.

Lyn

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jnk
 
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Re: UARS and nasal congestion? Options?

Postby jnk on Thu Jan 06, 2011 2:13 pm

Nasal congestion can cause bad breathing during sleep. When your sinuses are blocked, the increased "pull" needed to get the air in through the nose can cause other parts of the upper airway to tend to close. (Personally, I find that using a nasal-pillows mask and getting the humidity just right helps my sinuses to open up at night, but that's just me--your mileage may vary.) If the sinus meds often solve the problem for you, that may be an indicator that sinus surgery could help your problem. An ENT who specializes in helping patients with sleep-breathing problems may help to assess whether sinus surgery might help you or not. (I heard a lecture by an ENT last night who discussed that in some detail. You may also benefit from some of his other statements: viewtopic/p553869/Manhattan-AWAKE-Meeting-Dr-Park-on-UARS.html#p553724 .) Central apneas are an entirely different issue, though. ASV is mostly for treating forms of central sleep apnea, from what I understand. I personally have not heard of ASV being used to treat UARS, myself.
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SleepingUgly
 
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Re: UARS and nasal congestion? Options?

Postby SleepingUgly on Thu Jan 06, 2011 9:38 pm

What symptoms led you to have a sleep study in the first place?

In a sleep study, I believe your breathing is measured at your nose, so your nose being congested will affect the results (if I understood what I was told correctly).

You should see an ENT and an allergist, unless allergies have already been ruled out.
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

twintrbl
 
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Re: UARS and nasal congestion? Options?

Postby twintrbl on Fri Jan 07, 2011 12:58 pm

Thanks everyone! A few notes to fill in blanks...

Already use Breathe-Right strips - I agree they are *great*! I know about the rebound with Afrin... with me, even 2 nights can cause rebound on the 3rd night, so I really can only use it one night at a time. I save it for the nights that I can barely breathe through my nose at all. :(

During my CPAP sleep study I used the regular nose mask, but I hated it. I tried the nasal pillows with the BiPAP study and liked those much better, so that's what I was using once I got my BiPAP home. It also had a humidifier. I had a clear enough airway that I never opened my mouth, so if the machine itself didn't drive me nuts, it might reduce the congestion enough to sleep thru.

I just can't tolerate the machine. It took hours to fall asleep, and when I did, I woke up again several times - each time taking another hour+ to fall back to sleep. And what sleep I did get felt totally non-restful. We know from my BiPAP sleep study that it increased central apneas significantly (from <1 an hour to 10!), so I'm guessing that's what's robbing me of rest. My body and brain simply don't tolerate it. That increase in central apneas is apparently one of the major potential side effects with BiPAP, and is one of the main reasons someone even invented the Adaptive Servo Ventilator. So it's very possible that the ASV might do exactly what I need. But for $$$ a month for the rest of my life, if there's a more targeted solution that solves the underlying problem of my nasal congestion, that sounds a lot better all the way around. It almost feels like one of those cases where the doctor prescribes one medicine for the problem...then has to prescribe another to fix a side effect...then another one to fix the side effect from the second one...and so on.

I think doctors tend to look at SDB as a single type of nail, which can be fixed with a breathing-machine hammer. Except maybe I'm not a nail - I'm a hex-head screw. Sure - if you beat it with that hammer long enough, it will sink it too, but not a tenth as easily and as well as finding a hex-head screwdriver.

I bought a sinus rinse kit and have decided to try it out, even though the idea of it honestly creeps me out. But I've had a few friends (and my mom) tell me it's not nearly as bad as it sounds, so if it will help, I'll deal. It sounds like it's better to use it right before bed? I'll try the nothing but water before bed too. That's a lot harder than it sounds, especially with kids going in 3 different directions constantly, but it's worth a try. Maybe I can only do 2 hours before bed, but that's more than I do now. Thanks for the tip (and the notes on the lecture), jnk!

Thanks for all the input - it definitely helps. If the sinus rinse and new bedtime routine doesn't do the trick, I'll find an ENT. Thanks!

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Re: UARS and nasal congestion? Options?

Postby tiredintenn on Fri Jan 07, 2011 3:34 pm

I too have UARS with mild OSA. Adjusting to PAP has been a nightmare. I just can't get restorative sleep using the machine. I have read that people with UARS have hypersensitive nervous systems so adjusting to PAP is more difficult than the typical OSA sufferer. I believe this to be true for me at least. I have only been on PAP for 6 weeks so I am still trying but so far I have noticed zero benefit. I also tried the dental device and it didn't work either. Good luck.

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jnk
 
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Re: UARS and nasal congestion? Options?

Postby jnk on Fri Jan 07, 2011 4:07 pm

twintrbl wrote: . . . I think doctors tend to look at SDB as a single type of nail, which can be fixed with a breathing-machine hammer. Except maybe I'm not a nail - I'm a hex-head screw. Sure - if you beat it with that hammer long enough, it will sink it too, but not a tenth as easily and as well as finding a hex-head screwdriver.

I bought a sinus rinse kit and have decided to try it out, even though the idea of it honestly creeps me out. But I've had a few friends (and my mom) tell me it's not nearly as bad as it sounds, so if it will help, I'll deal. It sounds like it's better to use it right before bed? . . .

My personal opinion is that a breathing machine is always the place to start, even for UARS, since many have been helped by it. It is always worth the full shot--meaning, getting the leak down and the AHI as low as possible. Many have adapted to it once they have the right mask and have tweaked their pressure to the sweet spot and have gotten used to using the machine. After that, if problems remain, bilevel is a good thing to try, in my opinion. That may allow a bit more pressure to be used to stabilize the airway further. (The problem can be getting insurance to play along.) After that, I would try a titratable oral appliance. Finally, I would look into surgery. But I would be doing all the common-sense things Park recommends the whole time, too. That's just me. There IS no standard approach to UARS yet, it seems.

As for the sinus rinse, most find it works best to use it about an hour before bed. If you do it right before lying down and hosing up, the residual salt water in your sinuses may bother you. So give an hour or so for the salt water to drain out before going to bed. It is my opinion that the plastic squeeze bottle is much better to use than the pot that only pours the solution into your sinuses. The pressure from squeezing the bottle helps the rinse to be thorough. The neti pot is mostly for those who cannot tolerate the pressure of the squeeze bottle. It is no big deal to do sinus rinses. Think of it as taking a comforting, leisurely swim in the ocean, but over your sink. :) Nothing could be more natural and refreshing, if done with the right solution the right way, once you are used to it.
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Re: UARS and nasal congestion? Options?

Postby Jersey Girl on Fri Jan 07, 2011 4:32 pm

I agree with Jeff. I have the squeeze bottle with the AYR nasal rince - it comes with 100 dry packets of saline that I mix with very warm (not quite hot) water about an hour or so before bedtime.

I also find that the proper humidity from my machine really helps. Additionally, I take something called Zyzal (it's like Zyrtec without the extra ingredients). This keeps the sinus clear so that allergies do not make a bed for infection.

My husband has UARS and he has been prescribed a straight pressure of 9. His s9 climateline hose is set at 78 degrees and he always has proper humidification. He is a mouth breather and so he has a Mirage Quatro full face mask. It has stopped is very loud snoring and although we look funny - me with my s8 and Aussie heated hose and Swift FX with nasal pillows, him with his s9, Climateline hose and Mirage Quatro full face mask, we sleep like babies.

Hope that the nasal rinse helps and you might want to look into either Zyzal or Zyrtec.

Best regards,

Jersey Girl

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mgrunk
 
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Re: UARS and nasal congestion? Options?

Postby mgrunk on Fri Jan 07, 2011 11:49 pm

I suffered from a stuffed up nose for over 10 years - I never knew to complain about it.

I would seek out an ENT as this really is something to get taken care of. You shouldn't have to suffer so often.

My chronically stuffy nose means when I get a cold, my nose goes crazy and it sets off asthma. So, I've had sinus surgery twice. The first one was 5 years ago and very, very conservative in only touching the maxillaries and reducing the turbinates. The one I had in June widened all the openings. But, really the thing that was most significant was having my turbinates reduced w/ the first surgery. Just a couple of days after surgery and I could breath through my nose for the first time in years (without drugs). The rest of my sinus surgery was about opening all of the sinus cavities so that the fluid can drain instead of being a bed for infection.

So, even if you have no infection, but chronically swollen turbinates, you can't breathe through your nose and speaking from experience, it seriously affects sleep. I simply can't sleep when my nose is stuffed, I wake when I move to mouth breathing.

An ENT will try out all the nasal steriods available, a different kind may work better for you. There are also medications like astipro if allergies are involved, along w/ Singulair. But, I don't know that surgery will be ruled out - if you are unable to get air moved through your nose even in no significant infection / fluid levels are detected then that is a problem to be looked at.

Forgot to mention - saline rinses totally rock! I actually use a water pik w/ a special nose adapter because I do rinses so often and want to put 16 ounces of water through my sinuses. But, for me at least, I use the baking soda / salt mix and warm water. It not only washes the mucus out, it seems to shrink the nasal passages. When my sinuses are bad, I do it before bed, and then have to get up in the middle of the night. But, I sleep much better. So do try it - you'll quickly get used to it.

I have serious across the board allergies to nearly everything inhaled - I developed the allergies as a adult and of course no one seems to care why - they just throw more meds at it. But, the allergies have lead to my chronic inflamed sinus passages. I'd have to live in a bubble to avoid them.

And, I don't post much - my sleep study was all hypopneas - and after my last sinus surgery, we took the pressure down to 4 and had no episodes, so it looks like as long as I keep my sinuses open, I don't have issues w/ breathing at night.
Michelle
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SleepingUgly
 
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Re: UARS and nasal congestion? Options?

Postby SleepingUgly on Sat Jan 08, 2011 9:36 am

mgrunk wrote: my sleep study was all hypopneas - and after my last sinus surgery, we took the pressure down to 4 and had no episodes, so it looks like as long as I keep my sinuses open, I don't have issues w/ breathing at night.


You were titrated in the lab and they decided 4cm was adequate? Or you titrated yourself at home?
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

mgrunk
 
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Re: UARS and nasal congestion? Options?

Postby mgrunk on Sat Jan 08, 2011 10:46 am

No my dr titrated at home using an APAP. The range kept going down until we hit the bottom of the range.
Michelle
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