Coughing up mucus in the morning

Hi All,

Just wondering if anyone has had a similar experience or can point me in the right direction.

I have been a CPAP user for the best part of 9 years now. I also suffered recurrent chest infections for years and have recently discovered that some issues I have experienced with my throat feeling tight after CPAP use was related to a build up of yeast from all the antibiotic use over the years to deal with the chest infections.

Since resolving this problem last year I have been able to use CPAP every night without the throat tightness. Prior to this I was regularly on and off CPAP.

February 2014 I had fundoplication surgery and hiatus hernia repair as there was evidence of stomach acid making its way into my lungs. The surgery has proved to be effective in reducing chest infections.

However what I have observed over the last 9-10 months is that almost every morning about 30-60 minutes after I get out of bed I cough up mucus, usually clear but sometimes with a little light yellow in colour. I also notice that there is a lot of mucus in my nasal passage that needs to be cleared out and that my nostrils have a little bit of "crusty" material in them. I feel quite congested in the nose when I first take my mask off.

My breathing through my nose during the day is actually quite good and it is certainly better than it was prior to the surgery.

Since using my new Resmed Airsense 10 with nasal mask (I have always used nasal mask, but only bought the new machine in September 2014) I have always felt like I have a much drier mouth than I used to with my former S8 machine. The temperature and humidity settings are set to 27C (80.6F) and 4 respectively. I live in Perth, Australia and the coldest night time temperatures over the last 8 months have been anywhere between 8C (46.4F) and 22C (71.6F). Currently they are around the 8C (46.4F) mark but will gradually decrease over the coming winter months.

They always say that when troubleshooting you should look at what has changed. So pre surgery, I never used to cough up in the morning, except on the occasions when I got an infection. I reckon that post nasal drip has become really bad since the surgery and I also am using a different CPAP machine.

Any thoughts?

I have a loose "smokers cough" every morning and i have never smoked. It takes a good cough to clear and then am fine the rest of the day. I attribute it to the humidifier but when i try lowering it i am too dry. I am interested in hearing responses. Post nasal drip could be a possibility too.

I'm one who can't tolerate warm air from the humidifier. I'll wake up choking on sinus drainage. Due to dryness, I need more humidity, but I simply can't. Just have to deal with the dryness. But I have noticed since I'm now on a ResMed instead of my former Respironics machine with the fine filter, I'm having more sinus trouble. Going to have to see if ResMed has a fine filter to keep out allergens. Not sure what's available for your machine, but I'd suggest using the best filter available.

Dry mouth means mouth breathing which means with a nasal mask you are losing therapy.

Coughing up mucus could mean GERD is still there. Do you seep flat or do you have the head of your bed raised?

I agree with Blackspinner - make sure the GERD is under control - that could lead to the mucous - I know it did for me.

Along with the last two responders, I'd also ask what your reports look like. Are you using software to monitor your therapy?
I would think there may be some indicators in there, somewhere........leaks, higher AHI or other numbers, etc.


Den

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Thanks for all your responses. There are some pertinent points raised which has helped direct my own investigations.

I probably should have mentioned that I am a mouth breather and I have always worn tape.

I visited my sleep technician on Thursday just gone and he uploaded my data and went through what was going on with my sleep. It clearly showed that late in my sleep cycle, about 1 - 2 hours before waking there were mouth leaks (I'm pretty sure that is what he said). So we know something is going on.

Anyway, I thought about everything that I have and haven't done re CPAP since my fundoplication surgery and I realised that I used to use Nasonex nasal spray pretty much every night before going to bed prior to the surgery, but I have not used it since as I originally felt that breathing through my nose had improved after the surgery.

Given how congested I feel in the morning I am now back on the Nasonex and will report back in a few weeks to see how I go.

droberts wrote:Thanks for all your responses. There are some pertinent points raised which has helped direct my own investigations.

I probably should have mentioned that I am a mouth breather and I have always worn tape.

I visited my sleep technician on Thursday just gone and he uploaded my data and went through what was going on with my sleep. It clearly showed that late in my sleep cycle, about 1 - 2 hours before waking there were mouth leaks (I'm pretty sure that is what he said). So we know something is going on.

Anyway, I thought about everything that I have and haven't done re CPAP since my fundoplication surgery and I realised that I used to use Nasonex nasal spray pretty much every night before going to bed prior to the surgery, but I have not used it since as I originally felt that breathing through my nose had improved after the surgery.

Given how congested I feel in the morning I am now back on the Nasonex and will report back in a few weeks to see how I go.

You really need to get the software and do the downloads yourself to monitor your own therapy.


Den

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I think Elle is on the right track re. post nasal drip. I've been checked by a list of medical specialists (pulmonary, allergist, ENT, gastic) and none could find a cause for almost daily mucus and, in my case, throat clearing. As you did, I too had a Nissen Fundoplication for chronic GERD. It resolved other (gastric) issues, but didn't help a bit with the throat clearing and mucos. Post nasal drip seems to be the culprit.

You could be still having silent reflux. It gives you post nasal drip. Have you had a gastroscopy to be sure your esophagus is ok? It can give you esophageal (Barrett's) cancer

That is really interesting. I think it may be prudent for me to go back to my GP and organise to get another gastroscopy. It would be my first since the fundoplication and hiatus hernia repair surgery.

Nick Danger wrote:I agree with Blackspinner - make sure the GERD is under control - that could lead to the mucous - I know it did for me.

Were you able to resolve the issue? Can you inform me of how if you did resolve the issue?

BlackSpinner wrote:Dry mouth means mouth breathing which means with a nasal mask you are losing therapy.

Coughing up mucus could mean GERD is still there. Do you seep flat or do you have the head of your bed raised?

I sleep flat but am prepared to try sleeping raised. Would an additional pillow be sufficient or are you suggesting something more complex than that?

I thought I should provide an update on where I am at.

I went back to my GP with a written document of all my symptoms. He went back through some old scans and found one from 2008 which indicated I was suffering from sinusitis. I had told him that I had started back on Nasonex but he got me to have another CT scan on my sinuses. This time it indicated moderate rhinitis.

He told me that it would take about 4 weeks for the Nasonex to take effect and sure enough the coughing and mucus has subsided dramatically since commencing back on Nasonex. I still get a bit of mucus in my nasal passage and throat in the morning, but nothing like I was experiencing during April.

I am just kicking myself that I didn't pick this up last year and am concerned that I have done further damage to my lungs with the months of coughing up phlegm in the morning. Will have to see what happens from here I guess.

droberts wrote:
I am just kicking myself that I didn't pick this up last year and am concerned that I have done further damage to my lungs with the months of coughing up phlegm in the morning. Will have to see what happens from here I guess.

The problem was probably not in your lungs but in the bronchial tube. It protects itself from stuff like nasal drip or acid reflux by producing mucus and then having "bronchial spasms" (coughing) to clear it.

Re the bed: Some use a wedge pillow and some lift the bed by using some form of blocks. I am sorry I didn't get back to the thread earlier.