RhinoSinusitus (or something like that)

It's been almost a year of very successful APAP usage....Got my AHI down to the .50 range with a 9cm lower limit. I am convinced it was worth it and plan to continue it.... BUT, I need some feedback on a problem. As you know, sometimes when you solve a problem, you cause other problems.

I have used the ReSMed AirFit P-10 nasal pillow mask with great success. If it were not for it's minimalist nasal pillow approach I probably would not have had the great success I did have, but it seems that the continual forcing of air through the nasal and sinus passages has taken a toll on me.

The sinus passages above the bridge of my nose seem to be irritated and, at times, hurt, even spreading and causing a headache. It isn't the upward, physical pressure of the mask pillow which is causing the problem. I believe it is the continual passage of air over the membranes which inflames them.

I have seen an ENT doctor, but without a CAT Scan or MRI she didn't want to advise anything except Ibuprofen or Acetaminophen. These pain killers do help, but are surely not the long term answer.

Seems to me that there are some solutions to consider (in no particular order) and I need your feedback on them:

1) Continue to take over-the-counter pain killers (Obviously doesn't solve the problem in the long term and, in too large a dose have serious side effects).

2) Get the CAT Scan or MRI to see if there so something else going wrong (though I am pretty sure the problem is directly related to the continuous air passing over the sinus membranes).

3) Change to a different kind of mask which doesn't force all the air through those sinus passages (I have a ResMed AirFit F-10 FFM which I could try but would take some getting used to - or maybe another type of mask - I am open to suggestions)

4) Change the humidity setting (I have tied that, but no real difference by changing the amount of pass-over humidification) Saline solution/sprays help only minimally.

5) Stop using APAP for a short (?) while to give the membranes a chance to settle down. (I know this is heresy and the symptoms might return anyway.)

6) Lower the pressure from my current lower limit of 9cm back to the original 5cm (My AHI will probably go up to 1.5 or 2 or more as it was before I raised it). I am unsure as to whether the pain is related to the raising of the lower pressure or not - I don't think so....)

or any other approach you might think of....

You guys are great, and I really appreciate your feedback.

Thanks,
Paul

The term I use is "cpap rhinitis".
What humidity settings have you tried and was any setting an improvement at all?
Are you just using "pass over" with no heat at all added? Which is usually what we are referring to with pass over humidity term...water in the tank but no heat added so minimal humidity.
Are you using the heated hose that is an option for the PR S1 60 Series humidifier?
Are you having any sinus/nasal symptoms besides the pain?

To bypass the nose...you might look at the Oracle from F & P but it comes with a whole new set of challenges but it might work for you.

I have used nothing but a nasal pillow mask for well over 6 years. The only time I have had sinus issues was when I ran out of water and the nasal mucosa and sinuses got dried out...any my pressures are a lot higher than yours. I am not so sure it is the pressure that is the culprit but more likely it's a humidity thing.
Some people need a lot and some people don't.

Pugsy,

Thanks for the quick reply...

I was using unheated pass over humidification at a setting of 3 and at a setting of 5 with no apparent difference that I noticed. I can try adjusting it again though. I don't have much of a need for heated humidification as rain out isn't really a problem where I live. Nevertheless I will be happy to try it.

I do have a heated hose and can try a heated humidifier setting as well.

There are no other symptoms that I have noticed besides the sinus pain and associated headache over the top and front of my head

I will look into the Oracle mask after trying the humidifier changes for a few days.

Regards,

Paul

Hi Paul,

I have found doing a brief sinus rinse with alkalol to be very helpful.

http://www.amazon.com/Alkalol-Natural-S ... N3GKAY5HW1

Since I use it by itself, I only use a very small amount before my body starts rebelling. But it works.

I tried regular sinus rinsing and it just made things worse. Also tried combining alkalol with a regular sinus rinse to no avail.

Best of luck in finding a solution.

49er

Please note...that if you wish to use the heated hose and adjust humidity that if the heated hose is connected you must be in the clinical setup menu to adjust the humidity settings...which are 1 for 70% and 2 for 80% and 3 for 90%.
With the heated hose the air temp is controlled by the knob when you are not in the clinical setup mode.
At the lowest setting it adds 4 degrees to the ambient room temp and at the highest setting it adds 16 degrees to the ambient room temp.
This is one of the things I really like about using a heated hose. I get to alter the hose air temp and still maintain same humidity. Summer hose air temps are much cooler than winter hose air temps but humidity is constant.
It isn't all about rain out control either. But it's nice to not have to deal with rain out which was a constant winter time problem for me before I got the heated hose.

The settings on the machine for humidity when not using the heated hose default to the "new System One humidification system" which uses sensors in the machine to help it figure out what humidity to deliver. I never could find out what it is supposed to deliver but my own person experience with that "new system" was even at a setting of 5 it didn't put out much added moisture...at least not near what one might think at the highest setting.

Try your heated hose. Remember you have to go into the clinical setup menu to set the humidity and give the setting of 2 a try...there's a reason that ResMed elected for 80% on their S9 machines as the automatic default. If going by the majority of people...that setting works well. It's a good starting point.
In terms of hose air temp...choose what feels good to you. I like the warm air in the winter but that warm air doesn't feel so good right now. So I have the hose air temp on the lowest setting but it still prevents rainout now because the ambient room temp helps.

If you do end up trying the Oracle...be prepared to use maximum humidity...your mouth will need it.

49er,

Thanks for the feedback....

As you mentioned, I too didn't have much success with a plain saline rinse. After I try the humidification changes which Pugsy recommended, I might try Alkalol.

Paul

"Try your heated hose. Remember you have to go into the clinical setup menu to set the humidity and give the setting of 2 a try...there's a reason that ResMed elected for 80% on their S9 machines as the automatic default. If going by the majority of people...that setting works well. It's a good starting point.


If you do end up trying the Oracle...be prepared to use maximum humidity...your mouth will need it.[/quote]

Pugsy,

I know (thanks to your previous help last year) how to set up the humidity and the heated hose.... so a relative humidity setting of 80% and a heated tube temp setting of 2 sounds like a good starting point. Let's see how that works for a few days. Hopefully I won't have to change the type of mask, but if so, I would certainly look at the Oracle.

Thanks again,

Paul

My sinuses were ruining my life. They have fought my CPAP journey every step of the way. I have gone through 14 masks looking for one that would not upset them.

I did not have the pain as you do, but was experiencing balance issues, dizziness and lack of focus...along with what I call a 'cotton stuffed head' syndrome. I dug out my old Oracle and following the instructions given by JDS74 have made a successful start back into the use of the Oracle. I have to say, at least give the Oracle a try.

After one week of use...balance is so much better, dizziness is gone...and my focus has improved to the degree that I wrote a post on a freelance site...it was accepted. Had not been able to write for over a year. I also was able to mow half the front yard (and it was high) My energy level had been so low I would just look at the grass grow.

The Oracle does take some getting used to...but it can be done. Last night I forgot my nasal plugs after I had gotten up during the night..turned out I did not need them.
Bragging here...my results from last night:

bdz wrote:My sinuses were ruining my life. I did not have the pain, but was experiencing balance issues, dizziness and lack of focus...along with what I call a 'cotton stuffed head' syndrome. I dug out my old Oracle and following the instructions given by JDS74 have made a successful start back into the use of the Oracle.

After one week of use...balance is so much better, dizziness is gone...and my focus has improved to the degree that I wrote a post on a freelance site...it was accepted. Had not been able to write for over a year.

The Oracle does take some getting used to...but it can be done. Last night I forgot my nasal plugs after I had gotten up during the night..turned out I did not need them.

Wow! I thought I had it bad.... so glad that you were able to get the relief you wanted. If the humidification doesn't do the trick then I will look into changing the mask.

Glad you are doing well now,

Paul

Paul, I was not trying to downplay your symptoms...just have a few more years in than you. I started in 2007, so my sinuses have had a LONG time in fighting back.
Despite the negative aspect that seems to follow the Oracle, it is doable. What makes it work versus not work...is your attitude. I had the wrong attitude the first time I tried it.

Hope the change in humidity does work for you...but if it doesn’t.... the Oracle is waiting!

BDZ,

No offense taken.... I was just honestly responding to your situation as I saw it. You are correct in that attitude is so important.

It's the "long timers" such as yourself and Pugsy (and many others too many to mention here) who make this list so valuable and helpful. I really appreciate your input and help.

Thanks,

Paul