Stuffy nose causes increased sleep arousals?

[davep700]

My ENT, a sleep specialist, says that my chronically stuffy nose (due to a structural problem) worsens my sleep quality such that I can consider my AHI to be twice what it reads untreated on my sleepy study report.

I am told these arousals would not be picked up on CPAP machine statistics, however, I don't know why these arousals would not show up on the polysomnogram. Has anyone been told something similar?

This is interesting to me because my feeling of fatigue started around the same time as my stuffy nose. Perhaps I have had the sleep apnea condition for far longer. If that theory holds true, it could explain why my fatigue feels severe but my OSA is only moderate.

[Julie]

You wrote about the same problem in your post of yesterday... and got many replies (mine asked if you're using more humidity - if any at all - than you need for local climate. Unnecessary humidity can cause congestion).

[davep700]

It's a different and specific question, related to that same subject.

[Julie]

But it's still best to return to the orig. thread so we can see the history (and not make the mistake I did).

[jnk...]

Start as many threads as you want.

Any narrowing of any part of the airway can exacerbate sleep-breathing issues. But for most, optimized PAP therapy makes sinus issues more a minor factor than a major one, especially if an APAP is being used that is doing well at adapting to pressure needs moment to moment. Surgery can make PAP easier, though, when sinus issues are especially severe.

Severity of sleep problems in association with OSA is highly individual and based on many factors beyond simple AHI-based classifications of "severity." So no need to expect some sort of direct correlation between non-treatment AHI numbers and amount of fatigue, especially for those in the so-called mild-to-moderate range of AHI.

Once treatment has begun, you mostly use any "reports" for trending to make sure there are no large leaks and to optimize treatment by choosing a treatment pressure (or range of pressures) that keep(s) the number of measured events as low as possible and that improve(s) quality of life. So there is generally little need to get too sidetracked with what names to give any future changes in breathing during PAP use or whether they would "show up" with further testing, other than maybe for curiosity's sake, of course.

It is only when long-term use of optimized PAP isn't doing the trick that more subtle issues may need to be more closely examined, but those usually turn out to be more about sleep issues in general than subtle PAP problems.

IMO.

[robysue]

My ENT, a sleep specialist, says that my chronically stuffy nose (due to a structural problem) worsens my sleep quality such that I can consider my AHI to be twice what it reads untreated on my sleepy study report.

I am told these arousals would not be picked up on CPAP machine statistics, however, I don't know why these arousals would not show up on the polysomnogram. Has anyone been told something similar?

In a PSG if an arousal is not associated with an event that can be scored as a sleep disordered breathing event (OA, CA, H, RERA) or an arousal associated with PLMD, then it will most likely be labeled as a "spontaneous" arousal.

My guess is that your chronically stuffy nose does not lead to events that meet the stringent scoring criteria for OAs, CAs, Hs, and RERAs, but it probably does lead to a large number of spontaneous arousals.

So look at the number of the spontaneous arousals listed on your sleep study report. If your sleep study showed that you were averaging over 5 spontaneous arousals per hour of sleep, then it's quite believable that the spontaneous arousals (due to the stuffy nose) may be significantly contributing to the disruption of your overall sleep architecture and the overall quality of your sleep. And an excess number of spontaneous arousals on top of OSA is going to add to how lousy you feel in the morning

This is interesting to me because my feeling of fatigue started around the same time as my stuffy nose. Perhaps I have had the sleep apnea condition for far longer. If that theory holds true, it could explain why my fatigue feels severe but my OSA is only moderate.

Many things can cause bad sleep. Untreated or undertreated OSA is one thing that can cause bad sleep, but it's far from the only thing. It sounds to me like the chronically stuffed nose pushed your already bad sleep caused by the moderate OSA into the really horrible bad sleep caused by the combination of moderate OSA and chronically stuffed up nose.

Using xPAP should help fix the part of the really horrible bad sleep caused by the OSA. But you may also need to figure out a way to deal with the nose problem as well before you start to feel like you are getting good sleep instead of not "really horrible bad sleep".

[davep7000]

I Don't seem to have Spontaneous Arousals on my sleep study report. I Have "Arousal Index" of 9.9/hour.

It lists sleep time, sleep efficiency, sleep onset, REM latency, percentages of each sleep tage, total respiratory disturbances, AHI index, Indices for Central, REM and NREM, supine and non supine AHI and percentages, oxygen desaturation statistics and average heart rate.

[davep70000]

Do most PSG reports track periodic limb movements and spontaneous arousals?

[davep700]

.... I feel like my report is incomplete. I wonder why they didn't bother tracking this information.

[jnk...]

I believe you may have misunderstood your ENTs statements and the statements made here.

What evidence do you have that your report is "incomplete"?

What evidence do you have that there may be some important information that "they didn't bother tracking"?

What exactly are you trying to accomplish or figure out?

In most circumstances, the primary questions being addressed by an ENT sleep doc are the following: (1) Is the patient likely to benefit from PAP? and (2) Is the patient likely to benefit from surgery? Testing can be used to help answer those questions as far as what appears to be damaging sleep. And if testing helped to answer those questions, then the testing was successful. If, however, the ENT is offering an opinion beyond what testing was able to demonstrate in regards to possible benefits from surgery, that may be an opinion that would motivate you to get a second opinion from a second ENT before submitting to surgery.

The primary benefit of nasal surgeries for sleep conditions is that they can make PAP treatment easier and more successful after the surgery. But for many of us with nasal conditions, we have chosen to make PAP work for us without submitting to surgery and have been able to get great sleep using PAP. If your sleep does not improve with PAP and surgeons manage to convince you that they can help make PAP better for you by means of surgery, you may have to trust their subjective judgment based on their experience and success statistics and experiences of their other patients.

[davep700]

Thank you , that was a thoughtful answer. Sorry if my remark wasn't clear. My PSG report has no information on Spontaneous arousals (or limb movements, though I doubt I have any). I am trying to say that I may not be getting the full picture of my sleep patterns from this report, that other individuals may have the benefit of getting.

[jnk...]

Thank you , that was a thoughtful answer. Sorry if my remark wasn't clear. My PSG report has no information on Spontaneous arousals (or limb movements, though I doubt I have any). I may not be getting the full picture of my sleep patterns from this report.

Which is OK, as long as the report contained enough information to suggest whether any available forms of treatment may be of benefit to you, since that is generally the purpose of medical testing.

[robysue]

Do most PSG reports track periodic limb movements and spontaneous arousals?

Do you have the full copy of the whole sleep study report or just the doc's interpretation and most basic summary information?

A full sleep study report typically runs between 3 and 7 pages long. It contains summary data as well as overview graphs that show when each event occurred and what type of event it was.

The doctor's interpretation is typically a one page narrative about the sleep study that may cite a few of the most relevant numbers from the data.

[Okie bipap]

When I requested a copy of my sleep study, it was 35 pages long, and the titration study was 19 pages. I scanned the whole thing into my computer and carry a copy of it on my Kindle so I have it with me when I travel. I also have a copy of my prescriptions on my Kindle.

[robz1]

This is what I believe is my problem.....I still wake up out of dreams with cpap.....I have had stuffy nose, inflamed sinus due to acid reflux......when I wake at times, I can tell one nostril is stuffed up.....not sure how the best way to go about dealing with this problem.....