restricted nasal airway - reason for tiredness?

[imrdyman]

Good evening ladies and gents. Im fairly new here and have posted a few of my charts already and the consensus seems to be that my readings are fairly good. Now that ive been sleeping with my cpap, it seems im even more tired than before and find myself taking extra naps and just feeling worse in terms of energy. So i was wondering if a reason for that could be that my nasal passages are restricted when i sleep as i use a nasal pillow mask and tape my mouth shut. The reason why it had me thinking is because i remember there was a time i was mouthtaping WITHOUT cpap and i felt more tired just like i do now. Do you think its a possibility that the airways in my nose are too narrow and its not letting the air from the cpap in enough? I would experiment with a FFM but i cant tolerate any and i have a few. Im able to breathe through my nose throughout the day just fine and im able to sleep by nasal breathing but our bodies change the way it rests on itself when we fall asleep so i thought maybe it could be possible. Ive ordered an o2 ring to check myself while i sleep, and i dont see my ENT until april or else i would ask him to look inside my nose. Thoughts? Of course i dont think anyone can diagnose this over a computer, wanted to start more of a discussion i guess, unless one of u want to come over and check my nose

Of course this could just be my body adjusting to cpap and craving "real" sleep but i wanted to consider other possible issues, thanks.

[Miss Emerita]

I'm glad you have an appointment to see an ENT. It's hard to say whether something going on in your nose is affecting your sleep. Checking your O2 levels before you see the ENT sounds like a reasonable thing to do. That way you can tell him or her about the results. You could also try two remedies ahead of time so you can report to the ENT whether they made a difference. One is to use Flonase about an hour before bedtime. (It takes a week or two to kick in, so be patient.) Another is to try a nasal rinse (e.g., Neilmed) earlier in the day.

You might also ask yourself whether something unrelated to sleep breathing is causing your daytime tiredness. Has your regular doctor run any tests (e.g., thyroid, autoimmune, iron, testosterone if you're a man)?

[Treatedandtired]

I do think there is some substance to your theory. I saw an ENT for the same reason late last year and he thought that I could benefit from turbinate reduction, though I should first try Nasacort or even a systemic steroid injection. I've not had great luck with the nasal sprays and am a bit apprehensive about the systemic steroid injection (though he claims he has many patients who get these 1-2 times per year with a great resolution of nasal obstruction symptoms). I have found that I have a bit less obstruction at night in auto humidity and with as little pressure as possible (8.4 - 9.4 for me, I believe, while still maintaining an AHI of 1-2). It seems like the increased pressure is an irritant to my turbinates.


There's a study that was done on this subject which you'll find by searching for...

'Nocturnal nasal obstruction is frequent and reduces sleep
quality in patients with obstructive sleep apnea'.

Also, there was a user by the name of Dr. Falcon who posted here with similar complaints and he found relief via allergy pills. Good luck!

[BigNortherner]

Of course restricted nose passages do not help, how bad depends on amount of restriction.

Perhaps doctors can measure.

How does breathing feel to you with CPAP on?

Internal configuration of nose varies with individual, some have crooked passages.

I had to use full face mask because sinus drainage was clogging my nose. I took the risk of having my sinus passages reamed out, that really helped so now I can use a nostril interface.
(I do keep my nose clear by blowing it, often use Vicks VapoRub decongesting gel before sleeping (vapours expand nose passages I think).)

(Reaming out sinus passages has to be done very carefully, there are devices and methods to guide surgeon.)

[imrdyman]

You might also ask yourself whether something unrelated to sleep breathing is causing your daytime tiredness. Has your regular doctor run any tests (e.g., thyroid, autoimmune, iron, testosterone if you're a man)?

Well i did do alot of blood tests maybe about a year ago for my frequent urination as i thought i may have had diabetes. Ive learned thats it a symptom of untreated sleep apnea though, as everything came out normal. They tested for alot of stuff but we didnt get into specifics as everything was normal but thats definitely something else to consider once i rule out a narrow nasal airway.

How does breathing feel to you with CPAP on?

It feels fine really. I also use nasal strips to open my nose up a bit more. I imagine the humidity also helps unclog the nose a bit too. I do feel my nose gets a little stuffy when i lay down, some positions make it feel worse. But its not enough to keep me awake, i can fall asleep with it.

I've not had great luck with the nasal sprays and am a bit apprehensive about the systemic steroid injection

Yep im always apprehensive about surgery or anything of that nature. Ive heard alot of horror stories of things like that just causing more problems.

Thanks for the responses and suggestions guys ill just have to wait for my ENT appointment to see what he says.

[imrdyman]

I had another question for you folks and didnt want to take up too much room starting a new thread.

When im looking at my flow chart, i zoomed in and saw that before almost every CA event or OA event, my flow became flat right before it was marked, what does that mean?. Ideally a normal flow chart should look like little mountains or hills next to each other right? Ive attached a screenshot, thanks!

[BigNortherner]

The research paper on nose restriction is at https://pubmed.ncbi.nlm.nih.gov/29105874/.

It just states the obvious.

But after it there are links that may be more useful.

[imrdyman]

The research paper on nose restriction is at https://pubmed.ncbi.nlm.nih.gov/29105874/.

Thanks brother. I slept with my O2 ring last night with my nasal pillows and O2 readings were normal. Hmm

[Treatedandtired]

My theory is that isn’t not about desaturations, but about the sense of restricted breathing altering our normal sleep cycles. In other words, bouncing you out of deep sleep and into something much more shallow. Perhaps along the same lines as UARS?

[BigNortherner]

There are of course various reasons for poor sleep:
- using computer late in evening is suggested as unwise (my Lenovo Thinkpad has a setting to reduce blueness of backlight after a time it can be set for)
- perhaps what you eat
- booze impairs sleep
- warmth of bedding (I try to keep shoulders warm but head cool)
- worrying/ruminating