CPAP and coughing up blood

[Jon_Danger]

Wanted to post a follow-up.

Saw the ENT again, and he scoped out my nasal passages/throat and saw nothing of concern, again.

Last time I saw him in 2021, we didn't have a discussion around possible causes, because I hadn't seen a pulmonologist yet, so he said that might be the cause and we parted.

I probably should have had the follow up with him sooner, but he went through a lot of likely/plausible scenarios with me.

His overall diagnosis is likely CPAP rhinitis. He said that he could see some inflammation in my nasal passages, but nothing intense or worrying. Since this is only happening post CPAP therapy, he suggested that my sensitive nose (I have always had terrible allergies, and sneeze quite often) has become sensitive to the pressure of the cpap, and I am developing inflammation while using my cpap, causing the small blood vessels in my nose/upper airway to bleed. Nothing worrying, just annoying. When asked why this is happening now after years of therapy with no problems, he said "your body can change, people develop allergies and sensitivities over years" This makes sense as you often hear about people developing allergies later in life (I am in my mid thirties)

Solution is 4 steps.

1. Use a Neilmed (or similar) nasal irrigation device with saline nightly, to rinse out/clear out both nostrils of congestion with saline.
2. If that doesn't work, we can add a steroid to the regimen to help stop the inflammation in my nose.
3. Switching mask styles to a "full face" type mask, to better distribute the pressure delivery.
3. Surgery.

Apparently, I have very narrow nasal passages, with a deviated septum. This is probably not helping things, as the narrowed passages just make the cpap pressure level more intense in that region, and may lead to them having to set my pressure higher to achieve the therapeutic effect. This is definitely something I have always kind of soldiered on with. I get "blocked up" in my nose quite regularly and often find it difficult to breathe through my nose sometimes (especially in fall/winter)

So far, a few nights into the nasal irrigation. I love the irrigation, it definitely helps me feel more "open" and easier to breathe, we will see if it reduces the amount of posterior nosebleeds I get.

I have my GI endoscopy at the end of the month. I am keeping that appointment, couldn't hurt for them to check, as I have a long history of reflux, which could be related to irritation of the throat as well. Might as well get that checked, and then we will have looked at all possibilities.

[Miss Emerita]

Sounds as though you had a good work-up from the ENT and now have a good plan for treatment. I hope the rinses will do the trick. I'm glad you'll be keeping the endoscopy appointment to check out the effects of reflux, which as you say may be part of the explanation for the bleeding.

[Jon_Danger]

So, just wanted to follow up.

Spent a lot of money on a gastroenterologist to do a scope of my upper GI. No bleeds/ulcers found that could cause this, reflux damage is not too bad, and I control it with medication. A couple polyps were biopsied, but benign, he said people that take anti-reflux meds get these, and they are harmless.

So, it does really feel like I just have developed (by getting older yay) more sensitive nasal/upper respiratory passages more susceptible to inflammation. The ENT didn't find an active nose-bleed, or anything that looked off, but suggested a lot of the steps told here.

It is still happening, and much more frequently this winter, but since I have been using the nasal saline rinse, I feel like it is much less blood, very tiny amounts.

Anyway, I guess your CPAP can certainly cause you to cough up blood, but it is just exacerbating an underlying issue. If it stays worse they said I can try a prescription steroid to lessen the inflammation, but we will see. It has never been scary amounts of blood, just concerning that it isn't going away. But I guess it isn't being caused by anything scary, so that is good. Doesn't make it any less annoying though.

[Miss Emerita]

I'm a lot older than you are, and as time goes by you may find that sometimes "annoying" goes in the win column!

[Dmkay]

I have been experiencing this very same issue over the past year. Blood in sputum upon waking in the morning.
Since it’s been a year since you posted this , how is your situation? Have you found any answers? Is it still the same repeating issue?
Thanks

[zonker]

I have been experiencing this very same issue over the past year. Blood in sputum upon waking in the morning.
Since it’s been a year since you posted this , how is your situation? Have you found any answers? Is it still the same repeating issue?
Thanks

unfortunately, jon hasn't logged in since july 2023.

[chunkyfrog]

Are you in the Northern hemisphere?
Winter gives many of us dry, irritable mucus membranes.

[Pugsy]

Folks I suspect the recent new account poster is a drive by. Before I got too engaged I would wait and see if he/she comes back.

I just got a feeling about this one. I could be wrong though.

[Dog Slobber]

Thread Title:

• CPAP and coughing up blood

And then this:

• And I realize the title is misleading, I never "cough" up blood, or have a cough or anything

It HAS to be related, this ONLY happens immediately after waking up, and one time while shifting side to side in the middle of the night.

No it doesn't HAVE to be related. Just because you don't know the cause, doesn't mean you get to make up a cause. This is known as an argument from ignorance.

[zonker]

It HAS to be related, this ONLY happens immediately after waking up, and one time while shifting side to side in the middle of the night.

No it doesn't HAVE to be related. Just because you don't know the cause, doesn't mean you get to make up a cause. This is known as an argument from ignorance.

um, i believe pugsy is talking about dmkay, not jon danger. as i pointed out jon hasn't been here in a bit.

[surf_rower]

But, as this has now happened not after a full nights rest, during a nap or after moving in sleep in the middle of the night. I think I just have an excess of mucus that is working its way down my throat, through gravity, and the cpap pressure, and then I clear my throat and it comes up, and that since I am clearing my throat a lot, I have irritated it, and it is bleeding. The bleeding is secondary to being congested/mucusy.

I have this. I asked about it on this forum a couple years ago, I think, and it didn't seem like others had the problem.

I'm 70, have reflux, and take one 20 mg omeprazole each morning before breakfast.
I'm allergic to our cats, and to dust, in our old dusty house. I was tested for this. No, Dr. Allergist, we are not getting rid of our furry family members. The allergy isn't terrible, I rarely sneeze or have watery eyes, and I can usually breathe through both nostrils. But this phlegm and hawking (sometimes with a little blood) every morning, geez. Sometimes I fear I'll choke on it!

But here's an exciting key fact:
I _never_ have the problem when I travel to a spanking clean airbnb. I take the same CPAP with me, drink the same beer, etc. etc. The only thing that changed is I went to a place without the allergens. This has been the case for years, with several different airbnbs each year.

Two months ago, I changed from a TapPap mask which is nasal pillows held on by a mouthpiece, to a cushion-only mask. The phlegm was reduced, but did completely not go away the way it does if I travel.

Now this week here is something super interesting. This issue has not happened at all the last two nights, and those two nights I had hot tea a couple hours before going to bed. Small sample size, but why don't you try drinking tea or something else hot/warm in the evening and see what happens in the morning? My hypothesis is that it helps thin the stuff so it drains normally, and in the morning it just ain't there.

My cat agrees with this. She is really staring at me right now.

[John10ey]

I spit up bloody mucus every morning. A couple months my unit quit and I went a month without using one. I had the same bloody mucus each morning.

I've had chest Xray = AOK. Just went to the dentist = AOK.

I do have a low CBC, complete blood count but OK in iron and B-12. I'm now wondering if I'm bleeding somewhere in the nasal or mouth continually and it only collecting/showing up overnight. My mouth is extremely dry when using the AirSense 11 and I've adjusted the humidity with no relief. I am using a full tank of water every night. The machine is new and I do think the high pressure is too high. Incident count is around 3.

I"m about to go to Urgent Care with a sample of the bloody mucus and ask to be checked for cancer. That should get something to happen.

Suggestions are welcome.

[vandownbytheriver]

(snip)
My mouth is extremely dry when using the AirSense 11 and I've adjusted the humidity with no relief. I am using a full tank of water every night. The machine is new and I do think the high pressure is too high. Incident count is around 3.
(snip)
Suggestions are welcome.

Mouth-taping helped me with dry mouth.

[zonker]

I spit up bloody mucus every morning.

no suggestions. just wanted to say i'm sorry you're going through this, but i'm happy you've posted. too many people come here and try to blame CPAP for the weirdest of developments. I'm glad you are seeking help, knowing it's not the machine.

good luck and do keep us posted, won't you?

[ChicagoGranny]

I"m about to go to Urgent Care with a sample of the bloody mucus and ask to be checked for cancer. That should get something to happen.

It's good you are seeking medical testing.

My mouth is extremely dry when using the AirSense 11 and I've adjusted the humidity with no relief. I am using a full tank of water every night.

Those two factors are indications of mouth-breathing. Are you using an oral-only interface?