Voice problems revisited

[Trinity101]

You may remember that a few months ago, I posed a question here about whether CPAP could cause me to lose my singing voice. The general consensus was no- but I still have not been able to sing, except for a few very isolated times.
Yesterday I asked my PCP again, and he said that he HAS seen this before in some of his CPAP pts- and it seemed to be a reaction from the constant air flow at pressure over the vocal cords. He gave me some antibiotics ( I have also recently had a sinus infection/ear infection) and suggested that I increase my humidity. If that doesn't help in a few weeks (antibiotics only for a week to ten days), he said that I should see an ENT to visualize the cords.
Will let you guys know what I find out- but it gave me some encouragement- this has been very frustrating to someone who just loves to sing!
A pleasant holiday season to all....
~joan

[-SWS]

Any chance you have symptomatic/asymptomatic acid reflux disease?

http://www.google.com/search?q=LPR+%22a ... =firefox-a

[robysue]

trinity,

wish I could give you some words of encouragement. I'm not a singer---can't carry a tune to save my life and no sense of rhythm.

But I have felt hoarse ever since starting CPAP 10 weeks ago. My hubby says I don't sound hoarse, but on the worst days, my throat sure feels hoarse when I talk. I notice it a lot when I'm lecturing to my classes.

Good luck with the current sinus and ear infections. And I really do hope you find something to help your vocal cords adjust to all that air that keeps blowing on them all night every night.

[-SWS]

Robysue, you might also consider the possibility of nearly asymptomatic acid reflux disease. Most people fare BETTER with acid reflux issues once they go on CPAP. However, over the years we have had more than a few patients mention acid reflux disease onset that was seemingly triggered by CPAP. Anecdotally, I think those are patients who claim at least some CPAP related aerophagia tendencies as well. Fluid dynamics in the upper GI tract are, after all, a two-way phenomenon.

Now here's where I ask that you and trinity both forgive my following layperson skepticism. But I think the vocal chords are very well designed by mother nature to tolerate passing air---with every breath we take during sleep and wake. The vocal chords are mucous membranes, however. So perhaps the underlying issue is dry CPAP air leading to infection. But if either of you manifest the slightest CPAP-induced aerophagia tendencies, then please see my LPR link above.

Good luck to you both!

[robysue]

-SWS,

Thanks for the links. I will remember to mention this possibility to both the sleep doc's PA and my PCP if the problem doesn't resolve itself relatively soon. In my case, reflux would be a largely asymptomatic since I don't seem to have any of the other symptoms. And I have to say the tests to diagnose it sound worse than the current ones I'm going through for the vertigo and tinnitus problems that have grown so bad in the last 6-9 months. (Those problems started before CPAP and the referral to the ENT by my PCP was done at the same time as the referral to the sleep doctor.) I would rather not be put on long term meds for reflux/gerd: At one point my hubby did have to take meds for GERD for something like 6 months or so. He tolerated them reasonably well, but did still have some of the more common side effects to deal with. But we have to do what we have to do.

Have to say that the tips at http://www.med.nyu.edu/voicecenter/pati ... eflux.html make a lot of sense, but they won't be much of a immediate help to me since these are things that I'm already doing as a way of combating insomnia or for my basic comfort any way: I've always hated tight fitting clothing and as a tiny, normal weight person, I've never been prone to eating "large meals." When I get full, I quit eating (yes, it's that simple for me) and I get full rather quickly. And tips to "avoid fatty foods, avoid spicy foods, limit caffiene, limit chocolate, dairy, etc, don't snack after supper, and try to exercise more" are all things that often get thrown into "good sleep hygiene" for insomniacs anyway---so ever since the CPAP-induced insomnia raised its ugly head, I've been doing those things quite conscientiously.

But, for what it's worth, I'm still concerned that the extra air may be causing me problems all by itself simply because

• Air blowing into my eyes via my sinuses and tear ducts was extremely uncomfortable when I was still on my initial prescribed pressure of 9cm. [And this was NOT a mask leak problem; the air was definitely getting into my eyes from inside my head.]
  
  I can still sometimes feel air blowing around inside my head when I wake up with my pressure at 8 cm. I can feel the air blowing down and tickling my throat too when I'm awake with my pressure at 8cm. And mouth leaks are NOT the reason I'm having this problem since it occurs on the majority of nights and my leak rate graphs indicate that I usually have NO leaks of any sort for 95+ of the night and the one or two leaks I have are usually very small, both in length of time and in max leak rate during the leak.
  
  I'm currently having some problems with pressure in my left middle ear that started with some medical tests on Tuesday and Thursday, but seems to irritated each night when I sleep in the sense that by the time I'm ready to go to bed, the pressure pain and fullness has more or less dissappeared, but it's back with I wake up each morning. I plan on reporting this to the ENT's office on Monday since the problem started after the tests were done.
  
  And sleeping with a fan blowing directly on me in the summer time has alway created the same sense of "hoarseness" on waking that I'm currently experiencing with CPAP, wheras I don't have this kind of "hoarseness" when the fan is not blowing directly on me.

[-SWS]

Robysue, I was and still am largely asymptomatic of my own acid reflux problem---except when I went to the ER many years ago with lobster tail stuck in my esophagus. Go figure! Well, I found this and some of your other anecdotes about sensory input---such as the MRI sound experience---very interesting:

And sleeping with a fan blowing directly on me in the summer time has alway created the same sense of "hoarseness" on waking that I'm currently experiencing with CPAP, wheras I don't have this kind of "hoarseness" when the fan is not blowing directly on me.

I wonder if you score high on this HSP screening questionnaire:
http://www.hsperson.com/pages/test.htm

I'm thinking any math professor who DOES score high on that HSP screening questionnaire might also research Dabrowski's over-excitabilities or "superstimulatabilities".
http://www.google.com/search?q=dabrowsk ... =firefox-a

I'm wondering if you have "superstimulabilities" to sensory input (CPAP, room fan, MRI acoustics) that occasionally induce counterproductive vagal responses. I'm wondering if that's even POSSIBLE. The vagus nerve facilitates proper LES closure. And I think stimulation of the vagal nerve can even induce hoarseness. Any hints of aerophagia?

[HoseCrusher]

Joan and Robysue, While low on the probability scale, there may be some form of contamination in your humidifier, hose, and/or mask that is contributing to some of your issues. You may want to consider daily washing of those items in an effort to eliminate one variable.

[robysue]

Robysue, I was and still am largely asymptomatic of my own acid reflux problem---except when I went to the ER many years ago with lobster tail stuck in my esophagus. Go figure! Well, I found this and some of your other anecdotes about sensory input---such as the MRI sound experience---very interesting:

And sleeping with a fan blowing directly on me in the summer time has alway created the same sense of "hoarseness" on waking that I'm currently experiencing with CPAP, wheras I don't have this kind of "hoarseness" when the fan is not blowing directly on me.

I wonder if you score high on this HSP screening questionnaire:
http://www.hsperson.com/pages/test.htm

I'm thinking any math professor who DOES score high on that HSP screening questionnaire might also research Dabrowski's over-excitabilities or "superstimulatabilities".
http://www.google.com/search?q=dabrowsk ... =firefox-a

I'm wondering if you have "superstimulabilities" to sensory input (CPAP, room fan, MRI acoustics) that occasionally induce counterproductive vagal responses. I'm wondering if that's even POSSIBLE. The vagus nerve facilitates proper LES closure. And I think stimulation of the vagal nerve can even induce hoarseness. Any hints of aerophagia?

More interesting links for me to follow up on. Haven't taken that HSP screening questionaire yet, but the very word "superstimulatablities" already sounds like it might fit. Although the MRI acoustics problem may well be a sign that the ENT's idea that SCDS may be causing the vertigo and tinnitus is correct. I'll know that in a couple of weeks when I see the ENT again. [In reading the symptoms of SCDS, they fit both my test results so far and my symptoms far better than other causes of vertigo do---particularly the fact that loud, low noises can trigger the vertigo.]

And "hints" of aerophagia is the wrong way to describe it: I get aerophagia---sometimes severe enough to make my stomach feel rock hard and appear distended from the extra air. Fortunately reducing the pressure from straight 9cm to my current 7--8 range has helped some, and the PA and doctor both think a switch to bi-level will be beneficial in managing the aerophagia.

And I do intend on asking about reflux at the next time an opportunity presents itself.

[robysue]

I wonder if you score high on this HSP screening questionnaire:
http://www.hsperson.com/pages/test.htm

No surprise on this one: I answered 18 questions "yes" and 14 or more "yeses" indicates a high probability of being "highly sensitive". And several of the other remaining 9 or so questions are in the "toss-up" category.

I'm thinking any math professor who DOES score high on that HSP screening questionnaire might also research Dabrowski's over-excitabilities or "superstimulatabilities".
http://www.google.com/search?q=dabrowsk ... =firefox-a

A very quick perusal of some of the top links invokes the reaction: How do these people know me so well? (And my daughter too for that matter.)

I'll have some fun looking at these links in more detail. And I have been told, all my life by many different people, that I do seem to be overly sensitive to all kinds of things.

Thanks for providing these links. They'll be a nice distraction from researching SCDS and perilymph fistula and other inner and middle ear disorders that are still in the differential diagnosis for the vertigo problems.

[Twentysix]

Hi, I'm am singer too and I only had a problem with the CPAP when I actually had a cold that resulted in a dry cough. The CPAP seemed to make that worse. However, cold is over and no problems. Even then I still had no problems with singing (just had 2 concerts in the same period, as always seems to coincide ) other than the dry cough I already had. Singing normally again now. Was having a chuckle on the post before, since I am a high sensitive person too. One of those that take the labels out of everything and have to wear their socks inside out. Good luck with solving the problems, don't give up.

[donnafowler]

Do you use any type of inhaled asthma meds? These can irritate the vocal cords.

Also, again the suggestion of LPRD--I was staying constantly hoarse and I present to groups of 100 plus every day for a living, which is not a good combination. A trip to the ENT and a laryngoscopy showed erosions on my vocal cords from the reflux -- I never had a clue that I had any reflux issues. And yes, for me it is much more noticible when singing.

Hope you find some answers.

[-SWS]

Robysue, if the Dabrowski material seems like a good match for you or your daughter, then you might want to take a curiosity peek at the sengifted.org website as well. Happy pleasure surfing.

[robysue]

Joan and Robysue, While low on the probability scale, there may be some form of contamination in your humidifier, hose, and/or mask that is contributing to some of your issues. You may want to consider daily washing of those items in an effort to eliminate one variable.

I religiously clean the nasal pillows every morning in a 1:10 vinegar:water solution since I'm sensitive to detergents and soaps too. Clean the hose and the water tank once a week in the same 1:10 vinegar:water solution.

Wash the Pad-a-Cheek pads when I'm doing laundry in the laundry detergent that i know I can use because it doesn't make me itch---it's a brand I've been using for years.

Use distilled water in the humidifier all the time.

Do you use any type of inhaled asthma meds? These can irritate the vocal cords.

No asthma meds of any kind. At this point no regular meds at all in fact---I consider myself rather blessed by the fact that I'm over 50 and not on any daily medication. I take the occasional benadryl or zirtac in my tree/weed/ragweed pollen allergy seasons---but only when the symptoms get bad enough. I also take the occasional ibuprophen for minor arthritis pain and headaches---but I'm really reluctant to take ibuprophen for headaches because once upon a time I had nasty bout of rebound headaches.

But the reflux stuff---I have to admit this is worth mentioning to my docs at the next opportunity since it can be asymptomatic and since I have been having problems with aerophagia. As I said earlier, I intend to remember to mention it the next time I see the PCP or sleep doc. It's on my written down list of things to remember, which I never needed to make before starting CPAP, but I know find is critical so that I really do remember to talk about the things that I think need to be brought up.

[robysue]

Robysue, if the Dabrowski material seems like a good match for you or your daughter, then you might want to take a curiosity peek at the sengifted.org website as well. Happy pleasure surfing.

Thanks -SWS. It does promise to be some happy pleasurable surfing and distracting in a GOOD way.

And if nothing else, it sure will be nice to read about somebody other than me who simply feels like they get sensory overload on a daily basis.

[Trinity101]

Thanks to all who replied- I do not have any symptoms of reflux, but it may be something to check out. I do wash my equipment frequently, maybe I can do more in that area- I DID clean out my humidifer tank every day when I first started CPAP, now less frequently- so that is certainly a place to improve.
On the hypersensitive scale, I scored very high- and my grandson is also a supersensitive person- no tags, etc- so that is really a possibilty.
I will try and check out each area, and let you know- again, this gives me renewed hope that I can overcome this and get back to singing!
Happy Holidays, everyone!
~joan