Nervous about CPAP after first month

[gilesitis]

Hi All,

I was diagnosed with moderate sleep apnea (22.5 AHI) earlier this fall. My pressure is set at 11 and I use the humidifier at a medium-setting. I began treatment on October 27, but I've had to cease therapy--at least for now. About two weeks ago, my nose began bleeding on and off one afternoon. It eventually turned into a posterior nose bleed that landed me in the ER and and the ENT Doctor. ENT DR. cauterized it and then I had to wear a nose pack for one week. I don't typically have nose bleeds at all, and the doctors aren't sure what caused it, but they suspect the CPAP may have contributed. Turns out I also have a deviated septum and spur. I then went back to my pulmonologist (who prescribed CPAP) and she seems to think the CPAP air may have caused it. She has changed the pressure to auto and it will go from 5-9; I have also obtained a climate-line hose for better humidity control.

Now, with that being said, she wants me to wait one week for healing of my nose and then resume therapy; however, I am just so nervous that it will trigger another nose bleed. Has anyone had a similar experience? Would you guys continue the therapy? Any suggestions for preventing further nose bleeds?

Dr's say I might could lose the mask if I get septum fixed and lose weight--but in the meantime--I don't really want to go without CPAP because of the negative health consequences.

Thanks in advance for any responses.

[archangle]

Dr's say I might could lose the mask if I get septum fixed and lose weight--but in the meantime--I don't really want to go without CPAP because of the negative health consequences.

If you need the septum fixed, fix it, but don't put much faith in that fixing your apnea. Most apnea is in the throat, not the nose, and most people will open their mouth if they can't breathe through the nose. If you have difficulty breathing through your nose, it may make it easier to use a nasal mask.

As for weight, it's a factor and it's a good thing to use it, but weight loss rarely cures apnea. It's part of our current fat shaming fad. Also, not many people are successful in losing weight and keeping it off.

Lots of surgeons are chop happy with delusions of grandeur and visions of dollar signs dancing in their heads. Be especially careful if they want to do anything beyond deviated septum surgery. Turbinate reduction, UPPP, and other procedures have a lot of side effects, and the surgeon's definition of "success" may not agree with yours.

Varying the humidity may help. You may need more or less humidity, it varies from person to person.

One option is an Oracle oral mask. You put a mask like a SCUBA mouthpiece into your mouth and it supplies air into your mouth. If you can learn to use it without the nose plugs, there will be no air pressure or air flow in your nose. Even with the nose plugs, you won't have the airflow in your nose to dry you out. I found the oral mask to be uncomfortable, but it can be a lifesaver for some.

I wonder if you could use some sort of nose plugs with your full face mask to keep from drying out your nasal passages.

[49er]

Lots of surgeons are chop happy with delusions of grandeur and visions of dollar signs dancing in their heads. Be especially careful if they want to do anything beyond deviated septum surgery. Turbinate reduction, UPPP, and other procedures have a lot of side effects, and the surgeon's definition of "success" may not agree with yours.

Archangle,

I am not sure where you are getting the statistics that turbinate reduction has alot of side effects. The main one to be concerned about is empty nose syndrome but that should never happen if the surgeon is very conservative about reducing them during surgery. If you do decide to have a septoplasty and turbinate reduction, one of your top questions to the surgeon should be what precautions will they take to make sure ENS doesn't occur. And make darn sure you understand their response.

The other issue is many swollen turbinates can be due to allergies. So if you have surgery to reduce them and not address that issue, the success rate decreases and and they grow back alot sooner. So again, make the the issues of allergies are addressed when seeing an ENT about nasal obstruction issues.

Agree with you about being cautious about the other procedures although for the right candidates, they can be helpful. But personally, I would not undergo them unless I had a sleep endoscopy that pinpointed the precise obstructions that indicated they would have the best chance of success.

Regarding weight loss curing apnea, the research is very unclear as to whether it does or does not. I would think having a narrow airway to begin with would lessen the chances of this happening. But as always, losing weight can only be beneficial whether it cures at the apnea or doesn't.

Finally, Dr. Stephen Park has said that deviated septum surgery has a 10% chance of curing apnea which I assumed pertains to people with the mild severity. A local ENT posted has posted research showing it doesn't no matter what the severity is. So I definitely agree with archangle that while having this surgery would definitely beneficial, the odds of it curing apnea are slim and none.

Haven't heard of cpap causing nosebleeds but don't really want to go against your doctors since obviously, you don't want to end up in ER again. So I will pass on saying anything more and hopefully, you can get this resolved.

Best of luck.

49er

[chunkyfrog]

Surgical repair of the septum would sound like a good idea if it were not for the nose bleed that required surgical intervention. I would not trust any doctor who would blame this problem on cpap without doing further tests.
Just my 2 cents, but I would not sleep well until the REAL cause of the nosebleed is settled.
I had a co-worker with a prosthetic nose--cancer.

[49er]

Surgical repair of the septum would sound like a good idea if it were not for the nose bleed that required surgical intervention. I would not trust any doctor who would blame this problem on cpap without doing further tests.
Just my 2 cents, but I would not sleep well until the REAL cause of the nosebleed is settled.
I had a co-worker with a prosthetic nose--cancer.

Great points CF. After reading your posts, I realize that gilestitis's doctor may be doing what many doctors do in coming to a quick conclusion of blaming something on a particular factor without doing a thorough investigation to make sure nothing else is going on.

Wow, I have never heard of cancer in the nose but I guess I shouldn't be surprised.

[gilesitis]

Thanks for everyone's comments. The doctors aren't saying for sure that the CPAP caused it, but they suspect it may have contributed. The ENT doctor took a thorough look at my sinuses with an endoscope and couldn't pinpoint a cause. He seems to think it is related to the deviated septum/spur in my nose. I have had a habit of squeezing blackheads on my nose(sorry, gross) so maybe that contributed somehow. I will not be doing that any more. I may look into getting the oral mask or nose plugs. I did not know that a mouth-only mask was available.

[archangle]

I may look into getting the oral mask or nose plugs. I did not know that a mouth-only mask was available.

The nose plug idea is just me thinking out loud. It's not a standard treatment in any sense.

The oral mask is here: https://www.cpap.com/productpage/fisher ... -mask.html

It comes with some nose plugs to keep air from leaking out the nose, but I and many others have learned to sleep with it without air blowing out the nose. If you get one, there are some tricks to doing that. Like I say, I found it too uncomfortable, but it does really change the way CPAP affects your nose. Some folks swear by it. It may be worth a try if you're having nose problems.