CPAP and coughing up blood

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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ChicagoGranny
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Re: CPAP and coughing up blood

Post by ChicagoGranny » Wed Jan 25, 2023 2:09 pm

Jon_Danger wrote:
Tue Jan 24, 2023 6:00 pm
I bought a hygrometer to put on my bedside table and the humidity is around 50% in the room.
This is on the high side, but still within a good range. Personally, I don't let my room humidity go above 50%.
The best relative humidity for sleeping and other indoor activities has been debated. According to the Environmental Protection Agency, the best indoor relative humidity falls between 30% and 50%, and it should never exceed 60%. Other studies suggest 40% to 60% is a better range. Regardless, 60% seems to be the agreed-upon threshold for indoor humidity.https://www.sleepfoundation.org/bedroom ... -and-sleep
I would experiment with lower CPAP humidifier settings. (Personally, I have no need for a CPAP humidifier. My nasal passages aren't dry during the night nor when I arise in the morning.)

BTW, you don't have an HVAC outlet blowing on or close to your CPAP, do you?

gingersnap10
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Re: CPAP and coughing up blood

Post by gingersnap10 » Wed Jan 25, 2023 4:01 pm

They did note that my nasal passages were very narrow and inflamed, and could not push the scope through that way. Had to route the endoscope through my mouth
I know you're getting a lot of ideas but this jumped out at me. I'd get a second opinion from a new ENT and mention this. If they couldn't see your nasal passages it seems they did not get a clear diagnostic picture.

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Janknitz
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Re: CPAP and coughing up blood

Post by Janknitz » Wed Jan 25, 2023 8:05 pm

Colomom said:
-Afrin (it can help with nose bleeds but shouldn’t be used long term)
Read "shouldn't be used long term" as NOT LONGER THAN 3 DAYS, if that.

Although Afrin can constrict the small blood vessels in your nasal passages, it also dries your nasal passages. That doesn't seem to be what you want.

But more importantly, Afrin causes significant rebound. So your nasal passages clear, but then become engorged again and then you really feel like you can't breathe through your nose, the only thing that brings relief is more Afrin, then more and more. I once spent the most miserable few days of my life weaning off a nasal decongestant because of this. It was TERRIBLE. Like an addiction, and took huge willpower not to reach for it so I could breathe. I didn't sleep those couple of days, because I was trying to lengthen the time between doses and the horrible feeling of being unable to breathe was making me crazy (yes, I could breathe through my mouth, but when I fell asleep I'd try to bring air in through my nose and absolutely panic when it seemed like there was a brick wall preventing air from passing through). Horrible! I will never, ever, touch a nasal decongestant again.
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palerider
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Re: CPAP and coughing up blood

Post by palerider » Wed Jan 25, 2023 8:39 pm

Janknitz wrote:
Wed Jan 25, 2023 8:05 pm
Colomom said:
-Afrin (it can help with nose bleeds but shouldn’t be used long term)
Read "shouldn't be used long term" as NOT LONGER THAN 3 DAYS, if that.
Actually, that's only if one uses it "as directed".

If one only uses Afrin at night, then one's nose has as 12 hour recovery period, and that puts off the dependence that sets in for a month or more (a very clever ENT told me that trick some years ago, and she was right).
Janknitz wrote:
Wed Jan 25, 2023 8:05 pm
But more importantly, Afrin causes significant rebound. So your nasal passages clear, but then become engorged again and then you really feel like you can't breathe through your nose, the only thing that brings relief is more Afrin, then more and more. I once spent the most miserable few days of my life weaning off a nasal decongestant because of this. It was TERRIBLE.
If that ever happens again (to someone else, of course, since you won't use it again), just stop using it on *one side* let that side go through the rebound congestion, then once that side of your nose is back to normal, stop on the other side.

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Re: CPAP and coughing up blood

Post by Janknitz » Wed Jan 25, 2023 9:45 pm

palerider wrote:
Wed Jan 25, 2023 8:39 pm
Janknitz wrote:
Wed Jan 25, 2023 8:05 pm
Colomom said:
-Afrin (it can help with nose bleeds but shouldn’t be used long term)
Read "shouldn't be used long term" as NOT LONGER THAN 3 DAYS, if that.
Actually, that's only if one uses it "as directed".

If one only uses Afrin at night, then one's nose has as 12 hour recovery period, and that puts off the dependence that sets in for a month or more (a very clever ENT told me that trick some years ago, and she was right).
Janknitz wrote:
Wed Jan 25, 2023 8:05 pm
But more importantly, Afrin causes significant rebound. So your nasal passages clear, but then become engorged again and then you really feel like you can't breathe through your nose, the only thing that brings relief is more Afrin, then more and more. I once spent the most miserable few days of my life weaning off a nasal decongestant because of this. It was TERRIBLE.
If that ever happens again (to someone else, of course, since you won't use it again), just stop using it on *one side* let that side go through the rebound congestion, then once that side of your nose is back to normal, stop on the other side.
Thanks for the tips, but as you say, I really never intend to use a decongestant spray again. I do use plain saline spray when needed--Only brands with no additives, because the additives really irritate my nose.
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Jon_Danger
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Re: CPAP and coughing up blood

Post by Jon_Danger » Wed Jan 25, 2023 10:23 pm

gingersnap10 wrote:
Wed Jan 25, 2023 4:01 pm
They did note that my nasal passages were very narrow and inflamed, and could not push the scope through that way. Had to route the endoscope through my mouth
I know you're getting a lot of ideas but this jumped out at me. I'd get a second opinion from a new ENT and mention this. If they couldn't see your nasal passages it seems they did not get a clear diagnostic picture.
This is the really annoying thing too, because it is like the CPAP related doctors and the ENT aren't communicating with eachother. They both blame eachother. The CPAP specialist I saw, said it couldn't be the therapy, I had been doing it for 3+ years with no issues, why would it start now?

I mean, besides our bodies changing and us getting older etc. I mean, it literally only happens when I am using the CPAP.

The ENT seemed very ... quick. I felt like I didn't get a proper diagnosis, but I didn't want to be a nosy (hah) patient. I have asked my Dr. to schedule a follow up with an ENT noting that it is happening more frequently, and other areas (lungs etc) are ruled out.

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ChicagoGranny
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Re: CPAP and coughing up blood

Post by ChicagoGranny » Thu Jan 26, 2023 8:20 am

Jon_Danger wrote:
Wed Jan 25, 2023 10:23 pm
I felt like I didn't get a proper diagnosis, but I didn't want to be a nosy (hah) patient.
Fearful of the "difficult" label??

https://www.youtube.com/watch?v=ZJ2msARQsKU

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Jon_Danger
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Re: CPAP and coughing up blood

Post by Jon_Danger » Sat Jan 28, 2023 11:22 am

Thanks for all of the suggestions, I got a follow up with the ENT, I can give him my log of events. About 13 instances in 2022-2023 so far.

And I realize the title is misleading, I never "cough" up blood, or have a cough or anything, it is more like "clearing my throat, and there is blood".

Every time it is the same. I wake up, move around a bit, and then feel like I got a lot of pleghm in the back of my throat, and I need to clear it, and I taste blood. Then there is red blood for a few minutes/throat clears. Then it goes away. I will also end up clearing my throat after eating and there will be blood in that too, but it is a very small amount and this only happens the day of or a couple days after I have an episode.

This morning, I cleared my throat on the excercise bike, and there was brown looking old blood, and a couple specks of new blood, the events tend to "cluster". It happened 2 nights ago, in the middle of the night. These are the worst times for it to happen. If I get up and go to the bathroom, like at 4 am, and then try to get back into bed and put my cpap on, I immediately feel my chest/throat cracking.

I think whatever has been sitting in my throat gets dislodged when I get up, and then I put the cpap back on and it blasts it down my throat into my lungs.

It is just so frustrating, because I absolutely love my cpap therapy. I sleep so well, feel rested all day, etc.

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ChicagoGranny
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Re: CPAP and coughing up blood

Post by ChicagoGranny » Sat Jan 28, 2023 12:16 pm

I would like to hear what your ENT says about this,
They did note that my nasal passages were very narrow and inflamed, and could not push the scope through that way. Had to route the endoscope through my mouth.
and what she says your mallampati score is.

RobertS975
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Re: CPAP and coughing up blood

Post by RobertS975 » Sun Jan 29, 2023 3:22 pm

Gastro MD here... are you coughing up blood (a tracheo-pulmonary source) or "hawking" up blood as in clearing your throat (indicating a source in the hypopharnx) or refluxing blood ( suggesting an esophageal source)?

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Julie
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Re: CPAP and coughing up blood

Post by Julie » Sun Jan 29, 2023 7:36 pm

He described the second option ('hawking') a few posts prior to yours...

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Jon_Danger
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Re: CPAP and coughing up blood

Post by Jon_Danger » Thu Feb 02, 2023 1:54 pm

RobertS975 wrote:
Sun Jan 29, 2023 3:22 pm
Gastro MD here... are you coughing up blood (a tracheo-pulmonary source) or "hawking" up blood as in clearing your throat (indicating a source in the hypopharnx) or refluxing blood ( suggesting an esophageal source)?
Yes, definitely "hawking"

It is the same every time, except for when it gets deep down into my throat, and I feel my chest/throat cracking. Then I have to cough to get it up. I think I have described it as my throat feeling "wet"

The most common thing is waking up, after moving around, I feel like I have a big loogie in my throat, and go "ahem ahem" to bring it up, and it will taste bloody, and there will be streaks of bloody mucus.

Another working theory, as the pulmonologist lookup summer of 2021 was completely clear, they noted some granuloma in my lungs, one near the top windpipe, that might be "sticking out" getting inflamed due to pressure/airflow, but when they did the endoscopy, it could not be seen, they did a lavage as well, negative, though they said I had signs of a few prior infections that had cleared up. Not currently infected.

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.

But, I would love to hear your thoughts. I do have a gastro referral, because the pulmonologist noted some cobblestoning of my upper esophagus, and I have always had reflux, (Currently on omeprazole long term), and it would be worth checking that out anyway, as a possible source, since there was at least some evidence of irritation there.

I have no chronic cough, no shortness of breath etc. I really don't think it is lung-related, but unfortunately the ENT was the first person I saw, and they checked things out quickly (I felt) and said to go to a pulmonologist and get a CT, as they could not find a cause.

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Julie
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Re: CPAP and coughing up blood

Post by Julie » Thu Feb 02, 2023 4:46 pm

Suggest you google side FX of omeprazole - lots and lots!

navbill
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Re: CPAP and coughing up blood

Post by navbill » Thu Feb 02, 2023 5:16 pm

my guess is that you have a topical vein somewhere in your airways that sometimes bleeds when it gets dry...maybe you
can have it cauterized by your doc...that's probably the source of the blood..

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Jon_Danger
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Re: CPAP and coughing up blood

Post by Jon_Danger » Fri Feb 03, 2023 9:36 am

This is my thought too, there is a blood vessel somewhere that is easily irritated and bleeds with the cpap pressure and overall dry air everywhere, either in my posterior nose or upper airway. Hopefully the ENT follow up will help find it.