Structural Reasons for XPAP Difficulties

Did you know that there could structural issues that prevent some people from adapting to XPAP therapy? In all I read on this forum, I don't recall seeing this.

I saw my allergist the other day -- the first visit since she sent me for the sleep study. (She did comment that she'd never had to talk to so many people to get one cpap machine before-- but it was said good naturedly so I didn't hurt the relationship. )

Anyway, I told her I'd like to get a full face mask for the nights I have problems w/ the nasal pillows due to sore nares; congestion. She said "let's determine if you have structural issues that are causing your difficulty." She pulled up my nasal cat scan and found that I have a bone spur in each nostril which reduces the airflow -- which mimics congestion and may contribute to my difficulties with breathing against the APAP airflow. (I was surprised she never mentioned this before -- but we were looking for causes for my cough -- not congestion!)

So I will be trying the FFM soon, but could possibly have surgery to remove one or both bone spurs. The idea of having clear nasal passages sounds wonderful -- but is it worth the surgery?

As most sleep docs are pulm or neuro, I wonder if they've ever considered the nasal structure as part of the equation:

I've had several CT scans for sinus issues-infections and have what my ENT considers good anatomy in my nose-nasal areas, so my issues are allergy-inflammation based. I told my sleep doc in our first session about this and my 35+ yrs of problems in my intake forms and in our discussion.

Unfortunately I don't think it is considered often enough when a cpap newbie is having trouble. I know someone who couldn't use cpap so they had the surgery on their soft palate and their uvula removed. It apparently didn't resolve their OSA as they are still symptomatic. When they mentioned wondering if their deviated septum that causes breathing problems may have been why they had trouble with cpap, I wanted to just scream. Maybe fixing the septum could have helped him avoid a surgery that has left him with chronic problems managing sinus drainage and with swallowing liquids. Your post is a good reminder to me to not too casually dismiss the possibility of structural matters when a newbie has troubles. If one didn't want a surgical fix and they were used to mouth breathing anyway, guess the full face mask would be the answer.