problems with ears DESPERATE FOR HELP

I am new to this forum and hope I can find some help. I was diagnosed about 9 months ago with OSA and was prescribed Remstar Plus C-Flex with heated humidifier. I found that I swallowed too much air with the original Flex Fit Nasal Mask, (I am a mouth breather due to sinus issues) so I switched to the ComfortFit Full mask. I find that if I wear the mask slightly higher on my face, the lower edge of the mask keeps my mouth closed and I dont have too much trouble with air in my stomach.

I stopped using the cpap for about 4-5 months, but I recently went back to trying to make a go of it. Since then (its only been 2 weeks) I have been experiencing SEVERE PAIN IN MY RIGHT EAR. In the manual for the Remstar it says if there is pain in the sinuses or ears to contact the doctor. I spoke with the RT people and they said they never heard of CPAP causing ear problems. (but then again they never heard of air entering the stomach either!) I went to my family doctor and he said he could see nothing wrong with my ears. I phoned my Sleep Doctor (who I have never even met before) but he didnt seem too familiar with the problem either. Actually I haven't spoken to the sleep doc yet. Its just been a series of messages left, but I hope to speak with him on Friday.

Anyhow, has anybody experienced pain in their ears? If so, how did you rectify it. I need to take pain pills every 4-6 hours to make it tolerable.

Also, what is DME?? And does anybody know if or how one can switch suppliers of cpap equipment in Ontario?? The company I deal with is very unpleasant in uninformed!


Thankyou for reading my long post and I appreciate any input into this.

LeeAnne in Niagara

Leanne,

I've had pressure in my ears from certain masks, but usually just when I turn it on for the night and then it goes away. Yes, it can create pressure and I would think pressure can cause pain in the ear. I would see an ENT (not talk to anyone on the phone as they can't diagnose a problem that way) and make sure that you don't have an ear infection that this extra pressure could perhaps be aggravating maybe or just to make sure you're not doing any damage by using the mask, not that you are probably using it right now since it's probably too painful. There's no chance there could be water in your ear from swimming creating extra pressure in there, is there?

DME's are RT's. At least where I go, they are. My son is an RRT and he's not a doctor, so they aren't, either, unless they gave up a career practicing medicine and just decided to be RT's (doubtful). I would go to an expert when it came to my ears. Don't want to take any chances. It is a fact that you can have pressure in your ears from CPAP therapy and aerophagia viewtopic.php?t=3831, which is air in the stomach, too. So for these people to tell you they've never heard of those two things, I'd suggest going elsewhere for your answers.

Do you have another mask/interface you could try and see if that produces the same pain you're getting with this one? Sorry I can't be of more help to you. Good luck and let us know how it turns out, please.

Thanks for you quick response. I havent been swimming in years so I doubt it is a water problem. My family doc looked and said he didnt see any signs of infection. The reason I only spoke to my sleep doctor on the phone was because the original sleep doctor I saw has closed up shop and the patients were transferred to a clinic in Toronto which is over an hour away from here. I will be phoning the clinic on Friday to speak to him and hopefully he will be able to tell me if this is a problem from the cpap. It doesnt hurt when I use the machine (I take motrin or tylenol 2 for the pain and it helps). It hurts mostly when I am up during the day.

LeeAnne

Leanne,
I wish I could have been of more help to you. I'm glad your regular physician didn't see any infection, but I don't know what an ENT would discover that perhaps a primary care physician couldn't or wouldn't. And funny how the therapy doesn't hurt your ear, but it hurts during the day. Are you always upright when you feel the pain or in any particular position which could help you when you speak with the new doctor Friday regarding a diagnosis?
Please let me know what happens. You've got me curious now. I hope you feel better. I would be glad at least the Motrin helps for now, unlike when babies have problems with their ears and nothing helps them. Boy, do I remember those days.
Best of luck and sorry I couldn't give you more help. Maybe someone else who reads this will be able to.

I have also had severe ear pressure in my right ear, and it feels like it's starting in my left one too. The doctor also told me that there is no infection or fluid. I feel like I am losing my hearing in that ear. I am using the Mirage Swift nasal pillow mask. I've turned my pressure down from a 7 to 6 to see if that helps. My last resort has been going to an allergist who thinks I may have food allergies.

Has anyone ever tried the Oracle Oral mask? I wondered if that would be better on the ears.

Leeann (sorry I've been adding an E to the end of your name, just noticed),

7 is not a high pressure, but I have stated quite a few times in the past week or so that the Swift seems to be harder on me than other interfaces I've used before or since. It is the only one on which I mouth breathed or had mouth puffs and the air seems to just be stronger, which of course it's not. Cinnabar today mentioned "turbulence" as being the cause in her post in the thread "Mouth Flapping," which I will past below:

Cinnabar wrote:Ozij, I think you are onto one of the many issues that can contribute to this problem. The more upward pressure an interface puts on the upper lip, the easier it is to push air out through the lips. (And the anatomy of each individual's lips also plays into how much this matters as well.)

I, too, am a Swift user who has experienced the dreaded mouth flapping. I noticed it most after I moved from a fixed CPAP at pressure 8 to APAP ranging from 6 to 12. Now, I average 8 (my titrated level), but my 90-percentile point hovers between 9 and 10. I get better therapy (AHI numbers) but I experience more "blowouts" and now use a chin strap. (This corrects most of them, but not all.)

I assume higher pressures will contribute to the problem. Those of us averaging pressures of 10 or higher probably encounter this phenomenon more often than those of us hanging out in the single digits.

Another factor I suspect (but cannot prove) is involved: Turbulence. Turbulence is a chaotic and tricky thing to quantify. But from my own experience and from what I've read on this message board, I suspect the Swift generates one of the more turbulent air flows of any of the popular nasal interfaces on the market today. (I also think that turbulence is the reason the Swift gets so much noisier at higher pressures.)

All nasal interfaces must generate the same level of air flow in the nasal cavity and throat to achieve the target pressure in a specific patient's airway. IMHO, some produce more turbulence than others while doing so. To move thru the Swift, air must take two right-angle turns in quick succession: one when exiting the air tube attached to the side of the mask and another when entering the nares. This extreme zig-zag means the air molecules are literally "bouncing off the walls" as they enter the airway at the target pressure. And the higher that target pressure, the more they "bounce."

Now, consider the airflow path thru masks like the Aura or the Breeze (neither of which I own or have used). For them, that flow path is more curved with less right angles. Less bounce, so less turbulence.

So is the turbulent air pressure from the Swift more likely to push open the lips now and then, versus the equivalent but "calmer" air pressure from these other interface designs? As I said, I can't prove it but I suspect it's a factor. And in the absence of comparitive experimental data, reading the experinces of those who have used both masks (like LoRi) are one way to confirm or deny that suspicion.

In any event, take care of yourself and I hope you find your answer Friday.

My ears bother me if a swallow a lot of air when the mask is on. My ears will bother me for a little bit, but then the pressure goes away.

I have a friend that was having ear problems with his ears shutting off and could hear again in a few hours. Turn out to be a humidifier issue increasing the humidity solves that problem.
One time I was getting dizzy during the day. That issue turn out to be mouth leaking during the night causing the ear drums to go in and out kind of slowly which upsets my balance for a time.

Hi LeeAnne,

You said you were prescribed the Remstar. Did you actually purchase the unit? If so, was it through the assisted device program? I have some information on this which of course would relate to your supplier.

Suggest you register in this forum, hey it's a freebie. Then tell us a little more about the process you went through -sleep study, titration and how you were referred to a CPAP supplier.

The bulk of the posts on this forum are USA related ie DME, Durable Medical Equipment supplier which is the same as Home Care Suppliers in Ontario. You must have had a sleep study done in a sleep lab and should certainly have met your sleep MD otherwise it would be unethical for a bonafide doctor to somehow provide you with a prescription.

There are a number of participants on this forum who are from Ontario as well as other parts of Canada and will assist you any way they can. Just need a little more information.

Bob F

Thankyou all so very much for your input. I am heading off to bed now but will register and give you all a full detailed rundown of my apnea tomorrow. Goodnight All!!!

LeeAnne

Okay.....so I am now officially registered on this site, and at Unclebob's request, here is my cpap story.

I kept waking up up gasping for air, and since my cousin (treated) and mother (untreated) both have OSA I figured I should have it investigated.

After almost a YEAR of waiting I finally had my sleep study. I had two night time tests and 2 daytime tests. A week after my tests I saw the sleep doctor who came from Toronto to see me (1 1/2 -2 hour drive). The doctor told me that I do indeed have OSA and also PLM (?) (periodic limb movement?) Based on the results of the first day test he felt it necessary to have my drivers license suspended, but the second day test went better so he decided it would be okay to continue with my license but to be extremely careful when driving long distances. (I do have a tendency to want to fall asleep when driving, although I never have!) The doctor prescribed my cpap machine and sent me on my way. He told me to go to a particular supplier in my city to get my machine. I bought the equipment with the help of the provincial government and my privtate insurance company but I do NOT like this supplier. I find then unapproachable, unsupportive and unfriendly! The pressure was initially set at 5. I had a titration study in Toronto about 2 months later and the pressure was set at 6. I never saw the doctor after the titration study though.

I initially was given a small mask that wet just over my nose, but since I have sinus issues (chronic congestion) and am a mouth breather I found I swallowed too much air, to my supplier changed me to the comfort full mask. I tried a chin strap but couldnt deal with it.

Now, here is where things get complicated.

I used the machine for a couple of months but hated it. I started having extreme back pain (unrelated to OSA) which made it difficult to get in and out of bed, and also to move in bed. That, coupled with the splints for carpal tunnel, and that stupid cpap, I just couldnt cope with it all. So I gave up on the cpap.

Now that my back is better I am back to trying the cpap again.

But.......(unclebob you are going to wish you hadnt asked me for my story!!)

While I was on my "cpap holiday" I got a letter from the sleep clinic that said the lab I had my testing done at (40 minutes drive my house) was closing and that I was to contact them for further directions. Of course, since I was on the "holiday" I threw the letter out and did not contact the lab.

Now I am back to using my cpap but am having pain in my ears and I am also wondering now if my pressure is set too low. After several phone calls I finally got ahold of the clinic in Toronto. (An hour and half from here). They told me that my original sleep doc was no longer with them and that another doctor was taking over his patients. She suggested that since the lab is so far from here that perhaps he could help me just with a phone call.

He called me back and left a message on my machine. He said that it was very unusual to have pain in the ears and perhaps he could "postulate a mechanism where this would happen" (huh??) He said he would be in the clinic on Friday and I could try and phone him then.

So.....that's my story. I don't know if the pain in my ears is related to the cpap but I will see what this new doc says tomorrow and if he cant help it will be back to my family doc.

Thanks for your help.

LeeAnne

LeeAnne in Niagara wrote:perhaps he could "postulate a mechanism where this would happen" (huh??)

Translation: He'll make an educated guess. (I've been known to make such obfuscating comments to my customers when I'm trying to buy time to think.)

LeeAnne,
It's Friday already in my part of the world - so my advice may be superfluous - but when I had ear infections - as a child - my ears would start hurting badly about 24 hours before the doctors could see anything. Get a GP or ENT to look into your ears once again - the pain you describe sounds too severe.

Ear infections can be caused by droplets being forced from your sinuses into your estruchean tube and an acute sinus infection is a counterinidication for CPAP.
O.

I am SUCH a bonehead! I cant beleive I forgot to call the sleep doc today. My ears were hurting at work so I took some motrin. By the time I got home my ears felt find and I didnt give it another thought. Now I will have to wait till next week. I might go to a walk in clinic this weekend if they bother me just to rule out infection or some other non-cpap related cause.

LeeAnne

Hi LeeAnne in Niagara,

Thank you so much for registering on the forum and telling us your story. I apologize for not responding sooner (under the weather). Really appreciate the time you took to fill us in and understand your particular circumstance.

While I do hope you get answers to your questions on this forum, there is also an ulterior motive on my part. As I mentioned the forum is largely USA oriented and unaware of specific issues faced by Apniacs in Canada and, of course, Ontario. So any input you have would be most beneficial for us Great White Northerners!

You indicated a concern with your supplier. Unless you are rolling in the dough you are stuck with your CPAP unit for a while. By law in Ontario with the govt funding, you must have a 3 year warranty on the unit. If you have a malfunction you will be stuck with your original supplier - who should also provide you with a loaner if your's needs to be fixed. You may also want to check out other authorized dealers selling your equipment. My sleep study MD gave me a list of a dozen suppliers to choose from. Some deal with only one brand while others offer all brands. It doesn't matter who you deal with they are all out to make a buck, especially from the uninformed consumer. Buyer beware.

Now that you have your CPAP, the next biggest thing is the mask. This alone can determine if you are compliant with treatment or not. In this regard, if your current mask is not working, I strongly recommend you do not go back to your initial supplier unless you have cost free exchange option. Masks in Ontario are really expensive and unless they provide you with multiple free trial usage, try to take control of your own treatment.

I would refer you to a couple of my first posts to see what my experience was regarding first xPAP purchase. I followed this forum for some time before making my purchase and have not been disappointed with the equipment I finally bought. Like you, I took advantage of the govt assistance and was forced to buy locally. Since then I have only been back to my supplier once for the free filters included in the deal. My supplier has been great but I think this primarily due to the info I gleaned here making me a more informed and demanding consumer.

In future, I intend to buy new masks, filters or replacement parts from CPAP.COM. Their prices are competitive and they gave me good advice when making my first purchase.

Also, my reaction to your pressure setting is that it seems low and you really wouldn't need the ramp feature.

Thanks again for your info. Hope the treatment works well for you!

Bob F