Sore throat for 9 months... Help!

Wow, that was a detailed response. Thank you! I really appreciate your bluntness. Let me answer your questions the best I can.

robysue wrote: First a question: Pre-CPAP did your wife dislike sleeping under a fan? Did sleeping under a fan cause her any problems with her throat? Because if sleeping under a fan could lead to throat problems, then it is possible that the CPAP blowing air directly into her throat could be irritating it the same way a fan can.

Doesn't remember any instances of that.

robysue wrote:So does your wife ever wake up with chipmunk cheeks? Or does she ever wake up feeling like she's got gas in her tummy or even further down? It's crude and unladylike, but I'll ask anyway: Does your wife ever seem to fart or burp a lot in the morning after she wakes up? Does she ever wake up with a significant amount of drool on her pillow?

No chipmunk cheeks. Not gassy in the morning, nor the farting/burping (and she isn't at all shy about it). No drool.

robysue wrote: So that raises the question: How does your wife feel when she wakes up in the morning ASIDE from the sore throat? Does she feel as though she's getting into good, deep sleep night after night? Or does she still feel as though she's been tossing and turning all night?

She sleeps like a rock. She used to be a ridiculously light sleeper before the CPAP; her pre-therapy AHI was around 25. If it weren't for the sore throat, she really would be a full fledged success story. But the sore throat is completely destroying her morale at this point. She left her old job as a paralegal to get into more voice work and then this hit only a year later. It's not there all the time, and it's very strange how it works. It's usually fine when she first wakes up; it gets worse almost immediately when she starts talking, which we think is why she feels it a lot more at night after I get home. But the timing with the CPAP seems too similar to just be a coincidence.

She tried her first dose of a muscle relaxant earlier today (Soma, since that's what they had a sample pack of). It didn't change much right away, but I don't know if we should expect it to. I'd heard Flexeril is better and less addictive, but not sure if it would have any more effect. She'll stick with it a few more days until it runs out, and she's seeing that ENT next week. The ENT also deals with apnea so hopefully he can come up with some ideas.

Does the wife complain of a dry mouth too or just the sore throat? Because at this point, I'm really starting to think that night time mouth breathing is probably not the issue. I would really start considering non-CPAP causes even though the throat problem started along with CPAP. And maybe that's the way to approach it at the doctor's office: Ask the question directly, "If I were not on CPAP and did not have OSA, but had these throat symptoms, what would you be testing me for?"

That's the route we've been going since the beginning. We're only now considering the CPAP issue. She does complain of a dry mouth, but we think that has to do with her medications (though it has gotten a little worse since the CPAP started). ENT just did another look at her throat/nose/etc. and found no trace of reflux. He says that he's pretty baffled, and that pain specifically made worse by talking isn't common from CPAP. He did ask some questions and identify a TMJ issue, which my wife had never known to be TMJ. It's pretty severe sometimes; in the past she's had to push on the side of the jaw for her mouth to open more than an inch. He says that there's a chance that could be affecting all the muscles in her neck.

Since then, she did a trial of Soma, and one 250mg pill would mostly relieve the symptoms for a few hours, but not completely. She's now trying Flexeril, pretty much the same deal. It has helped, but it's definitely a band-aid while we keep pursuing this.

Update: After a month off CPAP, there was a gradual reduction in pain, though it's still definitely there. She tried it one more time last night as a test, and today her throat hurts whether she's talking or not.

She also went to see a voice specialist and he thinks he sees a small bit of scar tissue on one of her cords. He suggested she go to two other doctors he trusts, without telling them what he found, and see if they come to the same conclusion. It's weird because every other doctor she's been to missed it thus far.

So now she's in a place where she's exhausted without the CPAP, and her throat hurts a lot more with the CPAP. Gonna be two weeks until the next appointment with those other voice doctors. Pretty lousy situation. As I mentioned before, Flexeril hasn't helped much but Soma did seem to help slightly. She might try going back to that, at least temporarily.

If anyone has ever dealt with vocal cord issues while on CPAP, any advice?

Well, good news is that there's nothing wrong with her cords. Bad news is that nothing is resolved. The third doctor suggested that her condition is called muscle tension dysphonia. Her neck muscles get incredibly stiff, and more so when she's on CPAP. No idea why it happens. But it's definitely related. The problem with muscle tension dysphonia is that it feeds on itself... the neck tension pulls the vocal folds apart and makes it harder to talk. Which makes it painful, which irritates the throat, which makes the folds separate farther, and the cycle repeats. No idea what to do now.

Sider wrote:. . . So now she's in a place where she's exhausted without the CPAP, and her throat hurts a lot more with the CPAP. . .

Are you absolutely sure the humidifier is working? If so, try it at different settings.

I wonder if a physical or speech therapist could help.
Some wag is likely to mention didgeridoo here--(beat ya to it!)
I kind of doubt that would help, but --who knows? . . .

Papit: Humidifier is working beyond a doubt. She's tried with it at low settings, high settings, and even the "classic mode". Her doctor is next having her drop the pressure down to the minimum to see if that helps at all.

chunkyfrog: She went to physical therapy for 3 months, twice a week, and just started going again after a 3 or 4 week layoff due to her prescription running out. She has gone to a speech-language pathologist for just as long, but only every 1-2 weeks. It's ridiculous that this has lasted so long. Whatever is causing the problem, the CPAP is making it worse, and the symptoms started with the CPAP.

Our latest theory is that her face is holding unnecessary tension when she has the mask on. She knows that she was clenching her jaw prior to falling asleep when she first wore it, leading to a bit of a TMJ problem for a while. Once she realized she was doing it, she stopped. However, she may be unconsciously doing it while she sleeps, or something similar. An idea we had to test it was to unplug the hose and let her sleep with just the mask to see if it has the same effect. If so, it's time to try changing masks.

This has been extremely upsetting for a long time now, and while we feel like we better understand the problem we still can't find a solution.

Sider, since you have explored more traditional approaches, how about a journey "Outside the Box?"

Industrial workers who work in less than ideal environments often wear respirators. Some of these are supplied air types.

A frequent complaint is extra muscle tension in the neck and a sore throat. Many of them smoke to find some relief.

I don't recommend smoking for anyone, but there are some soothing ointments that may help. The old standby is Vicks Vapo Rub. I am sure there are others that you can find.

I think the sore throat that these people experience is from dry air, but it is possible that some of the problem could come from muscle tension.

The muscle tension comes from having a mask hanging off of your face. It takes awhile to get use to having some additional weight on your face, and adjusting to the balance of it.

xPAP masks don't weigh very much, but it is possible that your wife is tensing up in an effort to keep it in place, and it could be something like the way the pillow cocks the head, or fiddling with her hair to keep it out of the mask.

To work on neck muscle tension, you will have to send her out in space... Well not really, but it is more fun if you play act.

Have her spend a few hours during the day laying in bed with the mask on and the machine turned on. Your part is to be the observer. You get to poke and prod her in an effort to chase and locate tense muscles. With concentration she should be able to go muscle by muscle and relax and better yet identify if there are any that won't relax. In addition, you can have her roll over and examine in detail how her body fits the bed and pillow in various positions.

When you land after the mission, a good neck, shoulder, and back rub will make this all worthwhile.

The air pressure keeps the airway open. It is possible that your wife is just pushing back. This rather unorthodox exercise while she is awake may help identify this and then she can try and find a way to relax and work around this reaction.

Hosecrusher - I love your unorthodox, "out of the box" ideas!

This sounds like a winner to me!

Think I'm gonna talk hubby into giving me your 'treatment' just for the heck of it

Cheers,
xenablue

I was diagnosed with thyroid cancer after complaining to my PCP about a "weird" sore throat. Just saying...

Hmmm, I much prefer lying on my side, resting my mask in the pillow.
When I lie on my back, the mask feels 'sloppy'--my leaks are worse--even with the air on.
And it bothers me.
If your wife can wear a nasal mask, maybe she could try the Sleepweaver.
It's practically weightless. Through cpap.com, the mask has free return insurance. No risk.

xenablue wrote:"Hosecrusher - I love your unorthodox, "out of the box" ideas!
This sounds like a winner to me!
Think I'm gonna talk hubby into giving me your 'treatment' just for the heck of it
Cheers,
xenablue"

Xena, that sure sounds like a winner to me too. Hosecrusher, I like your style! I'm gonna ask my wife for the same "treatment" for my troublesome throat-clearing habit. I have a few muscle relaxants around so maybe that too would be good, OR a downright STIFF unapologetic alcohol kicker. Maybe two even. Anything to perhaps help lighten up the stress of the battle here and all the less-than-fruitful doctors visits.

Flowers would be nice for your singing lady too.

Whoa, when did the party start?

I like the ideas popping out here, and might give them a try sometime soon. At this point, we're almost 100% certain that it's somehow related to tension in her neck, throat, and upper back, and it's noticeably worse when she's spent a night on cpap. It seems to be confined to the back muscles... not the jaw or face, really, nor anything on the front part of the throat. It's all the back part of the throat, the neck, etc., and no amount of massage or therapy so far has helped that. She's always had tension back there, but it's never been so bad that her throat would hurt when talking.

We really, really need to find a solution to this, and soon. Right now it's a tedious balance... she's trying to get vocal projects done, but she can't work on them every day because she's so tired. But if she uses the CPAP, she's awake but her throat hurts too much for her to work.

As far as other types of masks, can you give any specific recommendations? The only mask she's had is the one that was first given to her, and we don't know much about any others.

You may also want to try hypnotherapy. It will be a challenge trying to find someone qualified but what needs to be accessed is her subconscious. She will probably have to learn self hypnosis or a related therapy (autogenics) to keep the habit of relaxation happening.