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CPAP May Make Nasal Spray Ineffective at Night?

came across this tip online and wanted to see whether others agree.

"Hold the Spray Until Morning
Advise patients who are receiving continuous positive airway pressure (CPAP) therapy and who use a corticosteroid nasal spray for allergies to spray in the morning rather than at bedtime. If the spray is used in the evening, CPAP may dry it out, making it less effective.
—— Richard A. Honaker, MD
Carrollton, Tex"

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What does corticosteroid mean?
Corticosteroids are a class of medication developed to reduce tissue inflammation (swelling) -- looks like Flonase is one such product. here's some more info: http://www.aanma.org/2009/03/news-for-your-nose-nasal-corticosteroids/

susan mccord said:
What does corticosteroid mean?
So it's like OTC nasal sprays? I (rarely) use a mild 4-hour spray before I go to sleep if I feel stuffy, which I hardly ever do anymore. One shot of it qhs is sufficient for me to get to sleep.

Is Flonase Rx or OTC? Am wondering if he's talking about a prescription spray that Rx'd for specific conditions.

McCord
Corticosteroid nasal sprays, such as Flonase, require a prescription in the US. Corticosteroids are steroidal anti-inflammatories and reduce swelling. OTC nasal sprays are considerably different and contain oxymetazoline or a related chemical. Both are used as general purpose nasal decongestants.

One major difference is that corticosteroid nasal sprays are suitable for long term daily use, and OTC nasal sprays can only be used for a few days at a time. Over-use of OTC nasal sprays can cause rebound and dependency. Even though corticosteroid nasal sprays are steroidal, they are not absorbed and are in very low concentration, so they have very little systemic effect.
NOT TRUE, with the humidifier, I used Flonase a long time,( Ivax Labs ,here in San Diego makes a generic, but it has a different steroid, and isn't the same, even though Kaiser substituted it til I caught them) it's MORE effective, the air disperses it thru ur sinuses & now I use saline nasal spray occasionally, same thing, it's MORE effectively pushed thru.

Tim said:
Corticosteroid nasal sprays, such as Flonase, require a prescription in the US. Corticosteroids are steroidal anti-inflammatories and reduce swelling. OTC nasal sprays are considerably different and contain oxymetazoline or a related chemical. Both are used as general purpose nasal decongestants.

One major difference is that corticosteroid nasal sprays are suitable for long term daily use, and OTC nasal sprays can only be used for a few days at a time. Over-use of OTC nasal sprays can cause rebound and dependency. Even though corticosteroid nasal sprays are steroidal, they are not absorbed and are in very low concentration, so they have very little systemic effect.
"If the spray is used in the evening, CPAP may dry it out, making it less effective.
"


Mike,

I disagree with the doctor's statement, but cite some caveats. A properly working CPAP process does not cause more air flow through the nasal passages than in normal unassisted breathing. Properly working means no excess mask leak and either use of a full face mask or a nasal mask/pillows with no mouth breathing. In such a situation CPAP delivers air pressure not air flow compared to normal breathing.

But I do maintain that it is a good practice to use these types of sprays in the morning because some very few people are extremely sensitive to the corticosteroid to the point it will interfere with sleep if used in the evening.

In my own case, morning is a good time to use a neti pot just before a warm shower and clear my nasal passages of excess mucus then use the spray. If you use the spray when excess mucus is present, the spray will not be distributed as well. Also, and more importantly, when excess mucus is present, the spray will not be as well absorbed into the mucus membranes.

So, by default, I would say the doctor's advice is good.

Ciao.
i'm not clear on the distinction you're making between between air flow and air pressure.

Banyon said:
"If the spray is used in the evening, CPAP may dry it out, making it less effective.
"


Mike,

I disagree with the doctor's statement, but cite some caveats. A properly working CPAP process does not cause more air flow through the nasal passages than in normal unassisted breathing. Properly working means no excess mask leak and either use of a full face mask or a nasal mask/pillows with no mouth breathing. In such a situation CPAP delivers air pressure not air flow compared to normal breathing.

But I do maintain that it is a good practice to use these types of sprays in the morning because some very few people are extremely sensitive to the corticosteroid to the point it will interfere with sleep if used in the evening.

In my own case, morning is a good time to use a neti pot just before a warm shower and clear my nasal passages of excess mucus then use the spray. If you use the spray when excess mucus is present, the spray will not be distributed as well. Also, and more importantly, when excess mucus is present, the spray will not be as well absorbed into the mucus membranes.

So, by default, I would say the doctor's advice is good.

Ciao.
Mike said:
i'm not clear on the distinction you're making between between air flow and air pressure......

flow -noun: movement of a volume in or as if in a stream
pressure -noun: the exertion of force upon a surface by an object, fluid, etc., in contact with it

If you think CPAP provides more air flow (as compared to normal breathing), then state where the additional air goes.
gordon nelson: When you say that what somebody said is not true, you had better show why it is not true. Other than a couple of spelling errors, I believe that the information that I provided is accurate, and you said nothing that would refute it. I said nothing about the effect of CPAP on decongestants.

gordon nelson said:
NOT TRUE, with the humidifier, I used Flonase a long time,( Ivax Labs ,here in San Diego makes a generic, but it has a different steroid, and isn't the same, even though Kaiser substituted it til I caught them) it's MORE effective, the air disperses it thru ur sinuses & now I use saline nasal spray occasionally, same thing, it's MORE effectively pushed thru.
Tim said:
Corticosteroid nasal sprays, such as Flonase, require a prescription in the US. Corticosteroids are steroidal anti-inflammatories and reduce swelling. OTC nasal sprays are considerably different and contain oxymetazoline or a related chemical. Both are used as general purpose nasal decongestants.

One major difference is that corticosteroid nasal sprays are suitable for long term daily use, and OTC nasal sprays can only be used for a few days at a time. Over-use of OTC nasal sprays can cause rebound and dependency. Even though corticosteroid nasal sprays are steroidal, they are not absorbed and are in very low concentration, so they have very little systemic effect.
Tim said:
gordon nelson: When you say that what somebody said is not true, you had better show why it is not true. Other than a couple of spelling errors, I believe that the information that I provided is accurate, and you said nothing that would refute it. I said nothing about the effect of CPAP on decongestants.


OK Tim, Gordon can defend his own posts, but let me "pick" for a brief moment on two statements you made. You said, "....... OTC nasal sprays are considerably different and contain oxymetazoline or a related chemical. ........".

That statement is not correct. While there are OTC sprays that do contain oxymetazolone, there are also many types of OTC nasal sprays that do not contain oxymetazoline or any similar chemical. There are simple salt solution sprays, Zicam sprays, various sprays purporting to contain vitamins, "natural substances", and I even see one containing honey and another containing pepper (!), but all contain no oxymetazoline.

You also said, “Even though corticosteroid nasal sprays are steroidal, they are not absorbed and are in very low concentration, so they have very little systemic effect.” Now I am being picayune, but this statement is not true. Some very small amounts of corticosteroid spray is absorbed by most users and in some very sensitive users side effects such as mood change have been observed. But I agree with your statement that they have very little systemic effect.

I believe the main point of your post was to point out, “Over-use of OTC nasal sprays containing oxymetazoline can cause rebound and dependency” and to emphasize that corticosteroid sprays used properly are very safe. On these main points, I am in violent agreement with you.

Have a good one
sorry Tim- all that's true what you said. I was only stating mu .02 , that I have a positive affect using both Flonase and saline at night, it enhanced it, it's not my imagination because I used Flonase habitually, to my detriment, but I found on my #4humidity it seems to have a vaporizing affect w/ CPAPon those sprays, I don't see the point of using Flonase in the morning when you need it to breath at night. You can use it 2-3 times a day.

Banyon said:
Tim said:
gordon nelson: When you say that what somebody said is not true, you had better show why it is not true. Other than a couple of spelling errors, I believe that the information that I provided is accurate, and you said nothing that would refute it. I said nothing about the effect of CPAP on decongestants.


OK Tim, Gordon can defend his own posts, but let me "pick" for a brief moment on two statements you made. You said, "....... OTC nasal sprays are considerably different and contain oxymetazoline or a related chemical. ........".

That statement is not correct. While there are OTC sprays that do contain oxymetazolone, there are also many types of OTC nasal sprays that do not contain oxymetazoline or any similar chemical. There are simple salt solution sprays, Zicam sprays, various sprays purporting to contain vitamins, "natural substances", and I even see one containing honey and another containing pepper (!), but all contain no oxymetazoline.

You also said, “Even though corticosteroid nasal sprays are steroidal, they are not absorbed and are in very low concentration, so they have very little systemic effect.” Now I am being picayune, but this statement is not true. Some very small amounts of corticosteroid spray is absorbed by most users and in some very sensitive users side effects such as mood change have been observed. But I agree with your statement that they have very little systemic effect.

I believe the main point of your post was to point out, “Over-use of OTC nasal sprays containing oxymetazoline can cause rebound and dependency” and to emphasize that corticosteroid sprays used properly are very safe. On these main points, I am in violent agreement with you.

Have a good one
gordon nelson said:
........I used Flonase habitually, to my detriment, ....... I don't see the point of using Flonase in the morning when you need it to breath at night. You can use it 2-3 times a day. ...

Such misinformation about Flonase, how to use it, and how it works. Flonase is prescribed for use once per day. It has a build-up effect that provides relief for 24 hours or longer. It is often prescribed for daily use for indefinitely long periods of time.

From the Flonase website: "For best results, use FLONASE daily. Your nasal symptoms may begin to improve in as few as 12 hours. Maximum relief may take several days."

This forum is great, but like all forums (and all of life), people should be wary and verify from several soruces that they have found to be reliable in the past. And yes, this precaution includes everything I post here.

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