"please keep me updated about oximeters "
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CPAP Sinus Infection?
This is from a correspondence I've been having with Susan McCord, who gave me permission to share it with all you on the forum. Italicized emphasis is my own... Will be interested to hear what you guys think she should do:
"I've been sicker than a dog with this CPAP/sinus stuff since the day after Christmas. Nobody, including my sleep doc will really discuss it with me or else they just dismiss it. This has been going on, off and on, since shortly after I started CPAP in July.
Today I was at my cardiologist for a checkup, and was telling him about all this ongoing. Usually it goes away spontaneously in 2-3 days--this time it's hung on for 10 days so far. Can't stand it.
Anyway, cardiologist, who's also an internist prior, told me it's not uncommon at ALL for pts. on CPAP to have this and that I have an infection. I asked him why the MDs don't tell us about it--he and I have a VERY open relationship and he knows I can't stand having smoke blown up my ass--he told me it's because the sleep docs are so worried about compliance that they don't tell pts. about the possibility of sinus complications AND that it's not uncommon for them to avoid talking about it even if pts. bring it up. They tend to assign the sinus problems to something else.
I was mildly horrified and, frankly, I think he is too. He told me to talk to my PCP and get started on an antibiotic and whatever else PCP recs. He also said people usually stay off CPAP for a week or so till the infection clears. THAT scares me to death. I don't think I'm gonna do it. Internet says to d/c too, but I don't think I can......what do you think I should do???"
"I've been sicker than a dog with this CPAP/sinus stuff since the day after Christmas. Nobody, including my sleep doc will really discuss it with me or else they just dismiss it. This has been going on, off and on, since shortly after I started CPAP in July.
Today I was at my cardiologist for a checkup, and was telling him about all this ongoing. Usually it goes away spontaneously in 2-3 days--this time it's hung on for 10 days so far. Can't stand it.
Anyway, cardiologist, who's also an internist prior, told me it's not uncommon at ALL for pts. on CPAP to have this and that I have an infection. I asked him why the MDs don't tell us about it--he and I have a VERY open relationship and he knows I can't stand having smoke blown up my ass--he told me it's because the sleep docs are so worried about compliance that they don't tell pts. about the possibility of sinus complications AND that it's not uncommon for them to avoid talking about it even if pts. bring it up. They tend to assign the sinus problems to something else.
I was mildly horrified and, frankly, I think he is too. He told me to talk to my PCP and get started on an antibiotic and whatever else PCP recs. He also said people usually stay off CPAP for a week or so till the infection clears. THAT scares me to death. I don't think I'm gonna do it. Internet says to d/c too, but I don't think I can......what do you think I should do???"
Views: 23947
Replies to This Discussion
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Permalink Reply by Tim on
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I use nasal irrigation occasionally and like it. There a few things about the solution make it much more comfortable: The water has to be boiled to remove the chlorine, you have to use non-iodized salt, you have to use a little baking soda with the salt to make it alkaline, and don't use too much salt. You can get prepared packets of nasal irrigation mix that make things a lot easier -- make sure that it is buffered (includes sodium bicarbonate / baking soda).
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Permalink Reply by Meg on
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I have 2 comments on this based on my and my husbands experience.
== First, I have successfully survived the Christmas cold and head congestion while maintaining the use of my CPAP nightly and not needing antibiotics. With the onset of the cold I washed my face mask (nasal pillows) daily. I also use a nasal saline rinse twice a day (yes this really does work) and used OTC meds, cough suppressant, antihistamine and expectorant. The expectorant (guiafensin) did the best job. This stuff works great on the sinuses too!! . I didn't use a "decongestant" as it raises my BP and makes my heart race. I also increased the humidifier setting. 10 days, cold gone, just some left over snot.
==Second, my husband has used a CPAP/ BiPAP for easily 15 yrs. He used to get horrible sinus infections. Use of nasal rinse ( neti pot style) helped, but this biggest improvement occurred after sinus surgery and trimming of the turbinates. He still gets the winter cold, but has not had a sinus infection since the surgery.
DO not fear the neti pot / sinus rinse. Actually during colds, the recommendation is to use a hypertonic saline solution (double the non-iodized salt or 2 packets if using the NeilMed product) to mobilize those really thick secretions (aka snot). Yes this is safe for a shot period of time, not recommended for standard daily use.
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Permalink Reply by susan mccord on
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I NEED HELP!!!!! I'm the one who started this thread. I'm still not doing well. Before anyone yells at me, I AM going to call my sleep doc tomorrow. He's hard to get to--I've been using my PCP who's been my personal doctor for 35 years, and I trust him implicitly. However, I recognize the likelihood that he may not have top-level apnea information at hand.
I've been doing everything everyone on here has suggested, except Neti-pot. I still can't make myself try the thing. I need to get over it. At any rate, I've been on an antibiotic for nearly 7 days with some marginal improvement. However, by now my nasal passages and sinuses are so irritated and touchy that last night, for the first time, I couldn't tolerate my CPAP--couldn't breathe and had to remove it. Finally slept 6 hours without it--had a hard time sleeping 'cause it scares me to death to be off of it.
Can ongoing use of saline spray cause increased irritation and discomfort? I've always used it with occasional colds with no problem.....by now, I can hardly stand using it, even Ayr gel nasal spray.
One of the weird things about all this for me is that I've NEVER had sinus problems with the exception of 2-3 sinus infections over the course of my entire 67 years. My immune system is strong by history, I rarely catch colds, flu, anything like that. I'VE NEVER BEEN ALLERGIC TO ANYTHING IN MY LIFE, NOR HAVE I EVER HAD ALLERGIC SYMPTOMS.
All these problems began within days of starting CPAP July 2009. I take good care of my equipment, clean it regularly and always have. I've tried every kind of mask we (my DME and I) can come up with--the problem is no longer one of leakage, as far as I can tell--I'm comfortable with any kind of mask except nasal pillows.
I've been 100% compliant since August 2009. Have lost nearly 30# overall, by choice, since I was diagnosed. I feel like I'm doing as much as I can to treat this damn disease, and now I feel worse than I ever have, except that I no longer have brain fog and have re-gained my memory pretty much.
I'm starting to wonder if I can keep this treatment protocol going. Never thought I'd say that cause OSA scares me to death. I was diagnosed high moderate to low severe, depending on whether I believe the lab or my sleep doc. Regardless, I'm a believer that I need treatment. BUT, my quality of life is now in the toilet. I can't plan ahead ever, because I never know how I'm gonna feel. The symptoms I have are unacceptable to take into public, at least for me to be comfortable doing it. I sound and look like I have a bad cold and between the endless congestion vs. the stupid nasal faucet-running......well, most of you get the picture.
I'm interested in what one of you said about needing less pressure now that I've lost weight. Sleep doc wants me to lose 9 more # so he can rec a second titration and insurance won't kick it to the curb. (I'm on Medicare and have a good supplement that pays well, so I'm not sure that's a problem).
Hell, I feel like I just don't know anything anymore. I can't remember being this discouraged, even when I was diagnosed with heart disease.
This thread's been running for quite some time--frankly, the most recent responses are the ones that have been the most helpful. At least for me. I finally am hearing that I'm not the only person with these issues. I just can't seem to get a handle on the symptoms. And frankly, I'm just about over trying. God forgive me for saying that--I'm NOT a non-compliant patient. I'm just exhausted with trying to do the right thing and getting ongoing lousy results.....this episode began around 12/6 and, with the exception of a few days when it totally disappeared (as per history), it's been back and getting worse ever since.
I'm sure I need an ENT consult. I suppose I need to see an allergist. It takes forEVER to get into a new specialist in Indianapolis. So how long can I continue with this? I honestly don't know......
Sorry to be such a downer about all this--this is the only place I feel like I can unload. My kids continue to tell everyone that asks that I'm "doing great" 'cause they just don't want to face the fact that I'm not. Oy vey.....
Susan McCord
te>Meg said:I have 2 comments on this based on my and my husbands experience.
== First, I have successfully survived the Christmas cold and head congestion while maintaining the use of my CPAP nightly and not needing antibiotics. With the onset of the cold I washed my face mask (nasal pillows) daily. I also use a nasal saline rinse twice a day (yes this really does work) and used OTC meds, cough suppressant, antihistamine and expectorant. The expectorant (guiafensin) did the best job. This stuff works great on the sinuses too!! . I didn't use a "decongestant" as it raises my BP and makes my heart race. I also increased the humidifier setting. 10 days, cold gone, just some left over snot.
==Second, my husband has used a CPAP/ BiPAP for easily 15 yrs. He used to get horrible sinus infections. Use of nasal rinse ( neti pot style) helped, but this biggest improvement occurred after sinus surgery and trimming of the turbinates. He still gets the winter cold, but has not had a sinus infection since the surgery.
DO not fear the neti pot / sinus rinse. Actually during colds, the recommendation is to use a hypertonic saline solution (double the non-iodized salt or 2 packets if using the NeilMed product) to mobilize those really thick secretions (aka snot). Yes this is safe for a shot period of time, not recommended for standard daily use.
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Permalink Reply by 99 on
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mixing herbal and conventional medicine can exasperate the problem you are treating, very often the treatment for the same alment is taken from diferent directions and the treatment by both simultainously will make it worse
so stick with one or the other not both
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Permalink Reply by sleepycarol on
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Have you thought about seeing an ENT?
Have cultures been done? I am wondering if you don't have a strain that is resistant to antibotics. I know there have been times over the course of years that I have had to have the anitbotics switched due to them not working on whatever infection I would have. I have suffered from numerous sinus infections over the years and know that at times they can be difficult to eradicate.
Be sure and take a multi-vitamin to help your immune system from getting even more weakened.
I know how difficult it can be to get into the doctor when you need it. I know around here we have 1 sleep doctor, 1 ent, 2 ob doctors, etc. and so wait times can be lengthy. If we need specialized treatment that means a trip of 70 miles or more one way to get to a bigger city. It can be a bummer, especially when you don't feel good.
I truly hope that you get to feeling better and be sure to take care of yourself.
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Carol--No cultures done. No mention made of them before. How do they culture something like this??
Yes re: ENT--finally got some referral sources from--guess where!---my cardiologist!! I hadn't been able to even find any near where I live, Ridiculous but true. So I'll probably call one tomorrow. Want to call sleep doc first to see if I can get in.
How do we know which MD to see????? PCP? ENT? Allergist? Sleep doc? GYN????? !!!! UGH!!
I do take a multivitamin every day--thanks for the support, Carol......
I swear, I never thought my life would be like this....guess no one else did either though.
sleepycarol said:Have you thought about seeing an ENT?
Have cultures been done? I am wondering if you don't have a strain that is resistant to antibotics. I know there have been times over the course of years that I have had to have the anitbotics switched due to them not working on whatever infection I would have. I have suffered from numerous sinus infections over the years and know that at times they can be difficult to eradicate.
Be sure and take a multi-vitamin to help your immune system from getting even more weakened.
I know how difficult it can be to get into the doctor when you need it. I know around here we have 1 sleep doctor, 1 ent, 2 ob doctors, etc. and so wait times can be lengthy. If we need specialized treatment that means a trip of 70 miles or more one way to get to a bigger city. It can be a bummer, especially when you don't feel good.
I truly hope that you get to feeling better and be sure to take care of yourself.
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Thanks for your input, Meg. I'm paying attention to everything you guys have to offer. I'm in a fair amount of distress at the moment, so just ignore any of my neurotic yakking.
I DO appreciate the support I'm getting on SG. Thanks again.
Susan :-)
Meg said:I have 2 comments on this based on my and my husbands experience.
== First, I have successfully survived the Christmas cold and head congestion while maintaining the use of my CPAP nightly and not needing antibiotics. With the onset of the cold I washed my face mask (nasal pillows) daily. I also use a nasal saline rinse twice a day (yes this really does work) and used OTC meds, cough suppressant, antihistamine and expectorant. The expectorant (guiafensin) did the best job. This stuff works great on the sinuses too!! . I didn't use a "decongestant" as it raises my BP and makes my heart race. I also increased the humidifier setting. 10 days, cold gone, just some left over snot.
==Second, my husband has used a CPAP/ BiPAP for easily 15 yrs. He used to get horrible sinus infections. Use of nasal rinse ( neti pot style) helped, but this biggest improvement occurred after sinus surgery and trimming of the turbinates. He still gets the winter cold, but has not had a sinus infection since the surgery.
DO not fear the neti pot / sinus rinse. Actually during colds, the recommendation is to use a hypertonic saline solution (double the non-iodized salt or 2 packets if using the NeilMed product) to mobilize those really thick secretions (aka snot). Yes this is safe for a shot period of time, not recommended for standard daily use.
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Thanks for the info, Roger.
Susan
99 said:mixing herbal and conventional medicine can exasperate the problem you are treating, very often the treatment for the same alment is taken from diferent directions and the treatment by both simultainously will make it worse
so stick with one or the other not both
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Permalink Reply by Steven Y. Park, MD on
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Susan, I just read this entire post, and felt that I had to make a few comments and suggestions.
For the people that don't know me, I'm an ENT physician that specializes in integrative care for sleep apnea. Sorry to hear about your continuing problems. I see your situation all the time in my practice, and your condition is not too surprising.
Which antibiotic are you on? What other medications are you taking for the sinus problem? Usually for sinusitis, you need multiple medications, including decongestants and allergy sprays. Now you're in the timeframe of what we call chronic sinusitis, and the treatment is different, sometimes requiring 14 to 21 days of antibiotics. Someone mentioned a culture, which is a good thought, if your current course of antibiotics doesn't significantly improve your condition, along with oral steroids. If all this doesn't work, a CT of the sinuses is the typical recommendation.
If the CT shows findings consistent with chronic sinusitis, then your ENT will recommend the routine things, like either another round of antibiotics or surgery.
However, it's more likely that your CT will show normal or minimal findings, which essentially rules out an infection to begin with. Definitive studies have shown that most cases of what patients and doctors treat as "sinusitis" are not really infections, but a migraine of the sinuses. It's a neurologic response to irritation of the sinus cavities that causes pain, pressure, headache, post-nasal drip, colored mucous, and nasal congestion. Weather changes, especially temperature, pressure and humidity changes are a potent migraine trigger, and this can affect the sinuses as well. I think you mentioned that it first started after such an event.
This is why sometimes, CPAP can aggravate or irritate the nasal or sinus passageways, since the nerve endings are hypersensitive. Sometimes it starts immediately when people first start using it, or occurs later when the person gets a cold or an allergy attack, which causes inflammation, causing more irritation to the sinuses.
I realize that there is a legitimate concern regarding contamination with the CPAP equipment during colds or infections, and as everyone here has pointed out, there's no consensus even within the medical community as to whether or not to stop CPAP temporarily. My personal opinion is to continue using CPAP, unless you find it too uncomfortable. If it's making your sleep worse, then rest for a few days. Otherwise, you can continue with supplemental medications like decongestants, allergy sprays, and lots of nasal saline. Your nose is full of normal bacteria, even when you're not sick. These bacteria infect the sinuses (and ears) only after something else causes inflammation (usually a viral infection, reflux, or migraine inflammation). This is why some people get multiple courses of antibiotics and it either doesn't work at all or it keeps coming back.
It's also important to note that sleep apnea itself is a major cause of inflammation in the nose. If you have a simple cold or an allergy attack, then with a stuffy nose, your CPAP pressure will probably be too low, due to increased nasal resistance. Plus, having nasal congestion can actually worsen untreated sleep apnea. This is why it's important to keep the nasal passageways as clear as possible. Different people have a combination of different reasons for nasal congestion. Most will have a deviated nasal septum along with enlarged turbinates that get even bigger with colds, and due to the narrowed facial structures in sleep apnea patients, the nostrils will tend to cave in easier, even with a little nasal congestion. So not only do you need to treat the inside of the nose, but the nostrils as well (with nasal dilators like Breathe Right or Nozovent).
Also, by definition, most sleep apnea patients have chronic (or non-allergic) rhinitis, which is an involuntary system imbalance that causes your nose to be either stuffy, runny, or both. In many cases, it's confused with allergies. You can have both allergic and non-allergic rhinitis.
You can use a Neti-pot in the short term, since most nasal saline preparations act to decongest the nose. Many people swear by them, but some people hate them. It really depends on what your nose can tolerate. A recent study showed that in users with frequent sinus "infections" who were using a Neti-pot daily for years, once they stopped, the number of sinus "infections" dropped significantly. Saline is probably good for short bursts, but it can clear out the protective mucous layer, as well as to paralyze the cilia that propels mucous out of the sinuses.
I can't make a recommendation specifically for you, Susan, but if I saw someone with your exact situation in my practice, this is what would recommend: Afrin for 3 days, along with a topical nasal steroid, and 2-3 times a day Neti-pot irrigation. Breathe-Rite or Nozovents if you have nasal valve collapse. If not improved, consider getting a CT to correlate the findings with the culture. If you have chronic sinusitis, then an aggressive 14 days course of a stronger antibiotic, along with the other adjunctive meds.
If your CT is normal, then treat for migraines, including dietary restrictions and possibly migraine medications (natural and then prescription), along with a referral to an acupuncturist to help you realign the imbalances of your involuntary nervous system.
Sorry I can't be of more help. Please keep us up to date on your future progress.
Steve
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Hi Steve--I'm sitting here crying with relief just reading your reply. Short of sitting in your office right now, I can't imagine any way you could me more helpful to me than you've been right here. So many people have been trying to support me, and advise me (at my request), but you're the first person who's been able to give me some understanding of what's happening to me.
Honestly, I'd begun to think there was nothing that could be done or that I'm just nuts.....last night was the very first time since July that I couldn't use my CPAP--I just could not tolerate it. Couldn't breathe. I've been using it faithfully ever since all this started way back the week after I started treatment in July, up till last night. Having been 100% compliant all these months, and seeing all the improvement I've had, I've been scared to death that I'd have to d/c treatment. I'll try it again tonight and see if I can manage it.
I know this acute phase happened after the AZ trip--I started having tiny hints it was coming back a couple of days before I came home and when I got here, it just exploded and hasn't stopped. Last night=no CPAP. Tonight my nose is bleeding whenever I blow my nose. I've NEVER had any kind of nasal bleeding, sinus trouble, allergies, none of it, and I'm 67 years old.
I can't even tolerate saline nasal spray as of last night. It burns like fire and make my nose run like crazy. From what you said about overuse of that stuff, I think I probably HAVE overused it. I thought it was okay to use it as needed and it seemed to help up until yesterday. It feels like my entire nasal/sinus cavity are inflamed and hot. Have an ongoing headache. I don't know why I'm sitting here telling you all this stuff that I'm sure you already know.....
Okay, I don't have a printer at the moment, so I'm gonna take my mini-laptop with me to whichever MD I can get in to see tomorrow. It'll probably be my PCP. My sleep doc is hard to get to. I'm gonna try again, but if I can be seen I'll be surprised. I KNOW I can see my regular doc--he always gets me in, regardless. I can't imagine getting into an ENT on short notice, but I think I'll try that first. At least I have something concrete to think about now.
Thank you so much, Steve. Jeez, I'm SO grateful to you for taking the time to respond to this. I've wanted to contact you, but I know you're really busy. So, extra thanks for caring so much about ALL of us here on SG.
Susan McCord
Steven Y. Park, MD said:Susan, I just read this entire post, and felt that I had to make a few comments and suggestions.
For the people that don't know me, I'm an ENT physician that specializes in integrative care for sleep apnea. Sorry to hear about your continuing problems. I see your situation all the time in my practice, and your condition is not too surprising.
Which antibiotic are you on? What other medications are you taking for the sinus problem? Usually for sinusitis, you need multiple medications, including decongestants and allergy sprays. Now you're in the timeframe of what we call chronic sinusitis, and the treatment is different, sometimes requiring 14 to 21 days of antibiotics. Someone mentioned a culture, which is a good thought, if your current course of antibiotics doesn't significantly improve your condition, along with oral steroids. If all this doesn't work, a CT of the sinuses is the typical recommendation.
If the CT shows findings consistent with chronic sinusitis, then your ENT will recommend the routine things, like either another round of antibiotics or surgery.
However, it's more likely that your CT will show normal or minimal findings, which essentially rules out an infection to begin with. Definitive studies have shown that most cases of what patients and doctors treat as "sinusitis" are not really infections, but a migraine of the sinuses. It's a neurologic response to irritation of the sinus cavities that causes pain, pressure, headache, post-nasal drip, colored mucous, and nasal congestion. Weather changes, especially temperature, pressure and humidity changes are a potent migraine trigger, and this can affect the sinuses as well. I think you mentioned that it first started after such an event.
This is why sometimes, CPAP can aggravate or irritate the nasal or sinus passageways, since the nerve endings are hypersensitive. Sometimes it starts immediately when people first start using it, or occurs later when the person gets a cold or an allergy attack, which causes inflammation, causing more irritation to the sinuses.
I realize that there is a legitimate concern regarding contamination with the CPAP equipment during colds or infections, and as everyone here has pointed out, there's no consensus even within the medical community as to whether or not to stop CPAP temporarily. My personal opinion is to continue using CPAP, unless you find it too uncomfortable. If it's making your sleep worse, then rest for a few days. Otherwise, you can continue with supplemental medications like decongestants, allergy sprays, and lots of nasal saline. Your nose is full of normal bacteria, even when you're not sick. These bacteria infect the sinuses (and ears) only after something else causes inflammation (usually a viral infection, reflux, or migraine inflammation). This is why some people get multiple courses of antibiotics and it either doesn't work at all or it keeps coming back.
It's also important to note that sleep apnea itself is a major cause of inflammation in the nose. If you have a simple cold or an allergy attack, then with a stuffy nose, your CPAP pressure will probably be too low, due to increased nasal resistance. Plus, having nasal congestion can actually worsen untreated sleep apnea. This is why it's important to keep the nasal passageways as clear as possible. Different people have a combination of different reasons for nasal congestion. Most will have a deviated nasal septum along with enlarged turbinates that get even bigger with colds, and due to the narrowed facial structures in sleep apnea patients, the nostrils will tend to cave in easier, even with a little nasal congestion. So not only do you need to treat the inside of the nose, but the nostrils as well (with nasal dilators like Breathe Right or Nozovent).
Also, by definition, most sleep apnea patients have chronic (or non-allergic) rhinitis, which is an involuntary system imbalance that causes your nose to be either stuffy, runny, or both. In many cases, it's confused with allergies. You can have both allergic and non-allergic rhinitis.
You can use a Neti-pot in the short term, since most nasal saline preparations act to decongest the nose. Many people swear by them, but some people hate them. It really depends on what your nose can tolerate. A recent study showed that in users with frequent sinus "infections" who were using a Neti-pot daily for years, once they stopped, the number of sinus "infections" dropped significantly. Saline is probably good for short bursts, but it can clear out the protective mucous layer, as well as to paralyze the cilia that propels mucous out of the sinuses.
I can't make a recommendation specifically for you, Susan, but if I saw someone with your exact situation in my practice, this is what would recommend: Afrin for 3 days, along with a topical nasal steroid, and 2-3 times a day Neti-pot irrigation. Breathe-Rite or Nozovents if you have nasal valve collapse. If not improved, consider getting a CT to correlate the findings with the culture. If you have chronic sinusitis, then an aggressive 14 days course of a stronger antibiotic, along with the other adjunctive meds.
If your CT is normal, then treat for migraines, including dietary restrictions and possibly migraine medications (natural and then prescription), along with a referral to an acupuncturist to help you realign the imbalances of your involuntary nervous system.
Sorry I can't be of more help. Please keep us up to date on your future progress.
Steve
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Permalink Reply by RL on
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Thank you Dr. Park! Your review and advise is greatly appreciated. I believe this will help myself and others to consider the variables in our individual situations, knowing better what to do and what to discuss with our own doctors, when dealing with what can be complex sinus issues and using our xPAP equipment.
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Permalink Reply by Melinda Hertel on
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Thank you so much for this invaluable information! I will be keeping a copy of your response so that I have more information to offer the patients who come to EZ CPAP for help with their apnea and equipment!
Steven Y. Park, MD said:Susan, I just read this entire post, and felt that I had to make a few comments and suggestions.
For the people that don't know me, I'm an ENT physician that specializes in integrative care for sleep apnea. Sorry to hear about your continuing problems. I see your situation all the time in my practice, and your condition is not too surprising.
Which antibiotic are you on? What other medications are you taking for the sinus problem? Usually for sinusitis, you need multiple medications, including decongestants and allergy sprays. Now you're in the timeframe of what we call chronic sinusitis, and the treatment is different, sometimes requiring 14 to 21 days of antibiotics. Someone mentioned a culture, which is a good thought, if your current course of antibiotics doesn't significantly improve your condition, along with oral steroids. If all this doesn't work, a CT of the sinuses is the typical recommendation.
If the CT shows findings consistent with chronic sinusitis, then your ENT will recommend the routine things, like either another round of antibiotics or surgery.
However, it's more likely that your CT will show normal or minimal findings, which essentially rules out an infection to begin with. Definitive studies have shown that most cases of what patients and doctors treat as "sinusitis" are not really infections, but a migraine of the sinuses. It's a neurologic response to irritation of the sinus cavities that causes pain, pressure, headache, post-nasal drip, colored mucous, and nasal congestion. Weather changes, especially temperature, pressure and humidity changes are a potent migraine trigger, and this can affect the sinuses as well. I think you mentioned that it first started after such an event.
This is why sometimes, CPAP can aggravate or irritate the nasal or sinus passageways, since the nerve endings are hypersensitive. Sometimes it starts immediately when people first start using it, or occurs later when the person gets a cold or an allergy attack, which causes inflammation, causing more irritation to the sinuses.
I realize that there is a legitimate concern regarding contamination with the CPAP equipment during colds or infections, and as everyone here has pointed out, there's no consensus even within the medical community as to whether or not to stop CPAP temporarily. My personal opinion is to continue using CPAP, unless you find it too uncomfortable. If it's making your sleep worse, then rest for a few days. Otherwise, you can continue with supplemental medications like decongestants, allergy sprays, and lots of nasal saline. Your nose is full of normal bacteria, even when you're not sick. These bacteria infect the sinuses (and ears) only after something else causes inflammation (usually a viral infection, reflux, or migraine inflammation). This is why some people get multiple courses of antibiotics and it either doesn't work at all or it keeps coming back.
It's also important to note that sleep apnea itself is a major cause of inflammation in the nose. If you have a simple cold or an allergy attack, then with a stuffy nose, your CPAP pressure will probably be too low, due to increased nasal resistance. Plus, having nasal congestion can actually worsen untreated sleep apnea. This is why it's important to keep the nasal passageways as clear as possible. Different people have a combination of different reasons for nasal congestion. Most will have a deviated nasal septum along with enlarged turbinates that get even bigger with colds, and due to the narrowed facial structures in sleep apnea patients, the nostrils will tend to cave in easier, even with a little nasal congestion. So not only do you need to treat the inside of the nose, but the nostrils as well (with nasal dilators like Breathe Right or Nozovent).
Also, by definition, most sleep apnea patients have chronic (or non-allergic) rhinitis, which is an involuntary system imbalance that causes your nose to be either stuffy, runny, or both. In many cases, it's confused with allergies. You can have both allergic and non-allergic rhinitis.
You can use a Neti-pot in the short term, since most nasal saline preparations act to decongest the nose. Many people swear by them, but some people hate them. It really depends on what your nose can tolerate. A recent study showed that in users with frequent sinus "infections" who were using a Neti-pot daily for years, once they stopped, the number of sinus "infections" dropped significantly. Saline is probably good for short bursts, but it can clear out the protective mucous layer, as well as to paralyze the cilia that propels mucous out of the sinuses.
I can't make a recommendation specifically for you, Susan, but if I saw someone with your exact situation in my practice, this is what would recommend: Afrin for 3 days, along with a topical nasal steroid, and 2-3 times a day Neti-pot irrigation. Breathe-Rite or Nozovents if you have nasal valve collapse. If not improved, consider getting a CT to correlate the findings with the culture. If you have chronic sinusitis, then an aggressive 14 days course of a stronger antibiotic, along with the other adjunctive meds.
If your CT is normal, then treat for migraines, including dietary restrictions and possibly migraine medications (natural and then prescription), along with a referral to an acupuncturist to help you realign the imbalances of your involuntary nervous system.
Sorry I can't be of more help. Please keep us up to date on your future progress.
Steve
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