"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 susan mccord on
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Hi Melinda--glad to hear you're gonna use Steve's info to help people. This has been one THE most difficult health issues I've ever had to deal with, including heart disease. If it weren't for Steve and his level of expertise and caring, I'd probably be off CPAP and out of the SG community by now. That's the desperation level I've gotten to. At least now I have a direction and, most important, HOPE!, that someone "gets it" and that there's something that can be done.
For God's sake, yes, SPREAD THE WORD!!! And thank you, on behalf of all the people you're helping every day.....
Susan McCord :-)
Melinda Hertel said: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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Permalink Reply by Mary Bogan on
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This was well-timed for me. I just went to the doctor yesterday for sinusitis. A lot of what Steve says resonates with me. I know I've experienced changes in stuffiness w/changes in weather. Also, I can concur that taking the multiple medications is very helpful for keeping nasal passages open. I am also glad to hear the warning about overuse of the Neti pot. I do use it occasionally but it has been floating around in my head that I should use it all the time. I'm glad to know to be careful about that. Finally, I am relieved to know that it is safe to continue w/my CPAP treatment. I have finally, after about 4 years, been making progress at keeping on my nasal pillows for more than an hour or two a night. I hate to have the progress impeded by this infection.
Thanks to Susan for sharing your situation and to Sleep Guide for this forum AND for Steve for sharing his expertise.
To safe and better sleep for us all,
Mary
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Permalink Reply by assholes showing my profile when on
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Susan, do you have aby headaches associated with your supposed sinusitus? Do you have any headaches normally?
Have you used any other over the counter nasal sprays or any Vicks rub in the nose? Also lastly, can i ask what your pressure is set at? I also think of chemical burns and heat burn. Does your CPAP have a humidifier on it and it the discharge air hotter than normal air substantially. Eevn cold can feel like buring when it encraoches sensitive nerves and blood vessels in the nose. Thanks.
susan mccord said: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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Hey Dr Steven, can a cPAP cause the blood vessels and veins in the nose become scarred from the constant air being presented against them. No different than how forced air at higher pressures can actually remove paint from steel. The forced air at higher pressures can cause pain due to this sharp pressure on sensitive nerve and blood vessels in the nose? Thank you for your involvment. We appreciate your opinion greatly!
susan mccord said:Hi Melinda--glad to hear you're gonna use Steve's info to help people. This has been one THE most difficult health issues I've ever had to deal with, including heart disease. If it weren't for Steve and his level of expertise and caring, I'd probably be off CPAP and out of the SG community by now. That's the desperation level I've gotten to. At least now I have a direction and, most important, HOPE!, that someone "gets it" and that there's something that can be done.
For God's sake, yes, SPREAD THE WORD!!! And thank you, on behalf of all the people you're helping every day.....
Susan McCord :-)
Melinda Hertel said: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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Richard, I just typed out a rather long reply answering all your questions and giving you some background--when I tried to send it, it began the sending process but never completed it. I then lost my internet connection and when I came back here, the message had disappeared. Aaaaaaaargh......!
I'm too tired to re-create it for you right now. I WILL, however, re-write it tomorrow. I'm sorry--not sure if it's computer error or operator stupidity!!
Susan
richard rydza said:Susan, do you have aby headaches associated with your supposed sinusitus? Do you have any headaches normally?
Have you used any other over the counter nasal sprays or any Vicks rub in the nose? Also lastly, can i ask what your pressure is set at? I also think of chemical burns and heat burn. Does your CPAP have a humidifier on it and it the discharge air hotter than normal air substantially. Eevn cold can feel like buring when it encraoches sensitive nerves and blood vessels in the nose. Thanks.
susan mccord said: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 Sandra King on
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Mine did the same thing with the long message that I posted on here. I got lucky and it posted anyway. I thought I had spent all that time in vain.
susan mccord said:Richard, I just typed out a rather long reply answering all your questions and giving you some background--when I tried to send it, it began the sending process but never completed it. I then lost my internet connection and when I came back here, the message had disappeared. Aaaaaaaargh......!
I'm too tired to re-create it for you right now. I WILL, however, re-write it tomorrow. I'm sorry--not sure if it's computer error or operator stupidity!!
Susan
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Wow!, Sandra, congratulations on the great weight loss!! That's a true accomplishment and not easy to get there.....hope all goes well for you!!
Susan McCord :-)
Sandra King said:RL, your allergy problems sound very familiar to me. I live in Ft. Worth (moved here almost 10 years ago) and the allergy problems here are really bad. My husband and I have been taking Loratadine everyday for a few years and also use a Saline Nasal Spray. I have very mild SA and was diagnosed 1 year ago. My sleep doctor prescibed Flonase (generic - Fluticasone Propionate), which he said to use about 30 minutes before bedtime, to give it time to work. I have also used Breathe Right Strips (my nasal passages are small and when I lay down, they seem to close up without them) for about 15 years. My husband (who does not have SA) and I had severe allergies and colds for about 2 or 3 weeks over Christmas, with lots of sneezing at first and a runny nose and occasional headache and congestion. We went through several boxes of Benadryl Allergy Sinus Headache. We were in Baton Rouge for about a week over Christmas and it did not clear up.
I finally remembered one thing that we both had been using for the last couple years and had run out of around Thanksgiving was Allergena Allergy Relief Zone 5. I bought some more of it and started using the drops everyday and the allergies cleared up in just a few days use. Zone 5 is a homeopathic blend of over 120 Antigens, for allergies of Trees, Weeds, and Grasses. The directions say to take 10-15 drops under the tongue three times a day. I warn you though, it tastes terrible. Zone 5 is a mix of all of the Trees, Weeds, and Grasses found in Kansas, Oklahoma, and Texas, that's one reason why it tastes so bad. It gradually desensitizes your body to these Antigens, resulting in better control of symptoms. Looking on the website: www.progena.com/shop/en/allergena.html you can find the zone that you live in. RL, I believe you would need Zone 6 - Arizona, Colorado, New Mexico, and Utah. I purchase mine at Central Market, but you can purchase them from the Allergena website online for the same price. I only use them two times a day, and a 2oz. bottle lasts for about 3 months or so.
Also, since I have always been a mouth breather, I was first prescribed with an Ultra-Mirage Full Face Mask, which has kept me fully compliant when I am congested and also for the whole of this last year. I was about 145 pounds overweight and since using CPAP, I have been motivated to lose weight. On May 26, 2009, I started going to Slim4Life, which is only located in the Kansas City and Dallas/Ft. Worth areas. As of today, I have lost 85 lbs. and still have about 60 to go. Because of the weight loss and the changing shape of my face (the place I lose weight first), I have tried several different masks over the last few months, because of air leakage. In October, I started having problem with burping air, while using CPAP. When it got to the point that it started hurting my lungs, I had to stop using the CPAP and use about 3 pillows to elevate my upper body so that I could sleep sitting up. I do not sleep that well in a recliner. I began to think that my air pressure was set too high, so I called my sleep doctor to see if I could get my pressure lowered. They had me come in and told me that they could not lower it without first having another sleep study done.
One week before Thanksgiving, I had another sleep study done. I went back to my sleep doctor the next week and they were able to lower my air pressure from a 9 to a 6. He said that I had 1 apnea at a 6 and if I wanted to get rid of them completely, I could be at a 7, but I chose to go with the 6, since I am still losing weight. I should have all my excess weight off and start maintenance by May. I asked my sleep doctor if I would have to used CPAP the rest of my life and he said, that in my case, hopefully I would only need it for a few more months, if I continued to lose weight. I also asked about how often my insurance would pay for a sleep study, and he said they would pay for another study after 20 lbs. of weight loss. Because of everything that I have read, and maybe since I am a perfectionist, I will not stop using CPAP therapy until my sleep doctor says it is ok. During this last year, I have discovered a few of my relatives using CPAP therapy and a few more that probably need it. Most of those relatives are overweight also, but we are now working on that.
I clean my mask, I'm back to using the Ultra Mirage Full Face, every morning, disconnect and hang my hose over the headboard to dry every morning and used distilled water in the heated humidifier. I admit that I do not clean the water chamber often enough, but I keep the filters clean and changed regularly on my machine. I have a very sensitive nose and sometimes smell different things while wearing the mask. Last week, I started using aromatherapy for my CPAP. I purchased a starter pack from www.cpap.com which includes about 13 different scented oils to try. You place a drop or two on one of the included pads and place that in the included stand. I place the stand on my nightstand, right behind the filter to my CPAP machine. I have tried about 5 different oils so far. The air through my CPAP mask sure smells better than the plasticky scent of my CPAP mask. Also, I have been sleeping more hours during the night, since starting aromatherapy. I hope that some of my experiences will help some of you. Now it is time for me to go try another new scent. Nighty night.
RL said:Just getting started with my CPAP, a little over a week, I am reviewing this subject carefully. I have had sinus problems ongoing for so long, I thought that was my biggest problem before I learned about SA. I had an allergy test in mid 2009, showing allergy to grasses, weeds and trees. I also notice a difference on days with higher pollution levels (Denver metro area). I had a "cold" the week before I got my CPAP, but thought it was mostly cleared up by the time I started with the CPAP. I have had very good success using my CPAP with nasal pillow mask and oxygen, with heated humidifier, though not feeling much energy yet. Though I have much less tiredness and brain fog in the morning, I still start to feel significantly tired by mid afternoon. I was thinking this was going to take some time, as I may be more oxygen depleted than I knew. Also, I am thinking that my cold was still lingering. I did notice a little yellow mucus a few mornings, despite using a new antihistamine nasal spray - Astelin. I did not think this was doing much for me, so I called my PCP, as I also had sinus and ear pressure and mild pain. My PCP immediately gave me an antibiotic script (without my asking), and another nasal spray we had talked about - Fluticasone Propionate, a corticosteroid. I think the antibiotic helped but not sure if it was enough, and will be using the corticosteroid nasal spray for about a month until it is gone, to reduce inflamation and congestion. Yesterday, I had a sinus (?) headache that I treated with ibuprofen, a half dose of sudafed decongestant, and loratadine (generic Claritin). This combo, along with the nasal spray did allow me to sleep well with my CPAP, though the sinus pressure is not completely gone. I have relied on these OTC medications so much in the past few years that I was concerned about them affecting my overall health. I see that I will need to monitor this closely, and make sure to keep my equipment very clean.
I also was wondering about the potential effect of the CPAP air pressure to push bacteria already in the nasal passages deeper into the sinuses, making it more difficult for the body to flush it out. I am also wondering what the best course of action is for myself - to lay off the CPAP to get the sinus infection cleared, or keep using it. I sooo want this CPAP treatment to work. I'm tired of being tired. I am also trying to increase my use of Nielmed Nasal Wash, which I recommend for keeping the nasal passages hydrated and flushing out bacteria and allergens. Another thing I have begun using occasionally is to eat a raw clove of garlic, chopped up in food, for it's natural antibiotic action.
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Permalink Reply by BeeAsleep on
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Thank you Dr. Park for your very helpful post. As a long time sufferer of sinus infections and migraines it is so helpful to see the BIG picture explained. Thank you for your time! We all know how busy you are. I will be printing out your post to take with me to my ENT and my sleep doc as well.
Blessing to you for all the service you provide on SleepGuide. bee
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Hi, my name is Mike, I am an RT who works in a DME in North Dakota (yes, it's cold here) and have been a therapist for 15 ears. I'm new to SleepGuide and this is the first post I've responded to but felt that this problem is not uncommon with my pts. and Susan's frustration prompted me to offer a couple of suggestions. First of all, I am assuming that Susan has a humidifier and my recommendation is that you replace that cannister first of all, most insurances replace them every six months. Second, replace the air filter in the back of the machine and if you have a Respironics unit, I would recommend adding the white pollen filter to the black foam filter as I have seen some improvement doing this. Lastly, and this one is a pain in the butt, try boiling the distilled water before you put it in your cannister. Bring it to a rolling boil for 10 to 15 minutes, let it cool and then add it to your cannister. This sounds like alot of work but distilled water is NOT sterile and I have had some good success using this method for my pts. who are chronically "plugged up". I hope this helps and don't give up, Susan, hang in there!!
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Permalink Reply by RL on
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Hi Sandra,
I guess I missed your reply before, there are so many posts for this thread. I will check out your suggestion for the homeopathic drops. I also discovered a new homeopathic nasal spray called Sinus Buster. It has homeopathic capsaicin. I would not recommend it for everyone, as it does produce a mild burning sensation for a few minutes. It is not bad to me, and I am somewhat sensitive, but it might not be for everyone. I do think it helped with my congestion, but I have only used it occasionally as I am also using my prescriptions.
Congratulaions on your weight loss too! I am hoping to do the same, over time as I feel better. Your experience is encouraging. With a BMI in the high overweight zone, I have a way to go, but not as far as some.
Sandra King said:RL, your allergy problems sound very familiar to me. I live in Ft. Worth (moved here almost 10 years ago) and the allergy problems here are really bad. My husband and I have been taking Loratadine everyday for a few years and also use a Saline Nasal Spray. I have very mild SA and was diagnosed 1 year ago. My sleep doctor prescibed Flonase (generic - Fluticasone Propionate), which he said to use about 30 minutes before bedtime, to give it time to work. I have also used Breathe Right Strips (my nasal passages are small and when I lay down, they seem to close up without them) for about 15 years. My husband (who does not have SA) and I had severe allergies and colds for about 2 or 3 weeks over Christmas, with lots of sneezing at first and a runny nose and occasional headache and congestion. We went through several boxes of Benadryl Allergy Sinus Headache. We were in Baton Rouge for about a week over Christmas and it did not clear up.
I finally remembered one thing that we both had been using for the last couple years and had run out of around Thanksgiving was Allergena Allergy Relief Zone 5. I bought some more of it and started using the drops everyday and the allergies cleared up in just a few days use. Zone 5 is a homeopathic blend of over 120 Antigens, for allergies of Trees, Weeds, and Grasses. The directions say to take 10-15 drops under the tongue three times a day. I warn you though, it tastes terrible. Zone 5 is a mix of all of the Trees, Weeds, and Grasses found in Kansas, Oklahoma, and Texas, that's one reason why it tastes so bad. It gradually desensitizes your body to these Antigens, resulting in better control of symptoms. Looking on the website: www.progena.com/shop/en/allergena.html you can find the zone that you live in. RL, I believe you would need Zone 6 - Arizona, Colorado, New Mexico, and Utah. I purchase mine at Central Market, but you can purchase them from the Allergena website online for the same price. I only use them two times a day, and a 2oz. bottle lasts for about 3 months or so.
Also, since I have always been a mouth breather, I was first prescribed with an Ultra-Mirage Full Face Mask, which has kept me fully compliant when I am congested and also for the whole of this last year. I was about 145 pounds overweight and since using CPAP, I have been motivated to lose weight. On May 26, 2009, I started going to Slim4Life, which is only located in the Kansas City and Dallas/Ft. Worth areas. As of today, I have lost 85 lbs. and still have about 60 to go. Because of the weight loss and the changing shape of my face (the place I lose weight first), I have tried several different masks over the last few months, because of air leakage. In October, I started having problem with burping air, while using CPAP. When it got to the point that it started hurting my lungs, I had to stop using the CPAP and use about 3 pillows to elevate my upper body so that I could sleep sitting up. I do not sleep that well in a recliner. I began to think that my air pressure was set too high, so I called my sleep doctor to see if I could get my pressure lowered. They had me come in and told me that they could not lower it without first having another sleep study done.
One week before Thanksgiving, I had another sleep study done. I went back to my sleep doctor the next week and they were able to lower my air pressure from a 9 to a 6. He said that I had 1 apnea at a 6 and if I wanted to get rid of them completely, I could be at a 7, but I chose to go with the 6, since I am still losing weight. I should have all my excess weight off and start maintenance by May. I asked my sleep doctor if I would have to used CPAP the rest of my life and he said, that in my case, hopefully I would only need it for a few more months, if I continued to lose weight. I also asked about how often my insurance would pay for a sleep study, and he said they would pay for another study after 20 lbs. of weight loss. Because of everything that I have read, and maybe since I am a perfectionist, I will not stop using CPAP therapy until my sleep doctor says it is ok. During this last year, I have discovered a few of my relatives using CPAP therapy and a few more that probably need it. Most of those relatives are overweight also, but we are now working on that.
I clean my mask, I'm back to using the Ultra Mirage Full Face, every morning, disconnect and hang my hose over the headboard to dry every morning and used distilled water in the heated humidifier. I admit that I do not clean the water chamber often enough, but I keep the filters clean and changed regularly on my machine. I have a very sensitive nose and sometimes smell different things while wearing the mask. Last week, I started using aromatherapy for my CPAP. I purchased a starter pack from www.cpap.com which includes about 13 different scented oils to try. You place a drop or two on one of the included pads and place that in the included stand. I place the stand on my nightstand, right behind the filter to my CPAP machine. I have tried about 5 different oils so far. The air through my CPAP mask sure smells better than the plasticky scent of my CPAP mask. Also, I have been sleeping more hours during the night, since starting aromatherapy. I hope that some of my experiences will help some of you. Now it is time for me to go try another new scent. Nighty night.
RL said:Just getting started with my CPAP, a little over a week, I am reviewing this subject carefully. I have had sinus problems ongoing for so long, I thought that was my biggest problem before I learned about SA. I had an allergy test in mid 2009, showing allergy to grasses, weeds and trees. I also notice a difference on days with higher pollution levels (Denver metro area). I had a "cold" the week before I got my CPAP, but thought it was mostly cleared up by the time I started with the CPAP. I have had very good success using my CPAP with nasal pillow mask and oxygen, with heated humidifier, though not feeling much energy yet. Though I have much less tiredness and brain fog in the morning, I still start to feel significantly tired by mid afternoon. I was thinking this was going to take some time, as I may be more oxygen depleted than I knew. Also, I am thinking that my cold was still lingering. I did notice a little yellow mucus a few mornings, despite using a new antihistamine nasal spray - Astelin. I did not think this was doing much for me, so I called my PCP, as I also had sinus and ear pressure and mild pain. My PCP immediately gave me an antibiotic script (without my asking), and another nasal spray we had talked about - Fluticasone Propionate, a corticosteroid. I think the antibiotic helped but not sure if it was enough, and will be using the corticosteroid nasal spray for about a month until it is gone, to reduce inflamation and congestion. Yesterday, I had a sinus (?) headache that I treated with ibuprofen, a half dose of sudafed decongestant, and loratadine (generic Claritin). This combo, along with the nasal spray did allow me to sleep well with my CPAP, though the sinus pressure is not completely gone. I have relied on these OTC medications so much in the past few years that I was concerned about them affecting my overall health. I see that I will need to monitor this closely, and make sure to keep my equipment very clean.
I also was wondering about the potential effect of the CPAP air pressure to push bacteria already in the nasal passages deeper into the sinuses, making it more difficult for the body to flush it out. I am also wondering what the best course of action is for myself - to lay off the CPAP to get the sinus infection cleared, or keep using it. I sooo want this CPAP treatment to work. I'm tired of being tired. I am also trying to increase my use of Nielmed Nasal Wash, which I recommend for keeping the nasal passages hydrated and flushing out bacteria and allergens. Another thing I have begun using occasionally is to eat a raw clove of garlic, chopped up in food, for it's natural antibiotic action.
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Permalink Reply by sleepycarol on
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Dr. Park,
Thank you so much for your very helpful reply. I see myself in much of what you posted and as having had chronic sinus issues since grade school and migraines I can relate to your post.
This explained so much more than what any doctor had ever told me.
I wish you were closer to where I live as I would love to have you for a doctor.
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Hi Mike--welcome to SleepGuide, and thank you so much for your post. I do have a humidifier, it has been replaced, and I do change both filters--new white one (check it often), and I wash the foam one when I wash equipment which is usually every other day.
I have to be honest and say I don't see myself being compliant with boiling distilled water!! It's no doubt a helpful measure to take when difficulties with CPAP are occurring chronically. I'm glad to have the info, but I probably won't do it.
Don't know if you've had a chance to review this particular thread yet--it's a long one! When you do, look for Dr. Park's reply re: exactly what it is I'm dealing with here. It's the first time anyone's been able to clarify and provide direction re: meaning of symptoms, and further treatment options.
These symptoms began within the first week of CPAP treatment, end of July or beginning of August '09. Started out coming and going 2-3 days at a time, spontaneously appearing and spontaneously disappearing. Very intense but didn't last overly long. (I have no history of allergies or sinus problems). Between these events I felt fine.
The end of November I flew to AZ for 2 weeks. Began having inklings of sx a couple of days before I got home. The second day after I arrived home, symptoms came back with increasing acuity--lasted about 2 weeks, were very intense. Again spontaneously disappeared for a couple of weeks around Christmas-time. Came back VERY intensely and continued to get worse to the point of extreme distress. (See Dr. Park's post for what was happening). My PCP tried me on Doxycycline which helped for a couple of days, then didn't. After Steve's info, I took his post in to my PCP, he concurred, and put me on Levaquin 500 mg. for 10 days. I've had 5 (once a day) doses, and today is the first day I could tolerate being out of the house for nearly 2 weeks. Still having symptoms but there's a definite change for the better. So, I'm (guardedly) hopeful!!
Will post a new Discussion if I continue to improve--I've had a tremendous amount of support on SleepGuide. Not sure how I'd have persevered with treatment without all the people who have been staying in this mess with me.....
I think you'll find this a great apnea site--and again, we're happy to have you onboard!!
Susan McCord :-)
Mike Myers said:Hi, my name is Mike, I am an RT who works in a DME in North Dakota (yes, it's cold here) and have been a therapist for 15 ears. I'm new to SleepGuide and this is the first post I've responded to but felt that this problem is not uncommon with my pts. and Susan's frustration prompted me to offer a couple of suggestions. First of all, I am assuming that Susan has a humidifier and my recommendation is that you replace that cannister first of all, most insurances replace them every six months. Second, replace the air filter in the back of the machine and if you have a Respironics unit, I would recommend adding the white pollen filter to the black foam filter as I have seen some improvement doing this. Lastly, and this one is a pain in the butt, try boiling the distilled water before you put it in your cannister. Bring it to a rolling boil for 10 to 15 minutes, let it cool and then add it to your cannister. This sounds like alot of work but distilled water is NOT sterile and I have had some good success using this method for my pts. who are chronically "plugged up". I hope this helps and don't give up, Susan, hang in there!!
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