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Why does CPAP plug my nose, and causes acid reflux?
Anybody else have this problem? I put on my CPAP and go to sleep, and within a couple hours my nose is plugged and throat burning from acid reflux. Thanks for any responses.
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Replies to This Discussion
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Permalink Reply by Banyon on
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Give us some specifics: Mask? Machine settings? Sleep position(s)? Humidifier setting? Had acid reflux before CPAP? Head of bed elevated? Time between dinner and lying down? History of allergies/nasal congestion?
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Permalink Reply by Matt on
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No history of allergies, yes some nasal congestion(not enough to bother me at night before though) . Dinner 2-3 hours prior to sleep, no snacks. Head elevated a bit. Never had acid reflux before PAP. Two machines; ResMed ASV and Respironics M-Series BiPAP, both at 14 IPAP 9 EPAP.
One issue is that the pressure holds my esophageal sphincter open and pressurizes my esophagus and stomach, and that pushes the acids back up my throat along with air, belches. The other issue is when my nasal cavity gets plugged to where the PAP can't overcome it, I start sucking harder through my nose, and that creates a negative pressure in my upper airway that sucks the acid up my throat.
I use a full face mask and have no leaks. I've tried Nexium, and now Zantac; neither have helped much. Can't think of how to better explain it, or anything I left out. Thanks for your interest, Banyon.
Banyon said:Give us some specifics: Mask? Machine settings? Sleep position(s)? Humidifier setting? Had acid reflux before CPAP? Head of bed elevated? Time between dinner and lying down? History of allergies/nasal congestion?
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Yes I use a humidifier, tried all the settings and maximum seem to work best.
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Permalink Reply by Rooster on
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Banyon, I hope you don't mind me jumping in here. You and I have discussed this before and I had even greater problems than you.
Matt,
1. The congestion needs to be dealt with. There are several possibilities. The first thing I would look at is that maximum humidifier setting. Are you aware that too much humidity from a CPAP humidifier can cause nasal congestion? That sounds like what is happening to you. I believe you are in Portland and there is no lack of humidity in the air. Would you happen to know, or be able to estimate, the relative humidity in your bedroom? In my bedroom the relative humidity is typically around 50%. At these levels, I leave the humidifier tank empty and the setting at zero. Sometimes during the coldest part of the winter when the gas heat runs a lot, the humidity in our house will drop. When it gets down to 30 to 35% humidity in my bedroom, I will put some water in the tank and turn the setting to one or two. But that is only for a few days each year.
2. Acid reflux. The best way to treat reflux is to raise the head of the bed four to six inches. I bought four-inch risers at Bed, Bath and Beyond to put under the legs at the head of the bed. This makes a big difference. The other thing is to eat dinner early and allow three to four hours before you lie down. Of course, avoiding heavy or spicy meals also helps.
3. Aerophagia or gastric insufflation (CPAP air leaking into digestive system). You may have some irritation of one or both of the esophogeal sphincters from the acid reflux. Get the reflux under control and the sphincters may heal and be able to hold the CPAP pressure back. This could happen, but in my experience it is unlikely, so you are still left with aerophagia. This can be a difficult problem. The solution for me is to sleep on my tummy in the Falcon position, http://www.uarsrelief.com/sleeppositions.html . This has eliminated gastric insufflation for me and it is also a good position for health of the spine.
4. Positional Sleep Apnea (PSA). This means your apnea is most severe when sleeping on your back and may require much higher CPAP pressures. I was titrated by a certified sleep lab at a very high pressure on my back. At home I have software with the CPAP and over several nights was able to titrate to a much lower pressure when sleeping on my sides or tummy. What position(s) do you sleep in?
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Permalink Reply by Mary Z on
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For those who do not know Matt, he is a quadraplegic (hope you don't mind me bringing this up Matt, but it may be germane to the suggestions people give).
Mary Z.
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Permalink Reply by RockRpsgt on
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It is possible that you are still having events. The negative pressure could be causing the reflux.
The term "positional apnea" still makes me giggle. In 99.9% of the apneac cases I have seen events have been worse in the supine position. This is the normal nature of apnea due to gravity and muscle atonia being the biggest culprit. I could see coming up with a name for apnea being worse in the lateral position. This would truly be "positional apnea". Supine apnea is just apnea.
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Thanks Mary, I've been reading this and researching, but can't reply yet due to microphone problems (speech recognition). Thanks for your post, Rooster, I'll give you a better response as soon as possible... whew that tuckered me out.
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Matt said: Thanks for your post, Rooster, I'll give you a better response as soon as possible... whew that tuckered me out.
After I posted it, I thought it might be overwhelming. Just know that it took me a long time to work all of that out for myself and start getting a decent therapy. I consider my OSA somewhat "CPAP-resistant" and nothing came easy for me. It's been five years since I started CPAP and I am still tweaking some things, trying some new things, and relearning some old things.
I did not realize you have SCI. That may make some things like sleep position even more challenging. Just more to overcome and maybe takes more time.
It sounds like you know how to persevere and I look forward to hearing from you at your own pace. There are times when three or four days go by before I get to look at the forum, so if you have any questions about how I handle my therapy, remember I will be back.
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Rock Hinkle said:The term "positional apnea" still makes me giggle. In 99.9% of the apneac cases I have seen events have been worse in the supine position. This is the normal nature of apnea due to gravity and muscle atonia being the biggest culprit. I could see coming up with a name for apnea being worse in the lateral position. This would truly be "positional apnea". Supine apnea is just apnea.
If I remember correctly from earlier threads, you have not read any of the literature on Positional Sleep Apnea (PSA). You then may be interested to read the most often referred to medical study on PSA which is one published in Chest Journal, October 2005, http://chestjournal.chestpubs.org/content/128/4/2130.long.
In this study, the authors discuss previous studies of PSA and write, "Prior studies have classified positional sleep apnea as an AHI in the supine posture that was twice that in the nonsupine posture. Using this definition, approximately 50 to 60% of patients with sleep apnea were classified as positional. When we utilized this definition, 143 of 248 evaluable patients (57.7%; 95% CI, 51.5 to 63.8%) met the definition for positional sleep apnea, ".
So using the most common definition of PSA, it has been found that roughly 50 - 60% of patients meet the criteria. That would mean that 40% or more do not meet the definition.
If you read the Chest Journal study, you will see that the authors propose a more strict definition for PSA in which many fewer patients meet the criteria and many more patients would be considered to have non-positional sleep apnea.
One big disappointment that I have personally experienced with two certified sleep labs and several sleep doctors, is the total lack of consideration of whether the patient has PSA, whether the patient could be treated with positional therapy alone, and whether patients with titrated pressures above 10 could be treated with lower pressures in conjunction with positional therapy. In discussion with hundreds of patients, it has been very rare to find ones who know whether they have PSA and what the implications for treatment are. The professional field has a long way to go.
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Thank you for that study rooster. Under those guidelines I do not believe that current studies allow enough time to correctly Dx PSA.
Rooster said:
Rock Hinkle said:The term "positional apnea" still makes me giggle. In 99.9% of the apneac cases I have seen events have been worse in the supine position. This is the normal nature of apnea due to gravity and muscle atonia being the biggest culprit. I could see coming up with a name for apnea being worse in the lateral position. This would truly be "positional apnea". Supine apnea is just apnea.
If I remember correctly from earlier threads, you have not read any of the literature on Positional Sleep Apnea (PSA). You then may be interested to read the most often referred to medical study on PSA which is one published in Chest Journal, October 2005, http://chestjournal.chestpubs.org/content/128/4/2130.long.
In this study, the authors discuss previous studies of PSA and write, "Prior studies have classified positional sleep apnea as an AHI in the supine posture that was twice that in the nonsupine posture. Using this definition, approximately 50 to 60% of patients with sleep apnea were classified as positional. When we utilized this definition, 143 of 248 evaluable patients (57.7%; 95% CI, 51.5 to 63.8%) met the definition for positional sleep apnea, ".
So using the most common definition of PSA, it has been found that roughly 50 - 60% of patients meet the criteria. That would mean that 40% or more do not meet the definition.
If you read the Chest Journal study, you will see that the authors propose a more strict definition for PSA in which many fewer patients meet the criteria and many more patients would be considered to have non-positional sleep apnea.
One big disappointment that I have personally experienced with two certified sleep labs and several sleep doctors, is the total lack of consideration of whether the patient has PSA, whether the patient could be treated with positional therapy alone, and whether patients with titrated pressures above 10 could be treated with lower pressures in conjunction with positional therapy. In discussion with hundreds of patients, it has been very rare to find ones who know whether they have PSA and what the implications for treatment are. The professional field has a long way to go.
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Hi Rooster, thanks for your patience.
Humidifier: Yes, I've experienced both extremes of humidity; too much, and not enough. I actually live east of Portland and we don't get much rain out here, so relative humidity in my room stays 30-40% most of the time.
Yes, I have been experimenting with raising the head of my bed, and it does help minimize the acid reflux. But it also exacerbates the issue of my head rocking downwards towards my chest and closing the airway when I relax to sleep - being limited to sleeping on my back definitely is a contributing factor. (I like the idea mentioned elsewhere here of wearing a C-collar, and might give that a try.)
I don't experience acid reflux when I sleep without PAP, so hopefully the esophageal sphincters are not permanently damaged.
The problem remains that the air rushing through my nasal cavity seems to make it produce more mucus, and that plugs it up so I can't sleep, and contributes to the acid reflux problem.
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