I've been dealing with my own bugaboo on this issue since the trees started pollinating in Buffalo back in March. Pre-CPAP, I'd have the sniffles and sneezles from the time trees started pollinating through the first good killer frost in the fall that would finally kill off the ragweed. My allergies are NOT major: Prior to CPAP, I'd be able to take OTC antihistamines on the worst days and simply ignore the minor congestion and minor sinus pain that would be around most days during growing season.
But with CPAP, I've found that I have to have a zero tolerance policy towards the nasal congestion triggered by my rather mild-to-moderate hayfever. When I'm congested, I find that the BiPAP's Auto algorithm frequently increases the pressures up to my max level of 8/6, which triggers more problems with aerophagia. And even more distrubing, increased nasal congestion seems to be correlated with increased AHI's---as in I'm more likely to have AHI's in the 3--4 range instead of the 1--2 range where I seem to feel better. I also think the increased nasal congestion seems to indicate that I've got some system-wide inflammation issues since the hand/foot pain seems to return whenever I have two or three days in a row with AHI's that are above 2.5. Hence the need for the zero tolerance policy towards the congestion.
What works for me is a three pronged approach and the timing of the parts of nasal hygiene are as important as the parts themselves:
- Early AM: I need to take half of a standard OTC Zytex every morning. The full Zyrtex was triggering too many problems with dry mouth and Allegra and Claritin just don't seem to get the job done.
- Late Afternoon or Early Evening: I try to do a saline nasal/sinus rinse (with a NeilMed Sinus Rinse bottle). On days with low pollen counts, it's not so critical. But if I've been outside working in the yard or if I've had a bike ride, it helps a lot. And on high pollen count days, it seems to be critical. But I also have to get this done several HOURS before bedtime since the sinus rinse seems to temporarily swell my nasal membraines slightly. It also allows plenty of time for drainage before bedtime.
- Bedtime: Two squirts of Flonase in each nostril. The new sleep doc prescribed this, and it's become a powerful ally in my battle to get my insomnia monster fully under contol so that the BiPAP can do its job every night.
Two good links for learning more about the importance of dealing with the congestion when you are on CPAP include:
- Nasal Breathing Video Series is from Dr. Barry Krakow's web pages
- Unstuff Your Stuffy Nose is from Dr. Steven Y. Park's web pages. Dr. Park is a forum member overat cpaptalk.com who posts under the name sypark
Question about the nightly use of Flonase. At some point, doesn't constant use of a nasal spray create it's own set of problems?
ReplyDeleteConstant use of an OTC decongestant spray will QUICKLY trigger serious problems with rebound congestion. That's why the all carry a warning to not use the past three days.
DeleteOTC saline sprays are generally recognized as safe to use on a daily basis. And for most people the cause no problems with rebound congestion. Same thing with neti pots and sinus rinses.
As for prescription nasal steroid sprays such as Flonase: These sprays do not directly treat the congestion by blocking the histamine reaction like an antihistamine nor do they instantly shrink the swollen tissues the way a decongestant does. Rather, over the long term they reduce the swelling and inflammation in the nasal passages. They are not designed for short term symptom relief, and the patient information packet says not to expect any improvement in symptoms for at least a week or two. Current medical thinking is that they need to be used every day (to be effective) and that they can be used every day for long periods of time without causing problems with rebound congestion