[CPAP] Can't get to the bottom of my congestion.

[G. Szabo]

Conversely, do not hesitate to share the tips and tests that you will continue to do to try to escape from the hell of a blocked nose, whether the results are positive or negative.

I have been having a similar issue. My nostrils started getting blocked about two hours after PAP treatment, and the blockade became gradually worse. I need to get up after four hours because of suffocation. Then my nose get spontaneously degongested about 5-10 minutes. I go back to sleep to start the cycle again. 

I side sleep to mitigate OAs. I use an under-the-nose nasal mask,  N30i, and a hypo-allergic filter on my APAP instrument, heated hose,  and humidity chamber. I clean my nose by injecting a salt solution into it every evening. 

My observation is that the pilow attachment of M30i makes the situation worse (because the pillow injects the air deep inside and dries out the turbines). Hence, I am using its cradle version. The higher the humidity, the later the congestion starts.

I definitely do not want to use any corticosteroids because they have adverse effects on some other conditions. The oxymetazoline nasal spray is not a corticosteroid but is not recommended for continuous usage. I have ordered a hyaluronic acid-containing spray and will report the results here.   

The only solution I could use successfully is the Alaxo nasal stent. But it takes some time to learn how to insert and tolerate it.

[Anewser]

Thank you very much for your feedback. I didn't know this product at all. I went to see on their website, unfortunately the price seems totally abused (800 to 1000 dollars !). I just ordered a kit of nasal tubes in PVC on aliexpress for less than 28 euros (with several different thicknesses and lengths). The problem with tubes and stents is that they inevitably cause inflammation of the sinuses.

A few months ago, I discovered "nesivine", a decongestant spray based on oxymetazoline which is very effective. It completely unclogs my nose and I can finally breathe for several hours before hell starts again. As you mentioned, this spray unfortunately cannot be used continuously and in the long term because of its harmful effects on health and its dependent effect (nose that is always blocked + and/or risk of stroke/embolism).
I use the product for teenagers 2X less dosed than the one for adults with either 2 sprays in each nostril, or 1 in the open nostril, and 2 in the blocked nostril. It works completely after 20 minutes at home. With the downside = blocked nose part of the day. I use it 1 night out of 2 or 3.

I noticed an important thing knowing that I am testing a Bipap with fixed pressure on inspiration and expiration, instead of a CPAP for several weeks. Even using a nasal spray that completely unblocks my nose, my hell remains the same: I sleep well 4 hours max with few apneas/hypopneas (1-3/h with the new machine + spray). And from the first wake-up = impossible to fall back to sleep because I have apnea peaks 20-25/h) even with the nose unblocked.
The reason for this hell = I systematically wake up with the back of my tongue stuck/suctioned to the back of my palate = I can no longer breathe despite the CPAP. I try to sleep by sticking my tongue out a few centimeters that I pinch between my teeth and I block my cervical and jaw with lots of clothes. I wonder if with a few hours of sleep, the muscle tone is not the same = the muscles of my tongue/cervical/mouth are contracted in different ways. Even increasing my CPAP pressure does not solve the problem.

Also for the blocked nose, it is really a very common symptom among Sahos. I after several videos that I have seen, it can also be due to the fact that breathing in our case is no longer done in a laminar manner, but in a turbulent manner due to our pharyngo laryngeal narrowing (narrowed palate, obstructing tongue etc.). So, instead of the air coming directly into the lungs when breathing, we really have to force ourselves harder to breathe = we suffocate + the nasal mucosa becomes inflamed much more easily because the air enters under high pressure = the nose gets blocked. (cf attached image).

I had an endoscopy under induced sleep which did not show the slightest problem with my nose/palate. Only an obstructing tongue base = I have an OAM which will be ready in 5 weeks. The video is only 3 minutes long so not enough time to see the moment when my nose gets blocked.

I saw that this problem was even more common for nasal masks because the air is propelled directly into the nose which attacks it even more and requires even more humidity.

[G. Szabo]

I saw that this problem was even more common for nasal masks because the air is propelled directly into the nose which attacks it even more and requires even more humidity.

Indeed, there is a vicious cycle. The worse the congestion, the higher the pressure the APAP delivers, leading to increased airflow, which dries the turbines further. The turbines swell to cope with the increased moisture demand, further restricting the flow. 

It is revealing that the congestion disappears after 10 minutes of waking up and never returns during the day. Some people believe that this is associated with the increased blood flow in the nose when one is in a horizontal position. Others claim that side sleep prevents the natural flow of mucus back to the larynx, and the mucus accumulates. 

Now, let me try to address your tongue problem: Try to sleep strictly on your side and tape your mouth. In this manner, the tongue assumes its natural position. 

I agree that the stent is expensive and takes a long time to tolerate. Therefore, I have been seeking simpler alternatives. So far, I have found the following things:

(I) a hyaluronic acid-containing spray (HylaMist). It helps to prolong congestion. I applied it three times in each nosehole before putting the mask on and reapplying it when I woke up during the night. It is a harmless spray; one can use it forever. 

(ii) TURBINE (trademark) by RHINOMED. You can order a sizing kit. I use the largest one because it goes deep into your nose. It definitely works and is more effective than those external nose-expanding tapes. It is expensive, but I can order similar low-cost replicas with the same structure based on its success.  

(iii) I run the instrument and the heated hose under rainout conditions to ensure maximum moisture.   

I will post a product review about my experience so one can find these items more quickly.

[SeePak]

kwhen

nasal plugging?

Mouth Breathing !!


answer:

Patrick McKeown !

Check him out !!

[SeePak]

aenswer


air comes into lungs a la Diaphragm !

Slower flow thru rest of airways = less suction

Check out Patrick McKeown !

Breathe Light, Slow, Deep

[SeePak]

Hey Yeliad.
Check out Patrick McKeown on the internet , nasal breathing.

And, Light, Slow, Deep breathing, most importantly.

He has all the science for nasal breathing advantages.

Mouth open while sleeping, or any time during the day can be a problem.

Gotta try it to see.

I had results in a couple days employing ALL DAY, ALL Times nasal breathing.
Getting rid of huge amount of anxiety and procrastination!

You have nothing to lose to try it!

Getting the diaphragm in shape is a super strong feeling that will naturally develop as you get the breathing down.

That transfers to your whole psyche, at least it did for me !

Solidifies the whole body.

Good Luck, you owe yourself to check it out.

[G. Szabo]

Mouth open while sleeping, or any time during the day can be a problem.

We have received your messages, needless to send them once more.
To clarify, I am a nasal breather all day and night. I can breathe deep and long through my nose as many times as I want,  as I have done many times, and I have no problem with it. 
Nevertheless, I have congestion during the night. 
Your suggestion is not for all of us.

[SeePak]

Yes you're very lucky Szabo.

If you can clear your nose once it's plugged that's awesome!

Those others of us aren't as lucky and there's some awesome breathing exercises that can help unplug and mostly keep the nose unplugged if a person is a mouth breather.

For those who need it they should check out Patrick McKeown.