The Nose Is Weirder Than We Thought

[paulag1955]

I noticed that as well.

[Lucid]

This question of the neti pot is going to bother me until I either go down a rabbit hole of nasal and sinus anatomy  or someone posts a link to an explainer.  My initial google search didn't turn up anything clearly showing where is the connection that the neti pot uses.  

[Lucid]

Here's a video tour of your nose!

https://www.youtube.com/watch?v=m5vDsPUp...20nostrils.

[Bhante]

It gets even weirder!

The left and right sides of the lower part of the nose are flexible, and can either be relatively open (more airflow) or relatively closed (constricted airflow). Some people (maybe everybody some of the time?) sometimes have problems with congested breathing simply as a result of this "flap" - which is effectively what it is - being closed. Furthermore my observation is that sometimes this can be caused by excessively high pressure on the CPAP (in my case there was a simple solution: handcuff the CPAP with a restrictive pressure range to prevent the naughty machine from escalating pressure beyond the limits that I set; this may or may not be a viable option for someone else). I have also found that excessive humidity - beyond a certain (pretty high) limit - causes congestion and increased apneas (i.e. the flaps close). Just very slightly reducing humidity completely resolves that problem. 

There are several muscles inside the nose that control these two flaps, opening them or closing them as required. (NOTE: The above linked article seems to be talking about the movement of these two flaps, namely the lower flexible outer walls of both nostrils, opening and closing to cause either clear airflow or congestion respectively; I leave this open in case there is some other mechanism that I am not aware of in addition to this). These muscles are controlled by the sympathetic nervous system, like the heart rate for example - which in simple terms means that it is not normally under direct intentional control. Nevertheless, like heart rate, it is possible to learn techniques for influencing it indirectly. Indian yogis have learned to gain conscious [indirect] control over this movement, and masters of the technique can for example at will breath in through one nostril and out through the other, and switch at will (without needing the assistance of a stick under the arm! The stick is probably only an aid to learning the technique). 

There is one simple technique you can use to experiment with this, and hopefully experience for yourself the opening and closing of the nostrils and the effect on air flow. Whilst you can easily try this for the first time either at times you are experiencing congestion or at times you are not experiencing congestion, in order to learn how to be able to open the nostrils I would recommend trying it many times both with and without congestion. First learn how you can change the shape of the nose using only facial muscles, then try to perfect the opening and closing of the nostrils, then practice frequently until you can change the opening easily and fluently, and finally try to maintain relative awareness of the nostril state as much as possible throughout waking hours, deliberately opening them whenever they are constricted. PRACTICE MAKES PERFECT!!! In the context of sleep apnea we are only interested in opening the nostrils when they are closed, not closing them when they are open. It may conceivably be harmful to develop a habit of closing the nostrils deliberately (since we cannot predict whether or not we are likely to repeat the habit in our sleep), so concentrate only on developing the skill to open them. Nevertheless, don't let that put you off experimenting with muscle movements that both open and close the nostrils, because that is essential for learning indirect control over them; it is only the HABIT of closing them that I would discourage. 

The very first step is to gain familiarity with the parts of the anatomy we are interested in. With a mirror close to the face, take short sharp in and out breaths while watching the nostrils. See how the sides of the nostrils are sucked in slightly during a short sharp in breath, and out during a short sharp out breath. Try to be aware of the physical sensations of the movement of the walls of the nostrils, and try to be as familiar as possible with that sensation - that will help you practice at any time without a mirror, including in the middle of the night at any time you feel congested. You can also place the index finger and thumb very very lightly above the lower part of the nose - BARELY in contact - (try experimenting with various different locations from below the bridge right down to below the nostrils, to gain more awareness of the movement). 

The next step is to "wrinkle up your nose", "screw up your nose", and generally experiment with all kinds of movements and distortions of your face (especially around the mouth, lips, cheeks and nose) and observe how this affects the shape of your nose. Observe which facial distortions cause the nostrils to open up, and which don't. It is especially beneficial to do this experimentation at times when you feel congested (i.e. the nostrils are closed), as every facial distortion that opens the nostrils immediately opens up the airways, and therefore is easier to notice as such. Obviously, this includes while you are in bed trying to sleep and are disturbed by a congested nose - hence the importance of awareness of the physical sensations of the nose and the sensation of the nostrils opening and closing. Equally it is especially beneficial to PRACTICE developing awareness of the physical state of the nostrils (open vs. closed) at any time throughout the day and throughout wakeful times during the night. 

Especially try to find facial movements that "lift upwards" the cheeks and/or nose - thereby you are likely to find facial movements that open the nostrils. Until you do find movements that open the nostrils, keep on experimenting with distorting the face in every way you can imagine until you start having success. Imagine making nasty faces, funny faces, inquisative faces, squeezing the upper lips upwards towards the nostrils (centred, left or right), and all other distortions. Once you find something with a positive effect it is relatively easy to develop it further through experimentation. 

The next step is to practice trying to open the nostrils while trying to minimise as much as possible the movement of the rest of the face. Initially you probably have to make quite extreme movements of the face to get the nostrils to open, but once you start developing movements with a positive effect you can quickly learn to open the nostrils with less extreme movements. Very important is to try to feel the movement of the muscles in the nose, and the movement of the sides in and out. 

After that, it is essential to practice, practice, practice, and try and develop both (a) the ability to open the nostrils at any time by changing the shape of the face, or preferably small parts of the face; and (b) AWARENESS at different times of the state of open-ness or closed-ness of the nostrils, and awareness of the sensation of the muscles in the nose and movement of the nostrils. 

Does what I described above help if you have a problem with congestion (that is not linked to colds/flue/allergy etc) during the sleep that increases apneas? Maybe!! An indication in favour (but not conclusive proof) - about 15 years ago when I first started using CPAP devices I had this problem. I did try special plasters on the nose that are supposed to hold the nostrils open, but had only limited benefit from the plasters and they caused big problems of air leaks. When I tried the above technique (my own idea!) I gradually learnt how to open my nostrils up at those times when I had problems. I use exclusively full-face masks, with which facial distortions especially tend to increase leakage, but by learning to open the nostrils with minimal facial distortion I learnt to get better results. At the time I reasoned that the central problem was how to transfer the ability to open the nostrils consciously and deliberately while awake, to a tendency to keep the nostrils open while actually asleep. If that transition is possible at all, then almost certainly the development of a well-established habit would be required, and that is what I set out to try and do. I also made an effort to maximise my ability to be aware of the state of the nostrils and of the sensation of the movement. Especially, conscious awareness whenever there is a constriction so that a conscious effort can be made to overcome it. 

The first benefit is that when waking up in the middle of the night as a result of closed nostrils causing congestion and apnea, you can deliberately open the nostrils and make it easier to get back to sleep. That benefit is definitely true, there is no doubt about it.

Is it possible to translate that benefit to keeping the breathing uncongested during sleep? That is unproven. But I can say that after practicing this technique for some time, the problem disappeared. COMPLETELY. And in well over a decade it NEVER ONCE CAME BACK! That is no proof, it is always possible there was some other quite different factor which resolved the problem. But I believe it helped me. Note that once the problem was resolved I forgot about it - I didn't need to keep on deliberately enhancing my awareness of the state of my nostrils at any moment - I seem to have developed and internalised at a sub-conscious level a habit of maintaining a low level watch over my nostril condition and responding to it directly whenever it needed influence. 

If you have a problem of congestion while sleeping (unrelated to colds etc) and decide to practice this technique, don't expect immediate results, it won't happen (except getting back to sleep more easily) - you have to develop a habit and awareness first, which takes time. But if you persist in practicing it over a decent period of time, do post a comment below (whether with or without success). If the problem does indeed go away more effectively for those who practice this technique compared to those who don't, then in that case that ought to be a strong indication that it really can beneficially affect nasal congestion during sleep. Don't forget my emphasis on AWARENESS - that is an essential part of the process!

[Bhante]

Here's a video tour of your nose!

https://www.youtube.com/watch?v=m5vDsPUpOGg

As you can see from the video, the statement that the two sides are not connected is completely false, as both sides lead to a single big cavity behind the nostrils. That cavity is above the soft palate, which is the upper rear part of the mouth. Obviously that cavity is in turn linked with the mouth cavity.

[Lucid]

Hi, Bhante

I've been away from my computer for a few weeks and just read your post.  Thanks very much for this detailed practical information, which I will try out.

Another thing I found interesting about the article was that people with deviated septums often feel that the wider nostril is the more constricted one, and ENTs still don't understand why.  This confirms my own experience.  Have you (or other readers) ever experienced that?