Trouble tolerating CPAP while sick (cough, congestion, nose bleeds)

[ColoradoMom]

Using his CPAP machine while sick has been a real struggle for my teenage son. He has a nasty cough and he feels like his cough becomes much worse while using CPAP. Because of his nasal congestion he feels air starved while using his wisp mask. We tried decongestants, they helped with the nasal congestion but created new problems, now my son is having bloody noses and vomiting blood (the vomiting blood has happened before, it was the result of nighttime nosebleeds that drained into my son's stomach). For the nosebleeds we have tried a saline nasal gel and a room humidifier, but it hasn't seemed to help so far.

Any suggestions on things to try to help make CPAP more tolerable for my son while he is sick?

[Gideon]

Try increasing the humidity on the CPAP or decreasing it.  People respond differently.
I used to believe in an FFM for when you are sick but I find that if I "tough it out" for 5-10 minutes that the CPAP pressure itself will break thru my congestion.  Yes, it seems difficult to breathe when stuffed.  It is ok to assist with mouth breathing while the machine's pressure is "blowing thru" the congestion.  Another possibility is to use a FFM while "stuffed"

[CB91710]

I agree on the humidifier settings. That can have a big impact on both nosebleeds and congestion. I tend to get very congested if the setting is too low, and occasionally have evidence of nighttime nosebleeds.
Personally, I find the nasal masks (as opposed to nasal pillows) to feel restrictive because of the way they tend to pinch below the bridge. I do much better with nasal pillows.
The FFM may be a last resort, but generally ends up not being all that comfortable because it encourages mouth-breathing, which results in dry-mouth.

[Newbee2016]

Using his CPAP machine while sick has been a real struggle for my teenage son. He has a nasty cough and he feels like his cough becomes much worse while using CPAP. Because of his nasal congestion he feels air starved while using his wisp mask. We tried decongestants, they helped with the nasal congestion but created new problems, now my son is having bloody noses and vomiting blood (the vomiting blood has happened before, it was the result of nighttime nosebleeds that drained into my son's stomach). For the nosebleeds we have tried a saline nasal gel and a room humidifier, but it hasn't seemed to help so far.

Any suggestions on things to try to help make CPAP more tolerable for my son while he is sick?

I too suffered a bout of cold and was stuffed up with some cracked inner nostrils and minor bleeding recently. Try upping the "Humidifier" to 5, "Humidification" to Adaptive and (hopefully you have a heated hose) Tube Temp to 4. If that is still insufficient, then change "Humidification" to Fixed. 

If your son's room temp is high/warm then you may not need so high a tube temp setting as condensation would be lesser under Adaptive humidification setting. If humidification is Fixed, then chance of rain out would be higher, in which case you can up the tube temp.

[Fats Drywaller]

I agree with the suggestions about the machine's humidifier and its heater settings. Humidification is a biggie.

Also, do you have a full-face mask as an alternative to the Wisp? It seems to me that being able to breathe through the mouth but still get the CPAP pressure would be a good thing. I mean the full-face type, not necessarily the old style, literally full-face, that looks like a gas mask. FF these days really just means "covering mouth and nostrils".

Resmed FF: https://www.resmed.com/us/en/consumer/pr...face-masks

Philips FF: https://www.sleepapnea.com/products/masks/#full-tab

F&P FF: https://www.fphcare.com/us/homecare/slee...s/simplus/

[Walla Walla]

I would use a full face mask. Decongestants dry out the nasal airways and than the nasal masks on top of it will really dry them out. At least with the full face mask a person can mouth breath without leaks. Nasal pillows usually will help keep the airway clear without decongestants but if that's not working I'd go with the full face mask.

[ColoradoMom]

Thank you for the great suggestions! We tried increasing the humidity, it didn't seem to do the trick so tonight we'll try decreasing it. A heated hose is a great suggestion, I'll ask his doctor about prescribing one. My son tried nasal pillows during his titration. He did well with the pillows, but preferred the wisp because he found it to be more comfortable. How much better would pillows do at clearing the nasal airways? Would we be better of trying the pillows or just buying a full face mask as a backup for when his sinuses are messed up? If we go the full face mask route I'll likely have to pay out of pocket so our best is probably ordering one on line. My son isn't overweight, but he is really tall (6'6"). The biggest issue I foresee with the full face mask is leaks. My son has some facial hair (mustache and goatee) and he often sleeps on his side. Any suggestions on a full face mask that might work well for him? My son has asthma and allergies, so problems with nasal congestion and dryness are going to be on going.

[Walla Walla]

If you do go full face mask I'd recommend the Remed F20 Air Touch. If nasal pillows than the Resmed P10 Airfit. I have both and they work well for me. YMMV.

[Fats Drywaller]

About the choice of FF mask, I can't help so will leave that for others. But I do want to mention something in case you and your son hadn't thought of this: To test all of this stuff, mask choices and machine settings, it's not necessary to be sleeping. If you don't mind moving the machine around, you (I mean he) can use it while reading, watching TV, using the computer, etc.

Of course, to someone who has a cold or flu, that's not much comfort. "As if using it while I'm in bed isn't bad enough!"

If there's an insurance compliance requirement that you have to keep up with, then using the machine while awake, in the hours before bedtime, also helps with that, because those are logged as usage hours.

[Dyinginmysleep]

I went through a real struggle trying to get used to my cpap machine. Would get sinus infections on a regular basis plus attempting to sleep with the mask was near to impossible. Finally gave up, and only years later was i able to find a solution, and that solution was the amara view full face mask. Although not perfect, it finally allowed me to get used to the cpap even with sinus infections, stuffy nose, even colds.