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+--- Thread: Sinus infection / recovering from surgery (/Thread-Sinus-infection-recovering-from-surgery)
Sinus infection / recovering from surgery - rpierce - 08-24-2023
Background: CSA-CSR diagnosis. My lab sleep study AHI was 112, and during CPAP titration at 14 cmH20, my AHI went down to 4.2. I used the machine for 15 days, initially experiencing severe aerophagia, which was substantially reduced by a sleep tech suggesting I change EPR from Level 1, Ramp to Level 2, Full. I seemed to be having an AHI of around 15.
Regarding apnea, I typically have a whole string of CA events right as I'm falling asleep, and when I wake up in the night and try to go back to sleep. Usually, once I'm out, it's largely smooth sailing, with events in normal range. While getting to sleep, I am actually somewhat conscious and aware during some of these events. It feels like I'm consciously controlling my breathing when I go on the machine, and there's some glitches as I go to sleep; sometimes I retain consciousness of them, waking enough to think, hey I need to breathe.
I've been experiencing chronic sinus infections pretty much all my life. My new sinus doctor had me do saline irrigations daily (I already was doing those) and put me on Flonase at night. (It helped open things up but didn't change the sinus infections.) Antibiotics (Cefdinir) didn't seem to help. I had an allergist referral, and a skin test showed dust, cat, and birch pollen allergies. Blood work showed low antibody titers for HIB and pneumo. She put me on Allegra, which didn't seem to do anything. I don't have carpet in my bedroom. But when travelling, I frequently don't get improvements, so I don't think it's environmental allergies causing this. So we scheduled sinus surgery for July 28. I also had HIB and pneumovax shots on Aug 14.
I had endoscopic sinus surgery, including enlarging openings to the cheek sinuses, turbinate reduction, and deviated septum repair. As of tomorrow, I'll be 4 weeks post-op. The good news: it feels like I have so much more space in my nose and I can generally breathe far more freely. The bad news: I still have elevated mucous production and post-nasal drainage. Some of this I attributed to the surgery recovery and the packing that was in there, but that was all cleaned out as of the 2 week post-op visit. As of Aug 18, I was seeing bits of blood and discolored snot when blowing my nose after irrigating, which is still persisting, and that made me think I have a sinus infection. My throat became increasingly irritated. It feels like the irrigation (using a squeeze bottle) is only flushing the front of my nose, and that there's a bunch of stuff at the back of my throat above my soft palette that won't go away. I'm wiling to consider that maybe this is a common cold, or still surgical recovery, and it will get better if I give it time, but it's nearly 4 weeks post-op and I'm starting to worry.
I resumed CPAP 3 weeks post-op as per the surgeon's requirements. The good news is that AHI seems down. It's now between 5-10, except for one good night where AHI was 3.87. Chart is attached.
For that good night (Aug 21): The differences here were: I was utterly exhausted when going to bed, so I went out like a light without too many CA events. And while I did wake up a few times (after 2:00, 3:30), I convinced myself to go back to sleep. I woke again after 4:30 and had some difficulty getting back to sleep (and there is my characteristic cluster of CA events, but that's about the only time that night I had a lot) and I think I also woke around 6:30 and attempted to get back to sleep.
On Aug 22, I had a sleep tech follow-up. As I noted feelings of aerophagia when I was mouth breathing, she wanted to increase the EPR Level to 3. We also raised the ramp start level to 5 and changed the therapy range from 5-15 to 6-15 so I could get some EPR relief initially. (The machine's floor pressure is 4, so when I start a ramp, it's as if EPR is off, and when I hit therapy pressure in 5 minutes, I'm only getting 1 cm relief, which doesn't feel good for nose breathing.)
With my sinus issues, I'm getting liquid (probably residual saline and mucous) shoot down the back of my throat when going on pressure. While I can swallow that down, I'm left with an awful feeling that the back of my throat is irritated, something is still there, and I need to keep swallowing. Attempting to swallow/clear my throat while on the mask is really stressful and keeps me from going to sleep rapidly. I'm trying to convince myself nothing is there, don't swallow. Still, it feels like torture.
I'm including last night (Aug 23) as a comparison for a bad night. While I still had sinus drainage problems on both nights, extreme tiredness meant I went out quickly hence didn't have time to focus on it on the 21st, but that wasn't the case for the 23rd. (Paradoxically, CPAP is working, I'm less tired during the day, but it means that come bedtime, I'm not ridiculously tired.) It took a while to get to sleep, with a string of lots of CA's. I woke several times and tried to go back to sleep, resulting in more strings of CA's.
One common problem is that around 4:30 am each night, my nose seems more clogged and it's hard to breathe through it. I wake up and try to go back to sleep. Sometimes I adjust the mask. It puts pressure upwards on my nose. This can cause pain (I have a septum piercing and wear a retainer, which makes the area extra tender) but it also makes nose breathing, particularly exhaling, harder. When the machine starts cranking up the pressure, I find loosening the straps helps, since the pressure pushes the rubber seal harder. Sometimes, it helps me breathe through my nose easier. But it isn't always successful, and I'm reluctant to mouth breathe because of aerophagia. I'm wondering if, at this time of night, the Flonase is wearing off and/or I have more mucous built up. I eventually got up around 4:45, tried to blow my nose, drink water, and it took a bit to get back to sleep.
My sleep tech is telling me that my AHI trend is in the right direction after surgery. She says central apnea may improve with time on CPAP. But it might not. After 6 more weeks, if I'm still stuck in the AHI 5-10 range, they'll bring me in for another sleep study and titration on an ASV machine.
I feel like I'm generally adapting well to CPAP therapy, if it wasn't for the [expletive deleted] sinus drainage issues! I really have to wonder what my AHI would be if I wasn't fighting with my throat and the mask tightness due to difficult nose breathing. Does anyone have any thoughts or advice?