High Resp Rate / I:E Times / Sinus issues

[Jake B]

Hello again,

I'm back with another question/issue. After a short BiPAP break while seeing a few doctors to explore other options, I used my machine again last night (more on that in a sec).

My most recent doctor visit was to a previous Ear/Nose/Throat doctor who had performed a nose/sinus surgery on me about 7-8 years ago. To keep a long story short, I have still had ongoing sinus issues all these years and it turns out I might need a new nose surgery to fix something called Nasal Valve Collapse (google for more info). My doc has had me doing an experiment the past few days where I use Afrin nasal spray in addition to my usual Breathe-Right nasal strips. He says if this helps me breathe better through my nose, the surgery should help permanently. It absolutely helps me breathe better.

Now on to the BiPAP use last night. I wanted to see if I would sleep any better with the combination of my nose being wide open from the Afrin spray/nasal strips plus the air from the machine, but it seems this combo made some weird things happen.

1) The majority of the time, my inhalation times were well above my exhalation times. This is backwards of how it should be - I:E should be 1:2

2) My respiratory rate was fairly higher than normal. I was at around 23 while the normal should be 12-16.

3) Pressures and AHI weren't anything of note. IPAP was around 10-15 which is typical, and AHI was below 1 as usual.

   

   

   

It's increasingly looking like sleep apnea may not be the root cause of my sleep disturbances/tiredness/fatigue. As mentioned before I've been visiting different doctors and hopefully will soon get to the bottom of my issues. For now, I'd like some opinions from you all about my chart from last night.

Please let me know if I can provide any more information. I'm sort of typing this up quickly so I hope everything make sense. Thanks as always!

[Sleeprider]

If nasal congestion or valve collapse is increasing flow limitation as it appears, my recommendation is to try using Flonase for longer-term relief rather than Afrin which is known for a bad rebound effect and dependency. I also think using Afrin to prove NVC is bogus. If when you inhale hard the nose collapses in on itself, then NVC is a possibility, but this should not be affected by inflammation or congestion which is what Afrin or Flonase treat. I think your doctor is in the business of rotor rooting noses and is naturally inclined to find that problem. Also, you can greatly decrease any chance of NVC by using a nasal pillows mask, or if necessary a full-face hybrid that uses a nasal pillow to supply air and cover your mouth. This avoids the pressure on the outside of your nose of a conventional full face mask. Think about it. Not only does a full face mask put pressure on the sinuses from the cushion and frame, but the air pressure is also present outside the nose. If you already have nasal problem, this makes it much worse, while a nasal pillow actually inflates the nose from within.

You are more than welcome to purse the knife and rhinoplasty route, but there is an easier, less painful solution. We have seen in your other thread that with PS 4 you had good respiratory results and low flow limitation compared to this current chart, so I think the transient factor may be seasonal allergies. Flonase and a change in mask could solve this painlessly and effectively.

I want to encourage you to keep therapy threads together. You can certainly tell I have to cross-reference your other threads to put this conclusion together, and you would save me and other members a lot of work if you would just keep it together. Rarely is a problem like this an isolated topic that can be accurately viewed without considering your history, progress and other issues. I would like to merge this with the therapy thread where we could point out that your I:E issue and flow limit is new problem that was previously resolved. You are doing yourself a great disservice by jumping to this new conclusion because your doctor tweaked your nose and said you need surgery.