Is PAP therapy alone effective with chronic nasal congestion?

[Audio_mc]

If the main cause of sleep apnea is due to nasal chronic nasal congestion, can pap therapy alone even work efficiently?

[Goofproof]

1. It's not the major cause, and i've had nasal congestion for over 20 years XPAP has not made it worse. However, I have less when in bed using my XPAP. Jim

[jnk...]

main cause

Not generally considered a meaningful phrase in the context of OSA. That is because anything that affects breathing affects sleep in untreated OSA. All factors interact one way or the other in varying amounts moment to moment.

chronic nasal congestion,

May be caused by untreated OSA. May make untreated OSA worse. No one has perfect nasal health and conditions every night. There are always seasonal variations and variations night to night. But most OSA diagnoses are single-night snapshots of a moment in time for each individual patient.

pap therapy alone even work efficiently?

PAP can improve nasal issues at the same time that it prevents airway narrowing. And APAP can adjust its pressure during any momentary increase in nasal congestion and still react accurately in a timely way to any indications of impending narrowing in other areas of the airway.

Did I come anywhere close to addressing your underlying concern(s)?

[Audio_mc]

Yes Thank you both for your feedback!

[tyrone747]

A related question, can nasal congestion alone cause a sleep lab diagnosis of sleep apnea? A deviated septum is a contributing factor. Or would the doctor be able to see your airway somewhere downstream of your nose is closing based on the data? I just sometimes worry I'm wearing this mask when all I need is a good clear nose.

[jnk...]

can nasal congestion alone cause a sleep lab diagnosis of sleep apnea?

No. More is needed for a diagnosis. Sinus issues can at times cause someone to inch barely across the 5 AHI diagnostic line that allows someone to try PAP, but I would consider that rare. For such low AHI people, symptoms of bad sleep over time are a significant part of the diagnosis anyway, and our sinuses are what they are.

A deviated septum

No one has a perfectly aligned septum. If it is way out of whack, fixing it can make PAP easier, though.

sometimes worry I'm wearing this mask when all I need is a good clear nose.

I get the thought. But PAP is much more natural and effective than anything else medical that would treat sinuses. And sleep is too important to play around with, for reasons of safety and overall quality of health and life.

[prodigyplace]

A related question, can nasal congestion alone cause a sleep lab diagnosis of sleep apnea? A deviated septum is a contributing factor. Or would the doctor be able to see your airway somewhere downstream of your nose is closing based on the data? I just sometimes worry I'm wearing this mask when all I need is a good clear nose.

This sounds similar to me. CPAP has helped a lot and I actually use a nasal pillow mask.

[ChicagoGranny]

can nasal congestion alone cause a sleep lab diagnosis of sleep apnea?

No. The nasal passages could be completely blocked, and the mouth would just open reflexively to breathe.

With obstructive sleep apnea, the blockages are in the oropharynx, with extension to the laryngopharynx common. https://youtu.be/z12MEPiG4cg?t=112

[jnk...]

The connection, as I understand it, is that narrowed nasal passages during nose-breathing can increase the amount of negative force generated during inspiration.

Narrowing a wet paper straw at any location along its length increases likelihood of narrowing at other locations as well.

[ChicagoGranny]

The connection, as I understand it, is that narrowed nasal passages during nose-breathing can increase the amount of negative force generated during inspiration.

Of course, anyone with chronic nasal congestions should get to an ENT/allergist and get a treatment or correction plan. It's a quality-of-life decision. Even more important for someone with sleep apnea. Don't just let it go on. (Sorry, Nike.)

[jnk...]

All good points, CG.

I like the way this summary put things so succinctly about theories on the connection, in harmony with CG's statements:

The primary determinant of upper airway patency is the balance of forces between the negative pressure within the pharynx during inspiration and the counteracting force of upper airway dilator muscles, principally the genioglossus. The upper airway has also been described as behaving like a Starling resistor. This model views the upper airway as a hollow tube with a partial obstruction at the inlet, corresponding to the nose, and a collapsible section downstream, corresponding to the oropharynx. According to this model, when air is drawn through the narrowed inlet, greater suction forces are generated downstream and may contribute to the collapsing forces that affect the collapsible segment. Thus, when nasal obstruction develops, the downstream collapsibility of the oropharynx may be increased. However, there are a number of factors that reduce the significance of this upstream resistance on oropharyngeal collapsibility, not least the fact that the mouth represents an alternative route of breathing that can come into play when nasal resistance exceeds a critical point. -- "The nose and OSA: variable nasal obstruction may be more important in pathophysiology than fixed obstruction," W. T. McNicholas, European Respiratory Journal Jul 2008, 32 (1) 3-8; DOI: 10.1183/09031936.00050208 -- https://erj.ersjournals.com/content/32/1/3

[tyrone747]

So it seems that if you have a nasal restriction like congestion or a badly deviated septum a full face mask is a must? You need to be able to mouth breath if the nasal nasal resistance exceeds the critical point.

[ChicagoGranny]

You need to be able to mouth breath if the nasal nasal resistance exceeds the critical point.

This thinking is too complicated for me. Make it easier.

"You need to be able to mouth breathe if you can't get enough air through your nasal passages."

[jnk...]

So it seems that if you have a nasal restriction like congestion or a badly deviated septum a full face mask is a must? You need to be able to mouth breath if the nasal nasal resistance exceeds the critical point.

Some might argue the exact opposite for day-to-day use, since the nasal mask can help correct some of the issues. Remember, PAP machines can filter the air and customize humidity as pressure is applied directly into the nose to expand some fleshy parts to overcome limitations of anatomy and nasal condition while simultaneously encouraging nose-breathing. But, yes, a FFM in a drawer, just in case, may come in handy, if application of PAP with a nasal mask ever does not overcome blockage sufficiently on a given night. Personally, I have found that a nasal-pillows mask, with patience and effort on my part, and occasionally generic Flonase, is almost always able to correct congestion enough for me to make my use of the nasal mask possible and preferable at all times. Your mileage may vary. Please note that it is the nasal PILLOWS masks I find most effective, since the pressure inside the nostrils becomes higher than the pressure outside the nostrils. My nose partially "inflates" in a way with nasal pillows that it does not with other forms of nasal masks. That experience may be unique to me; I don't know. I am unaware of anything authoritative published on that distinction.

[prodigyplace]

So it seems that if you have a nasal restriction like congestion or a badly deviated septum a full face mask is a must? You need to be able to mouth breath if the nasal nasal resistance exceeds the critical point.

Not really. I have both and have been using a P10 nasal pillow mask the past 2 years except for about 1 day a year where I was too congested to use the mask.
I have not found a suitable backup full face mask in the few I have tried.