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Sleep Disorders

Nostril Burning Pain and Swelling

01/26/2010

Question:

I am trying to adjust to a bi pap machine with nasal pillow at night for sleep apnea. The mask fits fine. I am a nose breather and stomach sleeper. In a two week period, I have only been able to get through one night with the mask without nasal discomfort. (mostly left nostril) On another night, I decided to "tough" it out in spite of the discomfort, but had swelling on the left side of the nose up toward the eye and a bit of blood when I tried to blow the nose. I also take 2 liters of oxygen with it. It does have a water reservoir to prevent dryness. Also, I do not have a drainage problem. Is there anything I can do to alleviate the discomfort from this nightly procedure? Thank you

Answer:

It’s not clear to me from your question if your problem is primarily one of local discomfort from the nasal pillows irritating the nares or more one of nasal congestion. Further history will be needed to sort this out. However, I can provide you with some advice and maybe you can find this useful.

If it is primarily a problem of irritation of the nares, then there are a few options. For some individuals, using a mild lubricant to keep the nares protected can be helpful. This should only be in the form of a salt water (saline) gel such as Ayr nasal gel. Do not put vaseline or any other petroleum based lubricant in your nares as this can lead to lung problems. If this fails to help, then either resizing the nasal pillows or switching to a different interface (nasal mask, full face mask or oral interface) might be needed.

If you problem is more one of nasal congestion, then this might require a different approach. Nasal congestion is commonly associated with sleep apnea and may be part of the symptom complex of sleep apnea or a direct result of the treatment. When acute nasal congestion arises in an individual already on CPAP/Bipap therapy for sleep apnea, it can become a major problem and limit use of the CPAP/Bipap device. Acute congestion most commonly accompanies an upper respiratory tract infection or allergies. Treatment to minimize nasal congestion in this case will depend on the specific underlying cause (i.e. decongestants for a cold, antihistamines or nasal steroid sprays for allergies). For more chronic congestion, heated humidification with CPAP/Bipap is often beneficial (this may also help in acute congestion). If this doesn’t work, then nasal steroids may be needed to alleviate the congestion. In some cases, switching to an alternative CPAP interface (either a nasal mask, full face mask or oral interface) or an alternative treatment (such as surgery or the use of an oral appliance) is required.

You should discuss the above options with your Sleep Physician to determine which will be best suited for you. Helping you to use your Bipap should be a priority and can usually be managed with one or more of the above measures.

To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine's website at www.aasmnet.org. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. Good luck and here's to good sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University