It is quite common, especially in the first several weeks, for patients on CPAP to experience a greater amount of nasal congestion than they are accustomed to.  This is primarily due to changes in humidity and nasal irritation due to the constant increased air pressure.  Also, "reflex" nasal congestion occurs as the body responds to air blowing into the lungs.  In addition, ear popping and ear discomfort are often reported side effects of CPAP.  Fortunately, all of these symptoms are transient in most patients.  Typically, their impact on a patient's comfort can be minimized by utilizing medications to reduce nasal swelling and irritation.

    Two prescription medicines that we usually recommend include a topical nasal corticosteroid such as Nasacort AQ or Rhinocort.  These medicines can be used once of twice daily, as directed.  Additionally, for severe nasal congestion, we recommend Afrin 12-Hour nasal spray used at bedtime, one hour before CPAP is administered.  It is important to note that if Afrin is used more than once daily, rebound nasal congestion is likely to occur.  The nasal corticosteroids can be used indefinitely and are not associated with rebound nasal congestions; however, there is a 2 - 5% incidence of minor nasal bleeding associated with their use.  A third nasal medication that we may prescribe is Atrovent, used primarily to control excess secretions.

    Maintaining the home humidity at 45 - 50% may also prevent nasal irritation.  A detailed handout regarding humidification is available from this office.  In addition, if nasal drying worsens, a special steam humidifier that attaches to your CPAP unit can be obtained through the Home Health Company that supplied your CPAP unit.  First, however, this office should be contacted so that the appropriate paperwork can be generated for purchase of the steam humidifier.

    Recurrent nasal congestion can interfere with the eventual acceptance of CPAP.  If the nasal problems cannot be resolved with treatment as described above, a minor nasal procedure may need to be performed in order to widen the nasal passages for optimum comfort and improved compliance with CPAP.  Please contact your physician if persistent nasal congestion interferes with you CPAP comfort.

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