By Joseph Kriainin, MD, FAASM
If you couldn’t tell by the coat of pollen on your car in the morning, spring is upon us and so is the season of maximum suffering for those with allergies. Environmental allergies to pollens and grasses are extraordinarily common and can interfere with your ability to use your CPAP. In this article I tackle the two most common allergy-related issues that CPAP users face and give you insider tips to stay consistent with your CPAP use.
Complaint: “Sneezing and a runny nose is making it hard to keep my mask on at night.”
Tip #1: Use a non-sedating antihistamine
Non-sedating histamines selectively work on the H-1 histamine receptor and include the following, all of which are now available over-the counter:
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Loratadine (Claritin, Alavert)
Stay away from the “D” or decongestant versions of these meds as they contain a drug that can increase your blood pressure and cause insomnia.
Avoid sedating antihistamines like diphenhydramine (Benadryl) that can both make you drowsy and have negative effects on your “sleep architecture,” reducing the percentage of time that you spend in deeper, more restorative stages of sleep during the night.
Tip #2: Reduce exposure: change your air filter, tubing, mask, and water tray regularly and make sure to clean your equipment frequently.
The air filter on your CPAP machine is the first line of defense in preventing pollens and other particulate matter from getting into your CPAP system. Pollen, dander, and other allergens can also accumulate over time in your mask, tubing, and water tray. It is generally recommended to change your air filter once a month. You should change your CPAP mask, tubing, and water tray at least twice a year.
Wash your CPAP mask, tubing, and water tray regularly at least once a week and 2-3 times a week would be best. If you clean your equipment manually, use warm, soapy water with a mild liquid detergent soap like Dawn. Avoid heavily perfumed soaps. There are also many automated CPAP cleaners now on the market. Beware, some of these cleaners can actually damage your CPAP machine and void its warranty. These CPAP cleaners are safe for your machine.
Tip #3: Wash your bedding
Allergy sufferers should wash all of their bedding – including pillows and comforters – in hot water on a regular basis. Dust mites are one of the most common allergens. They are ubiquitous (and really scary looking) but proliferate in warmer, more humid conditions so they tend to get really bad in spring.
Tip #4: Allergy shots
This is a longer-term play. Allergy shots involve slowly desensitizing your body to the allergens it’s most reactive to by repetitive exposure to minute amounts of the allergens. A course of allergy shots often takes months to years to complete and, in the beginning, involves frequent (at least weekly) visits to the allergist so make sure that you have the time and motivation before you embark on this step.
Complaint: “My nose is too stuffed up to use my CPAP.”
Nasal congestion due to allergies is a common problem that can negatively impact CPAP use. Here are some ways to combat nasal stuffiness.
Tip #5: Rinse and reduce inflammation
The cornerstone of treating chronic nasal congestion is nasal sinus rinse with a gentle saline solution, typically followed by an intranasal steroid. Some people call nasal saline rinse “the Neti pot,” but there are many different types of containers that can be used for this that are not pot-like. I recommend Neilmed’s product. You should use this in the evening, 30-60 minutes before bed. You don’t want to use it right before bed because the large volume of water involved in this process needs time to drain out of your sinuses and could cause major-league post-nasal drip.
There is a common misunderstanding about nasal saline rinse – it’s not “spot” treatment. You can’t just use it on occasion and expect good results. You need to use it consistently for it to really work. After about 2-3 weeks of regular use, your cilia (hair-like processes in the outer layer of your upper respiratory tract) will start functioning more effectively, whisking mucus out of your system.
For best results, after you’ve cleaned out your sinus passages, squirt an intranasal steroid up there to calm inflamed tissues that can clog up your nose and sinuses. Like the second-generation antihistamines, most of these are now available over-the-counter without a prescription including the following:
- Nasacort Allergy 24HR
Please note that intranasal steroids are completely different than nasal decongestants like Afrin. Nasal decongestants should generally be avoided due to their tendency to cause a “rebound” effect when the medication wears off whereby your nose becomes even more stuffed up than it was to begin with. This leads to a cycle of dependence on the nasal decongestant. Intranasal steroids are not associated with this problem.
Warning: Nasal saline rinse is not for everyone. It does kind of feel like you’re being waterboarded. But if you can power through the initial weirdness of it, many people get hooked on it over time. If you can’t tolerate the nasal saline rinse, just try the intranasal steroid, which is easy to tolerate. Like nasal saline rinse, intranasal steroids need a few weeks of continuous use to really hit their stride in terms of effectiveness.
Tip #6: Use mechanical devices to open up your nostrils
Breathe Right strips are bandage-looking devices that gently lift and open your nasal valves. Be careful, because regular use can lead to some skin breakdown. Taking them off very gently after standing in a warm shower for a few minutes helps to minimize this.
If that’s not enough, escalate to nasal dilators such as these. Some folks will find these difficult to tolerate as they do penetrate your nostrils, which is a sensitive area.
Tip #7: Have a backup full face mask
Tip #8: Increase the humidity
Sometimes increasing the humidity setting above what you usually use is enough to open up congested sinuses.
Tip #9: “When in doubt, cut it out.”
This saying is an old med school joke about surgeons’ penchant for always wanting to operate. I rarely recommend nasal procedures to enhance CPAP tolerance. But, if you failed all of the above, you could consider a consultation with an ENT. Possible surgical options include the following:
- Turbinate reduction – reduces swollen soft tissue inside of your nose
- Sinus surgery – opens up the holes in your sinuses so that they can drain better
- Septoplasty – straightens a deviated septum
It is very important to understand that none of these procedures will have a meaningful impact on the degree of your sleep apnea; they are only useful to help open up your nasal airway to tolerate CPAP.
Dr. Krainin is a board-certified sleep physician and the founder of Singular Sleep, the first-ever online sleep center. He is an authority in sleep disorders and telemedicine. You can read his other blog posts here.