Continuous Positive Airway Pressure (CPAP) therapy is an effective treatment for obstructive sleep apnea. However, many sleep medicine physicians tout it as the Gold standard and I think this should be called into question. Fully 50% of patients fail this treatment in the first year due to various reasons. The most common are feelings of suffocation, air escape, and poor fit. This discomfort could result from various factors, but one significant contributor is nasal obstruction.
In this blog post, we will delve into the connection between nasal obstruction and CPAP therapy failure. We will also explore the findings of a well know study by Ikawa et al, which investigated the effects of septoplasty on CPAP treatment outcome in patients with nasal obstruction.
1. Understanding Nasal Obstruction and Its Impact on CPAP Therapy
Nasal obstruction refers to the partial or complete blockage of the nasal airway, causing difficulties with breathing. Individuals with nasal allergies, sinus problems, a deviated septum, or nasal polyps often suffer from moderate to severe nasal obstruction. When a person wears a CPAP mask, it is essential to have unobstructed airflow through the nostrils to optimize treatment effectiveness and comfort. If the nasal airway is partially or completely blocked, CPAP pressure may feel like suffocation due to increased resistance or excessive pressure build-up.
2. The Link Between Nasal Obstruction and CPAP Therapy Failure
Nasal obstruction can significantly hinder CPAP therapy success. When the nasal airway is compromised, it can impact the proper functioning of the CPAP system. Some common complaints associated with nasal obstruction during CPAP use include:
a) Mask Leakage:
When nasal congestion or obstruction affects the secure fit of the CPAP mask, it can result in improper sealing and air leakage. This not only reduces the effectiveness of the therapy but also leads to discomfort and a perceived sense of suffocation.
b) Ineffective Pressures:
Nasal obstruction can limit the ingress of airflow from the CPAP machine, causing increased pressure requirements to maintain an adequate airway. These higher pressures can exacerbate discomfort and make breathing against the elevated resistance feel restrictive.
c) Difficulty Exhaling:
Nasal congestion can make exhaling against positive airway pressure more challenging for some individuals. This sensation can contribute to feelings of suffocation, triggering additional discomfort and masking benefits of therapy.
d) Ineffective Treatment:
Sometimes people with long standing nasal obstruction are unaware that they are having difficulty breathing. The only indication that there is a problem is when they try CPAP and it fails to adequately treat the sleep apnea. Sleep partners can often hear patients snoring right through the mask. Patients with nasal obstruction often wake up feeling tired despite wearing the mask all night.
3. The Ikawa et al Study: Investigating the Impact of Septoplasty on CPAP Outcomes
The Ikawa et al study examined the effects of septoplasty (a surgical procedure to correct deviated septum) on CPAP treatment effectiveness in patients with nasal obstruction. The study involved 43 participants with CPAP failure due to nasal pathology. Upon receiving septoplasty, the researchers analyzed CPAP compliance, improvement in sleep quality, and reduction in symptoms.
The findings of the study revealed the following:
a) Improved CPAP Compliance:
Following septoplasty, CPAP compliance significantly improved, with patients reporting increased comfort and decreased mask leakage. Forty of the 43 patients undergoing septoplasty were able to wear their mask properly after surgical correction. The other three were cured of their sleep apnea after surgical correction of their nasal airway
b) Enhanced Sleep Quality:
Participants reported a reduction in sleep disruptions, fewer awakenings, and improved overall sleep quality after the procedure.
c) Symptom Reduction:
Symptoms commonly associated with nasal obstruction, such as snoring, daytime sleepiness, and fatigue, were significantly alleviated post-septoplasty.
These findings highlight the importance of addressing nasal obstruction in patients experiencing CPAP failure. By improving nasal airflow, septoplasty can lead to enhanced CPAP tolerance, better therapy adherence, and improved sleep outcomes.
Conclusion:
Uncomfortable sensations and a perceived suffocating experience during CPAP therapy can stem from various factors. Nasal obstruction plays a significant role in CPAP failure, leading to discomfort and compromised treatment effectiveness. Addressing nasal obstruction through interventions such as septoplasty can greatly improve CPAP compliance, reduce symptoms, and enhance overall sleep quality.
If you find that your CPAP feels suffocating, it is crucial to consult with an ENT (ear, nose, and throat) specialist. These professionals can perform a thorough evaluation, including assessing nasal patency, and develop a targeted treatment plan tailored to your specific needs. By addressing nasal obstruction, you can optimize the benefits of CPAP therapy and experience more comfortable and effective sleep apnea management.
