CHOKING ON MUCOUS WHEN USING CPAP

[mlaurel]

I have hypopnea with hypoxia that causes me to become confused and disoriented when I don't use my CPAP. However, when I use my CPAP large amounts of mucous will build up in my throat, blocking my airway. I wake up choking.  The mucous is yellow with streaks of blood in it.  The pulmonary sleep specialists do not know what causes the mucous to fill up my airways. I do have esphogeal dymotility (cause undetermined) and no gag reflex.  The best they can determine is whatever is affecting my swallowing may be causing this problem. One doctor said that I may not be swallowing in my sleep and saliva is going into my airway.  I question this because the mucous is thick and yellow. CT scan of the chest was negative, echo negative for pulmonary hypertension. I am frightened not to use my CPAP due to the confusion, yet the choking is horrible too.  Is there a disorder of the bronchi that can be causing this?  I only have the mucous when I use the CPAP.

[National Jewish Health]

The citation below is for an article which showed that obstructive sleep apnea (OSA) is associated with upper and lower airway inflammation.

Authors
Full Name Devouassoux, Gilles. Levy, Patrick. Rossini, Eliane. Pin,
Isabelle. Fior-Gozlan, Michele. Henry, Mireille. Seigneurin,
Daniel. Pepin, Jean-Louis.
Institution Sleep Laboratory, Exploration Fonctionnelle Cardio-
Respiratoire, University Hospital Grenoble, Grenoble
Cedex, France.
Title Sleep apnea is associated with bronchial inflammation and
continuous positive airway pressure-induced airway
hyperresponsiveness.
Source Journal of Allergy & Clinical Immunology. 119(3):597-603,
2007 Mar.

Continuous positive airway pressure (CPAP) cannot be a direct cause of yellow, blood streaked mucous but could indirectly facilitate it by increasing aspiration.  Whatever the cause of the inflammation, OSA or aspiration enhanced by esophageal dysmotility, the inflammation in small airways could result in the yellow mucus.  CPAP works in part by splinting the airways open that could facilitate clearance of the mucus and blood from inflamed airways, which would otherwise be collapsed when not on CPAP.  Such small airway inflammation could also be enhanced in an individual with a history of cigarette smoking.

If this were the mechanism of what you have experienced, it is conceivable that with the optimum use of inhaled steroids and inhaled bronchodilators, airway clearance of the yellow mucus would be improved during the day and not such a problem at night.

You might want to discuss with your sleep doctor if you could experience CPAP benefit at a lower pressure and if it might be possible to prevent the confusion and disorientation, by using low flow oxygen, without positive pressure.

Good luck.

[mlaurel]

Thank you for responding to my question on Aug. 6th. I am still attempting to get an appt with the sleep specialist. I am concerned because now I am having episodes of confusion and disorientation while on the cpap. When I finally get myself roused enough to realize where I am and go back to bed, I realize my airway is clogged with thick mucous. I no longer wake with coughing reflex to clear my airway. Since I no longer cough when my airway is filling with mucous, is it possible it is causing hypoxia? Thank you for the information on the study. I will be sure to share it with my sleep specialist. God bless.