UARS? surgery...

[clemente94040]

Diagnosed with mild Apnea 5 years ago. I have had lots of aches and pains since I was 24. Light sleeper. Normal weight.
Had UPPP, tonsilectomy and septoplasty 4 years ago. Did not help at all, but made CPAP a little more tolerable. (First few tries with CPAP gave me very bad sinus headaches.) RDI went up a little.
CPAP is not working well as I still have a lot of nasal blockage when I lay down. Wake up after about 3-4 hours with a very sore throat.
Tried oral appliance. Wake up after a few hours with a stuffed nose. Dentist noticed nasal blockage due to nose injury (football) and referred me to an ENT.
Have done 2 RF turbinate reductions. Still blocked when lying down.
Next month will do turbinate reduction surgery.

Questions:
Do UARS patients with nasal blockage find CPAP, BIPAP, or VPAP more comfortable (in general)?
Are there any other tests I should be asking for?

Thanks,

C.

[clemente94040]

Thanks Dr. Park.

I tried breath rite, but didn't notice a big difference. I bought nozovent earlier today. I wanted to give it a try after reading a little about it. I saw it in the discussions here.

My oral appliance does the cottle maneuver. It has two pieces that push outward and upward. (OASYS)  I don't notice a big difference, but since the dentist is interested in the nasal flow as well, he was the one who clued into the blockage. (I sat reclined in his chair for about 15 minutes waiting for him.) Since I am rarely blocked when upright and have no allergies, it just never clicked.

No one has really looked at my tongue lying down. I am getting a second opinion up in San Francisco before surgery. I will ask about this.

Thanks for the input.

C.

[Steven Y Park, MD]

Have you tried using Breath-Rite nasal dilator strips or Nozovent clips? Sometimes, flimsy nostrils can collapse when lying down. If it helps, you may want to address this as well when you undergo further surgery. Your ENT can tell if this is the case. If your nose is stuffy, a dental appliance won't work. Take care of your nasal congestion first, and you may want to consider trying the oral appliance or CPAP again. You probably have significant tongue collapse.

Whether you have UARS or OSA, having nasal congestion can prevent CPAP usage. There's something called the Cottle maneuver, where the doctor pulls the cheeks next to your nostrils out and up. If you  can breathe in much better, you have nasal valve collapse (or flimsy nostrils). I usually examine the entire upper airway with the patient flat on the back. This way, you can see where things are collapsing due to gravity. You can also get a much better view of the space behind the tongue. If you thrust your lower jaw forward in this position, you'll be able to see a significant improvement in the size of the airway.

Good luck.