Can Sleep Apnea Cause Chronic Sinusitis?

May 25, 2011

Here’s my response below to a NY Times article on chronic sinusitis. They talk about cutting edge research in diagnosing and treating sinusitis, but completely miss an important point. Please read my post below to see what I mean, and feel free to comment on anything that I’ve said.

Biofilms are the pathology de jour in chronic sinusitis research right now. A few years ago, it was our immune system’s response to funguses. Before that, it was allergies, and before that, bacteria. As long as we’re convinced that it’s a bad organism or agent that’s attacking our body (sinus) cavities, you may get rid of the infection, but you’re doing nothing to treat what’s actually causing the inflammation that leads to blockage of the sinuses. The same analogy can be made for anti-reflux medications. None of the proton pump inhibitors (like Prilosec or Nexium) or H2 blockers (like Zantac) actually do anything to prevent reflux. It only lowers acid production, without doing anything to prevent regurgitation of stomach juices into the esophagus or throat.

Interestingly, a recent large scale study showed that the vast majority of people who suffer from recurrent sinus infections, pain and headaches are actually suffering from migraines. This is a neurologic form of inflammation in the sinuses, which over-reacts to weather changes, chemicals, scents, or odors. Chronic inflammation can lead to swelling, leading to blockage of sinuses, which can predispose to infections by bacteria that normally live in your nose.

Saline is also commonly recommended for chronic sinus sufferers, but it’s a double edged sword: A recent study showed that people who used nasal saline irrigation frequently had more episodes of infection than those who didn’t. Yes, saline irrigation flushes out pollutants and bacteria, but it can also cause paralysis of the cilia, which are finger-like projections that move nasal mucous back into your throat. Saline is like a mild version of Afrin – it’s still a decongestant. This is why some people have to use saline every day, sometimes 3-5 times per day. They’re addicted, just like with Afrin.

Sinus problems are much more common these days due to underdevelopment of our facial bones, which also include our jaws. Over the past few hundred years, due to a radical shift in our diets, as well as our eating habits (soft, mushy foods, bottle feeding, etc.), our jaws are not expanding to their full potential. If your facial skeletons don’t grow as much, the natural nasal and sinus passageways will be more narrow, becoming more predisposed to obstruction with colds, allergies, or any kind of inflammation.

This is why most people with chronic sinusitis can’t (or prefer not to) sleep on their backs. Due to smaller oral cavity volume, the tongue takes up relatively too much space, which leads to more frequent obstruction while breathing at night. Breathing pauses (apneas) then can suction up your normal stomach juices into your throat, lungs and nose, causing more inflammation. Most people with chronic sinusitis will also have sleep-difficulty and one or both parents will be heavy snorers with typically undiagnosed sleep apnea.

I presented a poster many years ago looking at the incidence of obstructive sleep apnea in people who had persistent or recurrent symptoms after nasal or sinus surgery. Almost 80% were found to have significant obstructive sleep apnea. Now that I look for and treat sleep-breathing problems before considering surgery, the need to go on to sinus surgery has plummeted. Plus they sleep better.

 

14 Responses to “Can Sleep Apnea Cause Chronic Sinusitis?”

  1. Paul on May 25th, 2011 4:07 pm

    Is it possible the pressure from the cpap machines is preventing mucus from draining? I didn’t have sinus problems until I started using a cpap. Now I have constant sinus issues (mild, but constant).

    I end up sleeping on my stomach with my right ear down and that is where I have the issue – right ear, under the right eye and right side of the nose. Went thru 4 rounds of antibiotics and steroids and while they relieved it some, it has come back.

    So, could the cpap’s be causing some of the problems?

  2. Steven Park on May 26th, 2011 7:05 pm

    Paul,

    In certain situations, irritation from air passing through your nose can mucous buildup and swelling. You can treat it with extra humidity, antibiotics, nasal steroid sprays and antihistamine, but none of these medicines can help with your neurologically hypersensitive nasal condition. There’s one medication called Atrovent nasal spray that may help as it addresses your nervous system, but that’s another drug.

  3. Daniela on May 26th, 2011 7:25 pm

    I read with interest your comment, especially “Interestingly, a recent large scale study showed that the vast majority of people who suffer from recurrent sinus infections, pain and headaches are actually suffering from migraines. This is a neurologic form of inflammation in the sinuses, which over-reacts to weather changes, chemicals, scents, or odors. Chronic inflammation can lead to swelling…”

    I suffer from pains in my feet/calves along with headaches that seem to be weather related and all I know to do is to take advil. But since these ‘headaches’ can last up to four days (worse in the spring), I wish I knew how to reduce my chronic inflamation

  4. Steven Park on May 26th, 2011 7:35 pm

    Daniela, it sounds like you also may have allergic rhinitis in addition to your nonallergic (neurologic) rhinitis. Technically, you can get migraines anywhere in your body where you have nerve endings, even in your hands or feet. The key is to improve your breathing and sleeping at night. It’s a simple, but extended discussion. If you read my sleep apnea basics articles, especially the one on UARS, as well my various general articles and blogs, you’ll see what I mean. My book was written especially to answer your question. Please also join in and listen to my monthly live teleseminars that pertain to your various problems.

  5. Robin Sanders on June 8th, 2011 12:55 pm

    I found this article to be fascinating. I’ve had chronic headaches (migraine, sinus, TMJ, and tension) most of my life and was also diagnosed with moderate sleep apnea in August 2010 as well as chronic migraine and migraine related vertigo in December 2010. The nurse practitioner in the neurologist’s office informed me that many (or all) of my sinus headaches may well be migraines.

    Adjusting to CPAP, APAP, and now BiPAP has been a struggle because of pretty severe insomnia that set in on night 3. Aerophagia and headaches remain problems with the BiPAP. If I go to bed with a headache, the BiPAP seems to irritate it greatly. But even worse, there have been a number of times I’ve gone to bed about as headache free as I ever seem to get and wake up with a migraine in the middle of the night. Is it even remotely possible that the BiPAP is triggering the migraine in this case?

    And yes, the neurologist has been trying to find a prophylactic migraine med that I can tolerate without much luck yet. The side effects of these meds has definitely been a factor in the continuing insomnia issues. But recently they suggested a genetic test for a gene mutation that turned out positive and so they’ve now put me on Deplin, which is the brand name for L-methylfolate, which is a metabolized form of folate if I have my information correct.

  6. Daniel on October 23rd, 2011 4:06 am

    Can maxillary sinusitis cause obstructive sleep apnea? If so, where can I find a study done on this? Thank you.

  7. Steven Park on October 23rd, 2011 7:17 am

    Daniel,

    Anything that causes sudden nasal congestion can aggravate already pre-existing obstructions and arousals. One theory about why people get sinusitis is that the sinus and nasal passageways are too small. This can happen due to upper and lower jaw underdevelopment, which is the basis for obstructive sleep apnea.

  8. TeeAya Gaskin on February 2nd, 2012 4:41 pm

    I had sinus surgery two years ago in my right cavity to remove several polyps. I felt much better after a few months, but lately the pressure, and blockage has resumed with no help from using Flonase and Patanase.. Should I consider returning to my surgeon, I’ve heard polyps can grow back

  9. Steven Park on February 2nd, 2012 4:44 pm

    TeeAya,

    Yes, you should definitely go back to your surgeon. Interestingly, I did a study a while back looking at patients with recurrent symptoms after sinus surgery. Almost 80% were found to have significant obstructive sleep apnea.

  10. Aeleen on February 29th, 2012 3:54 pm

    This article really sparked my interest as I have felt, for quite some time, that my BiPap contributed to my on-going sinus issues. At night, it is hard for me to put my nasal pillows on right away (due to nasal congestion), I tend to pull my mask off during the night and in the morning, my sinus runs like a faucet for about an hour after rising. I have tried Nasonex, Flonase, saline sprays, oral decongestants for only short-time relief. I have thought about seeing an ENT for an evaluation of my sinus passages/cavities – but don’t relish the thought of surgery. Any suggestions?

  11. USAF Airdale on October 5th, 2012 12:09 am

    I deployed Southwest Asia in support of OIF/OEF (Operation Iraqi/Enduring Freedom) in 2010. The billeting contained large amounts of mold, fungus and bacteria. We were also exposed to a large amount of particulate matter during daily dust storms.

    Upon return to the US I had difficulty getting deep (REM) sleep and was referred for OSA testing. which was diagnosed as moderate to severe and a CPAP was prescribed and used with some relief. My particular settings are 12/4 on my Res-Med.

    Prior to this deployment I had no breathing issues or failed sleep.

    Now a military medical review board has reviewed and stated that my OSA is NOT related to the deployed environment.

    Is that possible? Are there credible studies relating OSA, these environments, etc to OSA?

  12. saneyat hasan on July 15th, 2013 8:22 pm

    I am 37 and I have been suffering from chronic sinusitis for last 15 years. I have always post nasal drip and nasal congestion. Every morning, I wake up and feel like I did not sleep at all. It interfere and compromise my job performance as an electronic test technician which requires study of schematic and equipment. I had 3 surgeries — turbinoplasty (2002), toncil surgery (2003) and 5 procedures in 2011. The 5 procedures are maxillary antrostopy, ethmoidectomy, concha bullosa, septoplasty and reducing more turbinates.
    I still suffer from chronic sinus problems: congestion, post nasal drip and lack of good night sleep. What can I do now?

  13. Mel on April 9th, 2014 6:52 pm

    In last year I have developed bad acid-reflux (still to be diagnosed but suspected GERD). It’s been hard coping with this change on my body in such a short time, but now I am waking up with what I believe is sleep apnea! It’s awfully frightening and I am getting little sleep – average 20-30 mins when I wake after falling asleep. This has been the last 2 nights particularly.
    What I am wondering, could the fact that I have a sinus infection be bringing this on now? I feel the back of my throat at base of nasal cavity is closing up/collapsing when I wake up, it is scary and I don’t know how this could stop. My memory has been terrible the last 2 weeks as well so I am thinking this has gone on for a lot longer than I realize. Thanks for any feedback.
    Exhausted!

  14. Steven Park on April 9th, 2014 8:36 pm

    Mel,good luck.

    It sounds like you may have OSA. Chronic sinus problems and OSA often go hand in hand. See your ENT or medical physician about undergoing a sleep apnea evaluation. Good luck.

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