Sleep Apnea, Nasal Congestion, and Headaches: A Patient's Journey

Recent issues with sleep apnea and nasal allergies have been causing headaches?

Hello, doctor.
I am 30 years old and currently weigh 93 kg.
My nose has been persistently congested.
I have suffered from sleep apnea for a long time (I have undergone two tests, and the most recent report indicated that I stop breathing about 100 times per hour; my current physician mentioned that she has seen very few cases this severe).
When I was younger, my family often said that I snored loudly and would suddenly stop breathing.
Even during my military service, my sleeping would disturb those around me.
I have undergone uvulopalatopharyngoplasty and tonsillectomy, and I have had nasal polyps treated several times, but there has been little improvement in my snoring.
I still experience nasal congestion, waking up with a stuffy nose during the day.
When I shower, my left nostril is usually clear, but my right nostril is always blocked.
As soon as I lie down to sleep, my nose feels congested, as if filled with mucus.
Could this be nasal allergies? (I see many patients with nasal congestion, sneezing, and runny noses, but I mostly experience congestion and only feel mucus when sleeping).
Since last year, I have been facing these issues, possibly due to my long-term sleep apnea and obesity, which have led to consistently high blood pressure.
I have neglected this "silent killer," thinking that if I lost some weight, my blood pressure would normalize.
However, my weight continues to rise.
My current physician has advised me to lose weight before considering other surgical options for improvement, as they may not be very effective otherwise.
She also recommended that I use a CPAP machine to improve my sleep quality.
I have been using the CPAP machine at night, and my apnea events average below 10 per hour (though I am unsure of the accuracy of this reading).
I have been using it for over six months and feel better mentally compared to before.
I used to doze off while sitting, but now I do not.
My current treatment plan includes using the CPAP machine, taking antihistamines, using nasal sprays, and focusing on weight loss.
I spray the nasal spray at night, but I often find that it makes my nose feel more congested, which may be due to structural issues or improper technique.

At the end of March this year, I suddenly experienced a feeling of pressure in my head (I have never felt this way before, and several times I thought I might have a stroke or a brain aneurysm).
This sensation lasted for several days, and I wondered if it was related to high blood pressure.
I then visited a family medicine doctor, who prescribed antihypertensive medication and instructed me to take it regularly without stopping.
After experiencing that intense pressure in my head, I have been diligent about taking my blood pressure medication and monitoring my blood pressure morning and night.
However, the headaches have not subsided.
I have discussed this with an ENT specialist; the pressure does not feel like a headache from eating ice too quickly, but rather a heavy sensation on the top of my head.
During these episodes, the area between my eyebrows and nose feels tight and heavy.
I do not feel the need to take deep breaths, but when my head feels heavy and my nose feels tight, my mouth tends to open slightly, resembling a dazed expression.
Although this sensation has become less frequent than it was at the beginning, it still occurs.
I have had a CT scan of my brain, which showed normal results, and I consulted a neurologist, but they could not determine the cause.
The doctor suspects it may be more related to my nasal issues.
I apologize for the lengthy message, but I hope you can provide me with some advice:
1.
Is my persistent nasal congestion without much mucus indicative of nasal allergies?
2.
Why is it that when I take a hot shower, my left nostril is usually clear while my right nostril is blocked? I can count on my fingers the number of times both sides are clear in a month.
Could this be due to a deviated septum?
3.
Is the sensation of pressure and heaviness in my head, along with the tightness between my eyebrows and nose, related to my nasal issues?
Recently, I have been facing various health problems, which have made me realize that I need to lose weight.
No one wants to rely on a CPAP machine or antihypertensive medication for life, but having dealt with sleep apnea since childhood and now experiencing headaches has made me very concerned about my health.
Currently, my blood pressure readings at home are relatively normal, typically around 120/70, occasionally a bit higher, with systolic pressure sometimes reaching 180.
However, whenever I have my blood pressure taken at the hospital, it tends to be inexplicably high.
My main concern is the cardiovascular risks associated with sleep apnea.

Dan dan de you shang, 30~39 year old female. Ask Date: 2018/06/25

Dr. Li Jiaxuan reply Otolaryngology

1.
I would like to ask why my nose is stuffy even though I don't have much mucus.
It is always congested when I sleep.
Is this due to nasal allergies? A deviated septum or turbinate hypertrophy could be possible causes, and chronic allergies can lead to turbinate hypertrophy.
2.
When I take a hot shower, my nose usually clears up, but only the left side is open while the right side remains blocked.
I can count on my fingers how many times both sides are clear in a month.
Could this be due to a deviated septum? It is very likely that a deviated septum combined with turbinate hypertrophy is the issue.
I recommend seeing an otolaryngologist for an examination.
3.
I experience a feeling of pressure and heaviness in my head, along with swelling between my eyebrows and at the bridge of my nose, and my mouth tends to hang slightly open.
Is this caused by my nasal issues? Nasal congestion or sinusitis can cause a feeling of pressure and heaviness in the head, along with swelling in the area between the eyebrows and the nose, and a slightly open mouth.
However, other causes are also possible (I have had a CT scan of the brain, so there are no major issues there).
Please pay attention to your weight and lifestyle regarding sleep apnea and blood pressure issues; if possible, please consider losing weight, as a 10% reduction in weight can lead to some improvement in sleep apnea.
Wishing you good health.

Reply Date: 2018/06/25

More Info

Your situation is quite complex, involving multiple health issues such as sleep apnea, nasal congestion, and headaches. Let's break down your concerns and provide some insights based on medical knowledge.

1. Nasal Congestion and Allergies: Your description of persistent nasal congestion without significant nasal discharge suggests that you may be experiencing nasal obstruction, which could be due to allergic rhinitis or structural issues such as a deviated septum. Allergic rhinitis typically presents with symptoms like sneezing, runny nose, and itchy eyes, but some individuals may primarily experience nasal congestion. The fact that you feel more congested at night and when lying down is common among those with nasal obstruction. It would be beneficial to consult an allergist for allergy testing to determine if you have any specific allergens contributing to your symptoms.

2. Deviated Septum: The observation that one side of your nose is more congested than the other, especially if this is consistent, could indicate a deviated septum. This condition occurs when the cartilage or bone that divides the nasal cavity is off-center, leading to uneven airflow. A deviated septum can cause chronic nasal obstruction, which may worsen during sleep, contributing to your sleep apnea. An ENT specialist can evaluate this condition and discuss potential surgical options if necessary.

3. Headaches and Pressure Sensation: The sensation of pressure or heaviness in your head, particularly around the forehead and between the eyebrows, could be related to sinus issues or tension-type headaches. Given your history of nasal congestion, it is possible that sinus pressure is contributing to your headaches. Sinusitis, which is inflammation of the sinus cavities, can cause similar symptoms. However, since you have undergone imaging that showed normal results, it may be more related to tension or stress, especially if you are experiencing anxiety regarding your health.

4. Sleep Apnea and Blood Pressure: Your history of sleep apnea is significant, especially given the severity of your condition (stopping breathing 100 times in an hour). This can lead to fragmented sleep and daytime fatigue, which can exacerbate feelings of pressure in the head and contribute to hypertension. It is crucial to manage your sleep apnea effectively, as untreated sleep apnea can lead to cardiovascular issues, including high blood pressure. Your current treatment with CPAP is a step in the right direction, and it’s important to continue using it consistently.

5. Weight Management: Your physician's advice to focus on weight loss is critical. Obesity is a significant risk factor for both sleep apnea and hypertension. Losing weight can improve your sleep quality and may reduce the severity of your sleep apnea, potentially alleviating some of your symptoms.

6. Follow-Up and Further Evaluation: Since you have already consulted with various specialists, it may be beneficial to have a multidisciplinary approach involving an ENT specialist, a sleep medicine physician, and possibly a neurologist. They can collaboratively assess your symptoms and determine if further imaging or specific treatments are necessary.

In summary, your symptoms of nasal congestion, headaches, and sleep apnea are interconnected. Addressing your nasal obstruction, managing your sleep apnea, and focusing on weight loss are essential steps. Regular follow-ups with your healthcare providers will help monitor your condition and adjust treatments as necessary. Remember, it’s important to communicate openly with your doctors about all your symptoms and concerns to ensure a comprehensive approach to your health.

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