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Have sleep apnea and use a bipap machine. Why did I begin to wheeze? Am I reacting to pollen or peanuts?

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i have sleep apnea and use a bipap machine successfully at night- however i am a never smoker or drinker, have a deviated septum since teen years and breathe thru my mouht except at night using the bipap. often i have some irritant in the back of my throat that cause me to cough to clear it. there results no mucus except perhaps a little clear- sometimes i have to cough several times to clear the back of the throat and cough hard to do it - the cough can them be a series of coughs. often w/o eating or drinking this irritant will occur. once i could not clear it quickly and i began to wheeze, and could not catch my breath- it was scary. what's going on? i am male 71, a runner athlete in excellent health 5'9" 170 lbs

this has been going on for at least a year- every medical appt -quarterly my lungs and heart are fine- XXXXXXX med dr thks allergies are involved but i do not seem to react to pollen or peanuts etc. i do know that eating ice creqam will cause my throat to swell and i have to cough to clear it- it is only temporary and does not linger after clearing.
my issue is an irritant(s) getting to the back of my throat and causing me to cough to clear it and a simple cough will not solve the problem and sometimes my airway is blocked and this has caused me to wheeze and not catch my breath. in those cases i try to relax and breath simple sort breaths becaus if i take a XXXXXXX breath the back of my throat is blocked and i have sever difficulty breathing.
Posted Thu, 14 Jun 2012 in Ear, Nose and Throat Problems
Answered by Dr. Ravinder Sharma 9 hours later
Thanks for writing in.
On the basis of the information provided it appears that you are suffering from obstructive sleep apnoea syndrome. I would briefly explain about the disease so that it is easier for you understand what we are talking about.
Obstructive sleep apnoea is because of the obstruction in the upper respiratory airway which includes nasal passages, throat and larynx (voice box). During sleep we all breath through the nose so if there is an obstruction at some point in nose or pharynx the patient will have snoring and this may further progress to episodes of apnoea (absent breathing) if the obstruction is too much. You are using CPAP and I feel this is a temporary measure to give you relief for some time.
There are a variety of the sites to cause obstruction -- nose, back of nose, long uvula of bulky posterior part of tongue, large tonsils. In your case the cause appears to be in nose --- as you said you have Deviated nasal septum.
Besides this obesity, hypothyroidism, short neck also are the established causes of sleep apnoea syndrome.
I strongly feel that a ENT consultation will settle the diagnosis. You will be requiring some blood tests, BMI, thyroid function tests, CT scan of nose and paranasal sinuses and pharynx and polysomnography to come to the diagnosis. Weight loss and septal surgery will be a great help in your case. I will be able to clarify the other issues once we have the reports.

You have also symptoms suggestive of allergy -- irritation in throat and constant desire to clear the throat. Allergy of airway leads to mucosal oedema and further worsens your symptoms. Antiallergic and decongestants will help you in this.

I hope this answers your concerns. Do let me know if anything else is required from my side
With warm regards
Ravinder Sharma
Above answer was peer-reviewed by
Follow-up: Have sleep apnea and use a bipap machine. Why did I begin to wheeze? Am I reacting to pollen or peanuts? 2 hours later
thanx for your insights dr sharma-to clarify i have been diagnosed with obs. sleep apnea thru a sleep study and i am using everynight a bipap ,nit cpap machine which works well a si use a small partial mask with flow valves at the nasal passage entries. for 90% of the time i do not wake at nightand sleep well. occasionally an "irritant" will tickle/trigger in the back of the throat when sleeping , awaking me and i take the mask off and clear with usually 1 or 3 coughs. last week, i could not clear it and suffered back of throat obstruction abt 3am and could not clear and worse had severe difficulty breathing, eventually i was able to take short breaths and relax and breathe normally. this is the only time this has happened at night but the same severe condition has occurred 3 times in the last 6 months.
should i get allergy testing and have on hand a rescue inhaler ASAP?

also are there alternatives to the bipap ?

thanx again
XXXXXXX mcleskey
Answered by Dr. Ravinder Sharma 22 minutes later
Dear Fmcleskey
Thanks for your feedback

I would like to add here --
About allergy -- allergy testing will tell you the common allergens causing problem in your case. This test has little significance but if you ask me I will say YES. If you know the offenders it will be easy to avoid them. An antallergic, decongestant and mucolytic combination will help in these symptoms

Please get a chest consultation too for the state of airay so that we can rule out problem in the chest. The need of rescue inhaler can be answered after it.

About CPAP and its alternative- I am of the opinion that if there is an obstruction in nose it is better to get it corrected and you don't need a CPAP daily. CPAP is a good choice if the patient is not fit for surgery. Septoplasty is a small procedure and can be done under local anaesthesia. I understand that you have been under treatment of a sleep specialist. But then -- Was there a certified Otolaryngologist in the team of doctors you met. I remember one of my case who was using CPAP and had polyps in nose. After surgery for nasal obstruction he no longer required CPAP.

I would further say that sleep apnoea syndrome requires a sleep specialist, Chest physian, Otolaryngologist and oral and maxilloafacial surgeon and at times a neurologist to make a diagnosis as the causes actually touches all these specialities.

I hope this answers your concerns

with regards
Ravinder Sharma
Above answer was peer-reviewed by
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