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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What could cause the inability to breathe every morning after sound sleep with the help of a CPAP machine?

Answered by
Dr.
Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14430 Questions

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Posted on Tue, 13 Aug 2019 in Medicines and Side Effects
Question: My son is suffering from a respiratory tic (we are told) as a result of a drug interaction between Allopurinol and Risperidone (we think). Three MDs have told us that they do not know what to do. My son sleeps well at night with a C-Pap machine, but the moment he awakes, then the gasping for breath begins. He says he can not get air into his nose. Three x-rays show no obstruction whatsoever as well as a CT. We have been sent home from the Immediate Care and Emergency Room, so he is in our bedroom trying to be brave about it. We would welcome another recommendation, thanks.

The three MDs were Internal Medicine, Pulmonologist, Psychiatrist, RNP, and inhalation therapist, who all agreed they had never seen anything like this. Exciting, but not what we wanted to hear, so we would like to hear any other theory that might be available, thanks.
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Better to consult psychiatrist.

Detailed Answer:
Hi

I can understand your concern.
No need to worry for major obstructive defect as his CT scan is normal.
He is doing well on CPAP. So no need to worry for worsening Sleep apnea.
In my opinion, he is having psychological problem.
So better to consult psychiatrist again.
Yes, possibility of drug interactions is there.
So he can change allopurinol and start febuxostat.
Febuxostat is also used for gout and it is safer than allopurinol with lesser interactions.
Please let me know his last uric acid levels so that I can guide you better.
I will be happy to help you further.
Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 43 hours later

Dr. XXXXXXX Bhavsar, first of all thank you so much for your response. I was not sure there was even someone out there with so many on-line scams.

My son visited his psychiatrist on Monday (4/9) afternoon, and the Abilify dosage was increased to 20mg. Today will be his second day on that dosage, and we know it takes a few days for the medication to begin to be effective. As of yesterday his breathing condition has not improved, but he is still sleeping well at night.

I have purchased a Navage Nasal Care Saline Nasal Irrigation Kit and was wondering about putting a portion of an inhaler medication into the saline solution. If this works for pharynx constriction, then would that work with nasal constriction. I recognize that this is probably a psychological problem, however, the constriction still appears to be present.

Please advise, and again thank you for time.



doctor
Answered by Dr. Kaushal Bhavsar 4 hours later
Brief Answer:
Yes, you can definitely use saline irrigation kit.

Detailed Answer:


I can understand your concern.
Sorry for late reply as I was busy.
Yes, you can definitely use saline irrigation kit. No harm in it.
Also tell him to do warm water gargles and steam inhalation 4-5 times a day especially before going to sleep.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 44 hours later
Dr. XXXXXXX Bhavsar,

Thank you for your replies, and I will try the kit as soon as it arrives. My real question is, do you think the Abilify (Aripiprazole) 20mg has any possibilities of working for my son? One of the side effects of Abilify is (shortness of breath), and this causes me some concern.

I hope that I have not insulted you by not answering the phone, but the U.S. phones and Internet have become full of scams, and I apologize. I do not think you are a scam. The general public can not be too careful anymore, and I appreciate your time.

Thank You,
XXXX
(Father)
doctor
Answered by Dr. Kaushal Bhavsar 20 hours later
Brief Answer:
I am glad that I convinced you that I am real.

Detailed Answer:


First of all sorry for late reply as I was busy.
And I am glad that I convinced you that I am real.
In my opinion, no need to worry for abilify related shortness of breath.
It is very rare side effect.
Hope I have solved your query. I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar 28 hours later
Again my apologies for the skepticism, but as you know there is even a Dark Web out there, so what are ordinary folks to think. Thanks for the Abilify clarification, and the Nasal Kit is offering some temporary relief. The best way to describe my sensation when I try to breath through my nose is that it feels like a flap is blocking my breathing effort. I am considering an ENT person because that is the only person I have not seen. Any thoughts would be welcomed.
XXXXXXX
doctor
Answered by Dr. Kaushal Bhavsar 16 hours later
Brief Answer:
Yes, you should definitely consult ENT doctor for this symptom.

Detailed Answer:


I can understand your concern.
Yes, ENT consultation is better for that symptom.
Are you asking for your self or for your son?
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Kaushal Bhavsar 5 hours later
Thank you so much. I am asking for my son (42 years old). I have requested a referral this morning from my primary doctor (insurance requirement) to an ENT. I will definitely keep you informed.

I think I will refer this service to others, since you have been so responsive. Medicine in the U.S. has gotten so commercial, and I understand why. You have been a great second opinion, and Americans have to know everything, but most of them really do not.

Thank You!
XXXX (father)


doctor
Answered by Dr. Kaushal Bhavsar 4 minutes later
Brief Answer:
I am glad that my advice is helping you.

Detailed Answer:


I am glad that my advice is helping you.
It's always encouraging for doctors to hear positive feedback from patients.
And I will be always ready to help you further.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.

Wishing good health to you and your son.
Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 32 minutes later
I told you that I have purchased a Nasal Flushing Kit (Navana) with saline solution. I was considering dissolving a small amount of Vic-Vapo-Rub into the solution and using that during the procedure. What do you think of this?
XXXX
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Yes, you can definitely use it.

Detailed Answer:


I can understand your concern.
It's great that you got your kit.
And yes, you can definitely use it.
No harm in it.
Just make sure you are using small amount otherwise it will irritate more.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 2 hours later
Thanks so much for the follow-up. I am also a bit concerned about the amount, so I will start with a small amount. My thinking, regarding the slightly treated saline solution, is the same as the idea of an inhaler for people with asthma. My son has a prescription for Albuterol, which we have not filled. I wonder if this might be helpful in the nasal solution?
doctor
Answered by Dr. Kaushal Bhavsar 7 hours later
Brief Answer:
Are you thinking about mixing albuterol with saline nasal solution?

Detailed Answer:


Sorry to say but I am not clear about this question of yours?
Are you trying to ask that you want to mix albuterol with saline nasal solution?
Please clarify this so that I can guide you better.
I will be happy to help you further. Wishing you and your son a very good health.
Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar 10 hours later
Thank you, and yes I am asking about mixing some Albuterol to the saline nasal solution for use in the Navara nasal flushing kit.

I tried the dissolved Vic-Vapo-Rub in the saline solution last night, and my son said it cleared out his nose well, but did not improve his breathing, which is what I expect to happen with the Albuterol, since this is a physiological approach rather than neurological solution. We are trying to get an appointment with a good ENT MD, and the process is slow, but a medical referral is required (insurance) and sometimes faster.

I wonder if hypnosis or a good XXXXXXX is the next step, partly joking.

Thanks as always,
XXXX
doctor
Answered by Dr. Kaushal Bhavsar 20 hours later
Brief Answer:
What is the particle size produced by that machine.

Detailed Answer:


Well, albuterol is effective only if it reaches to lung.
So particle size is very important in albuterol inhalation.
Routine nebulizer machine produce small enough particles to reach to the lungs.
But I am not sure about the particles produced by navara nasal kit.
So please let me know the particle size produced by it so that I can guide you better.
I will be happy to help you further. Wishing good health to your son. Thanks.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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