Thursday, January 24, 2008

Sleep Apnea and Ear Infections


Turns out I'm not alone. People using CPAP machines are prone to ear infections.

Sleep apnea, for those who don't know, is a breathing problem that affects people when they sleep. Tissues in your throat close off, airways in your nose are too narrow, and you end up having interruptions in the flow of oxygen that occur repeatedly through the night. Snoring -- loudly, and at times gaspingly - is one sign. Night sweats, waking up frequently to go to the bathroom, and daytime fatigue are other common symptoms. If I recall, men tend to suffer from apnea more than women; and the likelihood of developing apnea is higher in men in their mid-to-late 30's, getting worse as you age. Being overweight - which I am - also increases the risk. In very severe cases, people can die from sleep apnea.

I was diagnosed with "severe obstructive sleep apnea" about five years ago. Surgery -- cutting out part of your soft palate, uvula, tonsils, and etc. -- is sometimes recommended (see picture, below, which I took of a friend's throat four days after her surgery); but the most common and effective form of treatment is something called a CPAP machine. One wears a mask over the nose, hooked up to a machine which blows air - just ordinary air - into your nasal passages. The continuous pressure of the air keeps your nose and throat open, so you can breathe when you sleep; you don't snore, don't gasp, and wake up much more refreshed and alert. It takes a little while to get used to the mask, but once you do, your CPAP machine becomes a close friend.



Using a CPAP machine has side effects, though, which nobody told me about: in particular, the constant air pressure can affect your middle-ear. Whether it's just the pressure, or if bacteria and such are getting blown around inside my head when I sleep, I don't know, but I've had about four or five ear infections in my left ear - the side I breathe best through - since I started using the machine. (Like most people, I've barely had ear infections otherwise in my adult life). And either these, or changes brought about because of the pressure inside my head, have led to a gradual loss of hearing in my left ear. It's gotten worse over the last couple of years, so that I would guess that my hearing in my left ear is now 40% or lower; I've had to start retraining myself to talk on the phone with my right hand and ear, since when I try to talk on my left side - my preferred ear, for phone conversations - I have trouble hearing them. I have to try to remember to sit with my friends to the right at movie theatres, in case they want to whisper something to me. Whispering in my left ear means I won't be able to understand what you say, period.

Since I love music, and since I need to be able to hear my students' English as part of my job, the prospect of further hearing loss in my left ear scares the hell out of me. The idea of surgery is also pretty distasteful; I'm partial to my uvula, in particular (and am not sure the surgery really works). Looks like it's time to lose some weight and to start with some serious breathwork. I don't much want to choke to death in my sleep, but I don't want to go deaf, either.

40 comments:

Anonymous said...

I thought I was the only one! Every symptom that you described I am now experiencing...which hand to use while talking on the phone, whispering in my ear, etc. I am a nurse and I spoke with the RRT who runs the sleep lab in our health system and there is no evidence that this happens to apnea machine users. I even have an appointment shceduled with an allergist to try decide what was going on since I was told that there is no correlation between machines and the ears. Thanks bud...

Anonymous said...

Well I believe your right about ear infections and cpap's! I am a 48 year old female and have not had an ear infection since swimmers ear when I was a young child and in the year and a half since I have been using my cpap I have had 3 painful ones! I am thankful for your insight and at least I know what is causing them I have been STUMPED but no more
Michigan CPAP

Anonymous said...

You all need to use a heated humidifier. Solves the problem.

rick said...

CPAP isn't for everyone. There are mouthpieces that can work. Some surgical options have you back at work within 3 days with a moderate sore throat. Check out this site which explains options other than CPAP. www.thesleepmd.com. Reviews medical papers too.

Anonymous said...

The heated humidifier does not help. I used it for 3 hours and my ears began to roar. I have an extreme case of roaring in my ears and I believe it was caused by bacteria coming through the hose or damage to the eustachian tube in the presence of sinus problems due to air pressure changes in the weather. Since no other treatment is working such as a blood patch for CSF leakage or bed rest without a CPAP. I am now afraid I will have to live with it forever.

Anonymous said...

You may have undiagnosed diabetes or "prediabetes" which goes along with being overweight.

Diabetes might account for frequent nocturnal bathroom visits (increased sugar irritates / stimulates the bladder), night sweats (when your blood glucose levels drop, your adrenals rev up and your liver releases glycogen) and increased infections (bacteria love sugar.)

Being overweight is a factor causing sleep apnea, and I'm told that you may stop snoring and sleep better after losing even a moderate amount of weight.

Hope this helps: maybe all your problems can be treated simultaneously and you will get better rest at night! ;->

Anonymous said...

I have the same problems with my ears since using a CPAP machine. The heated humidifier does not seem to help or hurt the problem. FYI: Not all people with sleep apnea are overweight. I am not. I blame it on genetics. My father had it before we knew what sleep apnea was. I also credit a broken nose from a bicycle accident as a child that was never treated. This resulted in a deviated septum. I have been to Ear, Throat, & Nose specialists who could not connect the dots between ear infections and the CPAP machine. I have long suspected that the machine was causing the ear infections. It's almost funny the doctors are not hip to this concept.

rick said...

Totally agree with the weight comment although most people with sleep apnea are overweight, not everyone is. There is definitly a genetic factor. The most common things I see are a short mandible and a high arch hard palate with a narrow dental arch.
I am an ENT specialist and pride myself on staying up to date with the latest studies. Other than this post, there is nothing in the literature on ear infections and sleep apnea. I am pondering a research project to prove the relationship. Great work to those who set this up.
Rick Balys

ammacinn said...

Interesting that this post should garner comments just now: at the moment, I've just gone through another round of ear infections.

This time it started on a Thursday night, two weeks ago, in my left ear: I was feeling pressure and pain, along with a cold that was coming on. Within a few hours, I got to a doctor and started a 10 day course of amoxcil (500 mg) to knock down the infection, since these things terrify me: I don't want to go deaf, even partially.

Occasionally over the preceeding months I'd been able to "correct" my hearing by plugging my nose and "blowing out" my eustachean tubes, at the recommendation of two ENTs (one doctor I talked to expressed horror at the idea, note, saying I could also "blow out" my eardrums, so I've toned that down a bit). When this strategy worked, there would be a popping which would restore most of my hearing to my left ear. Occasionally the pop would go out my right... Thru this and other treatments - occasional treatment with Nasonex, a steroid - my hearing had more or less restored itself to a "normal level." It would fluctuate, but if I noticed it was dropping, I'd blow out my ear, and all would be well for awhile.

After this new round of infection, though: once again my left ear has lost hearing (it's easy enough to tell this by trading off the phone from my left to right ear; voices are much louder on the right). Blowing out the ear has no effect - I don't want to blow TOO hard, lest I damage my eardrum, but I can't get anything to pop with any level of pressure I feel comfortable with, so I've more or less given up. Plus for the first time the infection spread slightly to my right ear, too. I'm told by a doctor that he can see fluid buildup behind the right eardrum, and he's put me on a course of decongestants. The infection seems to have stopped, but my hearing was down to about 50% by midweek last week, as the antibiotics were running out... The decongestants seem to be helping, but two weeks since the initial infection, I'm still at reduced hearing - have to keep asking friends to repeat themselves, hear funny whooshing distortion when I try to listen to music, etc.

Anyhow, I'm CONVINCED that the eustachean tubes are adversely affected by CPAP, either by the altered air pressure or bacteria being blown about or a combination thereof. It amuses me that three doctors I've spoken two and two ENTs immediately tell me, somewhat defensively - like it's unworthy of serious thought - that "there is no evidence" that CPAP machines adversely affect hearing. I would lay a good wager that this is because no one ever thought to even TEST for such things. (They're scandalized by anything that isn't already in the literature, which surely slows down any new discovery - the presumption that "all is already known"). To me, it makes perfect sense that having air blown up your nose for eight hours a night is going to have SOME sort of effect on the eustachean tubes: how could it not? And presumably the multiple comments on this thread come from people who are randomly searching the internet looking for evidence of the same; who knows how many people are searching and NOT leaving comments... I'm very glad to see an open-minded ENT on the thread saying he plans to do something to study this. Rick, if I can help, do get in touch.

Meantime, a suggestion for apnea sufferers: turn down the pressure on your CPAP to the LOWEST LEVEL POSSIBLE that you can still comfortably breathe at night at. The less pressure the better, as long as you're breathing; it is very possible that your settings are higher than they need to be. The frequency of infections seems to have gone down for me since I dropped the levels, and I'm still sleeping okay.

Also, I do think losing weight is a good idea. Genetics no doubt DO play a role in apnea - my father has it too - but he stopped having problems breathing at night after he lost weight, so there's a good chance I would too, right?

Ed in Connecticut said...

I also have started to have ear infections since i started to use the CPAP. 3 in about 9 months. My docters says no conncetion, I am not inclined to belive him.
Ed in Connecticut

Steve Burgess said...

Am I ever glad I stumbled across this! I've been a CPAP user for about a year but I've had a "cold" for the last 6 months that I can't get rid of. Lately I've been thinking that my "cold" might be an infection resulting from CPAP use. I've also had ear problems such as continous ringing, a feeling that my ears are blocked and some occasional balance problems. I know that there's lots of other reasons for these these things but before CPAP I rarely had these problems. I've made the appropriate Doctors appointments to have things checked out and I'll be asking lots of questions about the CPAP connection.

ammacinn said...

I've convinced my ENT, I think, that my CPAP is contributing to my ear problems. Under his advice, I've been doing nasal irrigations with something called Neil Med and spraying Nasonex up my nose, while running my CPAP machine at the lowest possible speed that still helps me sleep. Occasionally - and very carefully - I've plugged my nose and "popped" my ears, which is a bit of a trick to do (wiggling your jaw and swallowing and such can help get the air to go up into your eustachean tubes); like I say, I've told this is hazardous, so do it carefully, if at all. Anyhow, I've almost got full hearing back in both ears, no ringing, and I can still breathe at night. It's a good course of treatment.

Anonymous said...

I've been using a CPAP for 9 years - haven't really had any ear infection problems until this year. Since Jan 2009 I've had at least 8 occurances, mostly relating to the left ear. The only thing that I can remember changing is that I changed the mask from an 'over-the-nose' type, to an 'in-the-nostril' type. Can't see how this would make any difference though. (Rod from Sydney, Australia)

Rick V. said...

I too am going through this same situation...No ear problems prior to cpap. (I use a full face mask) Now for about the last 2 weeks I've had this fullness, popping, crackling in my ears. The first couple days the pain in my ears and head were so bad I though my head was going to explode....Right now my dr. has me on an antibiotic, and sudafed. I also use Neilmed nasal irragation at least twice daily.
I had nasal surgery 5 months ago and have been on the cpap for about a year.
I use to get sinus infections (nose and throat) before the surgery....This ear problem is ALL NEW!!!
I've continued to use my cpap which has a heated humidifier, and things have not gotten much better.
I'm going to go off my cpap for a while beginning tonight 11-30-3009, and see how things go.
I would be more than happy to be involved in any research studys linking cpap to ear problems.
So Rick the ENT, give me a shout if you are truly going to research it.
I am a retired firefighter so I have time for such a study if it will help myself and others.
my email is: hotvawt@yahoo.com

Thanks
Rick

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Anonymous said...

I have gotten a strange side effect, myself. I suspect that the air is not all going where it should (the lungs). My CPAP causes me to burp and fart because I get air blown into my stomach. I also get acid reflux.

Anonymous said...

Interesting to real all the comments. I've been thinking I'm the only one having noticed the ear infection connection with using the CPAP.

I'm an avid scuba diver and since I dove a lot, from time to time I got the "swimmer's ear" infection. Since I started using CPAP, the number of infections has just increased rapidly. I've managed to get five, one after another. I could not connect the dots, was thinking there was something in the water or another issue with my immunity, but since I always stopped using the CPAP when my infections occurred, they went away in 3 days usually. After going on CPAP again, another infection was there in a few days.

I've decided to stop using the CPAP for a while, to let my head clear and get rid of the infections. Guess what, they all went away and never occurred again, even though I kept on diving like before.

I've booked an appointment with my sleep doctor which will be soon and would like to see if I could get a surgery done instead. CPAP is a no go for me, unfortunately.

Best of luck to you all who still can use them.

Elsa said...

Geez, that's scary...

It is better to stop snoring naturally, but if it does not respond to simple remedies, including non-surgical ones, should be discussed with a physician or sleep specialist.

Anonymous said...

I had the same issues until I started using Neilmed sinus rince twice per day. in the morning when I wake up and again about an hour before I go to bed....make sure you use the netipot though as the squeeze bottle can squirt the saline mixture too far into your sinus's and give you a sloshy feeling.....this helps wash out any bacteria etc that gets in.....has worked fantastic for me.....
Make sure you use distilled water with the neilmed and warm it a little in the microwave....
you can get the neilmed at just about any drugstore.

roiski said...

i srarted using a cpap machine in july 2010 it's now the end of nov.
i have developed a cough that i can't
seem to get rid of always coughing
flem up from my throat.

Anonymous said...

Ditto ditto ditto re: more ear infections and clueless ENTs. My ENT says my nasal passages look dry, even after getting a new cpap 5 yrs ago that warms and humidifies. I suspect allergies can play a role, too, so I religiously take loratadine, but this was my own recommendation, not his. He still plays dumb when I suggest connecting itching eustacheon tubes and cpap.

So, I think it is easy to pigeon-hole when dealing with the public all day, whether its a retail electronics, auto-repair or an ENT shop. Maybe this explains the "cold shoulder" we get. Sure, I don't fit the pattern, but shouldn't this feed your curiosity ? I think somewhere here lies the difference between profession and "job".

William said...

ya the pain goes from one ear to the other and is itchy/ Sometime the ear is scally and dry. Benn on CPCP about 3 years.

William said...

sometime my ear gets itchy and i also feel pain inside if i push my finger along the side. Dry and scally. usuallly in the am and moves from ear to ear.

William said...

My ear(s) become dry and scally. and they itch severely. one day one ear the next day the other. push inside the side of the ear and it feel like the beginning of a ear infection. .sometimes when i take my finger out my finger is wet, damp. Been on CPAP bout 3 years and never before had ear problems.

Anonymous said...

Here is an article related to this topic: http://doctorstevenpark.com/the-biggest-ear-problems-for-sleep-apnea-sufferers

I have read several websites on this topic and it seems almost 95% complain about problems with their left ear. Mine is usually left, but sometimes right. I am curious as to why it's the left one for most people. My plan is to reduce the pressure and hope it helps, while I lose weight.

Anonymous said...

I have used the CPAP machine for 12 years and recently have developed ear problems. My CPAP provider and doctor both deny that the CPAP use and ear infections are linked. My symptoms are identical to those described. I also experience a discharge and an accompanying odor. I have read articles that indicate using olive oil to reduce the itching and help clean the ear canal. I cant stop using the CPAP machine and am suffering with the ear problem. I am relieved that your site has somewhat confirmed that using the CPAP machine and ear problems are connected, and provides some credibility to concern I have had for a while. I hope that your site highlights the issue and some resolves are found. I plan to continue visiting this site. Erc,ontario

Allan MacInnis said...

Yeah, it's weird how some providers have no idea that this is a fairly common problem. I mean, to put it in perspective - this blog is actually a bit of a backwater. It's VERY VERY rare that anyone comments on anything I write here. Yet every few months, someone new posts on this thread, because it turns out there are a whole bunch of people out in the world Googling the terms "sleep apnea" and "ear infections." I mean, mostly I blog about punk culture and movies - it's kind of weird that this turns out to be one of the ten most commented upon posts in seven years of blogging!

Anyhow, to just tack on a disclaimer - I am NOT a doctor, I am NOT qualified to give medical advice - I'm just sharing my own experiences and solutions that have worked for me. Still, all we have on this thread is a bunch of anecdotal evidence from people with similar problems - there's clearly SOMETHING at work here, but you need to discuss this stuff with your doctor before deciding on a course of action.

But DO discuss it with your doctor, especially if you're experiencing any of the ear problems mentioned above. There ARE doctors out there that I've spoken to who have ACKNOWLEDGED these problems exist, and/or at least entertained the possibility; if yours DOESN'T, maybe you should get a second opinion?

mvsjes2 said...

>> Yet every few months, someone new posts on this thread, because it turns out there are a whole bunch of people out in the world Googling the terms "sleep apnea" and "ear infections." <<

That's EXACTLY how I got here. I haven't had an ear infection for 40 years, been on CPAP for about a year and a half, and wammo! An infection that's lasted over TWO MONTHS and is still hanging on.

mvsjes2 said...

>> Yet every few months, someone new posts on this thread, because it turns out there are a whole bunch of people out in the world Googling the terms "sleep apnea" and "ear infections." <<

That's EXACTLY how I got here. I haven't had an ear infection for 40 years, been on CPAP for about a year and a half, and wammo! An infection that's lasted over TWO MONTHS and is still hanging on.

Chris Hipsher said...

I thought I was the only one. I appreciate you sharing this information. Never had ear infections in my adult life -- until using this darn machine.
I am considering robotics sleep apnea surgery in Chicago.

Anonymous said...

My husband has used a C-pap machine for years..If he didn't we would either be divorced or sleeping in separate rooms. The machine has given him better nights sleep and a bonus to me also because I get a good nights sleep also. But of late he has been complaing of ringing/buzzing in ears almost to the point where he refuses to wear his machine anymore. The noise in his ears is constant. Some research definately needs to be done..My husband tends to believe what he reads...whether proven or not. So the machine has it's bonus points but is it actually causing severe ear damage down the track in life....surgery has risks also...

allergykim said...

Thank God, I thought I was crazy. Never had your ear infections in my adult life After being on my C PAP machine for the last 2 years I've had ear infections every couple of months. I also have bad allergies and get allergy shots. When I suggested to my allergist that the two are maybe connected between C PAP and ear infections he didn't seem interested to want to even have a conversation about it. Thank you to others to have posted there is issues. I am wondering if the cleaning of the tube hose has something to do with it. I know I don't rinse mine out on the recommended basis as much as I should. Does anybody else have any comments to say how often they clean tubing? I am going to look into talking to my sleep doctor about lowering my pressure on my machine.

Anonymous said...

i also have been on cpap for about three years i had never had an ear infection until now i have had two ain the last six months i am currently wide awake with my left ear just throbbing there is no doubt in my mind these infections are related to the cpap

marion wright said...

I too suffer with hearing loss, itching in the ear, even feels like some ones tickling deep inside my ear, very irritating!I was told it was nothing to do with the CPAP machine, trust your gut instinct and insist it is!
I am going to email this page to my sleep clinic so I am believed! Thanks everyone:)

Jean said...

I have recently started with a CPAP machine and have noticed pressure, ringing and hearing loss. I believe it's definitely pressure related. On auto when you stop breathing you get blasted with pressure. I find 5-7 pressure better but am going to set 5-6 pressure. I don't want to get hearing loss from using the machine but also want a normal level of energy. The reason the docs and specialists don't want to make a link is money, they don't want to be blamed for damage to patients hearing.

Joe Mcintyre said...

Mine is also the left ear...and the Dr are clueless to why I'm having an ear problem

Mark Kildow said...

Colton ball in your at bedtime will stop this to some degree. I have same problem and this helps a lot.

perforated Ear said...

I agree many of the post in this article but your seems the most similar to what I am going through right New Year's morning at 3am i was awaken by the pain in my right ear, it was completely swollen throbbing and the ear canal was sealed from the inflammation.
I went into the emergency room and after 5 hours I was told my eardrum was perforated which simply means ruptured the doctor couldn't give me logical explanation other that maybe I had hit my eardrum with a Q tip and had I been so careless or something I have done for 30+ years and no prior suddenly be the reason my eardrum was perforated.
So they prescribed amoxicillin for the infection and norcos 5 365m for the pain.
As my eardrum was pounding and fluid dripping from my right ear that I am always laying on when I wear my cpap full face mask and whenever I make attempts to roll over to my back or left side my wife insit on me turning over to my right to minimize the noise she endours.
I came to the question as I moved back to my right side i felt an overwhelming pressure on my already damaged right ear from the air being pushed into my lungs... I had to search has anyone ever had ear damage from using a cpap and I came to this website and so many other ones confirming it was my stupidity or mistake of using a Qtip i have been using for the last 30+ years but the constant pressure of my machine and that may have affected my ear to the extent of perforated it and I don't want to go deaf.

Allan MacInnis said...

Very frightening! Good luck dealing with it. As you see, there are lots of people who have come to associate ear problems with CPAP, since people keep finding this post and commenting... Tho your story is the scariest i have heard yet... Hope between you and your doctors you can find a safe solution! Best of luck, hope the pain eases.

Marnie Dyne said...

I have been on cpap for about 3 years and the last year i have had 5 ear infections that never fully go away, i asked my gp if it was because of the cpap and she just looked at me like I was an idiot. I never used to get them before I used cpap machine, it's depressing, I can't hear well and find it hard to get to sleep because of throbbing sound in my ears :-(