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Thursday, December 12, 2013
Sleep apnea and choking
My husband has been diagnosed with sleep apnea and uses a CPAP machine fairly regularly. Prior to using the machine he had bad coughing spells when he was sleeping (whether in the bed or sitting up). He is now starting to have coughing spells with the CPAP machine. What needs to be done?
There are a number of causes of chronic cough, of which chronic bronchitis (especially in smokers), asthma, post-nasal drip and heartburn (or gastroesophageal reflux) are the most common. Sleep apnea often occurs in individuals with chronic nasal issues and post-nasal drip may accompany this. There is also ongoing debate about whether there is an association between sleep apnea and reflux disease. In both of these situations, treatment of sleep apnea with CPAP can, in some cases, be beneficial (however, it should be noted that it is more common for CPAP to cause or worsen nasal congestion, though the effect is variable between individuals). Sleep apnea by itself has not been found to be a frequent cause of chronic cough, though when the airway collapses in sleep, individuals may awaken with a choking and coughing spell as the airway reopens during an arousal from sleep. Treatment of sleep apnea with CPAP keeps the airway patent (open) during sleep and thus prevents the repetitive choking and coughing that occurs in some individuals.
It is possible that the symptoms you are describing could be related to suboptimal treatment of your husband's sleep apnea and the CPAP pressure setting may need to be adjusted. It is also possible that a cough in someone on CPAP treatment could represent an allergic reaction to components of the CPAP device or mask. Any of the above factors may be part of the reason why your husband experienced an improvement in his cough with the initiation of CPAP. Why the cough has recurred at this time will require some detective work and a visit with your husband's physician. The physician will ask questions and perform an exam to try to determine the underlying cause of the cough. Depending upon this evaluation, further testing, including a repeat sleep study, may be necessary to make a diagnosis.
To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine's website at http://www.aasmnet.org. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. The American Sleep Apnea Association also has some information on their website found at http://www.sleepapnea.org that you might find useful. Good luck and here's to good sleep!
Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University