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Sleep Disorders

Sleep Apnea and blood tinged mucus

06/05/2008

Question:

Has anyone with sleepĀ apnea ever had blood tinged mucus or rinsed your mouth out with water when gargling and it has blood in it? Is this common for the throat area when using the CPAP machine? Thanks.

Answer:

Bleeding can come from many areas of the airway tract, ranging from the nose (called epistaxis), the mouth (especially around the gums) and the lungs (called hemoptysis). The evaluation and management really depends on the source of the bleeding.

Bleeding related to obstructive sleep apnea (OSA) is most likely to be due to irritation of the lining of the nasal passages from the dry air under pressure delivered by a CPAP device. This is not uncommon, and we get this from patients occasionally. Some patients are prone to nose bleeds, and they report this with CPAP as much as without it. Other causes to consider for nasal bleeding include upper airway infections, chronic sinus problems, and seasonal allergies.

Patients who sleep in less humidified environments, or do not use adequate humidity in their CPAP device, may be prone to this type of bleed. Additionally, patients who have a significant mouth leak lose humidity through their mouth, which can contribute to the dryness. Your Sleep Physician can help you determine if one of these factors could be causing your problems. If this is the case, then you can empirically increase the degree of heat on your heated humidifier and see if this resolves the problem. Sometimes, adding a chinstrap to keep your mouth closed at night (and thus avoiding losing humidity (and pressure)) can be helpful. Finally, it may be useful to use a saline nasal spray during the day to keep the nasal mucosa moist and reduce dryness and irritation that may lead to bleeding.

I recommend that you be evaluated by your Sleep Physician as an initial step. Further history, coupled with a good head, neck and chest examination, can often lead to a determination of the cause of the bleeding. Additional testing may be needed to further sort out the diagnosis, and in most cases a diagnosis can be made and then appropriate treatment offered.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University