Before an intervention is called, I will go ahead and openly admit that I have a problem. I am addicted to over the counter nasal spray. Not because I have a killer sinus problem but because every time I fall off the wagon, the congestion returns with vengeance, blocking my nasal passages, stifling my sleep, and overall, decreasing my quality of life.
Summarizing from last weeks Grey's Anatomy, the medical term of my condition is Rhinitis Medicamentosa. This is quite different from Allergic Rhinitis for the onset of the condition is the continuous usage of OTC nasal sprays, as opposed to AR, which is a blockage of the nasal passage due to a common allergen. Most of OTC nasal sprays come in one of two different flavors; Oxymetazoline and Phenylepherine. Oxymetazoline is the most common active ingredient (as found in Afrin) while Phenylepherine comes in second (as found in 4-Way Nasal Spray).
My troubles started back in early May. I had begun an intensive weight training program and had been making good progress towards eliminating body fat while gaining muscle and strength. But coupled with my intense workouts, a tight schedule at work, a flurry of "oh shit" home repairs, and ignoring my blood pressure medicine, I quickly found my head feeling like it was going to explode, and I was hospitalized soon thereafter.
Slowly through the usage of a combination of drugs, my blood pressure came back down. But I started to realize another issue; I was still receiving headaches. Not the same headache that I had experienced earlier (frequent blood pressure checks confirmed this), but more of a sinus pressured pain. The intensity would originate from the top of the nose to around the eye-brow and would work its way throughout the top of my head. It was as if someone squeezing the top of my forehead.
The pain always intensified after nasal spray usage, and would weaken as the day progressed. Usually the pain would wear off after a period of 12-13 hours. The congestion always persisted even after the headaches died down. This lead me to believe that the headaches were induced by the nasal spray.
I finally broke down and purchased the Rhinostat titration system. The premise behind a titration system is that you utilize the substance as needed, and when the liquid reaches a certain point in the bottle, you add a dilutent to reduce the contents of the active ingredient. The Rhinostat system appeared to work fairly well in the beginning. The bottle is a peculiar design and didn't seem to penetrate my nasal passages the way a conventional nasal spray bottle did. The dosage of the decongestant is quite small, so if you find yourself frequently using your nasal spray, the Rhinostat system is going to become diluted quite quickly. Unfortunately the dilution of the system outpaced the withdrawal of my symptoms. In the end, I was left with a fully diluted solution and still a stuffy nose. In order to sleep, I relapsed.
I have tried several decongestant products since the Rhinostat system, and all have failed to clear my passageways. Here are the products I've tried in attempt to alleviate congestion (all of the products do not contain Oxymetazoline or Phenylepherine)
- Sinusbuster
- SnoreStop NasoSpray
- Colloidal Silver Nasal Spray by Source Naturals
- Sinus and Allergy Relief Nasal Spray by bioAllers
My Own Titration System
Since I was unsuccessful in finding a solution that allowed me to sleep in peace, I decided to create my own titration system that I could control the dosages.
Start with a full bottle of nasal spray and every time the fluid level reaches half, fill in the rest of the fluid level with Saline nose spray. BUT, not just any saline nasal spray. Don't go the cheap route on this; make sure that saline solution does not contain benzalkonium chloride (e.g. [http://www.walgreens.com/store/product.jsp?CATID=301459&navAction=jump&navCount=1&id=prod1068924] ). Benzalkonium chloride has been shown to further increase the rebound effect.
The Conclusion
So far, I still get somewhat congested and I can feel my sinuses swell up from time to time, but I think the intensity is slowing diminishing. I've heard that it takes 4-7 days to withdrawal cold-turkey, so utilizing a titration system I can reasonably expect double that time-frame before I can draw any real conclusions.
I see an otolaryngologist (ear, nose, and throat specialist) tomorrow. While I am skeptical that he'll have any real insight besides the standard "stop using the stuff!", I'll be sure to follow-up if he has any better solutions.
Update (9/4/06 10:11pm)
After further research, I've discovered that some individuals have had success with a relatively new antihistamine called Astelin that doesn't contain any steroids, Oxymetazoline or Phenylepherine. My ear, nose and throat doctor was able to provide me a months sample.
A word of warning, Astelin is extremely bitter and even with a big gulf of mouthwash, don't be surprised when the aftertaste remains. The substance has a sedative effect, and after a liberal dose, definitely made me sleepy. As a decongestant, it was mildly effective. My nasal passages opened up a bit, but by the time I had awakened in the morning, my stuffy nose had returned. Over usage of the medication only seemed to worsen my congestive issues. 3-4 pumps appeared to be the optimal dosage for effectiveness.
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