Nasonex "tunnel vision" effects on deeper dives?

[chinadan]

Hi-

I have been diving 60 trouble-free dives on a regiment of Hyzaar (a blood pressure-lowering drug), Xanax.

I have had stress ECG, echocardiogram, MRI etc. and am cleared to dive.

On deeper dives (below 30m) I do consciously feel the onset of Nitrogen narcosis and would desrcibe it as a soothing, relaxing feeling.

Recently, my doc put me on Nasonex to treat sinusitis.

On my first dive (26C water/35m/air) after being put on the nasal spray (which I take in the morning), I felt a very unpleasant "tunnel vision" effect and felt on the edge of blacking out. I panicked enough to having to put my hand over reg and mask as to not blow them out.

The next day I did 2 more deep dives with similar results (EANx 31 and 33).

Each time I surfaced with a considerable frontal-lobe headache that started halfway through the dive (sort of in exchange for the tunnel-vision) and it would subside within 1/2 hour after surfacing.

I have changed regs to eliminate saltwater aspiration and would describe my breathing as normal, although syptoms seem to fit CO2 toxicity.

I have established the depth where the symptoms occur at about 20m. Above, no problems at all.

Anyone have an idea if this steroid nasal spray (which is the only variable I have changed since my last trip) could be responsible?

Thanks!

 

[pharmguy]

I have been diving 60 trouble-free dives on a regiment of Hyzaar (a blood pressure-lowering drug), Xanax.

Recently, my doc put me on Nasonex to treat sinusitis.

On my first dive (26C water/35m/air) after being put on the nasal spray (which I take in the morning), I felt a very unpleasant "tunnel vision" effect and felt on the edge of blacking out. I panicked enough to having to put my hand over reg and mask as to not blow them out.

The next day I did 2 more deep dives with similar results (EANx 31 and 33).

Each time I surfaced with a considerable frontal-lobe headache that started halfway through the dive (sort of in exchange for the tunnel-vision) and it would subside within 1/2 hour after surfacing.

I have changed regs to eliminate saltwater aspiration and would describe my breathing as normal, although syptoms seem to fit CO2 toxicity.

I have established the depth where the symptoms occur at about 20m. Above, no problems at all.

Anyone have an idea if this steroid nasal spray (which is the only variable I have changed since my last trip) could be responsible?

Assuming that you are using proper technique with a nasal spray, it is much more likely that the underlying medical condition (sinusitis) is the culprit. Mometasone is not well absorbed through normal (i.e. unbroken) epithelial cells and thus should have virtually no systemic absorption. Even if your were ingesting a fair amount of the dose the liver metabolizes the drug at a decent rate leaving very little after the first past effect.

Have you had sinusitis before? and have you dove with it? Inflammation of the sinuses can also present with the symptoms you describe, after being aggravated by the increased pressure.

Check with an ENT or wait for a MD on the board to get back to you - but the medication is generally well tolerated with a low incidence of side effects. Have you experienced any headaches, etc above water or away from diving that occur within the timeframe of starting the medication?

Take care.

 

[chinadan]

Thanks for your reply pharmguy!

Hen or egg...hmmm, well, I started Nasonex since I had increased difficulties equalizing my right ear, so you may be on to something. I have not had headaches or similar problems before, which made this epsiode more frightening.

What baffles me though is the onset of problems at a relatively shallow depth of 20m. I went diving for a week and had these symptoms on every single dive, although 2 month ealier there were no symptoms at all.

How would siniusitis (which I have for a while now) casue such CNS-like symptoms? Headaches are "acceptable", but the tunnel-vision is scary.

I forgot to mention that I changed from Xanax to the generic version of the drug (alprazolam) and I changed taking the blood-pressure medication in the morning rather than at night...

Maybe it was the cold(er) water of 26C / 3mm full wetsuit, I don't know but I will soon find out as I am going on another trip in one month.

I wish I could see an ENT or a dive doc, but I am stationed in China where Western Doctors and scuba diving are scarce...

Cheers!

 

[pharmguy]

Hen or egg...hmmm, well, I started Nasonex since I had increased difficulties equalizing my right ear, so you may be on to something. I have not had headaches or similar problems before, which made this epsiode more frightening.

What baffles me though is the onset of problems at a relatively shallow depth of 20m. I went diving for a week and had these symptoms on every single dive, although 2 month ealier there were no symptoms at all.

At 20 meters you are at the equivalent of 3 atmospheres. That is a fairly siginificant pressure change. Inflammation can have a cummulative effect where the continued exposure worsens the inflammation over time.

How would siniusitis (which I have for a while now) casue such CNS-like symptoms? Headaches are "acceptable", but the tunnel-vision is scary.

It's been a while since my anatomy classes ... but ... the sinuses are located both below and above the eye sockets. There are a lot of nerves that can be affected by swelling of these cavities - the vagal nerve (I think) and perhaps the optic nerve to some degree.

I forgot to mention that I changed from Xanax to the generic version of the drug (alprazolam) and I changed taking the blood-pressure medication in the morning rather than at night....

Hyzaar has a decent half-life so changing the time would likely have no effect (steady state level of medication would largely negate the time displacement). Switching to a generic has virtually no consequences for most drugs. Generic formulations are virtually identical to the name brand formulations and (here in Canada) get tested in clinical trials to assure the same blood levels. I would rule out the generic switch as a cause of your discomfort.

Maybe it was the cold(er) water of 26C / 3mm full wetsuit, I don't know but I will soon find out as I am going on another trip in one month.

Perhaps. Maybe a contributing factor along with the increased pressure.

Take care.

 

[TropicalDiver]

Sounds as if you might have a panic issue here, very possibly unrelated to medication. Xanax, I believe, is an anti-anxiety medication - right? It might be that you are suceptible to experiencing anxiety and it just reared its ugly head recently on your dives. I have had similiar experiences/symptoms when doing deep or stressful dives. CO2 MAY also be the culprit - or adding to the reaction. Cold water exposure doesn't help the situation either, placing your body under more stress. Best suggestion I could give is to try distracting yourself when hyperventilating by focusing on something visually interesting and/or telling yourself that you'll be fine/it's just misfiring neurons in the brain telling you something's wrong when its not and powering through it. The more dives you get under your belt the easier it'll be to deal with it - focus on staying calm and in control of your situation. I still occasionally get "flashbacks" of my physiological reaction when diving and have to power through it. The key is to stay calm and not let the "fight or flight" reaction take hold.

 

[crpntr133]

Nasonex itself will do weird things to me. If I want to stay awake for 20+ hours I can rely on Nasonex. Adding Xanax, I don't remember that part since I slept through most of my post surgery days when I was taking both.

 

[Scubakevdm]

syptoms seem to fit CO2 toxicity.

That's what it sounded like to me too. It seems to me that CO2 build-up also aggravates and intensifies narcosis. Also, there could probably be some kind of synergystic effect from the drugs, but the medical end of it isn't really my bag. I mostly just know about swimming with the fish.

 

[chinadan]

Thanks for your response.

Basically I feel and have felt very comfortable under water.

I have been to these dive sites quite a lot and apart from the deep dive they are all very easy and pleasant.

Unless my anxiety is so tricky, I would say that I was experiencing a physiological reaction to depth (so to speak out of the blue and then hat panic-like reactions to it. All I can remember feeling a tunnel vision-like sensation that was beyond my control or experience, and it repeatedly started to hit me at about 20m depth.

I don't think my anxiety has a built-in depth gauge and I can dive easily up to 20m even in cold/dark waters with no problems.

I will eliminate variables one by one until I find the root cause...I tend to go in the direction Pharmguy has pointed me that Sinusitis may be involved, as that situation has gotten worse - and subsequently introduced me to Nasonex, which I at first thought to be the culprit.

Sounds as if you might have a panic issue here, very possibly unrelated to medication. Xanax, I believe, is an anti-anxiety medication - right? It might be that you are suceptible to experiencing anxiety and it just reared its ugly head recently on your dives. I have had similiar experiences/symptoms when doing deep or stressful dives. CO2 MAY also be the culprit - or adding to the reaction. Cold water exposure doesn't help the situation either, placing your body under more stress. Best suggestion I could give is to try distracting yourself when hyperventilating by focusing on something visually interesting and/or telling yourself that you'll be fine/it's just misfiring neurons in the brain telling you something's wrong when its not and powering through it. The more dives you get under your belt the easier it'll be to deal with it - focus on staying calm and in control of your situation. I still occasionally get "flashbacks" of my physiological reaction when diving and have to power through it. The key is to stay calm and not let the "fight or flight" reaction take hold.

 

[Remy B.]

I like to take the dust out of this thread.

Yesterday I did a deep dive with air from a boat, I have noticed that everytime on descent, when I do a deep dive I breath heavily, most likely by anxiety, after I reach the target depth I calm down and lower my breathing rate.

The dive from yesterday, I got tunnel vision, knowing that I was in a dangeruos situation and it was due to the CO2 buildup by the abnormal breathing rate, I exhaled deep to clear the CO2 from my lungs and breath again and things cleared up more, and my breathing rate reduced and I got better, but we started going from 56m to 45m and thing were back to normal.

It was my 1st time with air and that deep, I normally do Helitrox and didn't go beyond 46m and the mixes of 25/25 or 21/30, yesterday just air

Did I took the right decision to empty my lungs to eliminate the CO2 from my lungs and get new clean air in, or I just needed to control my breathing ?

For what I understood, and correct me if I'm wrong, is the same accumulation of CO2 makes you breath faster.

Did everything go to normal because I went from 56 to 45m or it just was a result of breathing more calmly and it has nothing to do with depth ?

 

[fmerkel]

You may be getting a hit from lack of CO2 > Hyperventilation.
Try this - just sitting comfortably start taking very large breaths at an increased rate. Keep it up for awhile. You'll start feeling 'weird'. You may get that tunnel vision. See if it's similar.
You recent experience my have more to do with controlling your breathing than getting rid of CO2.

Yes, the accumulation of CO2 is the PRIMARY stimulus for breathing, not O2 like lots of people think. But some circumstances, anxiety being primary, can lead to over breathing (hyperventilation), which make you feel weird, which makes you more anxious, which makes you hyperventilate > bad scenario.

In diving it seems anyone with a breathing issue thinks they have a CO2 'hit'. Sometimes it's actually the reverse. Hard to sort them out since it's uniquely individual and the 'subjects' tend not to want to be guinea pigs for experimentation.