Use nasal saline cleansing a minimum of twice a day (in the morning and evening). NeilMed has a lot of saline products in many forms that are easy and inexpensive to use.

When there is weakness of inspiratory muscles, I prefer Simply Saline™ since it is in pressurized can and only delivers a squirt when pressed, obviating sucking nasal secretions back into the unit.

Always compress one nostril and inhale while spraying so that whatever the velocity of the sniff there will be a better distribution to the mucous membranes of the nostrils. When using a solution, always do one puff at a time for each nostril. Repeat at least twice or until clear. If you taste the salt water, it has gotten far enough into the nose.

When blowing to clear secretions/saline, always compress one nostril and blow the other; then alternate. This allows the full force of the effort to more effectively clear the passages.

If you are fighting an upper respiratory infection, substitute the Simply Saline™ with Simply Saline Plus with menthol.

If you use oxygen, start by using a saline gel, after the cleansing and before one places the cannula in the nose. Ayr is the brand I suggest. It lasts longer. Also, it does not hurt to switch the cannula to the mouth to give the nose a break.

To stop a nose bleed, gently compress the nostril bleeding until bleeding stops. The time varies with the medication(s) you may be using or due to the severity of the mucosal inflammation. Once bleeding has stopped and the above cleansing has been performed, you can add elements.

If saline solution and saline gel are not enough, then use a cotton swab to apply a very scant amount of Vitamin A & D ointment to the lower base only of both nares (nostrils) to lubricate and coat this mucosa. If there is an infection, I prescribe Bactroban ointment twice to four times a day for five to seven days.

If allergies are the cause of nose problems, after the above saline cleansing, I prescribe NasalCrom (sodium cromoglycate), which is now over the counter. It blocks the allergic reaction from occurring, but it has to be used every six hours if allergy exposure cannot be avoided.

If that is not sufficient, one can use OTC Flonase or Nasacort twice a day and always after the cleansing.

Another potential help for allergy sufferers is taking Singulair before bedtime, which will block the cascade to congestion of the nasal mucous membranes.

OTC antihistamines, such as Benadryl and Chlorpheniramine can be soporific (induce sleepiness) and drying. The antihistamines loratidine, fexofenadine, and cetrizine in combination with oral decongestants might be better alternatives. However, the decongestants can keep one awake at night or be too drying.

If it is a clear mucous runny nose that is the problem, then Iipatropium bromide (Atrovent) nasal spray at 0.03% or 0.06% every six hours can be prescribed.

If bleeding is still a problem, see an otolarngologist (ENT). The sinuses may be contributing.

Obsessive use of a humidifier along with the ventilator, if you use one, is essential. But they may not be as efficient as is needed. The amount of moisture depends on the ambient temperature and the humidity as well. So, the same settings may not be sufficient on different days at different times. Also, they have to be meticulously clean.

Lastly, I teach breathing relaxation breaths for when one first gets up in the morning which can also be done any other time as well. Relaxation reduces stress, stress hormones and increases oxygen and reduces work of the heart.

• Start by sitting comfortably with back supported, head and back as straight as possible and arms extended with hands in lap.
   

• Breath air in through your nose into your thorax from chin to pubic bone counting to 4 until you are maximally expanded.
   

• Hold to the count of 7, if possible.
   

• Slowly exhale through pursed lips to a count of 8 using your abdominal muscles to help push the air out.
   

• Repeat for 3 cycles.
   

• If you are not able to hold for the counts, hold and exhale for what you can, but in the same ratios. Practice may increase your capacity.

On a personal note: I keep my nose cleaned twice a day whether I need it or not. It reduces upper respiratory infections. I keep a small nasal saline spray in my purse to use when exposed to coughers in public, in addition to hand sanitizer.