Do I need a CPAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
BlackSpinner
Posts: 9745
Joined: Sat Apr 25, 2009 5:44 pm
Location: Edmonton Alberta
Contact:

Re: Do I need a CPAP?

Post by BlackSpinner » Wed Dec 10, 2014 4:43 pm

Greendirt wrote:They are useful questions. Both are beyond me to answer. I can say I have a normal BMI and am otherwise healthy and use no medications. My condition was Sleep Syncope. My first doctor wasn't much use. The second could find no evidence of an obstruction.
A proper sleep study would have made the issue clear from the beginning. So yeah I doubt the whole thing very much.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Additional Comments: Quatro mask for colds & flus S8 elite for back up
71. The lame can ride on horseback, the one-handed drive cattle. The deaf, fight and be useful. To be blind is better than to be burnt on the pyre. No one gets good from a corpse. The Havamal

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: Do I need a CPAP?

Post by ChicagoGranny » Wed Dec 10, 2014 5:46 pm

BlackSpinner wrote:I doubt the whole thing very much.
+1

Here is what Greendirt wrote two months ago - viewtopic.php?f=1&t=101316&p=946032#p946032




Greendirt wrote:I can say I have a normal BMI and am otherwise healthy and use no medications.

Earlier: however since I am slim, quite fit and had [almost] no other health problems everyone expressed surprise I could have OSA
You need to rid yourself of the stereotype that slim, fit people don't have sleep apnea. Sorry that this was passed on to you by poorly informed medical professionals.

Plenty of slim, fit, even young, people have OSA.

User avatar
ButtermilkBuoy
Posts: 147
Joined: Mon Nov 19, 2012 9:13 am

Re: Do I need a CPAP?

Post by ButtermilkBuoy » Wed Dec 10, 2014 5:48 pm

ChicagoGranny wrote:Plenty of slim, fit, even young, people have OSA.
It is epidemic.

_________________
Mask

Greendirt
Posts: 50
Joined: Fri Dec 02, 2011 2:13 am
Location: Australia

Re: Do I need a CPAP?

Post by Greendirt » Wed Dec 10, 2014 8:45 pm

All I can say is that is what happened to me.

My doctor could find no cause of an obstruction. High BMI is a common cause of obstruction. In the absence of that, unusual anatomy is a potential cause. I don't have that either. No other cause for an obstruction was found. It was anomalous until I got the pacemaker and the symptoms went and a sleep study found normal AHI. The Dr was reluctant to order that study since I had no symptoms, but did so in view of the prior diagnosis.

So, the cause for me was not an obstructed airway. Maybe others without an identifiable cause of an obstruction have SA symptoms for another reason too (apart from CSA).

A sleep study report is just a report. It is not true that high reported AHI always means the only diagnosis can be OSA / CSA.

User avatar
BlackSpinner
Posts: 9745
Joined: Sat Apr 25, 2009 5:44 pm
Location: Edmonton Alberta
Contact:

Re: Do I need a CPAP?

Post by BlackSpinner » Wed Dec 10, 2014 10:10 pm

Greendirt wrote:
A sleep study report is just a report. It is not true that high reported AHI always means the only diagnosis can be OSA / CSA.
A sleep study done in a lab if done by partially competent people would have had you in cardiology getting that pacemaker put in before the night was over. They would SEE your heart doing its weirdness. Even a home study would show the pulse and O2 levels and BP levels dipping as well. So either you had the world's worst lab study, or the person reading your home study needed a seeing eye dog.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Additional Comments: Quatro mask for colds & flus S8 elite for back up
71. The lame can ride on horseback, the one-handed drive cattle. The deaf, fight and be useful. To be blind is better than to be burnt on the pyre. No one gets good from a corpse. The Havamal

Greendirt
Posts: 50
Joined: Fri Dec 02, 2011 2:13 am
Location: Australia

Re: Do I need a CPAP?

Post by Greendirt » Wed Dec 10, 2014 11:54 pm

A sleep study done in a lab if done by partially competent people would have had you in cardiology getting that pacemaker put in before the night was over. They would SEE your heart doing its weirdness.
No, it's not as simple as that. A slow pulse with good rhythm is not a cause for a pacemaker and may not cause panic in a sleep lab either. Asystole is different: It was a recorded period of 10.4 seconds between heartbeats that got me the pacemaker. That didn't happen in a sleep lab.

I understand the skepticism, the doc called what I have 'rare". But I think it's worth noting that there are alternative potential causes for a high AHI when there is no apparent cause for an obstruction and only a low pressure is needed. Especially if the therapy is only partly effective.

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: Do I need a CPAP?

Post by ChicagoGranny » Thu Dec 11, 2014 8:09 am

Greendirt wrote:High BMI is a common cause of obstruction.
Wrong! A poorly developed jaw resulting in a narrow airway is the most common cause.

High BMIs are sometimes the result of obstructions.
BlackSpinner wrote:A sleep study done in a lab if done by partially competent people would have had you in cardiology getting that pacemaker put in before the night was over. They would SEE your heart doing its weirdness. Even a home study would show the pulse and O2 levels and BP levels dipping as well. So either you had the world's worst lab study, or the person reading your home study needed a seeing eye dog.
+1

Greendirt, You need to take care of yourself because I can't, but I remain skeptical about what you are saying.

Have a nice week.

Greendirt
Posts: 50
Joined: Fri Dec 02, 2011 2:13 am
Location: Australia

Re: Do I need a CPAP?

Post by Greendirt » Thu Dec 11, 2014 3:15 pm

The point is that a pacemaker does not resolve any kind of obstruction. But they are proved (Google it if you like) to reduce OSA symptoms in SOME people. In my case, one day I was CPAP dependent. The next day I had no sleep apnea symptoms. What happened that day was the insertion of a pacemaker.

My medical advice was that since the symptoms were resolved without an obstruction being removed, there was no evidence I ever had OSA.

All I say is that there nay be other causes for the same symptoms for some people.

User avatar
Chevie
Posts: 346
Joined: Fri Nov 01, 2013 5:55 am

Re: Do I need a CPAP?

Post by Chevie » Thu Dec 11, 2014 3:34 pm

Greendirt wrote:But they are proved (Google it if you like) to reduce OSA symptoms in SOME people. In my case, one day I was CPAP dependent. The next day I had no sleep apnea symptoms. What happened that day was the insertion of a pacemaker.
I don't understand that. If I google, as you suggested, "pacemaker treats sleep apnea", I get hits about a device that stimulates a nerve to keep the airway open while you are asleep. This is not a heart pacemaker.

But what really puzzles me is before you had the pacemaker, you claim CPAP treated your severe obstructive sleep apnea. If the apnea was caused by a heart problem, how could CPAP treat it so well???

User avatar
OkyDoky
Posts: 2870
Joined: Mon Aug 25, 2014 5:18 pm

Re: Do I need a CPAP?

Post by OkyDoky » Thu Dec 11, 2014 4:00 pm

Greendirt wrote:The point is that a pacemaker does not resolve any kind of obstruction. But they are proved (Google it if you like) to reduce OSA symptoms in SOME people. In my case, one day I was CPAP dependent. The next day I had no sleep apnea symptoms. What happened that day was the insertion of a pacemaker.

My medical advice was that since the symptoms were resolved without an obstruction being removed, there was no evidence I ever had OSA.

All I say is that there nay be other causes for the same symptoms for some people.
Your syncope symptoms from a heart condition were treated with a pacemaker. Understandable. But the confusing part is you reported an AHI of 48 which was treated with CPAP and decreased before the pacemaker. I think this is concurrent but separate conditions.

I would want to see a copy of both of the sleep studies, if I was you, and see what the AHI was made up from, because a cardiac pacemaker only treated your syncope symptoms and I would't want to bank my life on the obstructions disappearing.
ResMed Aircurve 10 VAUTO EPAP 11 IPAP 15 / P10 pillows mask / Sleepyhead Software / Back up & travel machine Respironics 760

User avatar
Chevie
Posts: 346
Joined: Fri Nov 01, 2013 5:55 am

Re: Do I need a CPAP?

Post by Chevie » Thu Dec 11, 2014 4:47 pm

I bet at least one of the sleep studies was screwed up by the profession.

If the first one was false positive, OK.

If the second one was false negative,
OkyDoky wrote:I would't want to bank my life on the obstructions disappearing.
it could cost you dearly.

Greendirt
Posts: 50
Joined: Fri Dec 02, 2011 2:13 am
Location: Australia

Re: Do I need a CPAP?

Post by Greendirt » Fri Dec 12, 2014 6:16 am

This short medical report is of a fellow who was diagnosed with sleep apnea, got a pacemaker for syncope, then didn't have apnea symptoms anymore.

http://circ.ahajournals.org/content/107/23/2987

I might see what else I can dig up on the weekend.

User avatar
Therapist
Posts: 213
Joined: Sat Dec 31, 2011 3:31 pm

Re: Do I need a CPAP?

Post by Therapist » Fri Dec 12, 2014 8:09 am

Greendirt wrote:This short medical report is of a fellow who was diagnosed with sleep apnea, got a pacemaker for syncope, then didn't have apnea symptoms anymore.

http://circ.ahajournals.org/content/107/23/2987

I might see what else I can dig up on the weekend.
his wife reports that the sleep apnea is gone.
Well if the wife says it, it must be true.

_________________
Mask
Additional Comments: Pressure 8 - 12. Without CPAP I would be unhealthy.
I am not a medical professional and I have no medical training.

Greendirt
Posts: 50
Joined: Fri Dec 02, 2011 2:13 am
Location: Australia

Re: Do I need a CPAP?

Post by Greendirt » Sat Dec 13, 2014 3:01 am

I might tackle this by Q&A based on the preceding discussions.

Do you have Obstructive Sleep Apnoea (OSA)?
There is no evidence to indicate I currently meet any criteria for a diagnosis of OSA. I have none of the usual symptoms (eg: snoring, excessive tiredness etc) and a sleep study in a sleep lab in June 2014 recorded an AHI of 1.3 (nil apnoea, only hypopnea). If I went to a doctor now I could not be diagnosed with OSA or be advised to use CPAP since I have no symptoms.

Did you have OSA?
There was evidence for it when I had a home sleep study in July 2011 and up to the insertion of my pacemaker in January 2014. I was snoring badly, was exhausted all the time, thrashed around in bed, got up for the toilet too often etc etc and had an AHI of 48 recorded. On rare occasions when I did not use CPAP, those symptoms returned immediately and I felt dreadful.

Why do you doubt your breathing issues during sleep were due to OSA?
I certainly had sleep disordered breathing. But I am not persuaded I had OSA because:
[*] my measured AHI has dropped from 48 to 1.3 without any changes relevant to airway obstructions;
[*] there is no specific evidence there was ever any anatomical or mechanical obstruction to my airway;
[*] the symptoms of OSA disappeared as soon as the pacemaker went in;
[*] my health has continued to improve post-pacemaker consistent with getting oxygen around my body all day and all night, which I probably wasn't getting before; and
[*] my previous symptoms can be sufficiently explained by the slow heart rate and associated issues. You can't breath well if your heart rate is too slow and blood pressure is too low for your body.

When the pacemaker went in, I just felt totally different and so much better. The black patches under my eyes went, I had energy, my irritability went, I had energy, my memory returned, skin issues improved etc. After a week or two I tried not using CPAP and I felt the same as when using it, and my wife reported no snoring, thrashing around etc whether I used CPAP or not (probably like the guy in the 'short medical report' I noted above). Then I got the medical advice I had no need for CPAP as there was 'No evidence of any significant sleep disordered breathing', to quote my doctor's report.

Might the sleep studies have been wrong?
Maybe. But the results were consistent with the other symptoms in both cases, so they probably weren't very wrong.

Did CPAP help?
Yes, a lot. But not enough and I was getting worse. By mid to late 2013, on CPAP, I was becoming deeply tired, irritable, forgetful, lethargic etc. My wife said a few times I looked like was dying slowly (whatever that means). I don’t know what I’d have been like without CPAP at that time: maybe I needed it though the day too at that time!

How come CPAP helped if you don’t have OSA?
I suppose because air was being blown up my nose while I wasn't breathing correctly. That helps whatever the cause of disordered breathing is.

Is there any research evidence for sleep disordered breathing being improved by regular dual chamber pacemakers?
Yes, but not enough to make them a viable treatment option. Reductions in AHI of over 50% are reported. The new apnoea specific devices might be useful and less intrusive and costly.

The article ‘Implantable Pacing Devices and Sleep Apnea: Implications for Diagnosis and Therapy’ includes a useful summary. This link goes to page 3 where studies on pacemakers re SA are discussed: http://www.medscape.com/viewarticle/504430_3

Matsushita et al found a reduction in average AHI from 20 to 11 following pacemaker insertion in 40 patients. http://www.journalofarrhythmia.com/arti ... 1/abstract

Is there research to indicate cardio-inhibitory vasovagal syncope can affect how people breathe in their sleep?
Some, but not enough.

Puel et al (Sleep related breathing disorders and vasovagal syncope, a possible causal link?) and Krediet et al (Vasovagal syncope interrupting sleep?) really say that more research is needed, but that it is quite likely. Likely enough for a name to be given to it: sleep syncope.

Shouldn't a PSG have identified the heart issue?
I wish they had. But I suppose they'd identify the breathing issues as OSA and maybe any heart rate drops that may have been noted as 'normal for you'. There's nothing actually wrong with a slow pulse unless it causes a problem, some people live well with slow pulses. Not sure how many of them are over six foot like me, though.

In any case, it's not actually a heart issue per se, my heart responds to certain other body changes by slowing down. My heart is fine. That's why the PSG, a 24-hour holter monitor, echo-cardiogram, stress test, a year's worth of ECG recordings from loop recorder inserted under my skin where the pacemaker is now and any amount of stethoscope listening found nothing. They'd detect an arrhythmia, but I don't have one. The only evidence for this is an ECG recording of asystole (flatline) during an episode of syncope.

How did your diagnosis get made?
The cardiologist found nothing wrong with my heart after every non-invasive test was done. The long-term loop recorder recorded what happened to my heart during an episode of syncope, which turned out to be a year after it went in. What happened was a 10.4 second pause between heartbeats (asystole) after I felt nauseous at 3am. It was an awful experience; as were the previous five or six episodes in the early hours of the morning.

Now my heart rate is kept above 40 beats per minute and can’t drop more than 20 beats per minute in 20 seconds: if it tries, it's paced up to 80bpm. It works about 10 times a day and up to about 2 hours a day, often overnight. It's disconcerting to be sitting down, minding my own business nice and comfortably to then have my heart suddenly jump from 40 to 80 bpm like I've just run around the block.

What’s the point of all this?
People here have issues with breathing whilst asleep. High AHIs may sometimes have causes other than anatomical or mechanical airway obstruction, and if the cause is different then the right treatments might include something other than / in addition to CPAP. Most readers here will have OSA, or maybe CSA. But some might have something else that affects their breathing in their sleep as well as or instead of OSA. CPAP is great, it might have saved my life. But the other health issue I had, which was partly mitigated by CPAP, might have taken me just as surely as untreated OSA could have.

This is making me revisit the thought of enquiring into any research potential. I doubt there are too many people with this issue who also have the curiosity to consider allowing themselves to be poked and prodded and maybe have PSGs with pacemaker on and off (or set low) to prove cause and effect.

User avatar
zoocrewphoto
Posts: 3732
Joined: Mon Apr 30, 2012 10:34 pm
Location: Seatac, WA

Re: Do I need a CPAP?

Post by zoocrewphoto » Sat Dec 13, 2014 3:54 am

Please explain how the cpap helped before the pacemaker. How did blowing air down your throat take care of the problem if it was not obstructive sleep apnea.

Also, do you realize that obstructive sleep apnea does not mean there is an obstruction while awake? The doctor isn't going to find an obstruction just looking down your throat. I have a narrow airway, small recessed jaw, very typical of somebody with sleep apnea. While awake, I have no obstructions. I can breathe fine. While asleep, my throat relaxes, and that is what closes my airway down.

It sounds like your doctor has given you a false idea of sleep apnea where there must be an obvious physical obstruction. If you truly believe you do not have sleep apnea, please explain why the cpap helped before the pacemaker, and please post those sleep studies, especially the one proving you don't have sleep apnea.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Resmed S9 autoset pressure range 11-17
Who would have thought it would be this challenging to sleep and breathe at the same time?