CPAP and Pulmonary Embolism

[Rin7835]

Hello,

I was recently diagnosed with severe sleep apnea (2 obstructive, 5 central, 211 hypopneas over a 6 hour period). Last month I got my diagnosis and me DME has been dragging their feet on getting me a CPAP machine. Two days ago I ended up in the hospital with pulmonary emboli. I switched DME providers and my new providers want to bring me my CPAP machine tomorrow, but I'm worried about the effects of the CPAP machine on the pulmonary emboli. I'm currently on Xarelto for the next 6 months. I asked the er doctor if it was safe to use the CPAP with a pulmonary embolism and he said it should be fine but didn't have any further information to offer (the doctor was phenomenal, just didn't seem to have anything further to add). Does anybody have any experience with this? Thank you!!!

[WildMtnHoney]

What exactly is your concern?

I have only had *tiny* PEs that were of no concern, but a fairly large DVT, and am on anticoagulants for life due to Factor V Leiden. I trialed warfarin and had too hard a time keeping my levels steady but am doing well on Xarelto now, and for the past 6 months.

[Rin7835]

What exactly is your concern?

I have only had *tiny* PEs that were of no concern, but a fairly large DVT, and am on anticoagulants for life due to Factor V Leiden. I trialed warfarin and had too hard a time keeping my levels steady but am doing well on Xarelto now, and for the past 6 months.

I guess my concern is that the constant pressure in my lungs from the CPAP machine will dislodge the nodules or agitate the emboli before they can dissolve. I don't know much about sleep apnea and this was my first experience with a pulmonary embolism, so I don't know much about that, either. I've asked medical professionals if pulmonary emboli were a contraindication for using the cpap machine, but none have really answered my question (outside of the er doctor saying it should be fine). I'm only 24 years old and my health went on a rapid decline over these past couple of months and I've been slammed with multiple strange diagnosis that just don't make sense, so I'm feeling a little lost and confused in it all.

[Julie]

There's no 'constant pressure' on your lungs... the Cpap air is barely strong enough to just keep your airway (throat) open enough so regular breath gets through - you're not having 'extra' air pumped in, let alone to your lungs.

[WildMtnHoney]

I'm so sorry to hear about your troubles!

First off, the emboli are in your blood vessels, not your air ways. Next, the air pressure, while enough to hold your upper airway open, isn't enough to do much else.

However, all of this should also be explained to you by your medical team. Do you have GP (general practitioner) who is coordinating your care? That would be a good person to schedule an appointment with. Make a list of all your questions, about everything you have going on, and just go through the list, hitting every question. There may be some questions they have to refer you back to a specialist for, but for the basics, they can explain a lot.

[Rin7835]

I'm so sorry to hear about your troubles!

First off, the emboli are in your blood vessels, not your air ways. Next, the air pressure, while enough to hold your upper airway open, isn't enough to do much else.

However, all of this should also be explained to you by your medical team. Do you have GP (general practitioner) who is coordinating your care? That would be a good person to schedule an appointment with. Make a list of all your questions, about everything you have going on, and just go through the list, hitting every question. There may be some questions they have to refer you back to a specialist for, but for the basics, they can explain a lot.

Thank you for the information! I do have a GP and I saw her today. She told me to ask my pulmonologist or sleep specialist for more information, but the referral for the pulmonologist was just put in today and it will probably be 6 weeks before I can get an appointment in. My sleep specialist doesn't really talk to patients - just does the sleep studies and won't really answer questions beyond that. Since I will be getting my cpap tomorrow, I just didn't know if it would be safe to use it or not. The er doctor said it should be fine but didn't seem really confident in the answer so I thought maybe one of you fine people had experience with this already. I really appreciate your help!

[Julie]

The point of Cpap is to keep your throat open, not to deliver more air to your lungs. Period.

[Rin7835]

The point of Cpap is to keep your throat open, not to deliver more air to your lungs. Period.

Thanks, Julie I haven't actually gotten my CPAP machine yet, so I was just making assumptions in how it worked. I guess I felt that way because during my sleep study last month, it felt like it was difficult to exhale while the CPAP was running so I just thought it was pushing air back into my lungs.

[chunkyfrog]

Better machines have lower pressure for exhaling. Ask for that.

[Julie]

There's a feature on machines that helps with exhaling pressure and you set it to whatever is comfortable for you.

[palerider]

The point of Cpap is to keep your throat open, not to deliver more air to your lungs. Period.

Thanks, Julie I haven't actually gotten my CPAP machine yet, so I was just making assumptions in how it worked. I guess I felt that way because during my sleep study last month, it felt like it was difficult to exhale while the CPAP was running so I just thought it was pushing air back into my lungs.

the cpap DOES create pressure, but the only air going into your lungs is what you inhale into them. the cpap makes it easier to breath, which can reduce stress on the lungs, because they're not fighting against the restrictions of your throat.

as to the pressure that you're afraid of... go into the kitchen, get a tall glass, fill it with water, stick a straw into it, and blow. the pressure you've just made is MORE than what the cpap creates.

10cm/h2o is a fairly average pressure, that's like blowing bubbles with a straw stuck just under 4 inches into a glass of water... that's how much pressure you have to exhale against.... if you can do it in a glass of water, you can do it with a cpap.

[SleepyEyes21]

Hi Rin- I understand your concerns completely, as I also had a pulmonary embolism prior to starting CPAP. Mine, however, was large enough to land me in the hospital for 10 days, followed by a blood thinner for six months. I was not diagnosed with apnea until a year and a half later. It was then that I learned that OSA can be a cause of pulmonary embolism. (Just an FYI for everyone: emboli do start in your blood vessels, however- they can break off and travel to your airways - that is when they become pulmonary/ in your lungs.)
It is a scary thing, Rin; I also knew nothing about embolisms either and like you, had a ton of questions for my doctors. But WildMtnHoney is right: write down all of your questions and ask your doctors every single one, until your satisfied you understand it. You can also ask the respiratory therapist who brings your machine a lot of these questions; he/ she can tell you a lot about how the machines operate and what they do for you. I've always found my local pharmacist to be very helpful with medical type questions, so that may be another avenue to try just to give you peace of mind. Here's another idea: since you are already referred to a pulmonologist, get the name and number of that doctor and call their office and ask the staff that very question. Just tell them you've already been referred as a patient, and you want an answer and a call back from the office/ nurse.

Be well, Rin!

I'm so sorry to hear about your troubles!

First off, the emboli are in your blood vessels, not your air ways. Next, the air pressure, while enough to hold your upper airway open, isn't enough to do much else.

However, all of this should also be explained to you by your medical team. Do you have GP (general practitioner) who is coordinating your care? That would be a good person to schedule an appointment with. Make a list of all your questions, about everything you have going on, and just go through the list, hitting every question. There may be some questions they have to refer you back to a specialist for, but for the basics, they can explain a lot.

Thank you for the information! I do have a GP and I saw her today. She told me to ask my pulmonologist or sleep specialist for more information, but the referral for the pulmonologist was just put in today and it will probably be 6 weeks before I can get an appointment in. My sleep specialist doesn't really talk to patients - just does the sleep studies and won't really answer questions beyond that. Since I will be getting my cpap tomorrow, I just didn't know if it would be safe to use it or not. The er doctor said it should be fine but didn't seem really confident in the answer so I thought maybe one of you fine people had experience with this already. I really appreciate your help!

[Rin7835]

The point of Cpap is to keep your throat open, not to deliver more air to your lungs. Period.

Thanks, Julie I haven't actually gotten my CPAP machine yet, so I was just making assumptions in how it worked. I guess I felt that way because during my sleep study last month, it felt like it was difficult to exhale while the CPAP was running so I just thought it was pushing air back into my lungs.

the cpap DOES create pressure, but the only air going into your lungs is what you inhale into them. the cpap makes it easier to breath, which can reduce stress on the lungs, because they're not fighting against the restrictions of your throat.

as to the pressure that you're afraid of... go into the kitchen, get a tall glass, fill it with water, stick a straw into it, and blow. the pressure you've just made is MORE than what the cpap creates.

10cm/h2o is a fairly average pressure, that's like blowing bubbles with a straw stuck just under 4 inches into a glass of water... that's how much pressure you have to exhale against.... if you can do it in a glass of water, you can do it with a cpap.

Thank you for the information. My cpap is 11cm. It feels a lot more forceful than it really is, I guess! I am starting to feel much more comfortable with the idea of the CPAP machine. I wasn't given much information and with this cascade of recent events, I felt really in the dark. I really do appreciate your input - knowledge is power!

[Rin7835]

Hi Rin- I understand your concerns completely, as I also had a pulmonary embolism prior to starting CPAP. Mine, however, was large enough to land me in the hospital for 10 days, followed by a blood thinner for six months. I was not diagnosed with apnea until a year and a half later. It was then that I learned that OSA can be a cause of pulmonary embolism. (Just an FYI for everyone: emboli do start in your blood vessels, however- they can break off and travel to your airways - that is when they become pulmonary/ in your lungs.)
It is a scary thing, Rin; I also knew nothing about embolisms either and like you, had a ton of questions for my doctors. But WildMtnHoney is right: write down all of your questions and ask your doctors every single one, until your satisfied you understand it. You can also ask the respiratory therapist who brings your machine a lot of these questions; he/ she can tell you a lot about how the machines operate and what they do for you. I've always found my local pharmacist to be very helpful with medical type questions, so that may be another avenue to try just to give you peace of mind. Here's another idea: since you are already referred to a pulmonologist, get the name and number of that doctor and call their office and ask the staff that very question. Just tell them you've already been referred as a patient, and you want an answer and a call back from the office/ nurse.

Be well, Rin!

I'm so sorry to hear about your troubles!

First off, the emboli are in your blood vessels, not your air ways. Next, the air pressure, while enough to hold your upper airway open, isn't enough to do much else.

However, all of this should also be explained to you by your medical team. Do you have GP (general practitioner) who is coordinating your care? That would be a good person to schedule an appointment with. Make a list of all your questions, about everything you have going on, and just go through the list, hitting every question. There may be some questions they have to refer you back to a specialist for, but for the basics, they can explain a lot.

Thank you for the information! I do have a GP and I saw her today. She told me to ask my pulmonologist or sleep specialist for more information, but the referral for the pulmonologist was just put in today and it will probably be 6 weeks before I can get an appointment in. My sleep specialist doesn't really talk to patients - just does the sleep studies and won't really answer questions beyond that. Since I will be getting my cpap tomorrow, I just didn't know if it would be safe to use it or not. The er doctor said it should be fine but didn't seem really confident in the answer so I thought maybe one of you fine people had experience with this already. I really appreciate your help!

Thank you very much for the information! It is very comforting hearing from a CPAP user with a history of pulmonary embolism. I think more than anything else, having my fears validated instead of dismissed helps a lot. One of the nurses at the ER mentioned the sleep apnea could have actually caused the embolism, but the er doctor couldn't confirm that and my GP really just wasn't sure about it. I was only in the hospital for 1 day, but I am also on the dreaded blood thinners for 6 months. Nothing will scare you like being told not to fall so you don't die from internal bleeding!

I'm a 0 risk for pulmonary embolisms - young, active, healthy weight, healthy blood pressure, not on any birth control, never had a pregnancy, no history of blood clots in my family. It seems the sleep apnea is the only risk factor I have for it. I'm being tested for clotting disorders by a hematologist - but that's not until the end of July. I still am very scared, but I've gotten a lot of reassurance and information here. I'm glad you shared your story with me. I don't feel so powerless and alone anymore and I'm beginning to embrace the idea of the CPAP. Thank you!

[WildMtnHoney]

[quote="SleepyEyes21"](Just an FYI for everyone: emboli do start in your blood vessels, however- they can break off and travel to your airways - that is when they become pulmonary/ in your lungs.)[quote="SleepyEyes21"]

Actually...they are always in your blood vessels. They often start in a blood vessel somewhere else in the body - like in a leg (DVT, for example, is very common) then that may travel to the *blood vessels* of the lungs. But it is always in a blood vessel. Never ever in an airway.

Here's a pic for you, of what that looks like: