CSA

[My case: mitral regurgitation and CSA?]

Hi guys.
Found this forum while looking for CPAP devices, my name is Rudy and I'm 28.

I'd like to ask for an opinion to all of you, with the hope of finding a bit of relief from my doubts.

As I said I'm 28, non smoker, 1.88cm x 85kg, always practiced sports in various forms.

Since when I was a child, I have the memory of never been able to sleep quite right. I was a sleepwalker and had a healthy dose of nightmares almost every other day.
I had period of more relaxed sleep and period not so relaxed.
I always had occasional arrythmias during all my life.

A couple of years ago I started to have episodes of apneas more frequently but always randomly (like 10 times one month, then nothing for 3 months and then again, etc).
Now I don't know if they are proper apneas but this is what happens:
- It's always when I'm falling asleep or, more rarely, in the middle of the sleep
- I wake up immediately, aware of the fact that I forgot to breathe, with accelerated heartbeat and (the most horrible sensation of all), loosing consciousness of my body (at times I catch it when it's still numb, other times it felt like I almost "lost contact")
- When this happens I usually urinate 4-5 in a few hours
- Mouth feels like a tropical desert
- Sometimes I have a sort of "foggy" vision like a white transparent overlay after the episode

Last year, 2013, during a night with a couple of apneas, I had atrial fibrillation. Went into emergency. Recovered fine in one night.
After cardiological visits the result was that my heart is perfectly fine, apart from a minimum mitral regurgitation, which is harmless (that's what they said). Everything was caused by stress (their word, again).

Now: I've seen a reduction of apneas when conducting a more serene, carefree life, practicing yoga, and pranayama... but I'm simply not at all persuaded it's just stress. These nights I had some of the most frightening episodes of apneas I ever had and I'm home without my wife for a couple of weeks, so I was thinking to go and see a doctor tomorrow because I'm at a point that I'm afraid of the bed.

I have read that mitral regurgitation can cause shortness of breath, dizziness, and.. can be a cause of the apnea.

As I said, my episodes are totally random and not constant, but when they appear... it's really scare.
I hope I'll be hearing your opinions soon.

Thanks everybody
my best

[rudypv]

to the moderators: I've just messed up username and subject, sorry for the mistake!

[bwexler]

First you may be grossly overweight if your hight is only 1.8 CM.

Where are you located?

It seems you could use a major physical including an overnight sleep study and a visit with a cardiologist.
Once you have collected all the results come back hear and ask more questions. Some of the folks here are extremely knowledgeable.

[rudypv]

Hi there.

The weight is definitely not a problem, my body fat is about 9-11%. I'm a personal trainer, so that's when of the first thing I'm confident about.

Last year I went to two different cardiologists (in Italy) and their only answer was stress.
I'm now residing in Kent, UK.

[BlackSpinner]

Hi there.

The weight is definitely not a problem, my body fat is about 9-11%. I'm a personal trainer, so that's when of the first thing I'm confident about.

Last year I went to two different cardiologists (in Italy) and their only answer was stress.
I'm now residing in Kent, UK.

Just ask for a sleep study. Tell them you sleeping partners say you "breathe funny" and you have sleeping issues and heart issues.

[rudypv]

Hi there.

The weight is definitely not a problem, my body fat is about 9-11%. I'm a personal trainer, so that's when of the first thing I'm confident about.

Last year I went to two different cardiologists (in Italy) and their only answer was stress.
I'm now residing in Kent, UK.

Just ask for a sleep study. Tell them you sleeping partners say you "breathe funny" and you have sleeping issues and heart issues.

That's what I'm gonna do tomorrow.
The weird fact is that I don't snore and my wife never heard anything strange. She wakes up just because I suddenly wake up panicking.
Also: I'm not tired or sleepy during the day.

[SleepWrangler]

As I said I'm 28, non smoker, 1.88cm x 85kg, always practiced sports in various forms.

Previous poster was making a small joke about your reported height. Somehow I think even Tom Thumb would have a bit less mass.

I don't know if the experts can make any recommendations based on the symptoms you have described. Here is a useful outline of what you may want to discuss with a medical or sleep professional.

viewtopic.php?f=1&t=97065&p=899188#p899163

[rudypv]

As I said I'm 28, non smoker, 1.88cm x 85kg, always practiced sports in various forms.

Previous poster was making a small joke about your reported height. Somehow I think even Tom Thumb would have a bit less mass.

I don't know if the experts can make any recommendations based on the symptoms you have described. Here is a useful outline of what you may want to discuss with a medical or sleep professional.

Hi SleepWarangler,

thanks for the link, I'm gonna check it out asap.

Are you telling me that my symptoms are not totally compatible with sleep apnea?

PS
I just caught my typo

[SleepWrangler]

Are you telling me that my symptoms are not totally compatible with sleep apnea?

I think you need medical guidance and that any kind of recommendation you're likely to get will be along those lines. That's why I supplied the link. It may give you some help to understand what you should think about before you meet with your doctor.

[Todzo]

Hi there.

The weight is definitely not a problem, my body fat is about 9-11%. I'm a personal trainer, so that's when of the first thing I'm confident about.

Last year I went to two different cardiologists (in Italy) and their only answer was stress.
I'm now residing in Kent, UK.

Yes I kind of thought you were talking 188cm @ 85kg = BMI of 24. Now I find out that you are lean as well!! Nice job!!

My first thought however is protein source. Over here in the states meat means concentrated GMO chemical load. If you choose to go with whey – pretty much same thing – and – a source known to work with aflatoxin toward cancer. I have pretty well decided to develop slowly and not supplement finding range fed when I can.

Sleep apnea can create some very extreme internal pressure profiles as one struggles against the obstruction to breath. This has been shown to warp the walls of the heart and is known to be associated with atrial fibrillation. I can imagine that you run your kilometers regularly and so your lung muscles are probably strong indeed.

The body does not like apneas and so your stress hormones tend to rise when they happen. This can also raise your respiratory control loop gain[1,2]. It can also lower your arousal threshold[1,2].

Thoughts on your symptoms:

“aware of the fact that I forgot to breathe” - air hunger, likely part of an over reaction to the events

“with accelerated heartbeat and (the most horrible sensation of all)” - a sign of hyperventilation also likely part of the over reaction

“loosing consciousness of my body (at times I catch it when it's still numb, other times it felt like I almost "lost contact")” - another sign of hyperventilation over reaction to the events

“When this happens I usually urinate 4-5 in a few hours” - Stress reaction means sugar release into your system – which you do not use – so through the kidneys into the bladder.

“Mouth feels like a tropical desert” - from my own experience another sign of a hyperventilation over reaction to the events

“Sometimes I have a sort of "foggy" vision like a white transparent overlay after the episode” - Visual aura? If so yet another symptom of hyperventilation.

I think your system gets really upset, be it from obstructive apneas or from high respiratory control loop gain working with possible low arousal threshold likely becoming long term facilitated and so causing you to awaken in a state of long term facilitated hyperventilation. I used to wake up that way from time to time and solve it (at the time) with eucapnic breathing techniques

I think that high respiratory control loop gain could be related to a too low or too high vitamin D3 level. Where I live we get no UVB from the Sun from about August to April. Vitamin D levels drop all that time.

Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health.

It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details.

Also look at B-12, magnesium, and iron.

You have the “move well” thing pretty well down apparently. If you are up to it you might add two sessions a week of 85% maximum heart rate interval training. I find this helpful when dealing with respiratory control system gain issues.

But perhaps it is time to also look at eating well. Ever work with a dietitian? Maybe time to start. Three years recommended. Learning to eat well is a live long endeavor I believe. Some thoughts for your right now more colors of the rainbow veggies, more fiber, less added sugar, some fermented foods. Stay far far away from processed foods

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

[SleepWrangler]

thanks for the link, I'm gonna check it out asap.

Oh, I should mention that many of the forum contributors, not all of them by any means, followed the following diagnostic labyrinth:

• 1. See GP and get referral to sleep specialist;
  2. Sleep specialist evaluation leads to sleep study if appropriate;
  3. Sleep study may lead to titration study to determine therapy and prescription;
  4. In home evaluation of therapy and prescription;
  5. Purchase of equipment and start dial wingin.

If there are sleep issues but no subsequent sleep study then that would be a red flag. Some members really had to push to get the sleep study done. I only mention this because some tax funded health systems may have push-back because of cost. YMMV

Have you read the wiki for sleep apnea and the FAQ for this forum?

• https://en.wikipedia.org/wiki/Sleep_apnea
  viewtopic/t35702/Where-A-CPAP-Newbie-Should-Start.html

[rudypv]

Hey thanks a lot for the wonderfully detailed answer. Very informative and interesting. Allow me to ask you a couple of things:

Hi there.

Thoughts on your symptoms:

“aware of the fact that I forgot to breathe” - air hunger, likely part of an over reaction to the events

What I feel is more as if I sort of miss an inhalation... my breathing stops after an a exhalation. Other times, I feel like my breathing got someway out of sync (I wake up with a sort of "forced" exhalation)

“loosing consciousness of my body (at times I catch it when it's still numb, other times it felt like I almost "lost contact")” - another sign of hyperventilation over reaction to the events

The problem with this symptom is that it I wake up like that. I mean I wake up while I'm in a sort of almost fainted state

“Sometimes I have a sort of "foggy" vision like a white transparent overlay after the episode” - Visual aura? If so yet another symptom of hyperventilation.

I really don't know how to describe this one but , during the nights when I have more episodes, at second or third, a part of my visual field has that sort of overlay.

I think your system gets really upset, be it from obstructive apneas or from high respiratory control loop gain working with possible low arousal threshold likely becoming long term facilitated and so causing you to awaken in a state of long term facilitated hyperventilation. I used to wake up that way from time to time and solve it (at the time) with eucapnic breathing techniques

I'm very interested in this: when you talk about "high respiratory control loop gain working with possible low arousal threshold", is it something caused by physiological issues? As I said, usually in periods of relaxation and when I do my yogic breathing, etc... I don't have these episodes. Do you suggest me to look into the eucapnic techniques?

I think that high respiratory control loop gain could be related to a too low or too high vitamin D3 level. Where I live we get no UVB from the Sun from about August to April. Vitamin D levels drop all that time.


It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details.

Also look at B-12, magnesium, and iron.

I lived in northern Italy all my life which is quite similar to UK as weather (autumns and winters don't have that much of sun). Curiously enough, my wife is Brazilian and when we lived there I didn't have episodes. My cardiologist also said I was low in potassium.

You have the “move well” thing pretty well down apparently. If you are up to it you might add two sessions a week of 85% maximum heart rate interval training. I find this helpful when dealing with respiratory control system gain issues.

But perhaps it is time to also look at eating well. Ever work with a dietitian? Maybe time to start. Three years recommended. Learning to eat well is a live long endeavor I believe. Some thoughts for your right now more colors of the rainbow veggies, more fiber, less added sugar, some fermented foods. Stay far far away from processed foods

I mix bodyweight training with a bit of cardio, yoga and judo. The Judo class is quite demanding and it can be definetely seen as a good HIIT I suppose.

About the diet, I was used to be more "organic" in Italy... here in the UK it's a bit more difficult for me

[JohnBFisher]

Ditto on getting a sleep study. Waking up in a panic can be either due to obstructive or central sleep apnea. You can be UNDER weight and still have either. Weight is NOT a good indicator of the probability of having sleep apnea (either type). From my own experience I am very certain that I had obstructive sleep apnea even as a teen when I was 20 pounds or so under ideal weight. Didn't stop the horrible snoring. It just got worse with time.

The sleep study really is the only reliable method to figure out what your sleep problems are and how to attack them.

Best wishes ... and do keep us updated!

[Julie]

And for what it's worth (seeing as you're a newbie) the odd person on this forum may tend to be pushy when it comes to alternative health 'answers' and give the same answers to any and everyone who writes in with problems regardless of relevance... so don't assume (even if you can make sense of their notes) that all have great advice for you... stick with those who make sense.

[Todzo]

And for what it's worth (seeing as you're a newbie) the odd person on this forum may tend to be pushy when it comes to alternative health 'answers' and give the same answers to any and everyone who writes in with problems regardless of relevance... so don't assume (even if you can make sense of their notes) that all have great advice for you... stick with those who make sense.

stop the personal attacks