Sleep Apnea and Atrial Fibrillation are connected

Hi,

I have been on this site in the past as "One Tired Puppy". I haven't been on for years. When I was first on here in 2007 I started changing my settings on my machine like everyone else seemed to be doing. I have since learned that this is not a good idea without checking with your doctor first. Why? putting it up at high pressures for any length of time can start central apneas. But that is not all. People who have Atrial Fibrillation are more likely to have had sleep apnea first. Sleep Apnea does effect the heart. That is a good enough reason to be careful about messing with your pressures. I tried going up bit by bit to higher pressures but eventually came down to a pressure of 9 and stayed there. I found it was more comfortable and the doctor allowed me the 9 pressure over the previous 7. At a pressure of 9 my mask wasn't blowing off and I had much less leakage.

How much damage did I do with the months I was messing with my pressures? I'm not sure, but I have since been diagnosed with Atrial Fibrillation which is an electrical problem with the upper chambers of the heart. This can cause the heart rhythm to get out of control causing blood to pool in the left atrium which causes blood clots. These clots can go straight to your brain or lungs. This puts me at high risk for stroke now. I have also found out that I am a bleeder, so cannot take anti-coagulants to help keep me from stroke. Even Aspirin therapy is out because I cannot tolerate anti-inflammatory drugs. This makes my stroke risk even higher. There are Ischemic strokes and hemorrhagic strokes. Ischemic strokes may not be as bad and recovery better than hemorrhagic strokes which cause bleeding in the brain and can be fatal.

Another consequence of the high pressures over a few months may have caused a very bad esophageal problem (I can't say for sure) that causes chest pain which last for several hours at night and goes on for at least six days. The chest pain can be confused with heart attack as the symptoms are similar. I am wishing I had never experimented with high pressures for months and would have just consulted the doctor for need for pressure raise. Maybe, I would not have all the problems I now have. Another is with air blowing into my eyes, I also have vision problems made worse.

What I am trying to say here is, you do not know what consequences there could be for you by messing with your pressures. You may not have any consequences to it, at least not for months or years, but someone else on here might have very serious consequences.

I realize you will do what you want anyway, as I did, because everyone else was doing it and they seemed ok. I just want you to think about this before continuing messing around with the pressures.

At a pressure of 9 for the past years I am down to 0 apneas and .06 hypopneas per day. Taking it slow but steady at a comfortable pressure, hopefully that prescribed pressure, which if not enough, doctor will elevate, you will reach your goal without causing more medical issues for yourself. You can still track and record your therapy, but be able to show others that the slow and steady set pressure really does work over time and be able to show them the great results to encourage them to be patient.

I hope the best for each one of you and would encourage you to keep on with your therapy and not give up. People with Atrial Fibrillation are being sent to sleep apnea clinics now to help with the Atrial Fibrillation, keeping their out of control heart rhythms better under control. You may be getting some A Fib people on this forum, if you don't already have some on here. They especially must not be messing with their therapy as it could cause them their life.

For those of you who are experimenting, with pressures, please do not make big jumps. A one cm increase for a week or two at a time is safer and when you start coming back down do it the same way, gradually until you are at a very comfortable pressure close to what you were prescribed. I think the sudden jumps up and down are harder on the heart.

This once one tired puppy is older and wiser now, but unfortunately now has more morbidities.

Take care, and I hope you all stay healthy.
Lannie

Lannie, I am sorry to hear you have developed atrial fibrillation. However your pressure change experimentation most likely had nothing to do with it.

You experience a much greater pressure change by simply going up a hill that is 1000 feet above your current elevation. Heavens knows what would happen if you took an airplane flight... or dove to the bottom of the deep end of a swimming pool.

Many of us would love to have a doctor that is attentive enough to what we are going through to pay attention to proposed pressure changes. As it is we try to review the data provided by the machine and make small adjustments until the data indicates that we are at optimum settings.

In addition I think most of us report to our doctors what changes we have made and the data that suggested the changes.

Frequently, but not always, atrial fibrillation is a result of essential mineral imbalance within the body. This starts with low levels of vitamin D. Many find that their fibrillation is completely controlled by monitoring their vitamin D levels and taking a supplement of magnesium. Green leafy vegetables work better than supplemental magnesium but some people don't care to include enough green leafy vegetables in their diet.

Muscle spasms in the chest, arms, and legs can also indicate a mineral imbalance and are frequently eliminated by once again paying attention to vitamin D levels and making sure your intake of magnesium is adequate.

I agree that pressure changes should be small and if possible the doctor should be kept in the loop. But I don't expect the doctor to be as concerned with my health as I am and there are times where independent action is needed.

You bring up some very good points! Thank you!

CPAP can help with critical closing pressure issues.

But the pressure of CPAP drives the respiratory control loop gain higher and so may cause hypocapnic central apneas and long term facilitated hyperventilation. I have always thought that the resulting closed off circulatory system with the heart trying like mad to compensate would indeed be hard on the heart.

As well the pressure changes of CPAP along with noise and vibration work to drive our breathing and central nervous system above the arousal threshold. This also tends to increase respiratory control loop gain and to lower the arousal threshold as well.

I still wonder if Auto-CPAP is wise and am honestly concerned when I see doctors leave the range wide open as I often see mentioned here. I wonder how many heart problems result from that.

Yes we need to learn to use pressure wisely and conservatively.

In regards to using doctors, they are absent without leave.

I am glad to see people here learning to download data. I hope that others learn to use lifestyle changes first to make CPAP work rather than changing pressure at the drop of a hat. And as you point out raising pressure is tickling the dragon's tail! Do so at your own risk.

I am glad you have found good doctors. I am still on my quest.

Lannie
Yes, there are other people here that have Atrial Fibrillation. I was diagnosed with it after a bout with Congestive Heart Failure about three years ago. My Dr was about to send me to a referring Cardiologist to have my rhythm reset, But by that time my Afib had corrected itself. I still have it, but it comes and goes. I believe that is quite common. My primary Dr explained that it was far from a reason for over concern. Many of us with Afib are being treated for it, and living quite well. I have only "detected it myself" (felt it) one time in the three years. The thing you must do is make sure you keep your physician recommendations and follow them.

I am now being treated at the VA for my primary care which includes the Afib. They don't normally send you to have the rhythm reset unless the Afib is constant and interfering. However, they are very serious about blood thinning to prevent stroke risk. I am on a Coumadin/Warfarin regimen.They were checking me every week and then finally on a monthly schedule. The VA makes everyone on blood thinners to sign a contract that they will keep all their appointments and follow instructions. Once you do that - easy peasey. Just follow their instructions.

You mentioned you have a "bleeding risk". I would think this means your blood thickness is already thinned, so that would mean your risk of clotting is reduced. You should discuss that with your physician in detail so that you feel you understand what that means and that it does not mean it cannot be controlled. By the way you mentioned no aspirin. Ibuprofen and Naproxen Sodium are also NSAIDs like aspirin and should not be used either, Hopefully they told you that.

My Apnea was not diagnosed until last October when I started with the CPAP.

Since being treated at the VA I have had two cataract surgeries (not much bleeding) last fall. After that they recommended I have Blepharoplasty done (eyelid surgery to increase vision range) that does have bleeding- March 6th. They did an EKG that morning for safety and I was ok and they did the surgery. I was even awake for part of it. I was fully alert within 30 minutes after they were done. I am 68 years old with high blood pressure. But all these things can be controlled. Otherwise they would not have done the surgeries.

My take on the AFib, High Blood pressure, and Apnea thing is that I let myself get overweight and did not take "care of business". That's on me although there is a chance some of the problems are related to my service in the Marines in Vietnam. I was exposed directly to Agent Orange that was dumped after airflights. The AO got into our drinking water. We never knew - until it came out in news about three years ago.

I am extremely grateful of all the care I am getting at the VA and feel very confident that my problems can be controlled and improved. I'm not going to let Afib or Apnea beat me. I'm going to keep a positive attitude and take advantage of modern medicine. I'm glad they caught these things.

You mentioned that Afib and Sleep Apnea are related. I'd never heard that before. I do agree that having Afib means that we must be very devoted to our CPAP therapy. I'm going to be sure and ask the Pulmonologist at the VA when I see him next month for my final check before going into maintenance on Apnea/CPAP.

Please stay positive yourself. And don't be scared. Just be careful to follow and let the Dr's guide your care.
Lot's of people have Afib and you would never know. Don't let it dominate your life.
Let life dominate.

HoseCrusher, Thanks for your response.

"Muscle spasms in the chest, arms, and legs can also indicate a mineral imbalance and are frequently eliminated by once again paying attention to vitamin D levels and making sure your intake of magnesium is adequate.” HoseCrusher


I agree vitamin D and Magnesium are important and I do take them. The GERD, however is from too much acid in my esophagus, which acts up if I eat greens, any fruit like oranges, grapefruit, and not only green vegetables, but cauliflower, and too many foods to mention including steak, or ketsup. I went on a very limited diet and am just adding one thing at a time to see if I can eat it without getting the chest pain. It is the acid that is causing it. I have acid damage in my esophagus just from eating the foods I have always loved. I can’t help wondering if that didn’t start from all the air being pumped into me from the cpap machine. It causes me to bloat and burp, and makes my eye lids swell up from wind from the mask as well. I don’t know how to stop this from happening except to try to stay at as low a pressure as possible. For me, that has been 9 cm.

If you know a cure for this, I would be more than happy to hear about it as I want to get back eating normally and more healthy, especially greens.

GERD often goes with OSA and often seems to precede it if anything. Some people have said their's got better on Cpap, so while it may cause aerophagia (the bloated burps etc.), it's unlikely to have been caused by it.

Todzo, thank you for your response.

"But the pressure of CPAP drives the respiratory control loop gain higher and so may cause hypocapnic central apneas and long term facilitated hyperventilation. I have always thought that the resulting closed off circulatory system with the heart trying like mad to compensate would indeed be hard on the heart.”…Todzo


In 2007 I saw the sleep doctor because I had centrals showing up on my software. I was using the Sandman by Puritan Bennett, although I also had a ResMed Elite 8. On the Elite 8 software it was showing many hypopneas but on the Sandman software it showed both hypopneas plus several centrals. This was the reason I went to the doctor. I was very concerned about the centrals.

This was in July. I had started therapy the previous May. The sleep doctor didn’t seem to be concerned and didn’t even talk about the centrals. I wanted to get tested again so he could see them. He said you have to wait until the year is up. That would be 10 months later. I was frustrated and never went back for the yearly checkup. I did continue with the clap therapy though.

In all fairness, he was a good doctor and explained everything (except centrals) and had much patience. At the time I wrongly though he didn’t care. This was scary for me at that time which accounted for my emotions then.

I stopped thinking about the centrals until I was diagnosed with Atrial Fibrillation and then started wondering if there was a connection with your breathing stopping for 2-3 beats, then speeding up too fast. I don’t know if there is or not. Has anyone else thought about this? When we miss 2-3 beats with AF could that be the same as forgetting to breathe as opposed to not breathing due to obstruction?

Thank you for your response, OldSarge.

My primary Dr explained that it was far from a reason for over concern. ... The thing you must do is make sure you keep your physician recommendations and follow them.

OldSarge, I don’t know if you live alone or with a spouse or other family, but when you live alone it is a little disconcerting. My biggest concern is that because I am a bleeder, I might be more likely to have a hemorrhage stroke which can be fatal or extremely debilitating. No one would know if I had a stroke unless I was able to call and speak. I know Ischemic strokes may not necessarily be real bad and recovery is pretty good if you get help in time, but a hemorrhage stroke or cerebral bleed is more scary to me.

"You mentioned you have a "bleeding risk". I would think this means your blood thickness is already thinned, so that would mean your risk of clotting is reduced. You should discuss that with your physician in detail so that you feel you understand what that means and that it does not mean it cannot be controlled. By the way you mentioned no aspirin. Ibuprofen and Naproxen Sodium are also NSAIDs like aspirin and should not be used either, Hopefully they told you that.”

When I was in the hospital for two weeks after having a total bowel obstruction I had to have Heparin injections in my abdomen every day for that two weeks. Was that because my blood was too thick then? I think my blood is only thin when I was on the aspirin. I nicked my finger and it bled for three days, with bandages being changed. The aspirin made my blood very thin. All I know is that the cardiologist said I am at high risk for bleed. I would have to ask him about the thickness of my blood without blood thinners.

My cardiologist won’t put me on coagulants because of being a bleeder. He told my family doctor (who is new) to put me on a high dose Aspirin. I told my family doctor I cannot tolerate anti-inflammatory drugs as they caused ulcers in the past. He told me to just take a low dose Aspirin instead. I took a low dose Aspirin right after supper meal so that my stomach would be well coated. After a few months my stomach got irritated and sore and so I quit taking the low dose Aspirin too. I haven’t been back to see either my doctor or cardiologist for about 18 months or so. I need to get back. My doctor did warn me to keep my stress levels down. I have paroxysmal AF but apparently it does get worse over time as it is progressive according to Medical Journals. Some people might stay lone, or paroxysmal for many years while others may progress faster. If we get exercise, good nutrition, regular sleep and otherwise take care of ourselves (continuing on pap therapy) we may be able to keep the progression at bay and maybe even lessen the effect it is presently having on us.


"You mentioned that Afib and Sleep Apnea are related. I'd never heard that before. I do agree that having Afib means that we must be very devoted to our CPAP therapy. I'm going to be sure and ask the Pulmonologist at the VA when I see him next month for my final check before going into maintenance on Apnea/CPAP.”


You can read about this in Medical Journals. It is the sleep apnea itself before treatment that is hard on the heart and Medical doctors believe this strain on the heart is what causes Atrial Fibrillation. This is why now they are recommending everyone who has AF get a sleep study done and pap therapy.

GERD often goes with OSA and often seems to precede it if anything. Some people have said their's got better on Cpap, so while it may cause aerophagia (the bloated burps etc.), it's unlikely to have been caused by it.


Hi Julie,
I never had a problem with GERD or not being able to eat greens and many other fruits and vegetables and a lot of sauces before I began cpap therapy, so for me, I am pretty certain it is a cause, at least partially, because I am a mouth breather and I toss and turn all over the place all night. I get more exercise while sleeping than I do while awake. I think another possibility could be some of the drugs we are prescribed. I had been on Bisphomats (spelled wrong) bone builder for about 18 years before the GERD started, (it’s been known to cause esophageal problems) so I stopped taking the bone builder. Protein Pump Inhibitors can also cause fractures and even atrial fibrillation. There’s no winning with drugs.

IntelliPAP AutoAdjust Travel CPAP Machine with SmartFlex

My ResMed Elite 8 is 7 years old and not doing so well. I expect it is on its last days. I was checking out new machines and have chosen the same one you have except it has A Flex. I don’t know it that is different or the same thing.

How do you like this machine? I previously had a Sandman from Puritan Bennett and like it better than the Res Med. It had better flow for me. I used 9 cm pressure on the Sandman but had to put the ResMed to a 10 cm to get equivalent result.

Lannie, Sleep apnea causes heart problems. Not xPAP therapy. When you stop breathing your body responds with a "fight or flight" response and your body then has to process the chemicals produced during this startle. While the body can handle a couple of these a day when you subject it to several an hour you run the risk of damaging your cardiovascular system. Stinting your airway open with air eliminates the startle response and your body is spared from further chemical attack.

GERD has two main causes. One is structural. If the valve that is supposed to keep stomach content in the stomach is damaged, it doesn't do its job. The other cause can be chemical. The thought is that as people age their ability to get the digestive juices flowing is hampered and slowed down. In this case food sits in the stomach and ferments and that produces acids and gas that forces its way back up.

If the cause is structural, you need surgery to repair the damage.

If the cause is chemical, there are a variety of approaches. One is to neutralize the acid in the stomach. This take care of burping up acid, but since acid is needed for digestion it can hamper digestion. Another way is to supplement with the elements that make up the digestive juices working along with a naturopath to make sure you aren't doing additional damage. Another way is to make an effort to stimulate the flow of digestive juices prior to eating. Another way is to break the food down prior to eating to make it easily digestible.

Unfortunately, many people have to do a variety of things to control this and one simple solution is not found.

There's another way to live with GERD, something a lot of forum members do - get the head end of your bed up on 4-6 inch (no more!) blocks - it keeps the acid from rising.

Lannie, have you inquired about an ablation procedure?

Hi Chunkyfrog,

Lannie, have you inquired about an ablation procedure?


Ablation is out for people with high risk of bleed according to the medical journals. There is only one way that is available that would be safer, even though it too has risks. That would be insertion of a device into the left atrial appendage (where blood clots easily when it pools in here). The device is to keep the blood clots from leaving the left atrial appendage and going out into the brain. There are different type devices and different ways of implanting them. This is usually kept as a last resort after people have tried different coagulants and have had 2-3 ablations. I am 69 years now so will speak with the cardiologists on having the LAA done if that would be an option for me. The older you are, the more riskier so would like to get it done within a couple years at least.

The medical profession say the device to block blood clots from leaving the left atrial appendage and going to the brain is just as effective as the coagulants Warfarin and others. It must be expensive or why wouldn't they just do everyone this way rather than making them go through all the drugs and other procedures such as ablation and maze.

Hi Julie,

There's another way to live with GERD, something a lot of forum members do - get the head end of your bed up on 4-6 inch (no more!) blocks - it keeps the acid from rising.



I have been using an electric bed for the past six years because of the GERD. Because I also have acid damage to my esophagus I occasionally have to sit up straight for six hours as I cannot sleep because of pain. I also get swelling in my ankles so also raise the foot of the bed up some. The bed I purchased second hand and just got new mattresses. It was well worth the 500.00 I paid.

I also learned not to be late night snacking.

Hi HoseCrusher,


Lannie, Sleep apnea causes heart problems. Not xPAP therapy. When you stop breathing your body responds with a "fight or flight" response and your body then has to process the chemicals produced during this startle. While the body can handle a couple of these a day when you subject it to several an hour you run the risk of damaging your cardiovascular system. Stinting your airway open with air eliminates the startle response and your body is spared from further chemical attack.

Agreed! Sorry I did not make that clear in my post.


In regards to GERD,

Another way is to make an effort to stimulate the flow of digestive juices prior to eating.



How do you stimulate the digestive flow prior to eating? My stomach is also slow to empty and I had been given a med for it but it caused me to have jitters in my legs? It was a very weird feeling and I could no relax. I stopped taking that drug.