Questions Relating to GI Issues/OSA in My Case

All,

You guys all have much experience to share and I'm always grateful. I posted erlier and got some good info about what may have set my therapy back. Now, I thought I'd ask if any of you with GI issues would like to help me figure out an idea of what/how my particular GI issues may iteract with therapy. I've read through the all the general information, and I thought this would be best in a new thread. It's just general discussion as I run everything through by my doc. I'll give a little background.

In early 2014, I got what I now know are some of the classic symptoms of untreated OSA. I was having some brain fog and began waking around 6:00am feeling my heart beating right after I moved in bed or when waking. Soon it became difficult to go back to sleep and soon I was having trouble getting to sleep. As I got these poor feelings, I quickly was racked with anxiety and GI symptoms such as abdominal pain, acid reflux, zero appetitie, bloating, and palpitations. This went on to full blown insomnia and all the medical tests expected. Even with the raging GI symptoms, my work-up showed normal esophagus and mild, inactive chronic gastritis. Eventually, I came home in August with the Apap after a measured AHI of 9/14 and desats of 84/89. I had the growing pains that many experienced, but the GI issues got a little better right away.

Now, as I posted earlier, 2015 was a pretty good year. I got treatment to an AHI of around 1.3 and was sleeping for 4-5 hours before waking and going back to sleep on and off in the morning. I even switched to nasal pillows, and there were lots of good days and some real health benefits. I went off acid reducing medication in January and maintained a reasonable but less restricted diet with good eating habits. Never before or during this period did I ever have any classic symptoms of heartburn, evening coming off 2X ppi's for 12 months. Yet, I woke up a couple of times a few weeks ago with the heart beat feeling, sometimes in a dream sometimes maybe an event. I didn't worry too much about it as some was dreaming, but I did have trouble getting back to sleep in the morning hours. After a few days though, all the symptoms like before came back even though I can see no change in my data. The only thing I know is that I was beginning to increase my activity level prior to this as I had been feeling good.

Now with anxiety, OSA, and GI issues sometimes related, I'm trying to figure out if the primary component is really bad reflux, bad flares of gastritis, or anxiety disorder. With all these symptoms, sleep is almost impossible, and I have resorted to taking ambien to get a few hours each night. I have no idea how I would sleep without something. I just lay there with a throbbing left abdomen and tremendous anxiety. I know these issues stem from the OSA, but I really wonder if initially and now that maybe one is causing arousals which brought the OSA to light initially and is responsible for the relapse of symptoms.

I do believe something is affecting my sleep secondary to the OSA. Any ideas or thoughts that relate to your specific experience would be appreciated. I really wonder if treatment for anxiety disorder is warranted. Has it helped any of you with similar situations? I hate the idea that I might have to start reading another condition related forum. I like to spend my time right here!

Best,

Mike

I found increasing my minimum APAP pressure helped my reflux like symptoms a bit. My guess is I was struggling against some airflow restriction and bringing up acid. Experimenting with EPR might be worthwhile as well. Lower pressure might be worth experimenting with as well.

Do you use SleepyHead to read your data?

Along the lines of what "arch" said, experimenting with pressures and other settings may help you find what works best.
Everyone's different in this area. Sometimes straight pressure helps (GERD-type conditions can drive an APAP crazy changing pressures), different settings with exhale relief (including turning it off), (left) side sleeping, etc., etc.


Den

.

archangle wrote:I found increasing my minimum APAP pressure helped my reflux like symptoms a bit. My guess is I was struggling against some airflow restriction and bringing up acid. Experimenting with EPR might be worthwhile as well. Lower pressure might be worth experimenting with as well.

Do you use SleepyHead to read your data?

Yes. I have been since started. I don't see much there out of the ordinary, espcially since things had been going well. I did bump up my pressure and had a period of 5 hours of sleep with no OSA's. However, the anxiety of this is like starting all over again with therapy. Last night was fun, an AHI of 3.6 (all centrals while awake). It's probably time to get out of bed when waking.

I don't know about the reflux as I had 6 good months of level bed and no medication. Before the ill patch and OSA diagnosis, I had no GI symptoms at all.

I have a real hard time with out EPR from a comfort standpoint. I just raise the pressure to compensate.

Best,

Mike

Wulfman... wrote:Along the lines of what "arch" said, experimenting with pressures and other settings may help you find what works best.
Everyone's different in this area. Sometimes straight pressure helps (GERD-type conditions can drive an APAP crazy changing pressures), different settings with exhale relief (including turning it off), (left) side sleeping, etc., etc.


Den

.

My apap pressures don't bump much on normal nights when I was doing well, espcially as I have been raising the pressure. I was really doing great with the therapy and have no idea what brought on the GI.

I'm going to try a wedge and stay off the back. I'll sleep in a chair if I have to. Funny thing is, I finally got my pressures to where it was looking like back sleeping was not looking too bad.

Best,

Mike

Macpage wrote:I'm going to try a wedge and stay off the back.

What do you hope to accomplish by staying off your back? If you are getting gastric insufflation from CPAP, it might get worse while sleeping on your sides.

If you want to sleep on your back and use a wedge, be aware that wedges, with one exception, can cause reflux to become worse. This is because you bend at the stomach when using a wedge.

There is one wedge that is designed properly to prevent bending at the stomach by elevating your entire torso - http://www.medslant.com/ .

From the Medslant web page,

the patented Medslant™ wedge pillow is the ideal way to elevate your head and torso to relieve your acid reflux, but what is not made clear is elevating just your head and shoulders using bed pillows or a cheap wedge pillow can actually make your acid reflux much worse! Unless you get the angle and length of the wedge pillow just right you end up folding you body in the middle, constricting your stomach, making digestion more difficult and your acid reflux worse.

The Medslant™ pillow is designed to physician recommended guidelines for reducing acid reflux while you sleep:

It elevates your head 6 to 8 inches.
It forms a gradual incline that lets you sleep comfortably on your side or back with or without your favorite bed pillow.

The MedSlant wedge pillow can keep night-time acid down and provide a healthier, more comfortable night's sleep.

For GERD...Raise the head of your bed to avoid the problems Granny pointed out. Also, the best sleeping position for GERD is on your left side.

ChicagoGranny wrote:What do you hope to accomplish by staying off your back?

I'm just assuming that some recent back sleeping from my normal left side might by aggravating GI issues or perhaps causing more RDI's that I don't recognize on Sleepyhead. Pre Xpap, I was a back sleeper but took the advice here to try my side for therapy comfort. Recently, I noticed that my bouts of supine hadn't changed my AHI in any way I can interpret. I haven't had any air issues in a while.

Thanks for the link on the wedge. The one I have is very close to those dimensions but not quite. It could make a difference. I'm certainly willing to try.

Right now I just can't get comfortable lying down with or without Xpap. I have sensory overload focusing on sensations in the abdomen and feeling my heartbeat. Yes, I also really want to go to sleep as well. I'm sure sleep anxiety/general anxiety is a major factor, maybe the key. I guess I'm going to have to resort to Robysue's hardcore CBT or see a specialist.

Best,

Mike

APAP 8.6-11.4, EPR 3

If pressure this low yields a low AHI while sleeping on your back, then I see no reason to force sidesleeping.

LSAT wrote:For GERD...Raise the head of your bed to avoid the problems Granny pointed out.

Mike, In the closet, we have a Medslant wedge that Gramps and I both used at one time. But, it was so much easier to raise the head of the bed. One set of these blocks (bed risers) give you about as much elevation as the Medslant wedge, and they are cheaper and more convenient --> http://www.bedbathandbeyond.com/store/s ... =typeahead

We have them under our bed and they are not even noticeable in the bed, yet they are a big help.

Have you looked at one of the medical websites like mayoclinic.com, and are you following all the recommendations for home treatment of GERD?

Macpage wrote:hardcore CBT or see a specialist

Before going "hardcore", are you following these basic requirements for insomnia (and reducing anxiety)? -->

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps.
- Practice total abstinence of caffeine including sources like chocolate
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Optimize emotional stress in your life
- Use CPAP software to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular wellness visits to confirm there are no other medical problems.

LSAT wrote:For GERD...Raise the head of your bed to avoid the problems Granny pointed out. Also, the best sleeping position for GERD is on your left side.

I used to have the bed raised, not really sure if it helped. It's hard to raise our bed the needed height. The wedge Granny points out might be the trick.

When I was doing well, the left side was the posittion. I had to work for 6 months with a bra and tennis balls to train myself for side sleeping. Now, similar to when I first got ill before the OSA diagnosis, I can't even get remotely comfortable on my left side. All the sensations are much more pronounced and sometimes it feels like I have a beach ball in my upper left abdomen (before turning on my machine). I can blame a lot on anxeity, but not sure about this one. I have to get on my stomach to have any chance of sleep onset as this mutes the sensations to some degree. Before my GI brought up SDB, he had considered some type of soft tissue injury. I just think it's the lack of sleep.

Best,

Mike

There could be another explanation altogether for the middle of the night wakings. How's your blood sugar?

http://doctorkatend.com/what-really-cau ... the-night/ This happens to me, except it's around 4 am for me. It produces all the symptoms you complain of, including the reflux (from the adrenalin that happens with hypoglycemia). The only symptom you have I haven't experienced is abdominal pain.

Sleep apnea over time causes metabolic damage so you may not be at a point where you have been diagnosed with pre-diabetes or diabetes, but you may already be heading in that direction.

Just another thing to consider.

ChicagoGranny wrote:If pressure this low yields a low AHI while sleeping on your back, then I see no reason to force sidesleeping.

I tend to agree and have the pressure at 9 now. However, is that low AHI indicative of a low RDI as well? I would think that with my AHI, flow limits, and snoring where they are compared to pre-treatment that I would be doing better. It seems I do when I actually get sleep. I was progressing nicely.

Mike, In the closet, we have a Medslant wedge that Gramps and I both used at one time. But, it was so much easier to raise the head of the bed. One set of these blocks (bed risers) give you about as much elevation as the Medslant wedge, and they are cheaper and more convenient

Thanks for the link. I do have some 2x6 blocks to stack from before as we have a sleigh bed. Not too stylish but effective.

Have you looked at one of the medical websites like mayoclinic.com, and are you following all the recommendations for home treatment of GERD?

Yes. I'm hardcore on this, and I'm not sure why. I never had heartburn/reflux until a few months after the brain fog hit me. Even then, the abdominal symptoms were much more pronounced and came before any reflux like symptoms, which didn't appear until after not sleeping for days and having some constipation. I immediately went hardcore on reducing acid and started taking acid medication. In all honesty, the medication didn't have much of an effect. It tooks months to get to feeling like I could eat and only with the start of Xpap did the GI really improve. It remained that way the first half of this year on no medication, no symptoms, and a healthy but more varied diet. My wife has frequent heartburn, and thinks I'm nuts.

Before going "hardcore", are you following these basic requirements for insomnia (and reducing anxiety)

Yes, except for the whole emotional stress thing and less common medical issues. As we all know, it's really hard with the stress when not sleeping. I seem to have trouble having positive thoughts. It just seems like a negative loop. Part of feeling better earlier this year was building on the positives. I can't think of anything that changed as a stressor except the kids went back to school, which should have reduced the stress.

Best,

Mike

Janknitz wrote:There could be another explanation altogether for the middle of the night wakings. How's your blood sugar?

http://doctorkatend.com/what-really-cau ... the-night/ This happens to me, except it's around 4 am for me. It produces all the symptoms you complain of, including the reflux (from the adrenalin that happens with hypoglycemia). The only symptom you have I haven't experienced is abdominal pain.

Sleep apnea over time causes metabolic damage so you may not be at a point where you have been diagnosed with pre-diabetes or diabetes, but you may already be heading in that direction.

Just another thing to consider.

Ceratianly a possibility. I was in range at last PCP visit, and I have eaten healthier since 2014. However, I will pay attention on this visit. After probably a lifetime of SDB, nothing would surprise. Thanks for the suggestion.

Best,

Mike