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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
gracie97
 
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CPAP raising blood sugar!

Postby gracie97 on Sat Jan 13, 2007 7:21 pm

I'm noticing what may be a connection between CPAP use and blood sugar elevation and am curious if anybody else has observed or wondered about something like that also.

My morning blood sugar levels are significantly lower when I don't use CPAP. And I'm even wondering if CPAP use could have been a major factor in my recent development of type II diabetes.

My story:

I've been on CPAP (UARS & mild OSA) for 1.5 years. APAP, with pressure set 4-8. Use Aura nasal interface that seals very well.

Two years ago, my fasting blood sugar was a non-diabetic 90. In November 2006, however, I had a fasting level of 162, considerably into the type II diabetes range. My doctor commented that was quite a large increase for 2 years (my weight had not increased).

Since then, with diabetes medication (metformin), etc, the morning reading has dropped to 120 (should be no more than 112).

However a couple weeks ago I happened to mention my concern about morning blood sugar and also being on CPAP to my chiropractor. He immediately and emphatically declared that CPAP could be raising my blood sugar by cutting short my exhalations, thus creating a breathing pattern that is consistent a 'fight or flight' anxiety state, with the subsequent increased adrenaline (and/or cortisol?) causing my liver (or muscles?) to release more glucose into my bloodstream.

Now that was exactly what I'd been suspecting, having read that elevations in cortisol and/or adrenaline (or other stress-related hormones) could raise blood sugar overnight. And I'd also long been concerned about the 'panting' effect of the cut-short exhalation.

With that endorsement of my thinking, I tried a few nights without CPAP. Results: My morning blood sugar levels were about 20 points lower each morning, about 100, a very significant drop! Then I went back to CPAP for two nights, and it shot up 10 points. Then slept last half of last night without CPAP and this morning got my lowest blood sugar reading yet, 89!

My primary care physician had agreed with me, when I first went on CPAP, that the disruption of the usual relaxation breathing cycle in which exhalations are roughly twice as long as inhalations could exacerbate anxiety.

I should note that both my PCP and chiropractor are yoga devotees. And I have long used slow breathing with long exhalations to control my anxiety problems. So all three of us are at least somewhat oriented to view inhalation/exhalation ratios of important.

Perhaps those not as anxiety-prone as I am might fare better. And, of course, it could be something other than inhalation/exhalation ratios about sleeping with CPAP that is causing the discrepancies.

My sleep doctor, a neurologist, pooh-poohed my concerns about I/E ratios when I mentioned it to him 1.5 years ago (haven't spoken with him since and planning to find a new sleep doctor). Yet I've read that respiratory therapists set respirators to I/E ratios of around 1:2.

Even awake, trying to extend my exhalations while hooked up to CPAP at just a pressure of 4, I find it difficult make my exhalations longer than inhalations: That pressure just doesn't allow that. (CFLEX seems to hurry my breathing even more, so I have that feature turned off.)

Any comments on this?

Gracie

Started CPAP on 7/1/2005
Mild apnea
Plus upper airway resistance syndrome with severe alpha intrusion

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Wulfman
 
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Postby Wulfman on Sat Jan 13, 2007 7:53 pm

Gracie,

I've noticed the increase in my glucose numbers since starting CPAP. On the other hand, in my blood draw last fall, my other numbers (like my HDL "good cholesterol") improved......everything is now within the "normal" levels EXCEPT for those categories relating to my blood sugar. :(
And, I'm also losing some weight. :)

Den (tryin' ta figger it all out.....life has lots of trade-offs)

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Postby Guest on Sat Jan 13, 2007 8:19 pm

Den,

I'm taking your statement as further proof of my theory!

With your weight and everything else going down, your blood glucose should have dropped, not risen. So that rise is not just a rise from where you were before CPAP but also from where you would be now without CPAP.

Now I'm not advocating going off CPAP. But rising blood sugar on CPAP might be some indication that diabetics OSA or UARS might be better treated with surgery if possible.

Gracie


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Catnapper
 
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sugar and cpap

Postby Catnapper on Sat Jan 13, 2007 8:25 pm

I recently started a thread where I commented that my fasting glucose was elevated and wondered if that was possibly causing me to have trouble sleeping well. I have perfectly normal levels in all other tests without any medication, just have the fasting sugar problem. My thinking was that the stress from CPAP was elevating the glucose. I have had a difficult time adjusting to the therapy, and although my numbers are great, I am not sleeping well. Now comes your theory about CPAP and sugar. Very interesting.

I hope lots of people have ideas about this.

It is interesting to think that when CPAP is a new thing in life, as it is for me, that it modulates other health issues in new ways, both good and bad. My concern is that I have the elevated glucose level now and want to find a cause other than the obvious. Nothing like a little denial, eh?

Catnapper


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Rapunzel111
 
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Exhalation with CPAP

Postby Rapunzel111 on Sat Jan 13, 2007 8:41 pm

Hi Gracie!
I don't know what machine you have,but I have a Remstar machine with C-Flex,which allows easier exhalation.Somehow this machine blows air into your nose when you are inhaling and then lets up on the pressure so you are able to exhale as long or as short as you'd like.To my knowlege older machines are not equipped with the C-Flex feature thus making it more difficult to exhale.Maybe you could ask your company that helped you with setting the machine for you if you could try a loaner with C-Flex and then test your sugar levels after using one of these?Just an idea.
-Rapunzel111


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JeffH
 
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Postby JeffH on Sat Jan 13, 2007 8:49 pm

My blood sugar has gone down by 20 to 30 points in the morning since I got my APAP and got my pressures were they need to be. Don't know why yours are going up.


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Wulfman
 
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Postby Wulfman on Sat Jan 13, 2007 9:03 pm

Like I said, the other "numbers" actually improved......including my blood pressure. So, now I'm dealing with the glucose thing through dietary changes.

I definitely have not had any problems sleeping or with my therapy.


Catnapper,

I read the following in your thread also.....and was trying to figure out if possibly had any relationship to what I was experiencing.
One thing I was wondering is: If your body is (potentially) producing normal levels of insulin and you're losing weight......what does your metabolism do with the fat that it's burning up? Would/could that also elevate your blood sugar?

Catnapper wrote:My doctor wrote a book which she gave me to read. Here is a quote that you may find interesting:

The liver of people affected by diabetes may overproduce glucose. During the fasting state (without food), the normal liver produces enough glucose to keep the body’s energy demands satisfied. This is why people not on medication to lower blood glucose may go all day without eating and not experience a “low blood sugar reaction”. If adequate amounts of insulin are not produced, the liver will overproduce glucose during the fasting state. This is the reason people with diabetes often have high morning glucose levels despite the fact that they go to bed with a normal level of glucose.


Everybody's different.

Den
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tomjax
 
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blood sugar

Postby tomjax on Sat Jan 13, 2007 10:31 pm

I have little regard for chiropractors, but they will always have their followers.
I cannot imagine the fight or flight reaction being triggered by altered pap breathing.

I would like some reliable data on the increased glucose levels being increased with the only variable being PAP use.

There is probably a better explanation than being caused by PAP, but I could be wrong.
tomjax

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dlfarley RPSGT
 

elevated glucose levels on cpap

Postby dlfarley RPSGT on Sat Jan 13, 2007 10:58 pm

Metabolical when you are not wearing your cpap your body is utilizing more of your muscles to try and breath so its like you have been exercising all night long burning up glucose, when you are on your cpap on an optimal pressure setting you are breathing efficiantly throughout the night your muscles are relaxed and you are basically only using your diaphram to breath using less of your metabolism to breath therefore burning less glucose at night.
Also it depends what you have eaten the night before, lots of starches and carbohydrates will elevate your glucose throughout the night while eating proteins and fats and cellulose vegetables will have a tendance to not raise your glucose for long periods of time and your late night snack is the same every night on and and off cpap.
I hope this will shed some light on your predicament
Donald Farley RPSGT


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CollegeGirl
 
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Postby CollegeGirl on Sat Jan 13, 2007 11:17 pm

Given the choice, I'd choose controlling my diet and blood sugar a little more carefully over damaging my internal organs every time I sleep. But maybe that's just me. :D

For the record, though I'm a large woman, I've been lucky enough not to have blood sugar problems, and that hasn't changed since starting CPAP.

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Elle
 
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Postby Elle on Sun Jan 14, 2007 1:27 am

I cut this from a news site

...."The researchers evaluated 25 individuals with controlled Type II diabetes who had been referred to a clinic because of sleep apnea. They kept a food diary and had their glucose monitored with a sensor beneath the skin for three days. (Excessive blood glucose is the No. 1 indication of diabetes.) Then the monitor was removed, and the patients underwent sleep apnea treatment using a continuous positive airway pressure (CPAP) device. Patients wear a mask that gently pushes a constant stream of air through the nose during sleep. After about three months, the patients again kept a food diary for three days while their blood glucose was monitored.

What they found: The sleep apnea treatment reduced blood glucose levels, especially in patients who used the CPAP apparatus more than four hours a night."


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Wulfman
 
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Postby Wulfman on Sun Jan 14, 2007 10:27 am

dlfarley RPSGT wrote:Also it depends what you have eaten the night before, lots of starches and carbohydrates will elevate your glucose throughout the night while eating proteins and fats and cellulose vegetables will have a tendance to not raise your glucose for long periods of time and your late night snack is the same every night on and and off cpap.


I've actually had HIGHER (fasting/morning) glucose numbers following a day of eating lettuce salads.
This morning, I took my test for the first time in a couple of weeks. It was considerably lower (in the morning) than it has been for a LONG time. What did I have to eat yesterday? A half of a "sub" sandwich at noon and some pizza about mid to late afternoon......didn't even eat a supper meal (which is somewhat typical on the weekends).

Den

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gracie97
 
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Postby gracie97 on Sun Jan 14, 2007 6:55 pm

Some responses to people who were kind enough to respond to my post:

I didn't try a few night off CPAP on the recommendation of my chiropractor alone -- it was merely the addition of his opinion to that of my PCP and to my own experiences with and what I'd read about inhalation-exhalation ratios.

Also I'm on a highly controlled diet and exercise routine and keep very precise records, so I know that varying amounts and types of food and amount of exercise the day before does not account for these drops in blood sugar after nights off CPAP.

I find it amazing that I seem to be the only one here who is acutely aware of and concerned about the inhalation/exhalation ratio issue with CPAP! Am I the only person here who has done breathing exercises for anxiety and thus HAS EXPERIENCED (and even tracked) the physiological and emotional changes that result from changing the inhalation/exhalation ratio?

Perhaps part of the phenomenon I'm observing regarding my own blood glucose and CPAP use may be due my being especially anxiety-prone.

Another aspect might be that my apnea is mild and I'm mostly on CPAP for a modest case of UARS. So the gain I get from CPAP may be less than most others get (e.g. perhaps the people in the CPAP/diabetes experiment), and that might translate into a net increase in blood sugar. For people with really bad OSA, perhaps the sleep improvement may improve sleep so dramatically that blood sugar winds up reduced.

Anyhow, I'm certainly not planning to entirely stop CPAP treatment because of this phenomenon. Will be doing more experiments to see if results hold.

However even if I find out that CPAP is not raising my blood sugar, I'm going to try every means possible to get off it because that inhalation/exhalation ratio issue is just too worrisome.

Gracie

Started CPAP on 7/1/2005
Mild apnea
Plus upper airway resistance syndrome with severe alpha intrusion

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kteague
 
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Glucose and CPAP

Postby kteague on Sun Jan 14, 2007 7:45 pm

Interestingly, the more mask time I've been putting in, the higher my morning glucose has been. Have not documented my meals for correlation. Just assumed since much of what we read associates OSA as a risk factor for diabetes, that it had finally caught up with me. Funny that my fasting sugar was never this high when my OSA was untreated or poorly treated. May be coincidence, but enough to make me take notice.

As far as inhalation/exhalation ratios, it stands to reason that anything that is not as nature designed could have some effect on the body. Next week I am having some pulmonary function tests. Maybe I can remember to ask the RT their take on the subject because I can't even follow the discussions on setting pressures on a bi-pap or the functional difference between cflex and EPR. My cognitive abilites have greatly improved, but I'm functioning at a need-to-know level. Maybe there are those who are tuned in to this subject but just haven't read this thread, since that topic is not named in the thread title.

Kathy


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Postby Goofproof on Mon Jan 15, 2007 2:32 pm

Usually your sugar level rises overnight if you are diabetic, I take 60 to 70 units of insulin at bedtime, that allows me to burn off about 100 off the bedtime test nimber. I always error high so I don't induce a Coma while asleep, that maks me high in the A.M., and I taylor the next injection to correct it.

It's a rolleycoaster ride, very seldom do you get it level and then it's only for a few hours.

I think if you had apnea and were untreated, and had diabetes too, your waking up from not breathing would burn more fuel. The fight or flight response that races your heart and stresses your organs would burn more fuel than if your XPAP was working for you and you were sleeping at peace.

Jim

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