Switching CPAP to APAP --> Massive chest pain and GERD

[emma_chase]

Switching CPAP to APAP --> Massive chest pain and GERD

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Still waking up in the night randomly (AHI is under 1.0, so I am suspecting this is Desaturations happening during REM?)

Still waking up with heart racing

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re: Resmed S9 CPAP machine

My initial CPAP Pressure was set at 8.0, but I was still waking up with a racing heart AND random wakenings. My screen AHI always says under 1.0. So it's not just an Apnea situation.

I increased my CPAP pressures by '0.2' increments until the 'racing heart' awakenings stopped. It was at 9.6 pressure.

Random awakenings were still happening, so my Sleep Doc suggested APAP.

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Lat month, I was given the Autoset for Her with an APAP setting range of '5.0 <--> 12.0

Now I am waking up with BOTH a Racing Heart _and_ episodes of massive GERD.

Things have gotten so bad with the acid that I've had to quit my APAP (for now).

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I have gone back to my CPAP machine. (Until I can see the Sleep Doc in 2 months.)



Anyone ELSE having all this stuff happen with the CPAP to APAP switch??

What helps??

[Pugsy]

Use the available software to see exactly what your pressure (and a bunch of other stuff) is doing during the night.
For all you know even though it can go from 5 to 12 during the night, it might only be going to 7 or 8 and not going near the pressure that you found seemed to cause a reduction in your unwanted symptoms.

https://sleep.tnet.com/equipment

[emma_chase]

What software is that?

[emma_chase]

Which software is that?

Sleepyhead?

[Pugsy]

SleepyHead or ResScan or both if you wish.
Links to how to get either one at the link I posted.

[ajack]

This is almost an instant cure for gerd
put a house brick under the 2 legs of the head of the bed, so it is raised 4-6". this will put a slope in the bed.
cut down on the sugars and starches and go low carb.

your sore chest is from breathing with the higher pressure, it will go in a week as the muscles get use to it.

as has been said, get some charts up, you may want to put the max at the 95% pressure for now, that should balance apnea with side effects.

[emma_chase]

I've already had several cardiac workups. Doppler, Enzymes, Stress Test (treadmill), etc.

The GERD flared with reducing the XPAP pressure from 9.6 down to 5.0.

It is know that GERD and OSA can co-occur.

GERD is known to cause heart problems. It can even trigger AFib.

My GP doesn't think I have *primary* cardiac problems and neither does my Sleep Lab.

What I do need to do, like many of us in the long term, is to get control of my OSA and GERD via CPAP and lifestyle mgmt. Get the weight off, and all that.

In the meantime, though, I need to get things stabilized for day to day life and symptom mgmt.

[emma_chase]

I will try upping my APAP setting to 9.6-12.0.

I will also look into that software.

Yesterday I ordered a foam wedge pillow for GERD and OSA from Amazon.ca

Thanks for the replies and suggestions!

[Holden4th]

I've already had several cardiac workups. Doppler, Enzymes, Stress Test (treadmill), etc.

The GERD flared with reducing the XPAP pressure from 9.6 down to 5.0.

It is know that GERD and OSA can co-occur.

GERD is known to cause heart problems. It can even trigger AFib.

My GP doesn't think I have *primary* cardiac problems and neither does my Sleep Lab.

What I do need to do, like many of us in the long term, is to get control of my OSA and GERD via CPAP and lifestyle mgmt. Get the weight off, and all that.

In the meantime, though, I need to get things stabilized for day to day life and symptom mgmt.

I'm going to play devils advocate here based on my own experiences. I have some questions

Have you been confirmed with GERD and if so what are you taking to treat it? (Nexium or similar?)

When the palpitations/racing heart diminishes, does the chest pain ease?

Was your stress test done on an ECG only or was it a myocardial perfusion (where they inject radioactive isotopes into your bloodstream and x-ray you after the stress test)?

I went through the heart check up routines you did. ECG after stress test, Holter monitor, blood tests but nothing was found as I hadn't had a heart attack and I assumed that GERD was the issue. I remember the doctor at the hospital, after I'd been rushed in with chest pains and nausea, looking at my ECG results and saying it's OK, you haven't had a heart attack. He was right, I hadn't but one was imminent. It was when my new GP decided to up the ante that my serious CVD was discovered via a myocardial perfusion. Push for a more intensive cardiac check up. If you get a negative result then you've got some peace of mind. I ignored/denied my chest pain for years and it nearly cost me.

[emma_chase]

Thanks Holden,

I've had Upper Endoscopy for the GERD. It was Silent Reflux. People get CP (chest pain) but taste no Reflux. Put on Rabeprazole and it worked to stop the CP for about 2 years.

No, the CP and tachycardia are not related. The HR can slow down but the CP remains. I believe it is the Silent Reflux, as I was told preiviously.


Next, I am getting a 24 hour Holter monitor.

The fast heartbeat starts during sleep and I wake up with it. It is taking longer for the heart rate to slow down after these episodes. That is what concerns me.

My machine continues to say I am under an AHI of 1.0.

I was at a previous Sleep Lab (2002-2005) and the Sleep Doc there refused to give me CPAP b/c my AHI was 'only 4'. Yeah, well they need to consider that people may be desaturating, IMO?

My new Sleep doctor thinks it may be REM apneas. Apparently it is most common in females.

Thank you for your questions. I will CUT AND PASTE them into a Word document to take to my Sleep Doc and GP.

Emma


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I'm going to play devils advocate here based on my own experiences. I have some questions

Have you been confirmed with GERD and if so what are you taking to treat it? (Nexium or similar?)

When the palpitations/racing heart diminishes, does the chest pain ease?

Was your stress test done on an ECG only or was it a myocardial perfusion (where they inject radioactive isotopes into your bloodstream and x-ray you after the stress test)?

I went through the heart check up routines you did. ECG after stress test, Holter monitor, blood tests but nothing was found as I hadn't had a heart attack and I assumed that GERD was the issue. I remember the doctor at the hospital, after I'd been rushed in with chest pains and nausea, looking at my ECG results and saying it's OK, you haven't had a heart attack. He was right, I hadn't but one was imminent. It was when my new GP decided to up the ante that my serious CVD was discovered via a myocardial perfusion. Push for a more intensive cardiac check up. If you get a negative result then you've got some peace of mind. I ignored/denied my chest pain for years and it nearly cost me.[/quote]

[Holden4th]

Can I suggest that they also supply you with an SPO2 device when you get the Holter monitor. The two can be linked together. It's a PITA sleeping with the Holter (worse than CPAP) but it does give the doctors a good idea of what your heart is doing. However, it won't really detect any CVD.

Put on Rabeprazole and it worked to stop the CP for about 2 years.

So has it stopped working?

[emma_chase]

Figured most of it out.

Apparently, when there is an Apnea Event, there is negative pressure created. This negative pressure draws stomach acid and pepsin up into the esophagus, trachea, pharynx (throat) and even the ear and nose. The condition can be part of SILENT REFLUX.

I have found out more by watching YouTube videos by Dr. Jamie Kaufman (ENT in NYC). She coined the term Silent Reflux and has written an excellent book called "Dropping Acid" on the topic.

I am best if I don't eat for 3-5 hours before bedtime.

Got off APAP (Resmed AirSense) and I'm back on CPAP (Resmed 9). Going to be asking my Sleep Doc about trying BiPap b/c I still have Desatruations of 80% when I check by a finger clip oximeter at home.

Treating my Perimenopuase with Progesterone cream (Amazon) is also helping my OSA.


Apparently Perimenopause and Menopause increase a woman's risk/impact of OSA by 4x (300 % increase). Wow.

Progesterone has a stabilizing effect on the airways.

Feeling much better since I posted this OP way back.

Thank you everyone for your replies and ideas!

Emma

[zoocrewphoto]

I've already had several cardiac workups. Doppler, Enzymes, Stress Test (treadmill), etc.

The GERD flared with reducing the XPAP pressure from 9.6 down to 5.0.

It is know that GERD and OSA can co-occur.

GERD is known to cause heart problems. It can even trigger AFib.

My GP doesn't think I have *primary* cardiac problems and neither does my Sleep Lab.

What I do need to do, like many of us in the long term, is to get control of my OSA and GERD via CPAP and lifestyle mgmt. Get the weight off, and all that.

In the meantime, though, I need to get things stabilized for day to day life and symptom mgmt.

Your apap range starts much lower than your cpap pressure. So, of course, it won't do as well. It sounds like nobody bothered to look at the data when you were using the straight cpap of 8 and had an ahi under 1. Look at the graphs and see if there is a problem. It could be that the 8 is working great, and the racing heart us not sleep apnea. Or you could be having a really long event and that is what is causing the racing heart. Either way, lowering your pressure to starting at 5 isn't helping.

As for gerd, often that is caused by the sleep apnea. As your airway collapses, and you struggle to breathe, you actually have a vacuum going in your throat. You end up sucking up the acid. Treating the sleep apnea usually helps the gerd too.

As for lifestyle changes, most of them are nice, but don't really help sleep apnea. Weight can make it worse, but most people have sleep apnea due to structural issues. Things like narrow airway, small mouth (crowded teeth, scalloped tongue, small chin). These things might have been helped when we were young, if caught. But mostly, we are stuck with it.

[zoocrewphoto]

Got off APAP (Resmed AirSense) and I'm back on CPAP (Resmed 9). Going to be asking my Sleep Doc about trying BiPap b/c I still have Desatruations of 80% when I check by a finger clip oximeter at home.
Emma

There's no point in changing machines if you nobody is actually looking at the data. For example, WHY do you want to try a bipap? The only difference between a bipap and an apap is that you can have a larger difference between inhale and exhale pressures. You haven't mention exhale relief on either of the previous machines, so what is your hope with this?

If your ahi is truly below 1 AND you have are still having bad enough events to cause problems, then you have a couple possibilities. A cluster of events with most of the night clear. Or very few, but long events. If either is the case, it can most likely be corrected with the cpap or apap, just changing the settings. But you need to look at the data and make an educated decision.

It could also be something different. Perhaps a lung issue. Even low iron. I thought I was having asthma attacks last December as I was waking up gasping for air. It turned out that my iron was so low that my blood wasn't carrying enough oxygen. I went to the doctor, complaining that my asthma was acting up. I had a few other odd complaints too, and she looked at them and immediately tested me for iron.

Please posts graphs of a typical night or two. Let us help you determine if something can be improved with your sleep apnea or if that part looks fine.

[Sissy63]

Do you happen to have your EPR on? When I use that, I get a GERD feeling. I shut it off and it went away. I also keep my APAP range pretty tight. I don't let it go much under what I titrated at. That solved some issues for me.