Cortisol flood, MVP & such things

[Phoenixpuppy]

As a "newbie" I am SO grateful for the collective wisdom I've found here. I'm still slogging my way through the many of the posts and the general information. Long way to go

I was recently diagnosed and now know many of the symptoms I've been feeling, over the past 2 years especially, may be related to sleep apnea. I have a specific question about cortisol and the related weakness and fatigue that happens when I feel flooded with it. Before I have a full blown adrenal study done, has anyone else experienced this as a symptom of sleep apnea? If I understand correctly, the alarm that goes off im the body because of oxygen deprivation can set off the adrenal glands. I often feel the effects at very odd times throughout the day - like this evening when I was enjoying a dance production. Might be sitting still, or in dance class - completely unrelated to my activity. My resting pulse is under 60 or slightly under and I also have mitral valve prolapse. Can anyone share their experiences with these issues? Thanks.

[Julie]

Hi, has it been medically documented that your spells are cortisol flooding or are you self diagnosing? It's not something to guess at, and what you experience could be related to many other conditions, whether cardiac, neurological or something else. You must be seen by a doctor before trying to treat yourself for an undiagnosed problem or you could do serious damage, let alone actually miss treating what's really wrong.

[Slinky]

Mitral Valve Prolapse is really no biggie for most people. It runs in my dad's family and he was the youngest of 8 to die at 79. I was Dx'd w/MVP in 1976, the only time "they" could find it by stethoscope was when I was laying down. It is when MVP becomes Mitral Valve Regurgitation that it becomes a problem. And MVP does not necessarily progress to MVR. An echocardiogram would tell the story.

What are the symptoms of your alleged "cortisol flood"? Fast heartbeat at rest? Strong, erratic heartbeat at rest? Heart "flutters"? Any of these could be Atrial Fibrillation (A Fib). A Fib isn't necessarily a bad thing to worrry about either. But it does warrant the scripting of a 24 hour Holter monitor or if the symptoms don't occur every day then the scripting of a 7 day or even 30 day Event monitor. Some such cardiac arrhythmias are benign, some warrant treatment.

[Phoenixpuppy]

Thanks, Slinky and Julie. Yes, I do have regurgitation with the MVP, have used Holter monitor, etc. Recently tested again and it's not getting worse. MVP tends to be exacerbated when lying down, especially on one side which contributes a bit to restlessness sleeping with CPAp but once I'm asleep it's not too bad. The symptoms of this "cortisol effect" are why my cardiologist sent me for the sleep study because they weren't consistent with anything that usually happens with MVP. I will probably ask him or my family doctor about doing some tests to measure the amount of cortisol in my system. The best way to describe what it feels like is the way you feel after you've had a major adrenaline rush - shaky, weak, drained, sometimes with palpitations, etc. It may happen at any time of the day, even right in the middle of my dance class, or when I'm sitting quietly. Just weird. I'm assuming it is part of having had SA for a long time and is just suddenly getting worse.

As with many things I've read here, self-education can lead to some discoveries that doctors aren't thinking about. It's taken me years of complaining about this for any of my 3 doctors to suggest I might need a sleep study. I wouldn't say I'm self-diagnosing as much as researching possibilities and trying to educate myself. This forum is part of that. If this is a symptom that others have experienced then maybe I just need to let time and CPAP work their magic. If it's not, then maybe I need to push back with my doc and ask more questions. Constant overload of cortisol in the system can be very damaging to organs over time and I don't want to let it go if I should be getting further tests.

[Julie]

Just for the heck of it... have you had your blood sugar tested for hypoglycemia? Very similar symptoms.

[M.D.Hosehead]

Just for the heck of it... have you had your blood sugar tested for hypoglycemia? Very similar symptoms.

Julie's right. And given how common hypoglycemia is, it's the most likely explanation.

It's a hassle to get the BS drawn during an episode. If you know a diabetic who has a glucometer that would be the easiest.

You could try eating a glucose tablet--available in the diabetic section of the pharmacy--to see if that reverses the symptoms in 5 or so minutes. That would be consistent with hypoglycemia, but a blood glucose during an episode is the only definitive test.

Also, is your heartbeat steady, regular during an episode?

And do you have a way to take your BP during an episode?

Eventually, you will have to discuss these episodes with your dr. But the more information you can offer, the better the dr. will be able to advise you.

[DreamLady]

Just a couple of thoughts about cortisol. First, two things that I know REALLY affect cortisol are stress, and sleep deprivation. Guess what? Both can be caused by apnea. Once this adrenaline response is activated, however, it can take weeks for the storm to pass and hormone levels to return to baseline. It's based on a feedback mechanism, and as your body 'heals' from the damage caused by undiagnosed sleep apnea, this mechanism will start to function more normally. In the meantime, fluctuations can be troublesome, causing some of the symptoms you describe.

In addition, the symptoms could also be caused by general anxiety. Again, anxiety can also be caused by sleep deprivation, and worsened by therapy that is not quite dialed in yet. In my case, now that I'm six weeks into well-titrated cpap therapy, my anxiety seems to have resolved. My startle reflex is considerably reduced, and the slightest little thing no longer makes my heart race. It's taken six weeks to get this far, and I'm still noticing that I feel more like my old self every week.

Don't know if either of those things apply, but thought I would throw it out there for consideration.

[Phoenixpuppy]

Really good advice - all of this. Some time ago I did have a glucose test - fasting in the a.m. but it was several years ago - that's how long this issue has been going on. It showed no irregularity but you're right, in a perfect world I could test myself as it's happening. Are glucometer's expensive?? I think you're exactly right about this being some kind of hypoglycemic episode, even if it's without diabetes. Typically I do NOT have palpitations, rapid or irregular heartbeat with this - just what definitely feels like a huge sugar drop, although eating doesn't seem to help. I tend to have low blood pressure but I work at a blood center and the donor room is nearby so I can easily get my blood pressure taken and it's often in the normal range while this is going on.

I definitely need to visit my family doctor again. I think that the sleep apnea is part of this but I'm not convinced it's all of it. I am a pretty low stress person and even when life is busy and challenging, I just tend to deal with it. I'm good at shutting things off and relaxing.

I am curious about these periods I've had for ages of rapid, irregular heartbeat, excessive sweating, dizziness, etc. Is this what people refer to as a panic attack or does a panic attack always have psychological features too, like anxiety, fear, etc? I don't think I've every really felt panicked when these physiological things are happening but it's definitely stressful and on my radar - like, "can we please get this over with??!!"

[M.D.Hosehead]

Really good advice - all of this. Some time ago I did have a glucose test - fasting in the a.m. but it was several years ago - that's how long this issue has been going on. It showed no irregularity but you're right, in a perfect world I could test myself as it's happening. Are glucometer's expensive?? I think you're exactly right about this being some kind of hypoglycemic episode, even if it's without diabetes. Typically I do NOT have palpitations, rapid or irregular heartbeat with this - just what definitely feels like a huge sugar drop, although eating doesn't seem to help. I tend to have low blood pressure but I work at a blood center and the donor room is nearby so I can easily get my blood pressure taken and it's often in the normal range while this is going on.

I definitely need to visit my family doctor again. I think that the sleep apnea is part of this but I'm not convinced it's all of it. I am a pretty low stress person and even when life is busy and challenging, I just tend to deal with it. I'm good at shutting things off and relaxing.

I am curious about these periods I've had for ages of rapid, irregular heartbeat, excessive sweating, dizziness, etc. Is this what people refer to as a panic attack or does a panic attack always have psychological features too, like anxiety, fear, etc? I don't think I've every really felt panicked when these physiological things are happening but it's definitely stressful and on my radar - like, "can we please get this over with??!!"

1. OK your blood pressure is normal during these; you can check off one possibility.

2. You don't have to be diabetic to have hypoglycemic spells. You are right that fasting blood sugar cannot diagnose this problem. Eating may not quickly terminate hypoglycemia, particularly if what you eat doesn't contain a lot of sugar. Glucometers are expensive, but many diabetics have them.

3. It's not clear from what you say whether the "huge sugar drop" episodes are related to the "periods of irregular fast heartbeat". It's possible for a person to have both hypoglycemic episodes and a heart arrhythmia unrelated to each other.

4. Without some degree fear/anxiety, yours isn't a typical picture for panic attacks.

5. You are probably right that sleep apnea is not the cause of these spells.

[Julie]

The tachycardia (fast heartbeat) and sweating could be part of OSA, but they usually come on when you're asleep or have just woken up. You could be having panic attacks, but get your sugar checked first - it seems like an 'duh' situation to me.

[humdinger1]

You could check your temps three times a day and see what the average is. A wide fluctuation can point to adrenal fatigue. Take first temp three hours after waking then again in three hours then again in three hours. take the average and monitor for a week or so. Should not fluctuate more than .2 degrees. Make a graph. Low with wide variation indicates thyroid and adrenal involvement. Constant low with little variation mainly thyroid. Might want to get a saliva cortisol test. Must be off licorice and all cortisol products for a week before doing test. Some diural cortisol fluctuations espically a rise in the evening when it should be falling can keep people awake. An "adrenaline rush" can also be seen with adrenal fatigue. It is very annoying. I get it sometimes if I stay up too late. Cortisol should be highest in the am which helps you wake up and fall during the day and be at the lowerst at night. Burned out adrenals often need some support with cortef or hydrocortisone. humdinger 1

[cufamtx]

If you want to know what happens to people with too much cortisol google Cushing's syndrome. My husband had it. The best way to test cortisol production is a 24 hour urine collection. Lots of fun.

[Moby]

I've had these type of symptoms when i've overdone the caffeine, and also during menopause, the onset of which is easily detected with a blood test, as is any thyroid problem.

I also had panic attacks in my twenties, which were purely physical in nature. In fact my mind seemed a lot cooler and calmer than usual during them ... (but I've got ADD, so the adrenaline probably kick-started some neurons). There was no obvious predisposing incident to set off such a violent physical reaction, and no sense of doom - just surprise when it came on, rapidly followed by frustration at its refusal to go away.

Did you have one of these episodes when you were wearing the Holter monitor?

[DreamLady]

Panic attacks do not always involve fear or panic. I was very calm during mine. I just felt something bad was going to happen very soon (in spite of no evidence to support that feeling), my heart beat very fast, I felt shaky and weak, sometimes trembling, breathing hard, but unable to catch my breath, hands trembled. It made me very angry at myself (before I knew what was happening) because I couldn't understand why my body was acting like I was frightened, when I knew everything was fine. I was under no threat at all, often just relaxing calmly, or otherwise going about my business when these attacks would come on suddenly.

Thankfully, I'm now much improved, and have been weaned off the medication for several months with no further attacks.