Didn't use CPAP, now I have A-Fib

[RuthArt]

2006 diagnosed with OSA through Kaiser Sleep Study (the at home monitor) could not tolerate the Mask and gave up after 2 nights.
2008 went back and asked for new machine, got nasal pillows (but they might have gone inside the nostrils) and had to give up on them, my mouth kept popping open and the pressure was so high.
2014 Diagnosed with A-Fib so I went to Dentist who specializes in TMJ/Sleep Therapy, purchased an oral appliance. (expensive, but I was motivated to do something that might actually work. Not been
on it long enough to know yet....only 6 weeks)
Saw my new Dr. (Cardiologist) for the first time a couple of weeks ago, he wants me back on CPAP. I told him I can't tolerate it and have the oral appliance. He said I could do a sleep study to find
out if it's working.
Went to the Sleep Study yesterday, thinking I was going to have a monitor to wear all weekend....no, it was for a new CPAP. I told them I was tested at the Dentist and they found 3 Central Apneas
one night, none the other. I was under the impression that CPAP could make CA more frequent.
Well, bottom line, I tried the nasal mask with the Respironics machine and I only lasted 45 minutes....my heart was pounding, I had pain in my chest, I didn't feel like I was getting enough air and
had to take long breaths, .....I was in a panic and afraid I was going to go into A-Fib (I've been in normal rhythm for 5 months-taking Warfarin now too) I never got to sleep until an hour after I
disconnected from the machine. I will try again tonight, but I just feel it's not going to work. I don't know how to get through this, or if I should just go back to the oral appliance and figure that's
good enough.

[chunkyfrog]

Starting is difficult for some, even more so once you have "rewarded" yourself for quitting before.
I'm sorry you find yourself in this situation, but maybe with the help of the wonderful people here, you can succeed.
You will be amazed how much better your life can be. Welcome to the forum!

[49er]

Hi RuthArt2006,

Welcome to the forum although I hate doing it under these circumstances.

When you were diagnosed with OSA, what was the severity range? Many people with high pressures are often in the severe range although there definitely is not a relationship between apnea severity and pressure needs.

Anyway, the reason I am asking is if you click on the link in my signature regarding dental appliances, you will find they work best for most mild and moderate apnea ranges in getting the AHI below 5 but don't work as well for severe ranges. And I am not sure if that is an acceptable treatment for people with heart conditions who have sleep apnea. I take it your cardiologist was ok with that as long as it was providing optimal treatment?

Please use the link in my signature to fill out your equipment profile so members can better tailor their response to your situation. But a few thoughts.

Has anyone suggested a full face mask since you tried nasal and nasal pillow masks without success? They enable you to breath through your nose and mouth.

Also, many people who can't tolerate the cpap machine do alot better on bipap as it is alot more comfortable. Has that been suggested?

I would also make sure you have optimal nasal potency as that can derail pap therapy with certain people (not everyone). Has that been an issue for you in the past?

Personally, I would do whatever was necessary to make your pap therapy work because of your Afib. Hang in there as we will help you get through this.

49er

2006 diagnosed with OSA through Kaiser Sleep Study (the at home monitor) could not tolerate the Mask and gave up after 2 nights.
2008 went back and asked for new machine, got nasal pillows (but they might have gone inside the nostrils) and had to give up on them, my mouth kept popping open and the pressure was so high.
2014 Diagnosed with A-Fib so I went to Dentist who specializes in TMJ/Sleep Therapy, purchased an oral appliance. (expensive, but I was motivated to do something that might actually work. Not been
on it long enough to know yet....only 6 weeks)
Saw my new Dr. (Cardiologist) for the first time a couple of weeks ago, he wants me back on CPAP. I told him I can't tolerate it and have the oral appliance. He said I could do a sleep study to find
out if it's working.
Went to the Sleep Study yesterday, thinking I was going to have a monitor to wear all weekend....no, it was for a new CPAP. I told them I was tested at the Dentist and they found 3 Central Apneas
one night, none the other. I was under the impression that CPAP could make CA more frequent.
Well, bottom line, I tried the nasal mask with the Respironics machine and I only lasted 45 minutes....my heart was pounding, I had pain in my chest, I didn't feel like I was getting enough air and
had to take long breaths, .....I was in a panic and afraid I was going to go into A-Fib (I've been in normal rhythm for 5 months-taking Warfarin now too) I never got to sleep until an hour after I
disconnected from the machine. I will try again tonight, but I just feel it's not going to work. I don't know how to get through this, or if I should just go back to the oral appliance and figure that's
good enough.

[RogerSC]

One more thing, getting into cpap more gently is a really good idea. From reading your posting, it sounds like you had a severe stress reaction to the whole cpap thing. I'd suggest playing with cpap when you're not facing a whole night's sleep where you feel like you'll need to sleep well the whole night. Just play with it when you're reading or watching TV, or doing something stationary that you enjoy doing. Then you can try getting more air at the start by turning off any ramping and starting in at your target pressure,and see if that helps.

You don't have to put on a mask and immediately get a 0 AHI, or immediately feel comfortable with it. If you put on a mask and it isn't working for you, there are many different combinations of masks and machine settings that will give you good therapy and I'm pretty sure that at least one of these will be comfortable enough to help you get your stress level down, get the therapy that you need, and enough sleep. Starting with a list of things to try is really helpful, just the exercise of putting that together can be help lower the stress level. And then try those things in a relaxed, non-stressful environment and situation; e.g. not when a whole night's sleep is at risk *smile*.

Just my thoughts from reading your posting. I wish you well with this, I think that if you take it slowly that you can get on top of it. For example, after my first night with cpap when I couldn't get to sleep, I decided to try Ambien to help me get used to sleeping with all the gear for the first week and see what would happen.That worked fine for me, and then I stopped using the Ambien and was able to get to sleep without it. I also sleep with earplugs, which helps me not hear the cpap machine that's right next to my head *smile*. That really helps me, too.

[RuthArt]

thank you for your replies, I know this is the right place to be

My AHI is 26-28, so I guess that's moderate and the Dentist said that was treatable with the oral appliance (which is an adjustable, using bands on the sides to stretch the lower jaw forward)

And when my Cardiologist said it would be acceptable to use it if the AHI went to mild, that's why I thought he was ordering a sleep study to find out if it was working....thought he would want a base line.

thank you for the link to edit profile....I was not able to find it on my own!!

I'm sure I tried a whole face mask back in 2006....it was a horrible feeling, constantly leaking...I'm assuming masks have changed though, I may have to try it again. We are allowed to change our masks one time per 6 months....so I'll probably end up with all 3 eventually. This is through Kaiser Permanente.

I did mention Bi-Pap yesterday when I got my machine but they said that was only for people who have Central Apneas (which I told them I have) and they said if this machine shows they exist, then they will do a sleep study!!

By Nasal Potency, do you mean can I breathe through my nose well? The Dentist did take some x-rays that show I have a deviated septum, he recommended using Sinus Cones....I got some but they are too big, will have to exchange to small. I am also using some Xlear Nasal Spray (I was having issues with nose bleeds causing scabs inside the nostrils that narrow the channel) But I know I must breathe through my mouth during the night because I wake up with major dry mouth!

RogerSC, that's a good idea and I know it was something I was going to do....but the day got away from me and today won't work either because we are going to a play. Maybe I can try a nap before we go, it's always easier to nap on the couch while watching TV because I know I don't have to sleep. I've been told not to use a sleep aid, but I have been trying Valerian Root drop at night....not sure if it's working...I get too many racing thoughts, especially of death by suffocating (that's been happening for 40+ years) I'm 69

Again, thank you for your support, it's very helpful.

[49er]

Hi RuthArt,

No, ideal treatment is to reduce your apnea to 5 or below. I am not sure why Cardiologist felt it would be acceptable to reduce your apnea to mild, particularly in light of your A-Fib condition. Of course, if that is the best you would do, it is better than nothing but frankly, I wouldn't settle for that.

Totally wrong about bipaps being just for people who have central apnea. It is used frequently for people who can't tolerate cpap and who have high pressure needs. In order to have central apnea, it has to be at least 5 CAS per hour and be half or more or your total apneas per hour.

Exactly about breathing through your nose well.

Why were you told not to use a sleep aid since it might be helpful?

For full face masks, many people have found padacheek and remzzz liners helpful in controlling leaks and making them more comfortable. Something to try?

Best of luck.

49er

thank you for your replies, I know this is the right place to be

My AHI is 26-28, so I guess that's moderate and the Dentist said that was treatable with the oral appliance (which is an adjustable, using bands on the sides to stretch the lower jaw forward)

And when my Cardiologist said it would be acceptable to use it if the AHI went to mild, that's why I thought he was ordering a sleep study to find out if it was working....thought he would want a base line.

thank you for the link to edit profile....I was not able to find it on my own!!

I'm sure I tried a whole face mask back in 2006....it was a horrible feeling, constantly leaking...I'm assuming masks have changed though, I may have to try it again. We are allowed to change our masks one time per 6 months....so I'll probably end up with all 3 eventually. This is through Kaiser Permanente.

I did mention Bi-Pap yesterday when I got my machine but they said that was only for people who have Central Apneas (which I told them I have) and they said if this machine shows they exist, then they will do a sleep study!!

By Nasal Potency, do you mean can I breathe through my nose well? The Dentist did take some x-rays that show I have a deviated septum, he recommended using Sinus Cones....I got some but they are too big, will have to exchange to small. I am also using some Xlear Nasal Spray (I was having issues with nose bleeds causing scabs inside the nostrils that narrow the channel) But I know I must breathe through my mouth during the night because I wake up with major dry mouth!

RogerSC, that's a good idea and I know it was something I was going to do....but the day got away from me and today won't work either because we are going to a play. Maybe I can try a nap before we go, it's always easier to nap on the couch while watching TV because I know I don't have to sleep. I've been told not to use a sleep aid, but I have been trying Valerian Root drop at night....not sure if it's working...I get too many racing thoughts, especially of death by suffocating (that's been happening for 40+ years) I'm 69

Again, thank you for your support, it's very helpful.

[LSAT]

thank you for your replies, I know this is the right place to be

My AHI is 26-28, so I guess that's moderate and the Dentist said that was treatable with the oral appliance (which is an adjustable, using bands on the sides to stretch the lower jaw forward)

And when my Cardiologist said it would be acceptable to use it if the AHI went to mild, that's why I thought he was ordering a sleep study to find out if it was working....thought he would want a base line.

thank you for the link to edit profile....I was not able to find it on my own!!

I'm sure I tried a whole face mask back in 2006....it was a horrible feeling, constantly leaking...I'm assuming masks have changed though, I may have to try it again. We are allowed to change our masks one time per 6 months....so I'll probably end up with all 3 eventually. This is through Kaiser Permanente.

I did mention Bi-Pap yesterday when I got my machine but they said that was only for people who have Central Apneas (which I told them I have) and they said if this machine shows they exist, then they will do a sleep study!!

By Nasal Potency, do you mean can I breathe through my nose well? The Dentist did take some x-rays that show I have a deviated septum, he recommended using Sinus Cones....I got some but they are too big, will have to exchange to small. I am also using some Xlear Nasal Spray (I was having issues with nose bleeds causing scabs inside the nostrils that narrow the channel) But I know I must breathe through my mouth during the night because I wake up with major dry mouth!

RogerSC, that's a good idea and I know it was something I was going to do....but the day got away from me and today won't work either because we are going to a play. Maybe I can try a nap before we go, it's always easier to nap on the couch while watching TV because I know I don't have to sleep. I've been told not to use a sleep aid, but I have been trying Valerian Root drop at night....not sure if it's working...I get too many racing thoughts, especially of death by suffocating (that's been happening for 40+ years) I'm 69

Again, thank you for your support, it's very helpful.

No...You don't really have Central Apnea. You indicated that 3 CAs showed up...That's nothing. Most people will have several Ca's during the night. If you had 25-30 or more in clusters, you might be checked for Central Apnea. CA also stands for Clear Airway. You could have an apnea while awake with the machine running and no blockage. Bi-Pap is for people with high pressure requirements...ASV is for people with definite CA.

[ChicagoGranny]

Maybe I can try a nap before we go, it's always easier to nap on the couch while watching TV because I know I don't have to sleep.

Any time that you sleep, make sure not to sleep on your back. Apnea is the worse for most people while sleeping on their back because gravity is directly pulling the tongue and the soft palate into the airway.

When you get CPAP therapy working well it will be OK to sleep in any comfortable position.

[Woody]

A while back we had a discussion about desintizing to wearing a cpap. Something like just put the mask
on for 30 min without the machine for a few days till it doesn't bother you. Then work up to an hour just
having the mask on then get 1/2 hour sleep with the mask on and the blower running a few days and work
up from there to using it all night.

[HoseCrusher]

A couple of ideas...

Knowing that you will most likely have to adjust your warfarin as a result, try to incorporate a generous helping of green leafy vegetables daily. A good spinach salad will provide a source of dietary magnesium that may help keep your heart in normal rhythm.

The next idea involves establishing a routine for using your machine. Sit on the bed and take several deep breaths prior to putting your mask on. This will calm your nerves and provide some extra oxygen in your body to help you adjust to whatever your starting pressure is. In addition take a look at what pressure you are starting with. You may be able to kick that up a notch or two to minimize the feeling that you aren't getting enough air when you first lay down.

The next idea is to change your "state of mind." When you mask up visualize yourself on a tropical beach getting ready to go diving into the water to look at the colorful and exciting sea life. You should drift into sleep with a smile on your face and going to sleep should be something to look forward to - not something you dread.

There are many other ideas that you can incorporate into your therapy to make it very pleasant. You have to work at it but you should enjoy the results of your efforts.

[jacobsbd]

Even if they don't let you take home more than three masks, they should let you try on every one that the DME has on hand. When I was on Kaiser insurance they forced me to take one full face mask home with me for my test. It was terrible. Fortunately, I had an existing mask and cpap machine that worked so I knew what was wrong. I raised a stink and they suddenly found that they could get the mask that works for me.

If you have dry mouth every morning after trying the nasal masks, you are likely to be a mouth breather like I am. having a nasal mask on while mouth breathing is torture because the air goes where it wants instead of doing you any good.

you should be able to find a full face mask that fits without leaks. if it leaks in the office of the DME it is not for you. If they tell you that this one mask is the only one insurance covers, tell them you are thinking about buying out of pocket and would like to see what aprea has for you to try.

Good Luck and keep fighting.

[Midnight Strangler]

take several deep breaths prior to putting your mask on. This will .... provide some extra oxygen in your body

Really????

[old dude]

I didn't have a sleep study done (although I was certain I had sleep apnea) until after I was diagnosed with A-Flutter. It's similar to A-Fib, and I'm honestly not sure which is worse. People with A-Flutter normal develop A-Fib as well. The first sign I had was a resting pulse rate of nearly 200-pretty scary!

Listen, I know this therapy isn't pleasant or fun but you can do it. You have no choice. Well, you do have one choice...

The reason I know you can do it is that sooner or later your body will give in and you'll fall asleep. May not be a cakewalk but it's inevitable. I'd do all the things the good folks here recommend and then just tough it out. I know that's not a coddling way to state it, but it's the reality.

It will come, you just have to keep at it steadily. Note I didn't say keep trying. You cannot afford to try, you just have to do it. Many of us have gone through this same thing and understand what the process is. There's always help available here, thank goodness, and most of it be will be packaged more kindly than mine. But the end result will be the same.

[Greenkat]

Welcome RuthArt!

I also have Afib...persistent Afib...so I feel your pain!

My cardiologist insisted I have a sleep study as she said afib was not so common for most folks under 60 and sleep apnea was linked to early afib. I am 57. I went for the sleep study, and was diagnosed with moderate to severe obstructive sleep apnea! They say a lot of ppl have apnea for years before diagnosed so this cunning condition can do a lot of damage before we even know we have it.

I am also claustrophobic so I asked for the nasal pillows. Maybe I'm not doing things right or I am so desperate to maintain my health, but I adapted well from the start. I will admit the air pressure panicked me at first, but the suggestions you've gotten about trying the machine at other than sleeping times is worth the effort. I feel so much better from therapy after 6 months of treatment. I am afraid if I do not comply my afib will get worse and I will develop other serious health problems.

Both the afib & sleep apnea have been a wake-up call!

I'd be afraid to risk a dental appliance in lieu of cpap, but that is your choice. If I didn't have afib or another serious health problem I might give it a try, but not now.

Good luck & welcome to a very diverse group here! If you can survive some of the sarcasm you can get thru this!

Kathy

[bwexler]

Really!!

I understand what you're up against. When I was diagnosed with afib it was my first visit to my new Medicare Advantage doctor. He did an EKG about half way through the visit. Instead of completing the exam he said you have AFIB, you need to get to the ER right now. I don't want you dying in my office. I went to the ER. They wouldn't tell me what they were doing until I refused to allow them to give me injections. They kept me over night before giving me the test I went in for. Then when I refused the injections again they told me to get out of the hospital since I wouldn't cooperate.
I went back to the original doc one more time and he told me I also have AFIB. We arranged a sleep study and my AHI was only 84.
So I decided I had 2 choices, do CPAP or die. I chose the most pleasant of two bad choices.
My first mask was terrible, I have been through about a dozen in 4 years. Some didn't last one night others maybe a year. I have some full face masks for stuffed nose nights. Masks are the hardest part of making this work.

It sounds like you are where I was.