CPAP 0.5 year, still tired, need beta blocker cut?

Hey guys. I was diagnosed with hypertension a few years ago, and was put on a beta blocker (Toprol XL). I started at 50mg daily, but that wasn't enough, so it was increased to 100mg daily. This yielded normal blood pressure numbers.

Then my doctor, who never put "overweight", "snores", "tired" and "hypertension" together to arrive at a suspicion of "OSA", died. My new doctor immediately put these together, ordered a sleep study, and I got treated for my severe OSA (AHI=70, desats into the lower 70% range).

I've been on CPAP for 6 months. Mask fits great, no leaks, everything's going smoothly. I have a Respironics M-series Pro, and the 7/30 day leak numbers are fine (right around the inherent mask leak number) and the 7/30 day AHI is fine too (varies between about 2.1 and 3.4, always).

But I'm still tired and have "brain fog". Further, recently I started eating very healthily (no more white carbs, smaller portions, no sweets, much veggies, etc.), started doing cardio exercising significantly and regularly (exercise bike 45 min, 12.5 miles at 50% resistance every other day), and I'm getting MORE tired the longer I keep eating right and exercising.

Now that my OSA is essentially treated out of existence for 6 months now, AND the fact that I'm losing fat and strengthening my heart by eating right and exercising a lot, perhaps all these very good changes have collectively lessened or eliminated my need for the Toprol XL medication.

Have any of you experienced this? I'm pretty sure a normal person needlessly taking Toprol XL would experience consistent daytime fatigue, lethargy and some "brain fog", which is exactly what I'm experiencing (and increasingly so the fitter I get, it seems). So this theory seems viable. I might now be a "normal" person needlessly taking this stuff that I only truly needed while I was overweight with untreated OSA!

I'm considering asking the doc to dial me down to 50mg, then perhaps eventually weaning me to nothing at all, monitoring my BP frequently each step of the way to make sure it doesn't rise, of course. Right now my BP numbers are pretty normal (120's/70's) but my pulse can be pretty low (I'd say 55-70 or so, resting).

Any similar experiences? Do you guys think my theory might hold any water? It makes sense to me!

Thanks!

Sounds like a good plan.

I am a newbie only using CPAP for six weeks. I had a three year history of Atrial Fibrillation and was on a low dose of Toprol XL - 25 Mg plus Propafenone to control the occasional AFIB episode. I was diagnosed with Apnea 17 years ago and could not tolerate the mask so I just tried to eat a light supper and have no food or booze after 7 PM. Pretty much forgot about the apnea for 17 years. I went downhill all this past summer and ended up in the hospital for a complete cardiac workup. I was discharged on 200 mg of Toprol XL per day and felt horrible. At this point I was not even considering Apnea but I was having erratic heartbeats, vertigo, exhaustion and soaking night sweats. My brother - in - law - a small town family doctor told me to get a sleep study. I did so on 11/11 and got titrated on 12/5. I am on 10cm. of CPAP and just now convinced my sleep doctor to switch me to an APAP machine tomorrow. During this time period I consulted with my cardio and got my Toprol XL back down to 25mg plus 2.5 mg of Altace per day. He commended me for finding our about my apnea and said they don't often look for those things. I believe the Toprol made my apnea worse after I got out of the hospital - combined with an anxiety disorder (well, who wouldn't have one).

Misterdux

Hmmmm...I switched about 4 months ago from a beta blocker (atenolol) to another type of blood pressure drug. It may be coincidence (or even delusion), but my impression is that recently my OSA has gotten significantly better. Used to be that I couldn't take a nap without CPAP because the OSA would wake me up. But recently I've actually slept entire nights without CPAP with no sensation of apnea at all. And my energy is much better lately.

You're doing really well to have lost weight on a beta blocker: They are infamous for making people gain. Congratulations!

Grace

I'm the original poster.

Thanks for the comments guys. Actually, not only do I get more and more tired as I eat better and exercise more, I've also started getting occasional heart rhythm irregularities ("fluttering" in the chest, the occasional hard beat or PVC, etc.)

I'm increasingly starting to think that while:

100mg/day Toprol XL + untreated severe apnea + overweight = okay dose.

...after six months on CPAP with AHI < 3.0, eating great and working out at a decent frequency:

100mg/day Toprol XL + no apnea + less weight = way overkill dose.

I'm quite willing to bet this is what's going on. One should not treat their apnea for six months, get in shape, and feel increasingly exhausted the more that they improve those factors! And there's the heart flutters too, that another poster above mentioned.

An excessive dose of the Toprol XL would explain all this fairly nicely, though.

I'm talking to my doctor soon, and will request maybe a cut to 75mg or something, to see what happens.

Thanks guys!

It's me the original poster again!

You're doing really well to have lost weight on a beta blocker: They are infamous for making people gain. Congratulations!

Grace

Thanks Grace! I finally got sick of all the bad stuff that goes with being overweight. So I got myself a nice high-end semi-recumbent exercise bike, a 7-position flat/incline/decline folding bench and a pair of instant-change adjustable dumbbells.

I'm extremely satisfied with all of them. Total cost under $2,000, and it covers cardio and freeweight needs quite thoroughly. Best part is, the bench folds and slides under the bed when not in use and the dumbbells give you 15 different weight choices in only one pair. Minimal space, aesthetically pleasing (the bike and dumbbells look very slick indeed), yet a high-quality and extremely versatile system that does everything I'll ever need for total fitness.

So far, so good... just do it! It feels great once you get over the hump of starting (which admittedly isn't fun).