Any Way To Reduce Central Sleep Apnea without PAP?

[DeepThought]

Hello,

This is my first post to the board. I recently was pseudo-diagnosed with sleep apnea while having my first bout of atrial fibrillation. What I mean by pseudo-diagnosed was the EKG/SpO2 monitor kept yelling "APNEA" when I tried to nap after the afib self converted. The doctors came in and asked if I had it, to which I said, I don't know. Now I have been thinking and experimenting the last 7 days. For the past 10 years I can think of having times where I wake up all the time in a panic gasping for air. I thought it was my rare heart palpitations that I had diagnosed as benign happening at night and that what was waking me up, not an apnea event causing palpitations.

I'm 43 and relatively healthy, so the whole thing was a little weird to me. At the end of the ER visit, my blood potassium was at 2.7, well below normal 3.5. They believe it was a mix of the low blood potassium, a ton of caffeine that I drink (now eliminated), and the apnea that pushed it over. So I scheduled a sleep doc visit for next week.

The problem is that I am having huge anxiety from the apnea triggering another afib event. In addition, I believe I have mixed apnea or central sleep apnea. I do have the warning signs of a "fat tongue". I slept for a night with my tongue stuck out of my mouth (somehow it stayed there). My wife said I didn't snore for the first time in a long time. So, I thought that was it. I got a mouth guard to hold me over to keep the airway open... and it worked, for what may be obstructive apnea.

But then I started to notice something weird, which I confirmed this morning while trying to fall asleep by recording my breathing with a microphone. No matter what position I am in, my breathing starts to trail off a little, and then I stop breathing for 5-30 seconds. No snoring... no typical obstructive behavior, etc. I wake up in a panic with my heart racing.

So my question is... Is there anything I can do to reduce the episodes I am having before I get my real diagnosis? It is going to be several weeks at a minimum I can see before I can get anything prescribed, and I am dreading going to sleep every night (I slept 2 hours last night).

Thanks...

[trish6hundred]

Hi DeepThought,
WELCOME! to the forum.!
Hang in there for answers to your questions and good luck to you.

[justMongo]

K⁺ of 2.7 mEq/dL is really low. Are/were you on a diuretic?

If you have mixed apnea, you need to be on an ASV PAP machine. Discuss it with your doctor as there are some heart conditions that contraindicate ASV PAP. I believe CHF is one.

43 is sort of young to develop the myocardial changes that lead to afib; but it's still possible.

Low K⁺ and caffeine are definite triggers.

Apnea and afib sometimes go hand in hand. Get the sleep study. Avoid sedatives. And try sleeping on your side. Side sleeping may lessen the obstructive component of apnea.

[chill]

I got a mouth guard to hold me over to keep the airway open... and it worked, for what may be obstructive apnea.

But then I started to notice something weird, which I confirmed this morning while trying to fall asleep by recording my breathing with a microphone. No matter what position I am in, my breathing starts to trail off a little, and then I stop breathing for 5-30 seconds. No snoring... no typical obstructive behavior, etc. I wake up in a panic with my heart racing.

Snoring indicates a partial obstruction. If there is no air flow, there is no snoring. Stopping breathing is an apnea, obstructive or central. What you are describing could be a simple obstructive apnea without prior snoring. It happens. I always have OSA, I don't always snore. I don't have Central Sleep Apnea. I would also wake up in a panic with my heart racing. The only way to really know if they are true central apneas is to sleep attached to an EEG.

Try to relax and not over think this into an panic attack and follow JustMongo's advice. Focus on the fact that you have had this for over 10 years already.

Oh, and Welcome!

[Sleeprider]

Pretty good "chicken vs egg" question. What came first? A-fib or apnea? Obstructive sleep apnea is a common precursor to a-fib, but at this point it's way to early to be anxious about testing and possible results. Your K balance was so messed up, that alone could lead to serious complications. Try to stay relaxed until you have narrowed down the possibilities of whether you have apnea, what type it is, and finally how to go about treating it. You seem to be pretty well informed, but at this point, adding anxiety is not going to work in your favor.

As far as your recording breathing, the presence of some central apnea and irregular breathing at sleep onset is very common. It even has a name; sleep-wake-junk. Any of the PAP therapies and the sleep apnea tests, target events when you are actually asleep. That transition can be tough for a lot of people and reasons. I wouldn't be too concerned.

[srlevine1]

There is a definite correlation between AFIB and sleep apnea ( http://www.wjgnet.com/1949-8462/full/v5/i6/157.htm ) and you should be speaking with both your sleep doctor and cardiologist and they should be speaking with each other. Keep in mind that your sleep study (in a sleep lab vs. home-administered studies) is only a snapshot in time in unfamiliar surroundings wired-up three ways from Sunday and may not be fully diagnostic of periodic events such as AFIB+OSA. At the minimum, make sure that any breathing assistance device (CPAP, APAP, Bi-PAP, ASV) is data-capable and you load analysis software (see the forum header for software downloads) on your own computer for longer-term self-analysis. Many in the forum are long-time "hose-heads" and can help you interpret the data and formulate questions for your physician team. Best of luck.

[PaulaO2]

If you are having central apnea events, there isn't much that can be done about it. It is a brain thing. What you can do though is sleep sitting up in a recliner or use a wedge pillow in bed. This raises your upper body and removes the gravity factor of it pulling stuff down into the back of your throat, contributing to the hypopnea or obstructive events.

You can also put pillows at your back and force yourself to sleep on your side. With central apnea possible, I do not think stomach sleeping is a good idea.

In the meantime, this has been happening for a while. You are not going to die. What you are going to do is make it worse by worrying about it. You need to calm down and view it as a broken bone that is waiting for the swelling to go down before it can be fixed by the surgeon. It will be okay. But you need to slow down the worry and freak out. I know that isn't easy to do.

After your appt with your sleep doc, make sure the report is sent to your cardiologist and your GP. Give it a week then call them back and enquire about if it was sent or not.

[DeepThought]

Thanks all, this helps a lot. I have an appointment with my cardiologist tomorrow, GP on Monday, and sleep doc on Tuesday (forgot to mention that all). They are all in the same circle so everything is shared electronically, automatically. I just need to make sure they look at it.

As for the potassium, the wash out was due to drinking A LOT of water everyday and an energy drink (I know I know).

I have my mouthguard that pulls my jaw forward for now, until the xPAP machine is finally prescribed, delivered, and trained. My OSA is not bothering me for as much as I can tell. But like you all said, wait until the experts weigh in. Now I just need to figure out how to control this anxiety...

Thanks!