Cpap & Glaucoma

[Mosquitobait]

My titration study is still a couple of weeks away. I was disheartened to find out that cpap may increase eye pressure, possibly making my eye problems worse. I've already lost vision due to high eye pressure from leaking and swelling of optic nerve. It is under OK control now, but now I don't know what to do. I'm not even sure which eye doctor to call, but I'm going to start with my ophthalmologist on Monday.

Does anybody know if one mask is better than another for this problem? I already read that Fitlife Mask is not recommended. My goal had been either nasal pillows or a nasal mask because at this point, I just can't do a face mask anyway.

[PaytonA]

I think that the best thing to do is discuss this with your ophthalmologist, but I do not think that the pressure from any mask other than the Fitlife will be a problem. Again, listen to your eye doc. If for some reason you do not like what he/she is saying look for one who is better informed about CPAP.

Best Regards,

PaytonA

[WakeUpTime]

Sleep Apnea can significantly negatively impact eye health. There was a scientific article that came out on that subject. In the absence of CPAP (or another solution), the oxygen dips throughout the night on the fragile little blood vessels in the eyes can weaken the eyes significantly.

My eye dr and now eye surgeons will confirm that strong connection with at least one example.

[PaytonA]

WakeUpTime,

That is interesting and makes sense. Had not thought that far into it.

[storywizard]

Hi Mosquitobait

I have closed angle glaucoma...

I have read that sleep apnea can affect the eyes, I have mentioned my apnea with my eye doc, he did not seem to think that CPAP would be an issue, but for your own peace of mind I would talk with your own eye doc...better to be sure with these issues...

found this post on here...

http://www.apneaboard.com/forums/Thread-...e-pressure

all the best,

Storywizard

[Mosquitobait]

Thanks for all the tips and the links. I will report back what I find out. While I don't have normal glaucoma, I take glaucoma drops in order to keep the eye pressure down and anything that would affect that is of concern.

[PaulaO2]

From my conversations with my two eye docs, both say that untreated sleep apnea is worse than the CPAP machine in terms of eye health. That the eye pressure increase is minimal overall. In some limited cases, it can increase the pressure, yes, but not enough to make stop using CPAP better.

In other words, using the CPAP makes the eyes healthier and negates any possible negative effects.

As far as masks, I have less ear issues since I switched from nasal pillows to full face mask. Allergy season hit me like a truck today and my ears are blocked for the first time in forever which made me realize it HAS been a long time. And when I saw the eye doc a few weeks ago, my eye pressure was well within norms for the first time in years. Could be coincidence. It was a huge drop (24 to 17).

[Mosquitobait]

In other words, using the CPAP makes the eyes healthier and negates any possible negative effects.

Based on what I read, I agree with this in theory. But, I do not take negative effects lightly in any way. I'm already blind in one eye and lost 1/4 of the peripheral vision in my remaining eye last year. I want zero negative effects. I just have to figure out what the best choice is. Medicare pays $180 a month for glaucoma drops to keep my eye pressure lower. Makes no sense to negate that.

On the other hand, I have atypical glaucoma (high intracranial pressure). I read one study that indicated that treating sleep apnea can lower the intracranial pressure. Maybe the end result is lower overall ocular pressure? Don't know enough to determine this however and again, the studies are 6 years or older and small. Are there confirming studies? See, that's what I want him to find out. I don't have access to more current medical journals and don't understand half of it anyway.

[TyroneShoes]

In other words, using the CPAP makes the eyes healthier and negates any possible negative effects.

Well, its not quite that simple.

A quick perusal of the internet reveals that intraocular pressure is higher for folks using xPAP in a number of studies. Is that a problem? Probably for those sensitive to it, which may include those with a propensity for glaucoma or other similar issues. Certainly not something to be unconcerned about.

While using xPAP helps keep your desats to a minimum, which is healthy for bloodflow to the retina, high intraocular pressure is not healthy. Treating SA with xPAP may be healthy to retinal blood vessels, but this does not eliminate the negative side effect of higher IO pressure. About the best you could hope for would be to trade one for the other, which is a Sophie's choice no one should be put in the position of having to make.

So it becomes a dilemma. It seems that possibly someone concerned about this might be a candidate for a mouthgard instead of xPAP, or even the dreaded surgery. They should also do all of the other things (lose weight, sleep on their side, etc, etc,) that minimize SA.

If xPAP is still needed, it might make sense to have an APAP and start at the lowest pressure (4 cm) and let the APAP raise and lower from there in the face of events. That would not be as effective as setting the optimal lower pressure, but it still might be effective enough, while not keeping pressure in a range that is dangerous for long. But we are just guessing, and it is important to actually know before going down that path, implying professional advice.

There may even be a need for medical marijuana in small doses to help with the glaucoma.

Again, just guessing, but my best guess is that which mask you use may not matter, as the issue seems to be from the pressure applied, which affects the sinus area which is how it probably effects the eyes. More research needed there, of course. But the hydraulic principle would indicate that the pressure would be the same regardless of which mask, because the mask is part of that delivery system and delivering that pressure is exactly what it is designed to do, each and every one of them.

This can probably be managed, but it would be tricky and would require the careful guidance of a sleep doc along with an opthalmologist.

[PaulaO2]

Did you read the rest of my post or just that one sentence?

It has been my experience, and the advice from my two eye docs, that it is healthier for the eyes to use the CPAP and benefit from it overall than to not. I was very concerned about this because my eye pressure in my left eye had been steadily rising and changes in the optic nerve was happening. When I mentioned if I should stop use or decrease the CPAP pressure even if it meant less quality treatment, both doctors practically shouted no. It was their opinion (I did not see them both at the same time but on 2 different appts) that my eyes were healthier due to the oxygen I was keeping in my system because I was treating my sleep apnea.

If the use of the device does raise the eye pressure, it typically decreases once the person awakes and the CPAP is turned off. One study done on just 21 patients who were new users and were followed for just one month. Other eye conditions caused by untreated OSA improve or go away with the use of CPAP. The exception is anything to do with eye pressure but not enough studies (just the one) have been done to determine anything else.

The diagnosis of glaucoma does not happen until damage has been done to the optical nerve. One can have ocular hypertension for years and not have damage, which is what I have been experiencing. And, as the OP has said, one can have ocular hypertension and it not be "real" glaucoma (typically caused by blocked drain pipes or by changes to the optic nerve itself).

The reason I believe using a CPAP is better for a person with ocular hypertension than not using it, is simple: the eyes are not the only part of the body that is being strained. Sleep Apnea effects the entire body, every cell, every organ, every system. To not treat sleep apnea is an un-smart thing to do. Oxygen and sleep deprivation is harmful to everything, not just the eyes. The benefits far outweigh the risks.