Cpap & Glaucoma

[PaulaO2]

My eye docs have all agreed that the CPAP does more good than harm. That the oxygen it ensures my body (and therefor eyes) are getting each night far outweighs any eye pressure increase it may or may not cause. At this point, we are just monitoring the pressure and hoping for the best.

[OpineCone]

PaulaO2, I have no doubt that my CPAP is absolutely necessary and highly beneficial. There is no way I would want to stop using it. However, you seem to be missing some of the points that I and others are trying to make. It is not enough that CPAP treatment do more good than harm, it should be monitored and managed closely enough to maximize its benefits and to avoid unnecessary risk. That becomes especially important when there is a potential for very serious consequences from an error, as in the case of glaucoma.

As far as I can tell, ophthalmologists do not routinely communicate to sleep apnea doctors a preference for keeping CPAP pressures as low as possible for glaucoma patients. Perhaps this is understandable because ophthalmologists understand the importance of maintaining adequate oxygenation to the eyes. However, in my opinion, it would still be preferable for the ophthalmologist to ask the sleep apnea doctor to be careful to avoid unnecessarily high CPAP pressures for a glaucoma patient.

In my personal experience, two successive sleep apnea doctors kept me on the same unnecessarily high VPAP pressures for more than two years in spite of me reminding them repeatedly that I was a glaucoma patient. The first sleep doctor seemed to be interested only in the quality and duration of my sleep and apparently did not even check whether my pressure settings were consistent with the titration results. It was only because I visited my current sleep doctor this week, told him that my glaucoma had progressed more rapidly than my ophthalmologist had expected, and asked him to look at my complete history of VPAP pressure settings, that he noticed that my current settings were way too high. I believe that a direct contact by my ophthalmologist to my sleep doctor early on in my apnea treatment might well have resulted in prompt discovery and correction of the high VPAP settings, and likely an improved outcome for me.

[PaulaO2]

If the xPAP is set correctly, the pressure would not be unnecessarily high. Otherwise it is unnecessarily high for anyone, eye pressure issues or not.

This is an excellent example of why Sleepyhead software (or equivalent) is so necessary. It assists with patient empowerment.

I cannot get my orthopedist to speak with my neurologist. I cannot get the another orthopedist to send updates to my GP. All of these things are important for my health. So I do not ever see my eye doc and sleep doc (if I ever bother to speak to him again) ever discussing a patient together at the same time. It just is not going to happen in the Real World. Patient empowerment, us taking control over our own health, is really the only way these things are going to happen.

In this case, I would have to get a letter or something from my eye doc and take it to the sleep doc for an opinion. He/she would then have to formulate that opinion (either immediately or would promise to send a letter of their own). I would have to do a follow up call to the eye doc to see if they got the letter. If not, I'd have to contact the sleep doc and ensure they get around to getting the answer.

Or I could download SleepyHead software, watch my own data, and adjust my pressure accordingly. I could ensure it is as low as I could get it and still have AHI below 5, hopefully lower than that. If the AHI is as low as possible, the max pressure is as low as possible, then the next step would be go to the eye doc and test the eye pressure regularly.

And for the record, no, I wasn't missing any of the points previously made in my first post. I was merely stating what my eye doc and I had decided we would do in regards to the high pressure in my left eye.

[OpineCone]

PaulaO2, I totally agree with you as to the helpfulness of Sleepyhead or equivalent software and the importance of patients becoming actively involved in the management of all their health issues including sleep apnea. Fortunately I have my entire xPAP history in a huge Sleepyhead file and so it has always been easy for me to see what was going on and compare it with past experience.

However, it is easy to make mistakes if you make decisions about your own health care without careful research and analysis. This is especially true for many people beginning xPAP treatment because of several factors including, from my own experience: their initial lack of knowledge and experience; the possibility that their sleep apnea has undermined their normal powers of observation, reasoning and memory; and the likelihood that their attention is directed towards achieving compliance for insurance purposes rather than optimal treatment of their sleep apnea without unnecessary risk.

Even after the initial challenge of adapting to xPAP use, there is still a need to learn a lot more about monitoring AHI, mask pressures, leakage rates, sleep duration, and avoiding unnecessary risks. Also, the body of knowledge about sleep apnea treatment keeps expanding and it is all too easy to base important decisions on outdated information. It takes effort to keep up with new developments on an ongoing basis.

In that context, I am wondering about the possibility that you personally might benefit from more information from more sources. I don't know much about you but I am puzzled by some of your posts. For example, I do understand that there may be good reasons why you choose to have no further contact with your sleep apnea doctor. I found myself in exactly that position 18 months ago, and so I transferred to a younger, more specialized doctor who is a member of a sleep apnea team at a local hospital. He was very helpful at filling in gaps in my knowledge. Ultimately he made the discovery that my VPAP pressures needed immediate adjustment, having been set too high for the last two years. Might you benefit from finding a different, more specialized sleep doctor? If that is not an option, may I ask how confident you are that the low end of your VPAP pressure range is optimal? My first doctor's team set the low end of my VPAP range to the highest pressure I was expected to need as determined by titration, which my current doctor says was totally the wrong approach because the low end of the VPAP pressure range can often be way below the highest pressure needed without pushing the AHI above 5. I wonder how many other VPAP users are in the same position.

In a similar vein, I notice that you said in your 05-11-2015 post that your eye pressure of 17 was well within norms. Three years ago an ophthalmologist told me that 18 was too high and the target was 13 or less. Last week my current eye guy told me that the "gold standard" for eye pressure control in glaucoma patients is the range from 11 to 14. Food for thought, perhaps.

PaulaO2, I offer these comments only as suggestions and I fully recognize that you may already be on top of all these issues. Just trying to help, as others on this board have helped me.

[PaulaO2]

I'm not on VPAP. I use APAP. My AHI is below 5, usually below 3. Using the data I get from SleepyHead and the knowledge I have gained through this forum and my own research, I believe I have my sleep apnea well controlled. I see no reason to see a sleep doctor to confirm this. I get all I need, in terms of prescriptions, from my GP. She is pleased to see my blood pressure has dropped significantly since I go the APAP. So much so that for the first time ever, we are considering lowering my dosage. Now if only I could lose weight, I would be all good.

Wow, was it back in '15 that I last saw my eye doc? That would explain the nasty glasses and the squinting, eh? The pressure in that eye is, if I remember correctly, usually between 22 and 25 so 17 was freakin' awesome. No damage has been done yet so no diagnosis of glaucoma, just ocular hypertension.

[OpineCone]

Oops, my terminology was incorrect. I also use an APAP machine, a ResMed S9 AutoSet. My apologies for any misunderstanding.

We can't advise you on the glasses without a photo or two.  

[Mosquitobait]

My eye pressure has been on the high side (21-23) since the early 90s. All this time, it appears it was caused by high cerebro spinal pressure. Poo. They said at the time it was the high end of normal, but once you HAVE a problem, they try to lower it as much as possible.

Anyway, the sleep doc is clueless and doesn't actually care about the eye issues; so that was a waste. The neuro-opthymologist says that there just aren't enough studies but he is happy I'm using an apap and to use the lowest pressure that works.

This is an OLD article (2011) where they are more or less saying increased oxygen in the eye is a bad thing. Can't win.
https://source.wustl.edu/2011/07/more-ox...coma-risk/

[OpineCone]

Here's a long and detailed account of one glaucoma and sleep apnea patient's search for answers and effective treatment:

 http://www.skirsch.com/medical/KirschVisionLoss.htm

[Beej]

'Bout the only thing I could suggest would be reading about antioxidents and the eye, then discussing with the eye doc which of those might be useful for you.

[FormerFed]

This thread caught my attention as I have ocular hypertension and happened to have had a remarkable discovery at my latest 6-mo. checkup yesterday. Not that one person's experience has any bearing on another person's situation, I am writing just to illustrate yet another eye pressure/CPAP relationship. Be it causative or circumstantial, I cannot know, but my eye pressures have gone down since starting CPAP. Were 18 and 20 around the time I began CPAP, in April 2016. Were still 18 and 20 at my September eye checkup, and were both at 16 at yesterday's eye checkup. I don't take drops - being seriously myopic, have had annual eye exams nearly each of my 62 years. In 2012 pressure increases were noted for the 1st time ever. Not glaucoma yet, but I have a strong family history for glaucoma so I took the doctor's recommendation to have SLT surgeries in both eyes, as I would otherwise likely progress to glaucoma. Both procedures were successful. I also started having eye checkups every 6 months instead of annually. Pressures initially lowered to 14 in each eye after the 2012 SLT, then were steady, then began to moderately increase, as does happen to some, and is usually alleviated w/another SLT procedure, but pressures were still in okay zone so we just kept watching them. Don't know if I had OSA at that time, OSA was discovered, for me, in 2016. To track eye issues with the OSA/CPAP, I began episodes of palpitations last fall and also happened to have retinal detachment occur in one eye last fall, a common thing for a person with my vision. Palpitations were diagnosed as Atrial Fibrillation in January 2016. In February 2016 I was diagnosed w/OSA. In March 2016 retinal detachment occurred in the other eye. In April 2016 I began CPAP. Had eye exams every few weeks after each detachment to ensure no tears were occurring, the last of these was shortly after I began CPAP, eye pressures were checked also, they'd be up and down, more up than down, at the last retina checkup last spring, pressures were 18 and 20. No retinal tears occurring, I resumed the 6-mo checkup schedule. Sept. 2016, pressures were still at 18 and 20. At my exam yesterday pressures in both were down, 16 each. One last note, I highly recommend that anyone facing glaucoma investigate SLT (selective laser trabeculoplasty) in lieu of drops - I'm a fairly squeamish crybaby and found it not at all difficult.