Forcing sleep position

[desaturator]

Edit: My best guess is you are trying to treat the arrhythmias and you aren't sure if these desaturations are causing them so you are trying to treat these desaturations in the hopes it will help the arrhythmias?

That is exactly correct. It was noted in earlier (unrelated) hospital visits that my SpO2 was low (90-ish) a lot of the time. Nobody paid much attention to this, because I had bigger things to worry about at the time. It's only when I started to develop arrhythmias -- particularly bad at night -- that anybody thought about oxygen or breathing.

My doctors suggested CPAP ("prescribed" is too strong a word; it was more like "perhaps you should try...") because they thought my low-ish SpO2 might be the result of sleep apnea, and might be a cause of the arrhythmias (although I've never had any of the common symptoms of sleep apnea). But probably the main reason for the CPAP suggestion is that they can't find any other explanation for my arrhythmias.

It's pretty clear now that CPAP does improve my overall SpO2 a bit, but sleeping on my right side improves it a whole lot more, because (presumably) of the effect of gravity on the intra-cardiac shunt. Since I started sleeping only on my right, my SpO2 has been 96-97% all night, with only a few large drops each night (rather than dozens to hundreds). Hence this thread.

My hope is that I can get my SpO2 completely "normal" for a few weeks, I can repeat the holter ECG and see if it's fixed the arrhythmias. If it has, I'll get the shunt closed, and then think again about whether I need CPAP in the long term. If it doesn't, well, at least I will have tried everything that there is to try.

BW, DS

[SarcasticDave94]

Has there been any discussion with your doctors yet about beta blockers or calcium channel blockers? If I have it right, these medications are at the lesser invasive end of methods for arrhythmia control.

I myself have Premature Ventricular Contractions which sounds like a form of arrhythmia. I'm on a calcium channel blocker, Diltiazem, to control my PVCs.

I had complained for some time about my palpitation issue, shortness of breath, fatigue when having what was caused by these PVCs. Until my cardiac doctor put me through a chemical stress test, echocardiogram, and viewed the results, it was undiagnosed.

[Geer1]

For interest sake could we see an example oximetry reports on left and right side? Curious what your heart rate does during these periods of desaturation?

Do you have any way of knowing if/when arrhythmia are occurring? Based on our previous discussions it sounds like a holter monitor picks it up but you have been wanting to avoid since it is out of pocket. I thought healthcare in the UK was public/free, why would heart issues like this be out of pocket?

[desaturator]

Has there been any discussion with your doctors yet about beta blockers or calcium channel blockers? If I have it right, these medications are at the lesser invasive end of methods for arrhythmia control.

Thank you for responding. In fact, I have tried both beta blockers and calcium channel blockers. Since my symptoms are mostly at night, it's kind-of hard to know if they make any difference. However, in my last holter ECG it seems that they did not. Both these medications are relatively safe, at least in modest doses, but they don't seem to do a lot for me. I'm not overly worried about PVCs, although I have quite a few. I'm slightly worried about the AFib, and I'm very worried about the ventricular tachycardias. I'm sure that both these things can be suppressed by medication, but I think I'd be looking at amiodarone or procainamide or something nasty like that.

The problem with these kinds of medication is that, although they suppress the symptoms, they don't do anything to fix the underlying problem. In long-term studies they actually increased mortality. So I really want to know if my arrhythmias are actually being caused by something I can control (like oxygenation).

Having said that, since I started using CPAP I've only had one episode of tachycardia that was long enough for my Wellue to capture. I'm guessing that these episodes probably need to go on for tens of seconds, to show up on the Wellue as an increased heart rate (but I have no real way to test this). So maybe I no longer have any sustained arrythmias, which would be a result.

Because I'm paying for all these tests out of my own pocket, I want to be sure that my oxygenation is normal (-ish), and has been normal for at least a couple of weeks, before I pay for another holter ECG.

BW, DS

[Geer1]

Have you researched home ecg monitors? Looks like there are some options and if you could actually measure what is worrying you that would help understand what is causing what and if cpap helps etc.

Since you have to pay out of pocket for a Holter test you might be able to buy your own equipment for same price and then have unlimited access to test.

[desaturator]

Have you researched home ecg monitors?

I've certainly thought about it, but I've been put off by the cost. It's not just the equipment, but the proprietary event detection software that goes with it. I can imagine looking through a whole night's ECG, beat by beat, maybe once; but any more than that and I think I'd lose the will to live. The companies that make the software won't even supply it to individuals, which is another problem.

I've seen a few all-in-one devices sold directly from China, that claim to include software and even to run it on a smartphone. However, I'm reluctant to risk hundreds of pounds on something whose quality and accuracy is unclear.

I'm certainly open to suggestions in this regard.

BW, DS

[Geer1]

I wasn't sure if there would be ones with automatic report capability or not. I quickly looked at a couple options from here that seemed somewhat promising but you would have to research in depth.

https://www.healthline.com/health/ecg-mo...r-home-use

It would be nice to be able to measure what you are worried about and see if and how often it is occurring and how any of these changes (CPAP, position etc) make a difference.

You know you have minor desaturations but you and the doctors don't know if that means anything clinically relevant to the arrhythmias. My brief research on the matter tells me you would be having other symptoms if this was bad enough to be clinically considered an issue but maybe you are right and are catching this earlier than the average case.

Overall I think you have enough information that you need ECG data now whether it is at home or through an extended holter test with doctor. If you can do a week of monitoring that would be best. Try a couple nights without CPAP, one night sleeping on side without CPAP, couple nights with CPAP, couple nights sleeping on side with CPAP. Add in some periods of anything else you think might be relevant and then see if doctors can notice any correlations. Imo this is worth looking into sooner than later before you drive yourself crazy chasing things that you don't know are making any clinical difference or not, you already know that CPAP and sleep position have an effect on desaturations so there should be a clear correlation with arrhythmia if they are occurring relative to these desaturations as you have theorized.