[Health] CPAP induced heart problems

[Rcgop]

My road to SA started out differently than most. I was not sleepy during the day (even though it has improved), I did not wake up gasping for air, or have my spouse complain about snoring. My complaint was constantly waking up to a racing heart beat.
Once I got my machine, it cleared up immediately. I figured the racing heart was my body's way of waking you up. Sleep quality and duration was still unacceptable. As I adjusted, my numbers and leaks improved and I thought I had made it. Sleep was ok but still not like before SA. Nights were long but I was comfortable. I thought this was as good as it gets and I could live with this level of sleep.
Then suddenly sleep quality improved tremendously. 4 to 5 hours at a time and still improving. But numbers got worse (3 to 5 range). This is when the racing heart came back. A little less severe and only upon waking up. Looking at SH data it appeared to follow a 15 to 20 second CA.

Now comes my question:
I told my GP Doctor and he decided to run an echo cardiogram and 24 hr Holter monitor. He thought the results were good but not perfect. So, he sent me to a cardiologist. There I an EKG (results normal) and has scheduled me for a stress test in two weeks. If I wasn't scared before, now I am.

So far this is what he has said. "It appears your heart is not relaxing between beats as it should, possibly due to the CPAP. We will schedule the stress test and put this issue to rest."

Is this serious? Should I be worried?

I am back on an improving path and the racing heart is gone or greatly reduced.

What's up with this.

[justMongo]

First, relax. Quite a few people are referred to sleep studies by cardiologists.
There seems to be only a very limited subset of people for whom CPAP is contraindicated.

Racing heart is not a specific term. Could mean sinus tachycardia. Which is normal beat, just rate greater than 100 beats per minute at rest.
Could be a benign form of arrhythmia.

"It appears your heart is not relaxing between beats as it should..." could be what they call diastolic ventricle dysfunction. That's when the ventricle wall is stiff and doesn't create a suction upon relaxing. It's not uncommon. Usually on the left side.

I do not know your age; but changes in the heart muscle; especially the left side, are not uncommon in older people.
Get the test. Ease your mind.

[Ghost1958]

My road to SA started out differently than most. I was not sleepy during the day (even though it has improved), I did not wake up gasping for air, or have my spouse complain about snoring. My complaint was constantly waking up to a racing heart beat.
Once I got my machine, it cleared up immediately. I figured the racing heart was my body's way of waking you up. Sleep quality and duration was still unacceptable. As I adjusted, my numbers and leaks improved and I thought I had made it. Sleep was ok but still not like before SA. Nights were long but I was comfortable. I thought this was as good as it gets and I could live with this level of sleep.
Then suddenly sleep quality improved tremendously. 4 to 5 hours at a time and still improving. But numbers got worse (3 to 5 range). This is when the racing heart came back. A little less severe and only upon waking up. Looking at SH data it appeared to follow a 15 to 20 second CA.

Now comes my question:
I told my GP Doctor and he decided to run an echo cardiogram and 24 hr Holter monitor. He thought the results were good but not perfect. So, he sent me to a cardiologist. There I an EKG (results normal) and has scheduled me for a stress test in two weeks. If I wasn't scared before, now I am.

So far this is what he has said. "It appears your heart is not relaxing between beats as it should, possibly due to the CPAP. We will schedule the stress test and put this issue to rest."

Is this serious? Should I be worried?

I am back on an improving path and the racing heart is gone or greatly reduced.

What's up with this.

Your numbers got worse because you were sleeping deeper.
The racing heart coming back with a worse AHI is pretty clear.
You likely need to adjust your pressure to get your numbers back down. And likely the racing heart will again go away.

[Mosquitobait]

It's a lot harder to figure out therapy for those of us who have cpap machines NOT because of apnea but due to other issues such as heart problems. Docs have to figure out if those improvements are just masking something else. You DID improve and suddenly, you worsened. What's up with that? Hence the additional testing. It could simply turn out that cpap isn't the solution for your racing heart issue. For instance, in my case, oxygen would be a fix for me, but since cpap raises my O2 to a suitable level (91%) it is a better choice for me at this time. There is an alternative when this stops working for me - either oxygen at night only or a pacemaker. It could be that instead of a cpap, you need medication at night (unfortunately, side effects from some of those meds are seriously problematic!). Maybe a bipap?

[Sleeprider]

Well, you're getting plenty of professional help. Just let that take its course. I've never heard of CPAP induced heart tachycardia or arrhythmia so that's a new one on me. Logically what stress could up to 11 cm air pressure create? Keep us posted, but I'm skeptical of the CPAP connection.

A faster heartbeat would be normal reaction to a breathing cessation, clear or obstructive. If it is isolated incidents, there is probably not much to be done, but if you notice a pattern or correlation with pressure then it might be something you can address.

[hegel]

I have paroxymal afib;it almost always come on at night; I'm particularly committed to cpap precisely in order to avoid afib or tachycardia at night--which is common among afib sufferers. This is pretty important to check out. By the way, a 24 holter monitor is pretty short. Really, ask for a 48 hour monitor. It doesn't happen every night, right? You want to be wearing the holter when it does, however.

[justMongo]

There is a monitor called a ZIO patch. They glue it to your left pectoral area. No wires and you can shower. You wear it for 10 to 14 days depending on the doctor. You drop it in a prepaid mailer; and it goes to the lab for analyses. It will pick up those events that don't necessarily happen in a 24 hour period. Greatest thing since sliced bread!

For the OP, the cardio doc will be looking at the ECG during exercise and recovery -- lots of information to the trained eye.
Stress test is almost always combined with a nuclear med scan of the heart. Doc will be looking for valve function and regurgitation; plus wall motion.
If a person cannot exercise due to disability or being out of condition, lexiscan will be infused to stimulate the heart.

If they are going to use Lexi, there will be diet restrictions (no caffeine, chocolate...) plus fasting when you come for the test.

[hegel]

I have paroxymal afib. It mostly comes on at night. this is very common for a lot of people with this condition. Same thing with tachycardia. I religiously use my cpap precisely to help prevent this from occurring.

You might--should--consider asking for a 36 hour or longer holter monitor. these tests cost essentially nothing to you or the medical establishment, so don't worry about that. I've had doctors laugh and tell me that a holter is worthless if your events don't happen while you're wearing the monitor. QED. You need to find out what your events look like. You need to be wearing the monitor for that to happen. I would point this out and ask for the longer test.

what you describe is classic tachycardia/afib. You need to address this early on. Look, I may be wrong about what you're experiencing. But afib is always a progressive condition. You want to be on top of it early, to address it's progress. Again, I'm not a doctor and can't possibly pretend to diagnose what you're experiencing. I don't want to be alarmist. I'm not saying that this develops over weeks or months, so don't worry about that. I'm suggesting however that you flesh this out.

Stopafib.com is a good forum for all of this.

[hegel]

in the meantime, while I was posting, Justmongo has given an even better idea. The zio patch makes the most sense. I've worn one and it's no big deal.

[Rcgop]

Boy, that is a lot to digest. Thanks for all the comments.
JustMongo - I am 68
Hegel - most every night and it did happen the night of Holter moniter. Last few nights it did not. I classified those nights as "Best night ever"
Mosquitobait - I have very few OAs and HAs, mostly CAs. My 90% pressure is only around 8 to 9. And that seems to stop them. The CAs are the part that is improving.

I am in good health and walk 2 miles every day. Taking the test should not be a problem. In my spare time I dig palmetto stumps with a crowbar.

I am beginning I to think I need oxygen too.

As for progress on my therapy, it is always getting better (very slowly) sleep wize that is. As my numbers improve, my sleep remains the same. Then my sleep will improve and my numbers get worse. Sleep however never gets worse, just the occasional bad night.

Thanks again for the advice and I think this heart doctor will have some news in a few weeks.