Meniere's disease and CPAP use

[PaulaO2]

I am being evaluated for ear issues with the possibility of Meniere's disease as the topmost diagnosis. I got curious if my use of xPAP was contributing to the symptoms (either entirely or in part). So I did a search for Meniere's and CPAP. I found a very interesting article!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582051/

20 patients (16 male, 4 female) with unilateral (one sided) Meneire's disease and untreated OSA were tested for hearing loss, balance issue, polysomnography, etc. They had to stop any medication that would in any way effect their sleep. Meneire's disease gets worse with stress and bad sleep causes stress so...would treating the OSA assist with the Meneire's symptoms?

YES!

Increase in hearing
Increase in hearing range (in hertz)
Significant increase in balance ability

So on the one hand, xPAP use can contribute to ear issues due to the pressure, air flow, etc but on the other hand, the increased blood flow and better sleep can assist ear disorders such as Meneire's. xPAP use does not cause Meneire's but can in fact be part of the treatment. The researchers feel that sleep needs to be addressed with these patients and a sleep study done. Most of the medication given to those who have this disease interfere with sleep in some way so including a sleep evaluation would be good.

(bolding is mine)

It is well known that insomnia is associated with increased psychological symptomatology and perceived stress, higher predisposition to arousal, and greater impairments to quality of health.5–7 The relationship between Ménière's disease and stress is well documented, but that between Ménière's disease and insomnia is unclear. In our previous report,8 we first found that sleep quality of Ménière's disease patients was impaired. Ménière's patients had longer total sleeping time, lack of deep sleep stages, increased arousal, and occasionally also had obstructive sleep apnea syndrome (OSAS) and/or periodic limb movement disorder (PLMD). Poor quality of sleep may cause additional stress and lead Ménière's disease patients to a negative spiral of symptoms. Furthermore, poor sleep quality may result in Ménière's disease patients being refractory to medical management. Therefore, treatment focusing on the sleep disorders of Ménière's disease patients may become an additional new strategy for terminating the negative spiral of symptoms and reducing exacerbations.

...

Patients diagnosed with “Definite Ménière's disease” according to the guidelines for Ménière's disease by the American Academy of Otolaryngology-Head and Neck Surgery1 were recruited from the Department of Otolaryngology in Nagoya City University, Nagoya, Japan, from April 2011 to March 2014. The patients' chief complaints were vertigo attacks, dizziness, tinnitus, ear fullness, and/or hearing loss. No patient reported “sleep disturbance” as a chief complaint, and “sleep disturbance” was not brought up by any patients until we asked about that complaint specifically. The patients were instructed to discontinue all medications that could influence sleep, such as benzodiazepines for 2 weeks before polysomnography. Patients enrolled in this study had failed all medical management including diuretic therapy, low salt diet, and oral steroids. Consequently, prior to continuing in the study, patients were taken off all therapies which had failed in order to avoid unnecessary potential side effects. Twenty patients, 14 male and 6 female, were diagnosed as mild-to-severe OSAS (AHI ≥ 20) according to the International Classification of Sleep Disorders, Second Edition10 and were enrolled in this study. The age of the patients ranged from 33 to 82 (average 60) years, with BMI 20.7 to 28.5 (average 23.5).

...

We report on a unique subset of Ménière's patients who also suffer from OSAS. The findings of this study are surprising and encouraging in demonstrating that solitary CPAP therapy may play a role in not just improvement of vertigo attacks, dizziness, and activities of daily living, but also improvement in hearing function in this subset of patients. The effects of CPAP therapy on Ménière's disease patients with OSAS were evaluated six months after initiation of CPAP in this study, and we are in the process of further follow-up to continue to investigate the long-term effectiveness of this treatment strategy. In patients who do not tolerate CPAP, surgical interventions can be considered such as uvulopalatopharyngoplasty, base of tongue resection, hyoid suspension, or bimaxillary advancement, depending on the underlying pathology of the OSAS. Fortunately, all cases in this study maintained good adherence to CPAP over the 6-month protocol.

...

These properties may have the effect of aggravating OSAS symptoms. Ménière's disease patients who are refractory to medication may find themselves in a vicious cycle combining disease, quality of sleep, and stress.5–7 When prescribing sedating drugs to Ménière's disease patients, the possibility should be kept in mind that such drugs could have unintended consequences, in that such medications may have suppressant properties but also increase the severity of preexisting sleep disturbances, thereby counteracting one set of benefits with another set of drawbacks. Although it may be only 10% of Ménière's disease patients who have concomitant OSAS, such patients may be refractory to pharmacotherapy for Ménière's disease and only respond positively to therapies that benefit OSAS.

[cands]

As someone who has lived with one-sided Menieres for over 20 years, I am sorry to read you may have this condition. Luckily, (depending on how you define lucky) I am in the 'burnt out' phase, and no longer have episodes of vertigo. I have adapted to the loss of balance and rarely have issues except perhaps in the dark. (visual compensation plays a large part in balance with menieres). I am almost completely deaf in one ear.

I started CPAP two years ago. My hearing was obviously already too far gone for it to have any positive effects, although there have been no negative effects either. CPAP has been remarkable though in improving so many other aspects of my life.

I wish you all the best if the diagnosis proves to be Menieres. It is not pleasant, but you can get though it, and things can improve over time.

Regards,
Steve.

[gwc2795]

I was diagnosed with Meniere's disease 15 years ago. The ENT explained there was no treatment. I was prescribed Valium and Meloxicam to be taken as needed during an episode. Fast forward to 2011 and I began xpap treatment. Looking back I think I have had fewer episodes since I began xpap treatment although I do have the occasional bout. The bouts do not last as long. So maybe the xpap has helped. Thanks for the information Paula.

[yankees123]

PaulaO2 I thought you updated to a airsense10 autoset?

[Melman]

I hope the diagnosis is wrong because the disease can become quite debilitating. It is often progressive. I have been fortunate in being able to reverse the symptoms but, just as with sleep apnea, know I will never be cured.

 I was diagnosed with Meniere's disease 11 years ago. Although I never actually experienced vertigo, I had balance problems and could not handle seeing rapid motion for about a year. I was unable to drive for that period but have been virtually asymptomatic since then. The only medication I take for it regularly is diazide which helps which prevents absorption of too much sodium and helps maintain the proper balance of potassium and sodium but diazide and valium alone did not eliminate the symptoms. I was fortunate to have access to a top specialist. He recommended a very low sodium diet as the most effective control. I believe it works.

I have limited my sodium intake to 1,000-1,200 mg. per day. it's a lot harder than you may think. It's not just a matter of avoiding the salt shaker. Most processed foods have much more sodium than we realize. (Look at the sodium content of store purchased bread or canned soup.) I'm convinced the low sodium diet works not just because I've been asymptomatic for years since implementing the low sodium diet but also because when I go over my limit for two or more days (which is seldom) the symptoms of imbalance and dizziness begin to return.

If your interested there is an excellent book titled "500 Low Sodium Recipes" by Dick Logue available from Amazon. He also has a web site. I can't provide the link without breaking our rule but if you google his name you will find him.

As for the effect of xPAP I had a brick until Jan of 2017 and was non-compliant for most of 12 years until my PCP, not my sleep Dr., convinced me to use the CPAP regularly late in 2016  Shortly thereafter I got the Resmed machine, got help from the forum, and have been 100% compliance with AHI values under 1.0 ever since. So my Meniere's symptoms improved without xPAP. I have noticed, however, that the tinnitus that has plagued me for years has decreased significantly in the year I have been xPAP compliant. So it may be helpful. It certainly has not been harmful.

[PaulaO2]

PaulaO2 I thought you updated to a airsense10 autoset?

I did.

Oh, my profile. Duh. I'll fix that.

[PaulaO2]

As for the rest of you, your anecdotal evidence is great!

The research didn't point out that xPAP use is a treatment for Meniere's, but getting treatment for undiagnosed OSA also decreased the symptoms of Meniere's. xPAP won't work for someone who does not have OSA.

As for myself, my doc and I have been eliminating everything else but we decided it was time for the ENT. The ear ringing, fullness, and ear pain are just too much and have not decreased. Could be my use of CPAP put off symptoms of Meneire's. We'll never know.

[sonicboom]

To confirm what Melman wrote I can firmly state that a low sodium diet is critical in diffusing symptoms. Stay away from processed foods (very high sodium) and no salt shaker use at home or out. Cook without salt. After a month or so report back on your symptoms if you have maintained a low sodium diet.