afib and sleep apnea

[poppypete]

I would like some advice on whether to continue on APAP in the early hours of the morning, as it seems to trigger/interact adversely with my afib.


I can get my AHI <5 for 4-5hrs, but they go upwards of >30 if I continue using mask/machine.

My question/dilemma is simply whether I take the apnea risk without mask after a session of treatment on any particular night, and risk triggering adverse afib reaction, or is the apnea risk/treatment the priority?

• What comes first, the afib or the apneas???
  

I have central, obstructive, and sometime experience CSRs, but these CSRs and central are much more prevalent AFTER the successful treatment period early in the night's sleep.

The effect of keeping the mask/machine on, quickens my heart apparently, and I wake with chest discomfort (which isn't a heart attack)...so I'm leaning towards NOT using...but is there anyone who may have had similar experiences?


[I take Eliquis 5mg and Metoprolol 12.5mg morning and night; and expect to undergo a cardioiversion in June.]  

[Walla Walla]

Sounds like a great question for your cardiologist.

[SarcasticDave94]

Sounds like a great question for your cardiologist.

Dave is short of words he can use today...so I'll leave it as ditto Walla Walla's suggestion. best wishes to getting answers BTW

[Sleeprider]

In general sleep apnea is a precursor to afib, and untreated it is a significant risk factor. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5089463/ All considered, something to ask the doctor. The first question is, what kind of events seem to cluster in the morning? My guess would be they are central, and your CPAP cannot treat that. Let's do a little more in-depth look at this before making a decision, then you might have some better information to offer the doctor. How about a chart?

FWIW, untreated, and not knowing if you have apnea simply because they are not recorded, does not seem to make for a better health scenario to me.

[poppypete]

re: "How about a chart?"

I'll attach the overall night's data, followed by the two sessions which cause my concern.

Thanks

---

[attachment=5459][attachment=5459]

[Sleeprider]

That helps a lot. See your doctor for an evaluation of left ventricular ejection fraction (echocardiogram). If it is greater than 45%, the machine you need is an adaptive servo ventilator. No CPAP will treat the Cheyne Stokes Respiration and central apnea shown on these charts. If LVEF% is not above 45% this is information you and your doctor need anyway.

In addition to working with your cardiologist, notify your sleep doctor that you need to be evaluated for BiPAP with a back up rate such as ASV. Show him the charts. You will need to be scheduled for additional titration studies to evaluate the efficacy of ASV. CPAP is not capable of treating your condition. You may have some obstructive apnea, but your problem is primarily central apnea and periodic breathing. If you have LVEF> 45% and demonstrate efficacy on ASV, that will be your new machine. If either of those two options fail, you should still get oximetry to see if you qualify for supplemental oxygen with your CPAP. If you are not a candidate for ASV, you may qualify for supplemental oxygen or bilevel with spontaneous/timed bilevel support (BiPAP ST / VPAP ST).

Your situation is very complex. You have central apnea with Cheyne Stokes Respiration periodic breathing. This is a condition often associated with congestive heart failure. Your medical needs must be reviewed by qualified doctors in both cardiology and sleep medicine. This forum cannot provide any magic settings for your CPAP, however I think you should set your pressure to a minimum of 8.0 and maximum of 10.0 to prevent the run-away pressure which is chasing events unrelated to obstructive apnea. CPAP can help to improve oxygenation and prevent obstructive events if that is even part of your problem, so continue to use it unless directed by your doctor to discontinue.

In addition to your diagnostic sleep apnea study, were you ever given a titration study? I'm guessing not, and in your case that is a huge mistake. I apologize that this is a pretty harsh appraisal of your situation. I just think you deserve to know that you will need to work hard to advocate for proper care that can perhaps extend your life. So far you have been cast adrift to fend for yourself by the medical professionals that should have used their expertise to provide appropriate care. I hope this helps you to to get the help you very clearly need.

[Sleeprider]

If you have a copy of your diagnostic sleep study, it would be helpful to see that. If you don't have a copy, get it.

[poppypete]

[attachment=5463]Sleeprider...

re: "Your situation is very complex. You have central apnea with Cheyne Stokes Respiration periodic breathing. This is a condition often associated with congestive heart failure. Your medical needs must be reviewed by qualified doctors in both cardiology and sleep medicine. This forum cannot provide any magic settings for your CPAP, however I think you should set your pressure to a minimum of 8.0 and maximum of 10.0 to prevent the run-away pressure which is chasing events unrelated to obstructive apnea. CPAP can help to improve oxygenation and prevent obstructive events if that is even part of your problem, so continue to use it unless directed by your doctor to discontinue.

In addition to your diagnostic sleep apnea study, were you ever given a titration study? I'm guessing not, and in your case that is a huge mistake. I apologize that this is a pretty harsh appraisal of your situation. I just think you deserve to know that you will need to work hard to advocate for proper care that can perhaps extend your life. So far you have been cast adrift to fend for yourself by the medical professionals that should have used their expertise to provide appropriate care. I hope this helps you to to get the help you very clearly need."

I very much appreciate your comments, harsh though you fear they be ...

• ...and I'll clarify a couple of your questions contained therein.
  

I have a very helpful clinician overseeing my attempts at resolution of this complex situation. She came on board my case, by doing the sleep study on 12 Feb, which revealed my critical situation. I consulted with my heart specialist on 22 Feb, when the Afib was confirmed...and when I was prescribed Eliquis. Until I could see a sleep physician on 22 March, we tried varying the maximum up from 12 on which it had been set...but in not wanting me on an ASV, he has me trying 6-20, still on APAP. As the senior medical authority however, he has had to have my confidence, however I must say the clinician is the hands-on helper, so I'll refer these comments of yours on to her now, for further consideration, particularly regarding "...I think you should set your pressure to a minimum of 8.0 and maximum of 10.0 to prevent the run-away pressure which is chasing events unrelated to obstructive apnea.", which is exactly the conclusion I was coming to, and have been experiencing.

12 nights ago, the excessive beating of my heart until I woke, caused severe chest pains which took me to Emergency. I was kept in overnight for observation of the cause in the hope it would repeat, but alas no...so I came home with some beta blocker medicine.

I've ordered an oximetry wrist/finger reader which will help with further understanding of what goes on with my desaturation issue, so I'm hopeful I'll have some better understanding before I go and have a fresh electrocardiograph on 28 May.

In the meantime, I'll try again using the range you suggest and see what happens???

Thanks again...
Ps...last night I left the mask off, after my initial phase of 'treatment':

[poppypete]

Posted by Sleeprider - 46 minutes ago
[size=undefined]If you have a copy of your diagnostic sleep study, it would be helpful to see that. If you don't have a copy, get it.[/size]

[size=undefined]I have a copy...so can I refer that to you (privately)???[/size]

[Sleeprider]

That would be fine, I can send you a private dropbox link by PM.

I'm relieved this assessment is not all news and it may be helpful to you. See if you can get Echocardiogram to determine left ventricular ejection fraction at your next visit. That will determine whether we should pursue ASV or use CPAP and oxygen as the primary therapy.