Sleep apnea

Did a sleep study and was diagnosed with mild sleep apnea. When it comes to sleep apnea and afibb when do we or should we try and treat, mild, moderate, severe? I'm in relatively good shape(40yr old 6'4 205lbs active male).

How do you know or guess sleep apnea is causing or attributing to your afibb?

Had ablation 6/10/20 afibb free since.

Thanks!

Quote
Kleinkp
Did a sleep study and was diagnosed with mild sleep apnea. When it comes to sleep apnea and afibb when do we or should we try and treat, mild, moderate, severe? I'm in relatively good shape(40yr old 6'4 205lbs active male).

How do you know or guess sleep apnea is causing or attributing to your afibb?

A simple answer may be taping your mouth at night. See this thread: [www.afibbers.org]

You can see the difference this makes for me: [www.afibbers.org]

The tape I use is [correctbreathing.com]

This relates to carbon dioxide tolerance. Because of the Bohr Effect, [en.wikipedia.org] a higher level of serum CO2 (from higher CO2 tolerance) means a rightward shift in the hemoglobin dissociation curve [en.wikipedia.org] What this means is that hemoglobin binds tightly to O2 and a lower pH (more CO2) allows this binding to relax and more O2 to get into your cells.

More of my posts on the topic [www.afibbers.org]

My local EP, my sleep doctor (pulmonologist?) and Dr. Natale are all in agreement that for my mild sleep apnea, using a CPAP every night is the right choice.

I felt better immediately when I started using it, and I believe it is another tool to help your heart and other systems operate optimally. Some folks have a hard time adapting, but after 2 or 3 nights I settled in to it.

How do we know OSA affects AFIB etc? Do a little research, and I don't think you will find one EP that doesn't preach the benefits of treating OSA, just like maintaining a good weight, diet and (for many/most), limited alcoho or abstinence.

I have mild Sleep Hypopnea. Both Dr. Natale, my local EP and my Sleep Doctor all feel CPAP is the right choice for me.

Sleep apnea is a known contributer to afib.



Edited 1 time(s). Last edit at 11/11/2020 12:48PM by rocketritch.

Get hsCRP tested - it goes up if you're having apnea.

Prash Sanders and Dominick Linz are the leading experts on sleep apnea and AFIB.

[esc365.escardio.org]

[researchers.adelaide.edu.au]

BTW - Dr. Natale asks in every encounter if I am using CPAP - answer always 'yes'.

Well sounds like I'll have to deal with wearing that fighter pilot sleep helmet, so I can protect my ablation.

Klein - I got this one from Phillips - it just uses these little nose pads so it's not such a big deal.

DreamStation Auto CPAP Machine (DSX500H11) with Heated Humidifier by Philips Respironics × 1

I bought direct from CPAP1000.com for $479

Also consider doing these - I use an O2 ring that vibrates if I go below 90, I then put on CPAP. Many nights I don't need CPAP and maintain 93%+ O2 levels, other nights like last night - ring went off as soon as my head hit pillow.

[www.sleepfoundation.org]

Push the tip of your tongue against the roof of your mouth and slide the tongue backward. Repeat 20 times.
Suck your tongue upward so that the entire tongue lies against the roof of your mouth. Repeat 20 times.
Force the back of your tongue downward against the floor of your mouth while keeping the tip of your tongue in contact with your bottom front teeth.


[www.cpap.com]

1. Tiger Yell

Your throat is usually the biggest source of OSA problems, so strengthening the long, thin muscles there can certainly help. Try the “Tiger Yell”: open your mouth wide, mimicking the facial features of a tiger about to yell or roar.

With your mouth open as wide as possible, move your tongue down past your teeth as far as you can (as if you’re trying to lick your chin). The goal is to lift the uvula for 5 seconds at a time and repeat ten times.
2. Sing Loud and Proud

Singing is a great way to strengthen the muscles in your soft palate and upper throat, which tend to get weaker as you age. In one study, people with mild to moderate sleep apnea symptoms saw improvements after a 3-month program of daily singing exercises.

Start with simple vocal vowel exercises, like singing the sound of each of the vowels in an elongated monotone.
3. Tongue Slides

Studies have shown that doing daily tongue exercises can help treat sleep apnea symptoms, often caused by the tongue collapsing on the back of your throat. One of the best tongue exercises is the “tongue slide.” Push the tip of the tongue against the roof of your mouth (the hard palate) and slide the tongue backward. Repeat this 20 times.
4. Soft Palate Stretches:

An easy stretch for your soft palate is to open your mouth as wide as you can while saying “ah” in the back of the throat. Continue for 20 seconds. Close your mouth, wait five seconds, then repeat between five and ten times.

“Soft Palate Blowing” is another exercise in which you close your mouth and inhale gently through your nose, then press your lips together and exhale by blowing the air out from your mouth. Try to blow out air for 5 seconds and repeat ten times, three or four times daily.
5. Jaw Tension Release

A tight jaw puts pressure on your breathing passages. With your tongue in the resting position and your mouth closed, arch your tongue against the roof of your mouth and slide the tip of your tongue back as far as it will go along the roof of your mouth.

Keeping your tongue in this position, slowly open your mouth until your tongue can no longer rest on the roof of your mouth. Repeat for 5 minutes, two times daily.

The relationship between exercise and sleep apnea has been proven to be a positive and hopeful one for sleep apnea sufferers. Exercising regularly (cardiovascular, resistance, as well as the oropharyngeal exercises described above) can work well alongside other treatment plans, including CPAP therapy.

Damn insurance making me use it 40% of the time to cover cost.

Night I did sleep study I was having alot of ectopics not sure if that throws off study results. Either way I'm going to commit to wearing the damn thing.

Long term use is a problem - people use them for a few weeks to months and then get fed up with it. I'm a bit of the same but I let the data dictate use. I like seeing my hsCRP go down (and IL-6) not waking up with headache - typical after hypoxic sleep and no more snoring so she's happy. It's a win-win. My unit packs well and is 240V compatible so i've taken it to Europe 4 times w/o issue.

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Kleinkp
Damn insurance making me use it 40% of the time to cover cost.

Night I did sleep study I was having alot of ectopics not sure if that throws off study results. Either way I'm going to commit to wearing the damn thing.

Mine leaks. I’m losing bone so my facial bones are shrinking. I went from a medium full face mask to a small, have the strap so tight that I now have a circular concave indentation on my skull...yet my darn mask wakes me up with a hissing sound of escaping air. One night I just pulled it off just to sleep.

With Medicare I’m required to see a pulmonologist to keep Medicare benefits for paying for cpap supplies. I had my phone appointment yesterday and gripped about the leaks to deaf ears. So is it really helpful in preventing AF? I had an overnight 02 test as well and had a second of 88% and a second of 89% with an overall 94-95%. So is a leaking mask really helpful in preventing af? If I make my mask head strap any tighter I will have a bigger skull dent and could join a circus.



Edited 1 time(s). Last edit at 11/11/2020 04:17PM by susan.d.

Those are good #s Susan.

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NotLyingAboutMyAfib
Those are good #s Susan.

That’s what my pulmonologist said. But is 94 the result of a LAA or CS ablation or is it age? Could less blood emptying flow from the LAA isolation affect my O2 numbers?

I wouldn't question good results... only the bad ones.

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NotLyingAboutMyAfib
I wouldn't question good results... only the bad ones.

Yeah I’m not questioning 94-95% O2. The only reason I took the overnight O2 study was because my toes get uncontrollably spasms and lockup. I have to painfully unlock them. My GP said my extremities are not getting enough Oxygen. I keep an oximeter handy and notice 94% when this happens.

As much as you are curious on why you got pneumonia, without a satisfactory answer for closure, I too am not getting closure on why when I am in PVCs, flutter or AF, my feet and toes twist to unnatural positions. Plus me being compliant on wearing the cpap nightly —is it of value if the mask leaks and obviously not getting the prescribed pressure to prevent an apnea from occurring which could trigger AF?

Susan, I think if you're O2 level is adequate (above 90%) and you don't have any dips or too much accumulated total below 90% then you're fine regardless of mask leaks. My unit lets out pressure all of the time through a vent - AFAIK as long as during inhalation there is enough positive pressure to maintain 90% + (but better to be 93-96%) you're fine. My score last night was 9.9 with 0 dips and less than 2 minutes total under 90%. Heart rate was also flat line in 70s thanks to ECV and NSR. The night before it went from 130 to 30 and everywhere in between - just chaos.

Any luck with oral sleep apnea appliance? This constant air getting pushed down my throat is making good sleep a thing of the past. Granted only 6 days in now but I used to wake up feeling rested and ready to go. Which is worse better sleep or suffering trying to force sleep machine to work.

Prior to sleep machine I woke up rested, never sleepy during the day, never fall asleep watching tv or listening to books, felt alert etc etc.

Thinking oral appliance may be better.

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Kleinkp
Any luck with oral sleep apnea appliance? This constant air getting pushed down my throat is making good sleep a thing of the past. Granted only 6 days in now but I used to wake up feeling rested and ready to go. Which is worse better sleep or suffering trying to force sleep machine to work.

Prior to sleep machine I woke up rested, never sleepy during the day, never fall asleep watching tv or listening to books, felt alert etc etc.

Thinking oral appliance may be better.

I’m takes time to adjust. You will get used to it. Does your machine have a ramping function? I set mine for only 4 when I put it on and after 30 minutes it gradually increases. 4 is nothing-you barely feel it and it gives you time to fall asleep before it really blows. I got rid of the ramping after a while in the beginning once I got used to it.

Falling asleep is fine waking up to it gushing air down my throat then trying to get back to sleep is the main issue

Waking up to the sound of air leaking out of the sides of my mask .(not vent valve air release) is my problem because the hissing is noisy. It’s so tight now that I wake up with cheek dents and my scalp is getting getting more dented this past years

That is an interesting idea. I taught vocal music for 41 years and sang every day and still was diagnosed with mild sleep apnea. The concept sounds good though. I have used my CPAP EVERY day since I got it 26 months ago. Prior to that I would wake up every night in a sweat with my heart beating very fast. I'm not sure if it's related, as I I still have afib events, but the amount has cut in half to what they were before and I now sleep comfortably through the night. Now if I could figure out the other half Overall I feel better but it was a gradual improvement.

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NotLyingAboutMyAfib
Singing is a great way to strengthen the muscles in your soft palate and upper throat, which tend to get weaker as you age. In one study, people with mild to moderate sleep apnea symptoms saw improvements after a 3-month program of daily singing exercises.

JDfib - I would have hsCRP levels checked - as a side note, I was given colchicine after the ablation and it cut my hsCRP in half after just a few days. Per Prash Sanders and Dom Linz - hsCRP is the sleep apnea biomarker - the lower the better. The throat exercises also help - when I do them on a regular basis I can go without cpap and keep 93-95 O2 levels.

I sleep or should say slept great, cpap has been a real struggle. I think I'm going to try oral appliance. Reading my report it said I slept majority on my back. I usually sleep on sides, when had testing equipment hooked up I slept on my back for comfort. Sleeping on sides from what I read is the best for sleep apnea, so I bet my events are not normally as high.

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Kleinkp
I sleep or should say slept great, cpap has been a real struggle. I think I'm going to try oral appliance. Reading my report it said I slept majority on my back. I usually sleep on sides, when had testing equipment hooked up I slept on my back for comfort. Sleeping on sides from what I read is the best for sleep apnea, so I bet my events are not normally as high.

Wedge pillows to force yourself to sleep on your side. They sell hard foam wedges at medical supplies stores.

We always talk about obtrusive SA. Are there other kinds of SA?

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Kleinkp
Any luck with oral sleep apnea appliance? . . . . Thinking oral appliance may be better.

Hi Klienkp,

I've been using an oral device for going on 10 years for my mild sleep apnea. The testing says it works, and it's certainly easier and more comfortable (for me) than using CPAP gear. The downside, however, is that, in extending your jaw to open the air passages--all night, every night--there's a real danger of permanently throwing off your bite. Nowadays, they give you a smaller device to ease the lower jaw back into place each morning. My dentist tells me to wear it for 20 minutes or so. But this may or may not work. I started using the oral device--formally, "Mandibular Repositioning Device," before they had really figured this out. So my bite is more or less permanently off. For me, its a case of "lesser of two evils."

I don't know how much this tallies with the experience of others who may be using MRDs.

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NotLyingAboutMyAfib
Klein - I got this one from Phillips - it just uses these little nose pads so it's not such a big deal.

DreamStation Auto CPAP Machine (DSX500H11) with Heated Humidifier by Philips Respironics × 1

I bought direct from CPAP1000.com for $479

I use an O2 ring that vibrates if I go below 90, I then put on CPAP.

Hi NotLying,

Could you share with us (1) the make and model of the mask with "little nose pads" that you recommend?

Also (2) the make of the O2 ring and where to get it?

Thanks!



Edited 1 time(s). Last edit at 11/15/2020 11:53AM by ln108.

Not giving up on CPAP. My sleep Dr is worthless so I went alittle rogue. Turned Resmed 10 pressures down myself min 4 max 4. My plan is to get used to ultra low pressure and slowly increase to prescribed 5/15 pressure. So far at 4/4 pressure my AHI .3 AI .3 Central AI .1 and 13 leakage rate. Day 5 don't even notice pressure will increase alittle this evening.

I thought I'd see higher numbers AHI and AI?

I'm going to ask for another sleep study. Day of my sleep study I had very stressful night personally, was having 8-10 PVC a min and slept on my back because of tubes etc(normal side sleeper). Can stress and PVC increase or give false readings of regular sleep apnea?

In 108 - I looked for 20 minutes - they don't offer the version I have any more - the new ones look more cumbersome

My friend who had the same as me prefers this one - but I can't vouch for it. I am happy with my version

[www.youtube.com]

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NotLyingAboutMyAfib
In 108 - I looked for 20 minutes - they don't offer the version I have any more - the new ones look more cumbersome . My friend who had the same as me prefers this one - but I can't vouch for it. I am happy with my version. [www.youtube.com]

Thanks very much for this, NotLying. I appreciate the reference. What about the O2 ring? Are you using the Wellue O2Ring?

I was until 2 nights ago when it all of a sudden used to go all night long, then had 1 night where it died after 2 hours and now won't even come on. I got about a year and 6 months of use out of it. So about 30 cents a day. It definitely helped me dozens of times so I'd say worth it. I am going to replace it as I can't figure out out to crack it open and solder in a new battery. It does maybe register a little low (off by 2-3%) and accurately at times when I compare to other meters.

Definitely good for OSA and covid - for sure helped me diagnose my possible covid last week because low overnight #s showed up Wednesday despite cpap. My mistake was not in assessing covid and begin taking therapeutics right away. I waited until Friday AM and 24 hours and another bad night of sleep is a long time.

Apple Watch series 6 has been out for few months already and studies have confirmed its accuracy of detecting osa with over 90%. I’ve tested all kinds of osa devices and honestly this is by far the most accurate and easiest way of tracking your sleep oxygen level as well as heart rate with a well organized app storing all of your data.


[www.mobihealthnews.com]

Thanks, Johnny. Good tip! But the article is from 2017. See also The new Apple Watch says my lungs may be sick. Or perfect. It can’t decide.



Edited 1 time(s). Last edit at 11/24/2020 02:00PM by ln108.

Yes, but all devices suffer from this issue, especially if you’re wearing it all day. Apples official answer is “For a small percentage of users, various factors may make it difficult to get a blood oxygen measurement including motion, watch placement on the wrist, skin temperature and skin perfusion, and the blood oxygen app provides dynamic feedback to help users get the best reading possible.” I totally agree with them based on comparing all the different options out there and by far Apple Watch 6 was the most consistent and accurate with long term daily use.

Hi George,

Did you have sleep apnea prior to taping? Mild, moderate?

Thanks

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GeorgeN

Did a sleep study and was diagnosed with mild sleep apnea. When it comes to sleep apnea and afibb when do we or should we try and treat, mild, moderate, severe? I'm in relatively good shape(40yr old 6'4 205lbs active male).

How do you know or guess sleep apnea is causing or attributing to your afibb?


A simple answer may be taping your mouth at night. See this thread: [www.afibbers.org]

You can see the difference this makes for me: [www.afibbers.org]

The tape I use is [correctbreathing.com]

This relates to carbon dioxide tolerance. Because of the Bohr Effect, [en.wikipedia.org] a higher level of serum CO2 (from higher CO2 tolerance) means a rightward shift in the hemoglobin dissociation curve [en.wikipedia.org] What this means is that hemoglobin binds tightly to O2 and a lower pH (more CO2) allows this binding to relax and more O2 to get into your cells.

More of my posts on the topic [www.afibbers.org]