Sleep apnea, apnoea, or apnœa

Hi all,

I was chatting with a lone afibber colleague this afternoon. He's had afib for about 9 years. He has now determined that his cause/trigger is sleep apnea. A few years in, he had a sleep study and had 23 events an hour. That is a lot. A CPAP machine was prescribed, but never really worked well (he'd wake up 7 or more times a night, sometimes the mask would be off) and he had some episodes while on the CPAP. About 6 months ago, he got a mouth appliance to wear while sleeping and no longer needed the CPAP. The one time he's gotten afib since, he fell asleep without the appliance in.

He does not have the typical profile of a person with apnea. He is tall, about 6' 2" or taller and thin. He does have a neck with a 17 or 17 1/2" circumference. This large neck does put him at risk for apnea. His late wife told him he snored like a freight train.

There is probably info about apena and afib on this site somewhere. I recall people discussing it here nine years ago. Here is a thread from 2009 <[www.afibbers.org]

In any case, he feels apnea should be a cause that should be explored and ruled out for afibbers.

George

George

At the AFA conference I went to a couple of weeks ago I jotted down a few notes that I found interesting. One of them was:

"Sleep apnoea is a very powerful instigator of AF and is under-investigated. CPAP reduces the risk of AF and prevents recurrence after cardioversion or ablation. "

Can't remember which EP said it, and can't check my notes because I'm currently on a tiny island in the middle of the Indian Ocean scuba diving.

Gill

Sleep apnea, is one of the strongest contributors to AFIB, quite a lot of research has confirmed what most EPs have recognized for years from clinical observation that anyone with confirmed asleep apnea is at risk not only for AFIB, but are more likely to need follow up ablation(s), particular if they are not consistent in their use of CPAP machine when sleeping.

Shannon

I have sleep apnea; I have tried haveto wear the MANY mask giving to me to try. If I wear it 3 hours a night, I am lucky.

I have never had a episode of AFIB in the night time hours that I am aware of. I have heard of the Dental mouth appliance but also am told it is hard to sleep with.

Post surgery my hospital roommate used a cpap machine. A musical alarm was triggered every time he did not breathe That damn alarm went off every 30 seconds all night long. It sounded hundreds of times. His discharge was delayed several days due to Af. Dennis

George - My recent NutaEval (Comprehensive Metabolic Profile) indicated elevated lactic acid levels. My FM MD said that was an indication of sleep apnea and that I should have a sleep study even thought I don't fit the typical SA patient profile and don't snore. But as you note SA and arrhythmias are common.

I've been dragging my feet about doing the study as the thought of sleeping 'wired' wasn't appealing and I cannot see how could I ever get representative sleep in an unfamiliar bed and location. I learned from an acquaintence who helped set up a sleep study program for one of the large hospitals here in the Cleveland area that now patients can go to a participating motel and be set up there.

I also learned that the CCF has just opened a Sleep Study Department and will be doing a new study soon on apnea.. .but participants are ineligible if they have diagnosed atrial fibrillation, however. Typically a sleep study is about $5,000 and is covered by insurance. It was suggested that the Rx for the study be written for a 'split study'... which would mean first the evaluation is started and if after so many hours the patient is deemed to have SA.. .they stop the test and then switch to which type of management would be most suitable for the patient... the CPAP or the oral appliance that maintains the proper airway. They then test that during the same session...which avoids having to go back for another study...and another $5,000.

I had numerous patients who were using the CPAP devices with mixed success and complaints about noise, traveling with etc....so the thought of that was less than appealing should I test positive.

Then, I further learned that a local dentist has branched out to do initial screenings for SA that can be done in the home. If that is positive, then you go for the formal study and then the treatment options are chosen. This preliminary screening costs $150.. and you wear a "watch-type" instrument that includes an oximeter. See this: [www.itamar-medical.com] If you Google " Itamar WatchPAT" ... there are numerous links to reports on this initial screening method.

As it was told to me, if you test positive for SA with the WatchPat, then dentist doing this screening can custom fit the airway/mouth appliance. I have not gone for this yet because of schedule conflicts here and their schedule as the holidays approach.. .so in January, I'll be doing the initial screening and evaluation. It's appealing to me because a custom-fit dental appliance would hopefully be more compatible since I already use a bite plane at night to keep my TMJ happy. I have not yet learned the cost. I would hope that a custom-made device is more comfortable than a generic, off-the-shelf device.

The technician who set up the sleep study at the large hosptial mentioned that it was very common for those with AF to have sleep apnea. I discussed this with my Primary Care MD who said most people are in total denial about SA and there is no way they could really know unless they sleep with someone who observes that they have interrupted breathing frequently throughout the night. The opinion is that you can't 'know' yourself if you have it or not...so the sleep study is required.

I'll post about my results and experience when I am screened in January...weather permitting.

Jackie

Very interesting. After my stay in hospital on total life support, intubated, 2009, due to Influenza A/H1N1 (( I survived by the skin of my teeth friends - they did not expect me to recover from the acute bacterial pneumonia).... anyway, after the stay and the damage to my lungs and trachea, etc., I came out with heart issues, diabetes, hypertension, OSA and, of course, AFIB! I had never been sick a day nor in hospital a day in my life except for some stitches and tonsils out when I was 4 or 5.

I do not travel ANYWHERE without my APAP machine (advanced CPAP) and will take a small amount of O2 at night so that when I hit REM sleep I don't wake up due to shallow breathing and low blood oxygen. I can travel without it, but I sleep better with it, I think.

There is no question in my mind that OSA and AFIB are inter-related; same as many other human conditions are related to aFib.

To hear that one has 'cured' their aFib with a mouth appliance is astounding to me. Need more data. Need more data. Need more data. ......... does not compute.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

All,

Thank you for your comments. My friend knows I post here and suggested I post on his success. I'm pretty sure his dental appliance is custom, made by a dentist. My impression is that he did not have issues sleeping with the appliance and certainly, compared to the CPAP, it was a world of difference.

George

Thanks George... I'll post again eventually when I learn more about the dental appliance.

Jackie

I sent my friend a transcript of the above and asked for comments. Here they are:

1. I was fitted with a custom appliance from a dentist that specializes in these things. The cost was $1800. Initially it was not comfortable, but after some getting accustomed, I could sleep with it. Recently, I ended up ordering an over-the-counter device on line ($60!) that seems to work just as well and is more comfortable. I have had TMJ problems on and off during my adult life and its more noticeable since I started wearing these appliances. But self massage and specific jaw exercises help. The trade off is a small bit of TMJ for a good night’s sleep and, presumably, less or no AF.

2. My single AF episode since being off CPAP was just after a full night and approx 90 min nap the next day without the appliance. Also, for some unknown reason, I found myself sleeping on my left side that particular night. I’ve read anecdotal stories about how sleeping on the left side can aggravate AF. I try to sleep on my right using body pillows.

3. One thing that I failed to mention is that I’ve increased my Vit D intake. I started doing so about the same time I began wearing the device. I viewed a video talk given by a neurologist. Seems that she (the Dr.) starting advising her patients to increase D to deal with pain. One of the side effects was that the patients whom were on CPAP reported using the machine less (or not at all!) and sleeping better. All of her patients that increased D experienced better sleep. The Doc believes that Vit D is actually a hormone and not a Vitamin, which makes it essential for body functions, such as sleep. Better sleep, better health, etc. She believes that most folks in today’s culture are deficient in D There’s more to it – here’s the link. It’s hard to say for sure due to the timing with starting on the device, but I believe my increase of D did noticeably help with sleep. <[www.youtube.com]

4. Also, I have decreased my dimagnesium malate – approx 1/8 teaspoon per day now vs a full teaspoon before (1 tsp ~ 4 grams mag). Before the Vit D and the device, I was religious about getting my daily dose! I believe that some of the times when I missed taking the dimag in the past probably contributed to my AF episodes.

George



Edited 1 time(s). Last edit at 12/16/2013 01:05PM by GeorgeN.

Thanks, George... This is useful reference material should I need to consider the oral appliance route if I test positive.

Jackie

I was titrated Monday night; My CPAP setting will be 8 which is low. With a setting of 8 at the sleep center, I had only one incident where I stopped breathing. At a setting of 6, I had ZERO dreams.

The biggest issue is that Mask or any type of gear made for your head. I am trying really hard to keep my mask on but I wake up with the dry mouth because of medications I take etc.

Its a learning curve. Sleep Apnea is a known trigger of AFIB so I want to eliminate this possibilty but that Head gear is hard to tolerate 7-8 hours a night.

George,

Interesting and topical for me - or should I say my 75yr-old Uncle Brian. He's been overweight for decades (up to 21st at 6' high) and has diabetes and various heart issues for about 15 years including some nasty AF this last few years. He saw a top doc recently who discussed OSA with him - his wife confirms a long history of loud snorting and gasping. He now has a CPAP machine and he quite simply con NOT believe the difference this last 10 weeks! His diabetes has improved, he has MUCH more energy, he's losing weight without really trying, his AF is no longer occurring etc. In short he sounds so positive to speak to now and is a transformed man! Did his own research CPAP machine-wise and has sourced one of his own for around £650-00.

I have had OSA for many years: it is MUCH worse (so my partner tells me) when my weight gets to 18st or more (I'm a big frame wide shouldered 6' 4" chap). At 16st or so as I currently am she says I seem to sleep well with just some gentle snoring and no gasping/choking sounds/waking up gagging for air.

Certainly IMO a much bigger AF factor than is even yet realised. And another heavy price for the epidemic of obesity in the world today.

Just talked with a friend who also took the Butekyo technique breathing classes with me years ago, and she reminded me of what the instructor said about proper breathing and testing for whether you have sleep apnea or trouble breathing during sleep.

At night, tape your mouth shut with a paper tape that releases easily. Turn under a tab at both ends so there is a quick grab and release mechanism available... in case you wake up gasping for air. If you get through the night without having to remove the tape, chances are you breathe well and sufficiently through your nose ...as it should be. If you have to wake up to escape from the tape, then a sleep apnea study is in order.

Just be very sure that you can release the tape quickly. Practice with a strip or two before you actually sleep with it.

I'll be trying it myself.

Jackie

I have had several sleep studies and was told I have mild sleep apnea. I tried a CPAP machine for a while, and it basically was too bothersome. I have been using a dental appliance (mandibular repositioning/advancement device), supplied by a dentist who specializes in such things, with success. It's a lot more convenient, and easier to travel with, than the CPAP.

I understand, however, that it doesn't work for everyone. And it did cost $1,000+, though my insurance paid for most of it. I saw my dentist the other day and he said that new and improved designs are coming out, some now being imported from Europe.

I'd be interested in knowing more about your $60 over-the-counter device, George. Source?

Thanks!

--Lance

Lance,

From my friend: "The device I purchased on line is thru Vital Sleep – best to Google. There are others, but this one seem to work best for me. Also, there is a tongue holding device I ordered from Canada – Snore Solution, which did not work well for me – its about $99, but a similar device is prescription fitted in US by dentists – I think for approx $1000. The idea was to get away from the jaw adjustment move."

George

George,

The man you speak of must not have lone afib if sleep apnea is the cause of his afib.

Just saw an EP yesterday with hubby. My hubby (the reason I'm here) was diagnosed with sleep apnea 10 years ago and uses a CPAP every night. The Dr told him that sleep apnea is a cause of afib. Also hypertension, diabetes, athsma and a couple other things he has as well as the sleep apnea. So obviously he (hubby) is not a lone afibber since he doesn't have any other issues. He has only had the one episode to our knowledge, but I still keep up with this forum in case he has another because there is so much good info here

We thought he was having another episode a month after the first and rushed to the ER. The tech or whatever the guy was that did his ECG said he was no longer in afib, but instead had bradycardia with junctional escape. When I mentioned that to the EP yesterday he said he did not have that, but had an extra beat of some sort instead. I don't trust any Dr's and desire to know as much as possible to help keep him afib free.

Merry Christmas to all who celebrate, Rosie

GeorgeN Wrote:
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> From my friend: "The device I purchased on line is
> thru Vital Sleep – best to Google.

Thanks, George!

--Lance