AF Association
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Sleep Apnea and Arrhthmia

I was recently diagnosed with obstructive sleep apnea (OSA) and now am attempting to get used to a CPAP machine. As noted previously, I have had two ablations and have had no AFIB events in 16 months since the last ablation. However, I continue to get ongoing and disruptive PACs which are now only controlled with a low dose Flecainide/Metropolol combo

First, given what I’ve learned recently about OSA, I’m surprised that my cardio/EP medical team never once recommended getting a sleep test to assess whether I had sleep apnea when I was first diagnosed with AFIB two years ago. I’ve been a poor sleeper for many years so it’s dissapointing that they did not suggest such a test given the close connection between AFIB and OCA. Not much I can do about that now, but it goes to show how important that we do our own research and be our own advocate.

Second, I’ve been reading that the use of an APAP machine can have a beneficial impact on reducing both AFIB and/ or other arrhythmia such as PACs (based upon some clinical studies and antidontal data). Has anyone out there, that has successfully used a CPAP to sleep and breathe better, found that they have seen an improvement (reduction) in their arrhythmia? I intend to give the CPAP machine a decent shot to help me with my sleep but it sure would be an added benefit if my PACs slowed down thus elimination the need to stay on meds.

Thanks much

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My EP would not do ablation till I had a sleep test , now use cpap with full face mask as I am a mouth breather I am much better now rarely get up in the night

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Husband has CPAP machine. No change in AF unsurprisingly has had permanent AF for several years. No longer gets up to pee in the night and I sleep much better!!

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I am in a similar position, knowing that if I can deal with the OSA it is likely that the AF will improve. However, the CPAP does not work for me because having a mask and straps over the face means I don't sleep at all (I am a restless sleeper at the best of times). I use chin up bandages and a mandibular advance mouth guard thing instead but that is also uncomfortable. Is there any particular brand of CPAP that is less obstructive ? (the NHS model used in my trial was made in Australia I think.

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I use the ResMed - which is the NHS issue. It is the market leader. There are other makes - all cost are similar - circa £800-1200 + ongoing renewables such as masks etc so. The only other comment would be the newer models Airsense - have automatic pressure variance and so they are easier to breath out for me.

How long did you use it for and what advice did you receive from the clinic.

It took me 6 weeks before I could bear it for 4 hours and about 12 weeks until I slept through the night - but that first night - wow, I woke up feeling refreshed!

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Definately had huge improvement in general well being - as to arrythmias - very difficult for me to say as I have complicating factors but I really think it did stop my Arrythmia at certain points. I often put it on during the day if I go into Arrythmia or for a nap and it will often stop the episode - I posted about it a while ago.

My EP did recommend back to my GP asking her to refer me for sleep study in 2013-4 ish? and I have been using CPAP ever since.

It’s most unusual for an EP not to make that connection as the link is very well known. If I were you I might be questioning as to ‘why not?’.

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Dear JHCoop, YES! I fought with the NHS for two years to receive a CPAP. I had been diagnosed with OSA two years before my AF began. My wife worked in the NHS and had access to dozens of studies showing the integral relationship between OSA and AF. My respiratory doctor simple told me to ‘sleep on my side’! And my cardiologist poo-poohed any connection between AF and OSA. And why? Because if the NHS accept the connection, they will have to do something about it, and that costs money!

The good news: I went to the Papworth in 2016, got the CPAP, and have had no incidents of AF since then. And for the record: I began to have episodes of AF in 2013, which over time began persistent, usually beginning around tea time and lasting throughout the night. I took early retirement because I was too exhausted to work. If only the medics had allowed me to have a CPAP earlier in this process!

So YES, there is a link between AF and OSA and it is possible to be AF-free.

All the best,

Jack

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Thanks Jack. Good to hear.

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I was diagnosed with OSA over five years ago and began using a CPap machine. I didn’t really notice a difference in frequency of AFib events but continued to use machine every night . Recently, my provider upgraded my Res Med machine and this new one has a feature which allows you to see how many events you are having each night. I noticed I was getting over 20 events an hour so made appointment with sleep Dr. She explained that the pressure on the machine needed to be adjusted because I was now experiencing Central Apnea ! I never heard of this form of Apbea so asked for explanation. This form of apnea has nothing to do with obstruction but is the brain not signaling you to breathe. This is all new to me so I would recommend speaking to your sleep Dr about this. She adjusted my pressure and now my episodes are down to under 5 an hour. She believes that my Afib will improve now that the pressure has been adjusted because I will breathe easier and there will be less carbon dioxide back up! I’m honestly not sure that I understand this all but will do more research .

One thing I’ve learned is that sleep Apnea is a serious issue and definitely has to be handled. I hope that all on this forum will take this seriously and get a sleep study.

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U r right. It is a serious issue. I didn’t know why I felt tired all the time( besides having two jobs and two kids), but my husband noticed me holding my breath at night. Long story short, I was only about 25 lbs overweight at that time, but had a genetically small airway. I had a septoplasty, a uvulaplasty, adenoids and tonsils removed, a turbinectomy. All at age 50. I love my cpap. I sleep with it every night, but I still got afib at 68. Other factors involved, but mostly age I guess. Can’t blame my afib on sleep apnea alone. Everyone should have a sleep study if they have afib for sure.

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Since I have been pursuing chiropractic solutions (almost a year now) and the more positive results I obtain and the more I learn about chiropractic, when I read these posts, it indicates to me that nerves in the back have a hugh influence. I asked the chiropractor about sleep apnea and I think he said damaged nerves at cervical vertebrae C5 could be the cause. And since I know for sure, at least for me, the nerves that affect the heart are due to spinal subluxations, when people who have sleep apnea and AF and PAC's, this could be because their back is compromised. Even though my AF is pretty much gone, I can still wake up at night quite often to pee. This is likely because the T5 vertebrae, which still won't stay where it should be, also impacts the kidneys. So maybe when we have AF and pee as well, the nerves at T5 are part of the reason. I have yet to find research on any of this. But from my experience, I am very glad I pursued this chiropractic option versus drugs or ablations. It has been frustrating at times for sure, with setbacks along the way; and negative comments from medical and family contacts, who don't agree, don't help with my confidence to continue. Oh well, it is my back not theirs and I am the one who has far less negative heart symptoms so I have not given up yet and neither has my chiropractor.

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Very interesting about the nerves and a view from a chiropractor. So many causes for so many things and we can never be sure I guess what causes things to happen. A quote from my ER nurse was” you are like an old house with old wiring. It needs replaced and updated every now and then.” I guess that is where meds, an ablation, and/or lifestyle changes come in.

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Have to say I found your post EngMac very interesting indeed and shows the beauty of this forum in sharing the less obvious. If we have a belief and hope in an issue of our own we can often override the professional's views, as it is only us who have the closeness of the pain and know what helps to relive it!

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That is true. Thankfully, with the internet and sites like this we can do our own research and not be totally dependent upon physicians.

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lyzzie.

Its been such a long time since I've replied to anyone on the site, forgive me if I havnt entered it correctly, the names I mean. I too have sleep ap. and AF and reading below, I also attend Papworth hospital, they are the best, very kind and make sure you understand whats going on. I can't say enough what a difference it makes to me using the Resmed machine, it doesn't stop the AF but it certainly helps. Persevere with the machine, its worth it. I know it does sound silly, but sometimes you get 'leaks' around the mask, if you do, try dampening the skin around you nose where it rest, it helps it stick!!! and stops you getting a sore eye. Good luck, those resmed machine are the best thing since slived bread!!

Lyzzie.

I

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It took me a while, but I was determined since I was told I stopped breathing 30 times per hour. My EP requested. Sleep study after I was put to sleep to be cardio verted. He said my breathing was abnormal and needed a study. I have used it faithfully now almost 2 years, my first cardiologist for the first 2 years never mentioned a word. So I know how you feel😞

I think, wow I spent those first two years stressing my heart and entire body. No telling how long I have had it altogether. I have a respironics with full face mask, it is finally quite comfortable. I never thought I would get there, many nights of sleep interrupted with spewing air leaks or tightening it too tight. I would sit on the side of the bed and talk to it before putting it on... determined. The first month yuk, slowly got better. It is hard to say if my afib is better, I have persistent afib, I have to be cardioverted if I go into afib. Mine I am certain went undetected a while since I have always had other rhythm problems since 20’s.

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I know how you feel, it took someone on this forum to suggest I might have sleep apnea and once tested I was recording 68 per hour, it was undetected for 7 years, how much would that have costed the NHS, 3 cardioversions and 7 years worth of meds...not to mention my poor heart! Long live the sleep machines.

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I found out in Jan of this year after my first ablation, I have a very difficult airway. When I woke up, I was in ICU and banded on my wrist in neon orange-DIFFICULT airway!! They said to be sure and have on future medical records. They had such problems that I could barely swallow and I had dried blood on my lips. Obviously this could be a factor in my sleep apnea. I have been faithful to my cpap, I do not consider I have a alternative. I won the battle, not sure my talking to it helped, except I was determined....lol. Best to you in your process of elimination on the adjustment. I lay on my right side, with a pillow that I can contour under my chin to help my head from dropping down (closing airway more) during sleep. The pillow cannot be a solid foam or stiff polyfill, it needs to be one you can punch to shape. Hope this helps.

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Thanks. Using a prescribed and specially manufactured dental appliance, a breath strip to open nasal airway and a large u shaped pillow that extends down by legs (ironically by pregnant woman) to keep me on one side and so I won’t move to supine position. My AHI is improved at 5.5, but still slightly above the minimum for mild sleep apnea so I still have some work to do. Getting about 7.5 hours of reasonable sleep but still not waking refreshed. Will keep trying. Tried CPAP for a few weeks but couldn’t get used to it. It’s a journey.....

Thankfully, combination of ablation and meds keeping my AFIB away and no lifestyle restrictions for the most part.

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Many thanks for the tips

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I have been on cpap since 1997. Never got afib until feb 2016. Had one ablation July 2016 and now only have occasional bouts afib last only minutes. I am 70 years old and only meds are metoprolol and eliquis.no other health issues except 75 lbs overweight.

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jaha.ahajournals.org/conten...

I find this very confusing. Central sleep apnoes CSA seems to be less common than obstructive OSA. I'm not clear why initial treatment of CSA is with CPAP if there is no obstruction. or whether AF is more common because of low oxygen or raised CO2 levels when heart failure with AF which causes the same changes is a common cause of CSA.

It seems to me that there must be difficulties in diagnosis and interpretation of results. Dr Gupta emphasises how important it is to look for sleep apnoea if atrial fibrillation coexists with diabetes, hypertension and high BMI, but I am not clear whether this is cause or effect in the case OF central sleep apnoea.

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