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Apnea? There's Something Really weird Going On
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Tabbycat Offline

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Post: #1
Apnea? There's Something Really weird Going On
I was diagnosed with moderate apnea in 2012; AHI 26 overall, 19 on my side.
I have doubts about this test which I'll handle in a separate post.

I've had BP of 150/85-90 since 2009. Tried all kinds of meds and combinations; nothing even moved the needle. Exercised profusely at times; other times walked 2 miles daily. Nothing worked. Gained weight, developed borderline diabetes. Normal A1C but fasting BG of 126 or higher often.

So CPAP was the answer, so they said. Long story short, two years later I became 100% compliant with my S9 Autoset for nearly a year.

Result?

Nothing.
Nada.
BP did not change ONE IOTA. Some improvement in BG after reinitiating low-carb diet, but still too high.

I knew something else was wrong. I tried to tell the doctors. They all assumed I had some glandular problem. I could feel "panics" in my central nervous system, especially at night. At one point (before CPAP) I had BP attacks every day of 180 systolic. I could feel my sinuses getting clogged, as if in reaction to adrenaline. During this phase, I was tested for cortisol and it was 50% high. We later tested my catecholamines throughout a day, but they were normal.

I may have been 100% CPAP compliant, but I wasn't sleeping that long or that well. I'd have to use sleep drugs to get to sleep, then wake up in 4-5 hours to pee, then need more drugs to get back to sleep two hours later. I'd be lucky to get seven hours in.

This all got much worse recently as the stress of dealing with multiple serious family issues took its toll. I couldn't stay asleep long or deep enough. He suggested trazodone, an antidepressant that helps sleep, 100 mgs nightly.

The first night I took it, a miracle occurred.
Slept like a baby, but that's not all.

My BP dropped like a stone. It's now 125-135/65-80, all day every day.
BG is now 85-100, all day every day.
Slightly decreased appetite and losing weight steadily.

This one drug, which isn't even a BP drug, has done what all others have failed to do: undo my entire metabolic syndrome overnight.

But what about the apnea?
I definitely have it -- not disputing that.
But how exactly has it been affecting my health?

It appears the answer is: not much.
Apnea is A problem, not THE problem.
It may exacerbate my troubles, but it is NOT the cause of them.

Obviously we've confirmed I have some parasympathetic nervous system issue related depression/anxiety. I've always been a "nervous" person, even as a young man. Prolonged stress always made me sick in some way (e.g., IBS). Poor-quality is the more recent fallout.

CPAP may guarantee breathing (actually, I have doubts about even that) but it does not guarantee good sleep quality.

If there are any MD's on here with thoughts about this, please chime in.
(This post was last modified: 11-28-2014 04:48 PM by Tabbycat.)
11-28-2014 04:44 PM
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DeepBreathing Offline
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Post: #2
RE: Apnea? There's Something Really weird Going On
G'day Tabbycat.

As the wise man said "When your only tool is a hammer, then everything looks like a nail". Or to put it another way - a lot of medicos are one trick ponies. While it seems you do have apnea according to your sleep test, there are other things going on in your body and your life in addition to the apnea. I think it's great that you've found the magic bullet to address your serious medical issues. There may be other external factors (eg family crises etc) which also need to be managed. And your apnea? Well obviously (as you say) it's not the whole problem. But I think you'll find it's still there and your recent advances might be stalled if you go off PAP therapy. Maybe you should have another sleep test and see what that shows - your apnea just might have been a result of the other things, but I doubt it somehow.

Good luck getting on top of these things. Now, where can I find a magic bullet? Smile

DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 11-28-2014 05:10 PM by DeepBreathing.)
11-28-2014 05:09 PM
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TyroneShoes Offline

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Post: #3
RE: Apnea? There's Something Really weird Going On
I can't deny what your experience is, and I don't deny that it is sadly somewhat common.

It sounds like you had multiple issues, and they addressed the SA issue but not the more pressing issue.

But all that aside, SA is exceptionably measurable, as are the results of therapy, which can be 100% successful.

What we have not heard from you is what your AHI numbers were before therapy, and now after. If the numbers go down a significant amount, that can only be seen as effective and successful, regardless of opinions about the system that both of us may hold. IOW, you can only bash SA therapy if it is not effective (which it almost virtually always is) and if it is a correct diagnosis (of one of multiple issues in a case such as yours).

You have to look at that as a separate issue. It was either the incorrect diagnosis or it wasn't, and if it was correct, it was either successful or it wasn't. Everything else is a separate issue that should be judged, however harshly, on its separate merits.

As an Engineer, my approach professionally is that when I am confronted with a problem that is complicated and therefore somewhat overwhelming, I simply separate it into its basic parts, or subsystems, all of which are usually pretty simple, and deal with those individually. If I try to attack it all at once with no strategy, I will be unsuccessful. Most would agree that a personal computer is a complex system full of technology. But like everything else, it is really a combination of numerous subsystems, which in reality are actually pretty simple. It only is perceived as complex because if you look at it from a helicopter view, there is a perception of it being very complicated just because there is so much going on.

The same can be said about a complex medical issue. Understand each basic simpler part, and quantify the value of the information you have for each part, and deal with it accordingly, without the distraction of information that is only relevant to other parts. That is probably the most effective way to navigate the jungle of complication you find yourself in.

So, evaluate the SA therapy, and decide if it was right for you, by itself, in a vacuum. Then you can put that aside and deal with the other issues more effectively. Then you will more clearly be able to get to the bottom of "that something weird" that you perceive going on.
(This post was last modified: 11-28-2014 05:41 PM by TyroneShoes.)
11-28-2014 05:39 PM
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Tabbycat Offline

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Post: #4
RE: Apnea? There's Something Really weird Going On
Tyrone,

I am not "bashing" CPAP, but simply stating that by objective measurement -- of my health, which is the only measure that really counts -- it has accomplished basically nothing. To answer your question, my AHI on the S9 was 0-1 consistently.

Sounds great, but remember:

1) CPAP produced no measurable improvement in any health-related numbers
2) Trazodone DID produce instant results, regardless whether CPAP used or not
3) Sleep quality was not great on CPAP. Frequent awakenings and an inability to sleep long enough. More difficulty getting to sleep.
4) SPO2 monitor shows evidence O2 levels are worse on CPAP
5) Despite months of compliance, occassionaly my body would just refuse the treatment, saying, in effect, "You're not getting to sleep tonight with that thing on."
11-28-2014 06:17 PM
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Ghost1958 Offline

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Post: #5
RE: Apnea? There's Something Really weird Going On
Wasting my breath I know so Ill try to keep this short. Trazodone didnt improve your BP. Doenst have the capability to directly do so.

What did was getting enough sleep and the dulling effect on your stress level that drug causes.

It most definitely didnt improve your O2 levels. Not saying that didnt improve but that drug in no way can do that.

At 150 over 90 your BP wasnt that terrible. 90 is borderline and 150 though not the best is not a dangerous level to carry.

If you have SA then yeah its saved a whole lot of bad things happening to you. Though you may not have "numbers" to show it.

Like I said Im wasting my breath but Ive watched many a friend go the anti depressant route. All flowers to start off then pure hell to straighten up after a while with them finally getting off them to keep from having major physical health problems.

Do as you want but I suggest run dont walk to the nearest toilet and flush the whole bottle.
11-28-2014 07:26 PM
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Tabbycat Offline

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Post: #6
RE: Apnea? There's Something Really weird Going On
(11-28-2014 07:26 PM)Ghost1958 Wrote:  Wasting my breath I know so Ill try to keep this short. Trazodone didnt improve your BP. Doenst have the capability to directly do so.

You are completely wrong.
Hypotension is listed as a common side effect of trazodone.

If your agenda is to hate on antidepressants as an overprescribed cure-all, you're not getting an argument from me. Studies show they can be effective for around four months, but then lose effectiveness and create problems. They are a crutch -- a temporary one -- to allow your brain to repair itself. I never said I planned to be on it forever, though I'm sure most MD 's would be more than happy to oblige that.

As for "If you have SA then yeah its saved a whole lot of bad things happening to you", you have no basis for making that claim, and don't know any such thing to be true.
(This post was last modified: 11-28-2014 07:55 PM by Tabbycat.)
11-28-2014 07:48 PM
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PaulaO2 Offline
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Post: #7
RE: Apnea? There's Something Really weird Going On
Hey, whatever works. Right now to help with my major, ongoing migraines, I am taking an anti-seizure medication. And it works. The side effects are minimal.

I do agree with you that it is probably your nervousness that is exacerbating your symptoms. Your BP readings were on the high end of normal. Even your 'BP attacks' were still decent. If we overly watch and poke and prod a symptom, we see and feel things bigger than they are. Especially if there is an underlying mental issue "helping". Being able to sleep allowed the CPAP to then do its thing which further made sleep better which allowed more oxygen into your system which helps make your whole body feel better which....it's all good.

I've been on anti-depressants for many years. I come off of them occasionally, see if the world is any clearer, stay "clean" for a while, then pull my medicine blanket back over my head. Whatever it takes to give me a reason to get out of bed in the morning, I'm going to. What we have realized over the years is my tolerance is about 2-3 yrs, depending on the medication. I can tell when it isn't as effective and we start the switch over to another one long before it fails completely. So what I suggest is you and the doc come up with a second medication that will also work for you. And when you think it is no longer working as well, you switch over to the second med. It can't be a medication within the same family. Like, two beta blockers, for example. It has to be something different. Or, you choose to come off of it for a while to see how you feel. Let your brain stretch for a bit, see what happens.

Meanwhile, keep using the CPAP. Watch your numbers. Introducing a new medication, especially one that makes you sleepy, can sometimes create changes in your sleep data.

PaulaO2
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-28-2014 08:42 PM
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Ghost1958 Offline

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Post: #8
RE: Apnea? There's Something Really weird Going On
(11-28-2014 07:48 PM)Tabbycat Wrote:  
(11-28-2014 07:26 PM)Ghost1958 Wrote:  Wasting my breath I know so Ill try to keep this short. Trazodone didnt improve your BP. Doenst have the capability to directly do so.

You are completely wrong.
Hypotension is listed as a common side effect of trazodone.

If your agenda is to hate on antidepressants as an overprescribed cure-all, you're not getting an argument from me. Studies show they can be effective for around four months, but then lose effectiveness and create problems. They are a crutch -- a temporary one -- to allow your brain to repair itself. I never said I planned to be on it forever, though I'm sure most MD 's would be more than happy to oblige that.

As for "If you have SA then yeah its saved a whole lot of bad things happening to you", you have no basis for making that claim, and don't know any such thing to be true.

Ok Sleep-well
11-29-2014 01:26 AM
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TyroneShoes Offline

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Post: #9
RE: Apnea? There's Something Really weird Going On
(11-28-2014 06:17 PM)Tabbycat Wrote:  Tyrone,

I am not "bashing" CPAP, but simply stating that by objective measurement -- of my health, which is the only measure that really counts -- it has accomplished basically nothing. To answer your question, my AHI on the S9 was 0-1 consistently.

Sounds great, but remember:

1) CPAP produced no measurable improvement in any health-related numbers
2) Trazodone DID produce instant results, regardless whether CPAP used or not
3) Sleep quality was not great on CPAP. Frequent awakenings and an inability to sleep long enough. More difficulty getting to sleep.
4) SPO2 monitor shows evidence O2 levels are worse on CPAP
5) Despite months of compliance, occassionaly my body would just refuse the treatment, saying, in effect, "You're not getting to sleep tonight with that thing on."

I did not say that you were, but that still may have been a poor choice of terms on my part. Apologies.

But you are indeed doing exactly what I was talking about, which is conflating and confusing the issues as if they were XPAP therapy issues. If your AHI was significantly better at 0-1, then the XPAP therapy was effective, for sleep apnea, which is what it is specifically designed for.

1. If XPAP had no effect on other health issues, that should not come as a surprise, as it is not considered proper therapy for those other issues.

2. Trazadone is for one thing, XPAP is for another. Again, that XPAP had no effect should not be surprising.

3. XPAP therapy does not guarantee that you will feel better or be less wakeful. Again, those may be separate issues. XPAP is specifically to solve the oximetry level issues caused by SA, and to keep you healthier and prevent damage or propensity for certain diseases and daytime sleepiness issues. It is one tool, but the most effective one. But you may need more than XPAP.

4. That's a puzzler. A trained, experienced sleep med specialist, hopefully a Neurologist, should take a look. Maybe you never needed XPAP and should not have had it prescribed in the first place. Only an expert can figure that one out.

5. There is a real disconnect here between "months of compliance" and "I can't get to sleep with that thing on". You need to have an expert tell you why you can't.

Bottom line, the remaining health issues probably have little to do with SA, and should be looked at separately. Separate all of these issues into individual hard questions and then get straight answers from an expert, not just someone with a license, but with significant experience and training. Be relentless, like a dog with a bone. It's not their health at stake; it's your's.

To sum up, it does not sound like you have sleep apnea issues at all, but that you have other sleep issues not related to SA.

And, it is also easier to understand what is going on (your original request) if you remove SA issues from the equation, which is pretty simple to accomplish now that you do not have SA issues any longer.

But, hey, dealer's choice.
11-30-2014 01:32 PM
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