CPAP and pitting edema (fluid retention)

[pholynyk]

What srlevine1 said... Edema is one of the things which shows up as the kidneys begin to fail, or with diabetes - hence the 'diabetes socks'. The progression of kidney failure (chronic kidney disease) can be slowed if attended to early. Have you had your creatinine levels checked? My nephrologist didn't enlighten me for a long time; he thought my GP had told me.

Sorry to go off topic; I wish I could find a CKD forum as good as this one.

[melhecht7]

I have been on my cpap for 4 nights now and have the same problem except that my swelling is everywhere. I can hardly get a breath sometimes. My morning weight jumped 7 pounds from one day to the next. Very uncomfortable!

[justMongo]

Advise you to consult your doctor.

[Beelotus]

The EPR setting helps, unless my pressure raises for other reasons, in which case it is not enough. I am seriously considering bilevel, and will be discussing it at my next appointment - which will be with a new doc, hopefully next month. My old doc left the practice for greener pastures somewhere... I really hope the new one is as amenable to the idea as he was.

Hello DariaVader,
I am new to the forum, I have new onset moderate pitting edema since began with my CPAP 1 month ago... - as your post was 1 year ago - did you meet with resolution? If so, would you kindly share on that? Thank you!

PS I am not seeking medical advice from this forum, as multiple posts offer warning on...I am simply interested in hearing of successes dealing with this issue.

[San2024]

I have been using CPAP for almost 3 years, and the pitting edema on my foot has become worse. Doctors always said there was no relation between using CPAP and foot edema. I stopped using my CPAP a week ago, and now the edema is gone.  I definitely can say there is a direct relation between CPAP and edema.

[SevereApnea]

Well it's an old thread, therefore an old (and real) problem for some, and me.

My experience too, quick summary:

1. Started CPAP 2019/2020 never had leg problems before then could walk miles and miles, never had leg vein problems.
2. Soon after CPAP started I developed swollen leg veins. Not just swollen but painful veins. With pitting oedema. Limiting life style.
3. GP and Respiratory Physician in charge of my CPAP found no connection. Offered no explanation. Shrug.
4. Three DVT/Vein specialist referrals (as recent as 2024): found no DVT or leg vein incompetence and offered no therapy. Did I mention CPAP>>> blank faced stare...
5. Compression stockings of various sizes/types/etc do help the swelling but added to the painful leg veins. Treating a symptom only, not addressing the cause.
6. Extremely limited in what I could do around the house/yard because of the painful leg veins. Difficult to exercise/go for walks.

Switched to VAuto sometime 2022 onwards, hoping that more PS would help. Hmmm, maybe not, not for me anyway.

More PS made things worse, despite reducing flow limitations.
More Chest Pain.
More Chest fullness.
ED visits and hospital admissions with fatigue and chest pain.
Cardiology visits. Halter monitors. Stress EKGs all good. Stress Echoes all good.
Still no answers from the medical profession, cardiologist and respiratory physicians.

This year I started backing off my pressures.
Backing off my Pressure Support.
Felt better.
Last few weeks I started revisiting the S-mode with Easy Breathe enabled in the Vauto.
Effectively limiting the range of pressures to between 5 and 6.8.

Feels MUCH better.

Less waking with chest fullness / discomfort.

More importantly much less leg swelling on waking in the morning.

Veins still up a little, but much less, and importantly not painful anymore. Able to do more around the house and exercise more. I regard this as very significant and remain hopeful this will continue to improve.

For me, lower pressures, less pressure support, and especially lower prolonged EPAP/PEEP during the night improves venous return to the heart and less cardiac side effects.

Happily accepting AHI of around 2 and some short OSA, for me this seems to be a good balance.

The other thing I want to mention, in case it rings a bell with anyone, is this: my efforts to reduce or eliminate Leaks made all these symptoms worse
Best results for me are with leaks around 12 - 24.
For me, allowing for and accepting leaks reduces the sustained effect of PEEP over a 6 - 8 hour period of sleep, and therefore the side effects of PEEP. The issue of sustained EPAP/PEEP remains a difficult one to understand, yes even for the medical profession.

All medical therapy has side effects.
CPAP is form of medical therapy.
Ergo CPAP has side effects.

Question for you: is it just possible that too rapid and too fast a reduction in AHI from effective PAP therapy could be undesirable?
Just as overtreatment and too rapid of treatment of high BP or blood sugars would result in undesirable side effects?

(Looking back, if I had to start PAP therapy over again from the beginning, I would aim to lower my AHI (40+) slowly over a prolonged period of time to give the body time to adapt.)

My own opinion: personal titration over and above that which the sleep therapy professionals can provide, continues to be important.

PS. I no longer attend my Respiratory Physician for PAP advice, but this is not a recommendation, just food for thought.

What I am acknowledging is that despite the many factors at play in causing leg swelling and oedema, PAP therapy has the potential to complicate matters beyond the limits of knowledge of some medical practitioners.

Hope you all have a blessed Easter weekend and remain in good Faith.