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Central apnea and tinnitus
#1
Hi guys,

after a lot of reading I must say this forum is great. It is good to see that I'm not the only unhappy sleeper und that nearly always someone knows something to improve sleep problems.
Let me try this one:
I was diagnosed with OSA (AHI 19, nearls as many CAs as OAs) in 2012 but I think my symptoms go way back to the nineties. For a long time I had no idea what was wrong with my sleep and thought that my job was too stressfull for a restfull sleep (many visits of the bathroom).
Directly after the second night in the sleep lab I received an APAP machine and started to solve the basic problems (leaks, congested nose). When that was done I looked foreward to become a happy sleeper. It didn't happen. I'm still tired and with low energy during the day. Since I took early retirement I have the privilege to have siesta after lunch for 45 minutes (timer set, no PAP). After that I'm energized for the rest of the day.
For 3 days now I have a S9 und use SleepyHead. It looks as if the machine does it's job and presses a lot the OAs away, but there are many CAs.
Here are my questions to the community:

Can APAP induce CAs?
Can it become a habit to have CAs?
Has anybody noticed a correlation between AHI an tinnitus?

As an example for tinnitus - the best AHI I have recorded so far was 2.4, no tinnitus. Today I had an AHI of 4.5 and the tinnitus is whistleing loud and clear.
As an example for CAs as an habit - after yoga we have a relaxation phase where we kind of meditate. In the state of half consciousness I can feel myself not breathing for 15 to 30 seconds and stooping that with a deep breath.

____________________
Still an unhappy sleeper

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#2
Hi pizza41466, welcome to Apnea Board.

There are a lot of questions and sub-texts there, so I'll try to work through them...

Central apneas occur when the autonomous nervous system doesn't get the "breathe now" message to the lungs and associated muscles. This can occur if the level of CO2 in the blood is too low, and that in turn can be caused by PAP therapy. A constant pressure or autoset machine won't eliminate central apneas - you need an ASV machine for that, and they are really expensive. It's not uncommon for new users to experience central apneas until they adjust to the therapy. In your case, you had about 50% centrals at your first sleep test, so the question now is whether the number of centrals per hour is now higher when you're using the machine?

The related question is what is your AHI now (using the machine)? You mentioned having a 2.4 and 4.5 - is this a typical range? If so, it is below the target threshold of 5, which is regarded as being well controlled. Of course lower is better, but 2.4 to 4.5 is OK if not exactly ideal.

I don't think there is a direct relationship between central apnea and having long pauses in breathing while awake. AFAIK the two situations are controlled by different parts of the brain (though I stand to be corrected on that). I certainly notice my breathing slows right down and stops for maybe 10 - 15 seconds if I'm concentrating intensely on something. That's not the same as stopping breathing when asleep. So I don't think central apneas are a habit.

As for tinnitus - I hate it! I get a persistent loud high pitched whistling in my right ear (and to a lesser extent in my left). It's always worse when I'm tired or feeling off-colour. So to that extent a high AHI may contribute, simply because it makes me more tired.

Hope this helps.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
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#3
I am sorry to say that while people with SA notice and report Tinnitus there is no clear correlation between a CPAP usage and tinnitus - while it is true that there can build up a pressure difference between the inner and outer ear due to CPAP usage, the effect is negated upon waking and yawning, and while Tinnitus has hundreds of causes (thousands, maybe), the temporary pressure difference is not known to be one of them. If you are experiencing increased Tinnitus daily and it last more than an hour after you have awoken, you should see a specialist, as it may be due to a deterioration in the aural nerve, the beginning of the destruction of the tiny hairs in your inner ear that transmit the sound, a blood pressure change or any other number of problems, including and most commonly a simple correlation to ageing and hearing damage. CA does not correlate to daytime Tinnitus.

Waking cessation of breathing is not related to night time cessations of breathing - different parts of the brain control them.
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#4
Doc, is there any treatment for tinnitus these days? I had mine investigated quite a few years ago (MRI and all) but in the end the only therapy was a very good psychologist.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
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#5
In my research, CPAP can reduce inflammation. If you have minor, but chronic swelling near your ear parts, reducing that swelling can reduce or eliminate your tinnitus, depending, if course, what is actually causing the tinnitus. Tinnitus doesn't usually come and go as you are describing, so I'm willing to bet that may be your problem. I've had tinnitus in various degrees for 40 years.

I started CPAP about 3 weeks ago and roughly half of marked events are CAs. My total number of events, however, are way down. The tech said it's common and normal to have some CAs during transitional sleep. My AHI is now under one. Am I still tired? Yes, I'm still getting only 5-6 hours of sleep. But I am much improved. You might put your chart up from Sleepy head and get some advice from experienced chart readers.
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#6
(06-12-2015, 06:24 AM)DocWils Wrote: I am sorry to say that while people with SA notice and report Tinnitus there is no clear correlation between a CPAP usage and tinnitus - while it is true that there can build up a pressure difference between the inner and outer ear due to CPAP usage, the effect is negated upon waking and yawning, and while Tinnitus has hundreds of causes (thousands, maybe), the temporary pressure difference is not known to be one of them. If you are experiencing increased Tinnitus daily and it last more than an hour after you have awoken, you should see a specialist, as it may be due to a deterioration in the aural nerve, the beginning of the destruction of the tiny hairs in your inner ear that transmit the sound, a blood pressure change or any other number of problems, including and most commonly a simple correlation to ageing and hearing damage. CA does not correlate to daytime Tinnitus.

Waking cessation of breathing is not related to night time cessations of breathing - different parts of the brain control them.

Hi DocWils, thanks for the reply. Many years ago I have given up on simple by-the-book-solutions. The best advice was to ignore the mean little Tinnitus-bugger. Somtimes there are weeks without any Tinnitus where my hearing ablity is rather normal, but suddenly there he goes again, which is bad news for my wife, because I have to turn up the TV-volume. One of the specialist told me to look at the Tinnitus like a smoke detector. If something is wrong with the patient, the detector goes off and beeps, or like the smartphone with a very low batterie, that starts to sound an alarm. I thought, that in my case, the CAs might be behind the smoke. I was rather surprised to find more CAs than OAs in the SleepyHead report. I will watch the CAs during the next two weeks and then go to see my doctor to dicuss the situation.
____________________
Still an unhappy sleeper

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#7
(06-12-2015, 08:55 AM)Mosquitobait Wrote: In my research, CPAP can reduce inflammation. If you have minor, but chronic swelling near your ear parts, reducing that swelling can reduce or eliminate your tinnitus, depending, if course, what is actually causing the tinnitus. Tinnitus doesn't usually come and go as you are describing, so I'm willing to bet that may be your problem. I've had tinnitus in various degrees for 40 years.

I started CPAP about 3 weeks ago and roughly half of marked events are CAs. My total number of events, however, are way down. The tech said it's common and normal to have some CAs during transitional sleep. My AHI is now under one. Am I still tired? Yes, I'm still getting only 5-6 hours of sleep. But I am much improved. You might put your chart up from Sleepy head and get some advice from experienced chart readers.
Hi Mosquitobait, that is a new one. I never thought about a chronic swelling close to my ears, but that could explain the coming and going of my Tinnitus. I'm not yet ready to bet, because my ear specialist told me, that up today, it's not possible to record the local blood pressure inside the ear.
A minute ago the Swift SX was delivered, so that tonight I can put the F&P Opus in the drawer and hope for a better outcome. SleepyHead will tell tomorrow morning. Perhap most of my sleep was transitional.
I have to look more into SleepyHead to include charts.

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#8
(06-12-2015, 06:59 AM)DeepBreathing Wrote: Doc, is there any treatment for tinnitus these days? I had mine investigated quite a few years ago (MRI and all) but in the end the only therapy was a very good psychologist.

Tinnitus is a catch-all term for a variety of conditions all which are characterised by a sound perceived to be in the ear.

As such, there is no one treatment - first the cause of the tinnitus must be identified, and that can be very hard to do - I knew one man who had tinnitus to the point of distraction and he decided to take the drastic step of having his auditory nerves cut, rendering him deaf, in the hope it would stop the tinnitus - alas for him, the tinnitus was caused by something in his brain, not his ear, and he was now irreversibly deaf and still plagued by tinnitus. A true nightmare.

The most common treatment these days is a "buzzer", a sort of frequency generator made to match or cancel the frequency of the tinnitus and train the brain to ignore that frequency. But again, unless one can pinpoint the cause of the tinnitus, which is very difficult, there is no good treatment plan.

Some forms of tinnitus respond to Japanese acupuncture, which treats muscles directly rather than indirectly as the Chinese do, and this has much to do with forms that are cause by mandibular tension and mini-pressure build-ups in the mandibular joint region.

Some tinnitus is driven by medication or blood pressure, and those are usually easier to deal with than those caused by brain or ear based forms. Either way, as I said, you need to see a specialist (an otoneurologist) in order to better determine the type of tinnitus and possible therapies. I wish I could give you better news, but this is still black box medicine, I am afraid. New therapies are coming into play all the time, but they still help only the lucky few. So, get thee to thy healer, my friend.
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#9
(06-12-2015, 09:15 AM)pizza41466 Wrote:
(06-12-2015, 06:24 AM)DocWils Wrote: I am sorry to say that while people with SA notice and report Tinnitus there is no clear correlation between a CPAP usage and tinnitus - while it is true that there can build up a pressure difference between the inner and outer ear due to CPAP usage, the effect is negated upon waking and yawning, and while Tinnitus has hundreds of causes (thousands, maybe), the temporary pressure difference is not known to be one of them. If you are experiencing increased Tinnitus daily and it last more than an hour after you have awoken, you should see a specialist, as it may be due to a deterioration in the aural nerve, the beginning of the destruction of the tiny hairs in your inner ear that transmit the sound, a blood pressure change or any other number of problems, including and most commonly a simple correlation to ageing and hearing damage. CA does not correlate to daytime Tinnitus.

Waking cessation of breathing is not related to night time cessations of breathing - different parts of the brain control them.

Hi DocWils, thanks for the reply. Many years ago I have given up on simple by-the-book-solutions. The best advice was to ignore the mean little Tinnitus-bugger. Somtimes there are weeks without any Tinnitus where my hearing ablity is rather normal, but suddenly there he goes again, which is bad news for my wife, because I have to turn up the TV-volume. One of the specialist told me to look at the Tinnitus like a smoke detector. If something is wrong with the patient, the detector goes off and beeps, or like the smartphone with a very low batterie, that starts to sound an alarm. I thought, that in my case, the CAs might be behind the smoke. I was rather surprised to find more CAs than OAs in the SleepyHead report. I will watch the CAs during the next two weeks and then go to see my doctor to dicuss the situation.
____________________
Still an unhappy sleeper

Going by the fact you use nasal pillows and the history you describe, it may be that jaw tension is the culprit - you might be clamping your jaw shut against the pressure of the CPAP, possibly grinding, and this would set up a muscular tension similar to TMJ that could reflect as a tinnitus. Another possibility is a warning for blood pressure, or for potential min-strokes in the ear, a precursor to Sudden Loss of Hearing and Morbus Meniere. In each case, an otoneurologist is your best bet to consult. Please write down all your history beforehand so you can be sure to hit on all the details of your incidents. Only with a good, thorough history can we help diagnose an ailment, especially black-box ailments.
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#10
Just an add on for ear sounds. If you start hearing whooshing sounds that more or less occur in rhythm with your heartbeat, get thee to a doctor and tell them that it is a symptom of high intra cranial pressure. This is different from blood pressure. I lost some of my eyesight due to that last year. Happily, it looks like cpap will lower intracranial pressure, eliminating that as a continuing problem. Way better than spinal puncture. Unfortunately, the optic nerve damage is permanent.
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