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Cpap & Glaucoma
(05-11-2015, 10:00 PM)PaulaO2 Wrote: Did you read the rest of my post or just that one sentence?

It has been my experience, and the advice from my two eye docs, that it is healthier for the eyes to use the CPAP and benefit from it overall than to not. I was very concerned about this because my eye pressure in my left eye had been steadily rising and changes in the optic nerve was happening. When I mentioned if I should stop use or decrease the CPAP pressure even if it meant less quality treatment, both doctors practically shouted no. It was their opinion (I did not see them both at the same time but on 2 different appts) that my eyes were healthier due to the oxygen I was keeping in my system because I was treating my sleep apnea.

If the use of the device does raise the eye pressure, it typically decreases once the person awakes and the CPAP is turned off. One study done on just 21 patients who were new users and were followed for just one month. Other eye conditions caused by untreated OSA improve or go away with the use of CPAP. The exception is anything to do with eye pressure but not enough studies (just the one) have been done to determine anything else.

The diagnosis of glaucoma does not happen until damage has been done to the optical nerve. One can have ocular hypertension for years and not have damage, which is what I have been experiencing. And, as the OP has said, one can have ocular hypertension and it not be "real" glaucoma (typically caused by blocked drain pipes or by changes to the optic nerve itself).

The reason I believe using a CPAP is better for a person with ocular hypertension than not using it, is simple: the eyes are not the only part of the body that is being strained. Sleep Apnea effects the entire body, every cell, every organ, every system. To not treat sleep apnea is an un-smart thing to do. Oxygen and sleep deprivation is harmful to everything, not just the eyes. The benefits far outweigh the risks.

Thankyou for this post Paula...ThanksThanks


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I appreciate everybody's viewpoints on this. Talked to my ophthalmologist this morning. I don't think he was all that familiar with this issue, but is educating himself now. I told him that I was still going to use the cpap (for all the reasons Paula02 and others have said), but that my primary concern was which masks to avoid other than the full face mask (like Fitlife). He wants me to just select a mask that works for me and come in for eye pressure checks (as they already know my baselines). He also said to talk to the sleep doctor about it, which, of course, I planned to do.

What this tells me is that this issue is a bit under the radar even for glaucoma specialists. Perhaps not enough study has really gone on about it. OR... the doc simply thinks I'm unnecessarily focused on this concern, which he considers minor, in the scheme of things. As mentioned earlier though, my situation is the opposite of many with glaucoma. I have higher eye pressure because of high intracranial pressure, and the studies do show that CPAP does help to lower this pressure. I might send an email to my other eye specialist and see what he has to say on the mask issue.
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I do not have glaucoma, but my eye pressures have been consistently on the high end over the last few years. Now that I started cpap, my eye pressures have actually dipped into the normal range. Not sure if it's directly related, but I'll take it.
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(05-11-2015, 10:00 PM)PaulaO2 Wrote: Did you read the rest of my post or just that one sentence?

It has been my experience, and the advice from my two eye docs, that it is healthier for the eyes to use the CPAP and benefit from it overall than to not...

That point is well taken. Now let me ask you a different question:

Did you read the rest of my post or just that one sentence? (OK, maybe not so different after all)

Because it appears that you did not, while I certainly did read yours. Twice.

You are welcome to your opinion about what might be more dangerous or more healthy, and I might even agree with you, but you would probably not even realize that because of how you might be forced to answer the question above, if answered truthfully.

Still, what you put forward is an opinion, and only an opinion.

I do not deal in opinions, because opinions often do not matter. I deal in facts, because they always matter, and usually, a whole helluva lot more than any opinion.

I was not disputing your opinion, again which I might even agree with; I was disputing what were presented as facts, in the most possible non-confrontational manner available. And after carefully rereading your post out of courtesy to you, I stand fully and vigorously by my answer, which is that one does not negate the other; both are separate phenomena and both are something to be taken into account. The last part of that last statement might also be an opinion, but the first part (both before and after the semicolon) is definitely none other than a fact.

And the only reason I deferred to the facts over opinion in the first place is because I have an opinion too, which is that I consider it irresponsible to ignore these facts when someone's health is at stake and they could easily be convinced by opinion instead of facts. I was doing exactly the right thing, and I'd do it again in a New York minute.

If you use CPAP, intraocular pressure increases. That actually IS a fact, if you believe the studies that were done on this. And CPAP improves 02 flow which has many positive results; that too is a fact.

CPAP increases intraocular pressure. CPAP also aids the flow of 02 to the retina and everywhere else that blood flows. Both are facts, and both exist. What is not a fact is that one negates the other. It doesn't.

That you may hold an opinion that one approach may be healthier than the other isn't even an argument against what are the facts, because your opinion has to do with how healthy one thing is as opposed to another, while what I am stating is that CPAP raises intraocular pressure, regardless of whether one or the other approach is healthier.

And whether your opinion reflects truth or not is not the question. But the question is also not whether your opinion invalidates what are the facts. An opinion never invalidates the facts, which is why it is called an opinion, and not a fact.

But there are no facts supporting that using CPAP actually negates the fact that using CPAP increases intraocular pressure, or that improving 02 flow by using CPAP which has been proven in studies to increase intraocular pressure, negates the side effects of that. And that in itself is also a fact, and not an opinion.

You may think they negate each other, but thinking that is so does not make it a fact, it only makes it an unsupported, unfounded opinion, held, so far, by three people.

The facts will still exist, regardless of opinion.

Opinions can be important. I value your opinion. But facts are undeniably more important, and certainly more valuable than any opinion, which they will always very greatly outweigh.

And that's a fact.
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As a person who suffers from closed angle glaucoma, and has just had laser surgery on each eye to reduce IOP, I have been most interested in this thread.

The great internet is not really a very good place to find unbiased medical opinion, IMHO, however I wanted to see if there were any reasonable, to me, arguments regarding CPAP and glaucoma out there in the cloud as it were.

I found this magazine:
Page 9 is the page of interest,

also this study seemed good, it is very long, but good detail:

I am seeing my eye surgeon soon and will bring up the topic of CPAP and Glaucoma. I am sure it will be an enlightening conversation for us both.

But the main take away from my reading today, for me, has been that if you have OSA you should have your eye pressures checked regularly, not just for/or because of Glaucoma, but because sometimes the pressures are raised, sometimes not and it is better to be safe than sorry...IMHO....Sleep-wellSleep-well

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This thread is very relevant to my own situation. Three years ago I was diagnosed with normal tension glaucoma, and a year later with mixed obstructive and central sleep apnea. There had been unrecognized warning signs of both these conditions during the previous couple of years. I had personally become aware that my peripheral vision seemed to be shrinking and my reading accuracy to be falling, although my ophthalmologist found no evidence of any issue beyond the most obvious explanation for my concerns: the single giant floater in each eye which had resulted from posterior vitreous detachments in 2003 and 2004. I had also found it increasingly difficult to get through a day without unintentionally falling asleep at least once and had begun experiencing momentary brain shutdowns and restarts. Eventually my primary care doctor  realized that I needed a sleep study.

By the time my sleep apnea was diagnosed I was suffering extreme symptoms which I believe to have been the result of reduced nighttime oxygen levels. I could only sleep in my bed for 4 or 4-1/2 hours, after which I felt so feverishly hot and my abdomen was so wracked with pain that I had to get up and walk around the house for maybe 30 minutes and then sit in a chair for an hour or two before I could return to bed and try to sleep some more. My home sleep study before I had a CPAP showed that my blood oxygen level dropped to 73 per cent while I was sleeping. In contrast to that, my first night with my CPAP felt like a miracle. I used the equipment for a continuous 7.5 hours, achieved an AHI of 3.3 and, best of all, awoke feeling refreshed and with no trace of that abdominal pain that had been torturing me every night for the previous few months.

With the benefit of hindsight, it appears to me to be very likely that my glaucoma was at least partially caused by my sleep apnea.

Up to this point, my story resembles those of others who have posted before on this board. But now we get to a new wrinkle. Prior to my introduction to CPAP, slow and deep breathing had been my normal way to fall asleep. However I quickly discovered that my new CPAP machine, once reset to APAP, did not seem to like me breathing slowly and deeply. If I tried, it would starve me of air. If I persisted through the air starvation, the APAP would gradually increase the pressure until my mask leaked. If I tightened the straps to stop the leaks, my mask hurt. Eventually I learned to breathe differently. I found that short, shallow, quicker breaths work much better. After two years I am still using the shallow breathing technique. My AHI results are excellent, rarely above 0.3, and my sleep apnea doctor is entirely satisfied with my treatment. However, my glaucoma is becoming increasingly worse and I am concerned. In particular I am wondering whether my deliberate shallow breathing may be causing reduced nighttime blood oxygen levels, even though my AHI results are almost perfect, and the low oxygen levels may be causing further glaucoma damage.

My glaucoma doctor was initially skeptical about the possible causal link between sleep apnea and glaucoma but has gradually warmed to the idea. Thanks to this thread and my own searching, I now have a small collection of studies which demonstrate various aspects of the connection. I will be seeing him this week and will ask him to discuss my case with my sleep apnea doctor. My hope is that my doctors might prescribe something like a home test of overnight blood oxygen levels as a check on whether the APAP is doing enough to protect me from further glaucoma damage or at least slow its development. If the blood oxygen test reveals a problem, I can only guess what possibilities there might be for improving my APAP treatment - perhaps a different machine that would allow me to breathe more deeply, or maybe supplemental oxygen.

Has anyone else encountered similar issues? Can anyone suggest other approaches I might try?
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Several years into cpap treatment my vision began to change for the better. I have thought about why ? Oxygen levels improved ?

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This one is specific for high intracranial pressure damaging the optic nerve

Alas, despite the cpap, my optic nerve is back to a problem again, so I see the neuro-opthomologist tomorrow. Poo.
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Updating my post of 02-12-2017, this week I visited my ophthalmologist and then my sleep apnea doctor.

The eye guy was discouraged that his most recent attempt to reduce the pressure in my weaker eye by switching eye drops had made no difference at all, but he showed no interest in talking about the possible connection between my glaucoma and my sleep apnea and VPAP treatment.

The visit to the sleep apnea specialist was much more productive. He discovered that, two years ago,  my previous sleep doctor's office had set my VPAP pressures (11 - 17) way higher than my titration results would indicate. He is now trying me on 4 - 11. My first night using the new settings was highly successful with an AHI of 0.36, an average pressure of 7 and a maximum pressure of 10.54. Quite a contrast to pressures of at least 11 for the entire night.

I will report on the longer term effects of lowering the pressure settings in due course.
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Good news for you. Sleep-well

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