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Last chance, I'm failing!
I suffer from afib, had an ablation. My EP told I needed to be treated for my severe sleep apnea. Here's is the problem.

My first study, I was put on CPAP at preadure 15 . I took to it like a fish to water. Only caveat, I had to use full face mask, I'm not a nose breather. Any ways first six monthes were great, felt 10 times better. The one night I woke up, not breathing. Ripped the mask off, I was in afib, went hospital three days. Retuned home, started CPAP again, and WHAM woke up heart going 100 MPH, couldn't breath, ripped the mask off. I stopped using CPAP.

FAST FOWARD a year and half. Had ablation surgery for treatment of afib. As stated above my EP Doc. Told me I need to treat my sleep apnea as it has a direct coaltion to afib.

I got back to a sleep doc., tell hi. What happened previously, ask him if it could be central apneas caused by preasure. He say highly unlikely, just like my first sleep doc. He looks at my first slep study report and say you did not have centrals durring tiration, so highly unlikely.

I do ant other tiration study. He puts me on autopap 7 to 20. I have phillips resperonics machine with A flex.

First 10 days in, things are great, feeling better, took to it again like a fish to water. Last 6 days, same problem, I am waking up like I a having a hard time breathing. My average preasure is 10.5 . The highest it got was 16 one night. The lowest in a night was 8.5.

I ran a report and found no detections of central apneas. My AHI is running between 1.7 and 2.6 .

What is causing my failure with pap therapy. Sleep docs don't have a clue. To make things worse , I'm out of sleep treatment ins. Money. Have a $ 4,000 lifetime payout, so this was a "hale Mary" last chance for me. Our company is self surged, so I don't have an protection from the ACA. can't afford ins. From health exchange. Make to much for subsidies , not enough to afford "cadilac" insurance

Writing my story here out of desperation. Hoping for a miracle that someone has experienced what I have and can tell me how to. Fix it.

My EP said if I don't treat my sleep apnea, my afib will only get worse.

Excuse my spelling and typos, it's 5 in the morning, been up since 4 because of above mentioned problem. [/php]
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Hello dallasc5,

welcome on this board! Welcome

Maybe your problems are not (only) caused by CPAP therapy. I would ask the doctor about a 24h screening by ECG and blood pressure.

If the CPAP therapy had success it could be that the blood pressure was lowered. Many describe such an effect. If it is too low it can make a very high pulse rate.

Before CPAP therapy I had similar symptoms caused by excessive beta blockers. Let examine if the blood pressure goes down. - Just an idea.

I think this calls for closest cooperation with the doctor, not necessarily for a new machine!

All the Best!
Fat Rat
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I would suggest writing down the times you wake up struggling and then look at your reports to see what is going on at that time or just prior to you waking up. Then post that information here (showing the graphs will be very helpful) so we can see what is happening when you are struggling and offer you some help.

I am sure some others will have some thoughts and ideas for you.
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Have you checked your CPAP software for any correlating event that might be causing the heart rate to speed up? Obviously any extended period of OA (restricted) or lack of breathing due to a long duration CO (central) might be the culprit. Also consider getting a recording O2 monitor to see if you have an oxygen desat period that coincides with the awakening with rapid heart rate. Your doctor may have one you can use without having to buy one. If he doesn't and also doesn't think you need it, you might need to get a second opinion. JMHO

Consider sleeping on your left side. It favors the heart and side sleeping favors APNEA treatment and generally allows for lower pressures. Also consider sleeping in a semi-sitting position.

Stick around for some other opinions. There are some good heads here that may be able to give much better advice. You chose a good thread title and it should bring some fast responses.
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(09-27-2014, 06:13 AM)dallasc5 Wrote: First 10 days in, things are great, feeling better, took to it again like a fish to water. Last 6 days, same problem, I am waking up like I a having a hard time breathing. My average preasure is 10.5 . The highest it got was 16 one night. The lowest in a night was 8.5.

I ran a report and found no detections of central apneas. My AHI is running between 1.7 and 2.6 .

Hi Dallas. It does not sound to me like your current awakenings are related to Apnea events. You seem to be controlling those quite nicely.

My WAG is you need to have a quality conversation with your cardiologist. If I was your doc, I'd send you home with a heart monitor pack (I forgot what they're called) and see what's going on at night. I also would tell you not to panic, I doubt that it's a life or death thing, but it does get your attention when you feel like you can't breath. I'm guessing when the dust settles they're going to take a good long at any bp meds you're on and/or other drugs.

Stay with the apap though. You sure won't help anything by putting it in the closet again and allowing the apnea events to start back up.

Hang in there, you'll get this figured out.
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Holter Monitor is what I think they call those rigs.
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Greetings dallasc5,

Yes, PLEASE, get a Holter monitor (the 24 hr monitor from the cardiologist). A pulse/oxy meter for using with the CPAP/APAP. The stand alone pulse/oxy meters are relatively inexpensive, some are in the $30-60 range, and at the least you could see the O2 level when you wake up and feel you cannot breath. It would be great to have one that had a digital memory and/or tied into your CPAP/APAP.

Please, PLEASE do not stop using the CPAP/APAP.
Evpraxia in the Pacific Northwest USA
Diagnosed: 44 AHI when supine, O2 down to 82%
Treated since 20 Sept 2014:: 0.7 AHI, Settings 7-15, EPR on Full Time at Level 3
Better living through CPAP/APAP machines!
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Hi dallasc5,
WELCOME! to the forum.!
I'm sorry you are having such a rough time of things right now.
You should have a long talk with your heart doc about the problems you are having.
I encourage you to stick with CPAP therapy.
I wish you luck in getting all this straightened out, hang in there for more responses to your post.
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Hi dallasc5,

Atrial Fibrillation is a common side effect of untreated obstructive sleep apnea.

Like your doctors, I have no doubt that without adequate treatment for your sleep apnea the Afib (and other developing health problems, no doubt) will only get worse.

My ex-spouse needed two heart ablations before her Afib was stopped completely, and her doctors think the Afib developed because of obstructive sleep apnea which, in her case, was untreated.

If during sleep we ever roll onto our back and stay in that sleep position then our obstructive sleep apnea usually becomes much worse in that sleep position, so we may suddenly need much higher CPAP pressure.

Your machine may take several minutes to gradually raise the pressure in response to apneas. Even ResMed APAP machines, which raise pressure more aggressively than PRS1 APAP machines, don't respond at all DURING an apnea event but only after it is over.

There are things you can do to help yourself.

First is to use SleepyHead to look at your sleep data. What are the median and 95 percentile pressures? What is the breakdown between CA versus OA?

Second, making sure you are never rolling onto your back while asleep may be essential. Some manage to stay off their back by wearing a light knapsack to bed, or by wearing a tee-shirt with a tennis ball or two in pockets sewn on the back, lined up with the spine, right between the shoulder blades or a little higher.

Here is a recent thread where using a rolled sock to avoid back sleeping has made all the difference in the world:

Third, raising the minimum pressure on your machine to be fairly close to the 90 or 95 percentile pressure may be helpful. (Your 90 percentile pressure is the pressure your machine was at or below for at least 90% of the night, and it is also the pressure your machine was at or above for at least 10% of the night.)

Look at plots of your detailed data to see what is going on apnea-wise.

Central Apneas tend to be shorter than obstructive apneas. CA events rarely last longer than 30 seconds. With Central Apneas, as soon as we try to breathe, we do breathe. Obstructive Apneas can sometimes last very long, over a minute. With obstructive apneas, depending on the severity of the airway collapse, sometimes it may take strong effort and a jolt of adrenaline for our body to awaken us enough to end the airway collapse and suffocation which otherwise would have caused our death. The adrenaline may kick off Afib.

It was most likely inadequately-treated obstructive apneas (not central apneas) which caused the Afib attacks which awakened you and caused you to rip off your mask and go to hospital.

Again, setting the minimum APAP pressure closer to your 90% or 95% pressure would likely avoid most obstructive apneas.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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Quote:...I ran a report and found no detections of central apneas. My AHI is running between 1.7 and 2.6 .

What is causing my failure with pap therapy. ...

With that AHI you really don't have evidence of "failure with pap therapy".

As others have said, maybe your AFib is now your main problem (and yes, OSA could have caused or aggravated that.)

I think the key course involves Cardiologist (with some of the ideas above) and perhaps your Cardiologist WITH you Sleep Doc or maybe even a new Cardiologist with expertise on OSA.

You might even ask your current docs for a referral for a 2nd opinion, stating you want someone specifically experience with both.

Need to to find out if the ablation is doing the job (it doesn't always and it isn't always permanent.)

I take amiodarone which easily and immediately controls *MY* AFib with not surgery, stents, nor ablation procedures.

Now that in NO WAY means or even implies such would help you, but only a reminder that there is more than one approach to controlling AFib.

Sweet Dreams,

Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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