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Mask Design and eye pressures
#1
When I started CPAP in the middle of November my pressures in each eye were 23. After a month of CPAP with Quattro Air my pressures went down to 21 in each eye. Now with a month of being on the Nano Nasal mask my pressures have shot up to 25.

There have been several studies that say CPAP therapy can increase the pressure in one's eyes. I have written one of the authors to ask them which type of mask was used during the study.

I am wondering if the air being more concentrated in the nasal mask is responsible for my sudden dramatic increase.

article abstract:
Continuous Positive Airway Pressure Therapy Is Associated with an Increase in Intraocular Pressure in Obstructive Sleep Apnea
Stefan Kiekens 1 , Veva De Groot 1 , Tanja Coeckelbergh 1 , Marie-José Tassignon 1 , Paul van de Heyning 2 , 3 , Wilfried De Backer 3 , 4 and Johan Verbraecken 3 , 4
+ Author Affiliations

1From the Departments of Ophthalmology,
2Ear, Nose and Throat, and
4Pulmonary Medicine, and the
3Sleep Disorders Center, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
Abstract

PURPOSE. Several reports have demonstrated an association between glaucoma and obstructive sleep apnea (OSA), though the origin of this association remains unknown. In the present study, the influence of OSA and continuous positive airway pressure (CPAP) therapy on intraocular pressure (IOP) and ocular perfusion pressure (OPP) was examined.

METHODS. IOP, blood pressure, and pulse rate were measured every 2 hours during 24-hour sessions in 21 patients with newly diagnosed OSA. A first series of measurements was performed before CPAP therapy, and a second series was performed 1 month after the initiation of CPAP therapy. OPP was then calculated.

RESULTS. Baseline measurements showed a significant nycththemeral fluctuation in the average IOP, with the highest IOPs at night. After 1 month of CPAP therapy, the average IOP was significantly higher than baseline. The increase in overnight IOP was also significantly higher. A 24-hour IOP fluctuation of ≥8 mm Hg was found in 7 patients at baseline and in 12 patients during CPAP therapy. The mean difference between trough and peak IOP was 6.7 ± 1.5 mm Hg at baseline and 9.0 ± 2.0 mm Hg during CPAP therapy. Thirty minutes after CPAP cessation a significant decrease in IOP was recorded. There was a statistically significant decrease in mean OPP during CPAP therapy.

CONCLUSIONS. Patients with OSA demonstrated significant 24-hour IOP fluctuations, with the highest values at night. CPAP therapy causes an additional IOP increase, especially at night. Regular screening of visual fields and the optic disc is warranted for all patients with OSA, especially those treated with CPAP.

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#2
Sounds a little scary. I've been on CPAP for over 4 years; and my IOP is well within normal limits when checked twice per year.
Normal is defined as 10 to 20 mmHg. Every person has a variation over the day.
CPAP pressures are in the range of 10 to 20 cm-H2O.
1 mmHg = 1.36 cm-H2O
ergo, CPAP pressures are in the neighborhood of IOP.
The mechanism by which IOP might increase seems elusive.


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 was able to read the full article on the journal website by an error on their part as I am not a doctor or subscriber to the journal. The mechanism is speculated but the jargon was a bit beyond my limited medical knowledge. If I can get the full article back I'll let you know. Bit it went on about increased intracranial pressure and pressure of spinal fluid etc etc.
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#4
http://www.iovs.org/content/49/3/934.full.pdf

full text

short quote:
"Why CPAP therapy causes an
increase in IOP is not yet understood. One could speculate that
CPAP leads to an elevated intrathoracic pressure, which in turn
gives a pressure elevation in the venous circulation, which may
reduce the aqueous humor outflow through the episcleral
veins and could explain the increase in IOP"

If the above (elevated intrathoracic pressure) is correct, then the type of mask should not matter.
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
Thanks, I found it at a different site also. It makes you think. One of the things that happens to sedentary folk who are older is that there is veinous insufficiency and a lot of fluid in the legs shifts to the upper torso when we lie down. I often wake up with swollen hands in the morning.
This fluid has a circadian rhythm and the flow of all this fluid probably ends up in ones neck and eyeballs. I also found an article on
compression stockings and OSA that might be an answer to all these fluids sloshing around.
http://www.steadyhealth.com/articles/Com...a1931.html so I'm thinking of a mini program/experiment
I'll wear compression stockings in the daytime and also set a timer to get the hell out of my recliner every half hour and move around some. LOL
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#6
I think Lukie is on to something because I was using a FFM
for a while and found I was getting pronounced eye swelling and irritation at pressures above 17cm. ( A lot! )
I switched over to a total face mask and the problem went away.
The total mask applies pressure also to the outside of the eyeball as well so things tend to stay in balance.
So, for me it was all about the pressure being applied to the backside of the eye socket.
This week my TFM broke so I went back to the FFM.
By lowering the pressure a bit to the FFM the swelling went away but I still can run enough pressure to be
theraputic.
(Yay me! I have more options now! )

Cheers!

=^.^=

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#7
Well I decided having to go back to a full face mask was not worth it. I love may nasal nano and if I have to go on drops I'll go on drops.
At least I slept well and feel great.
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#8
Hi Lukie, I don't blame you a bit, I'd have a hard time with a full-face mask, I'm not saying I absolutely couldn't use one, but I know I'd have a hard time with it because I don't like a lot on my face.
Great to hear you had a good night sleep, (in the Nano,)that means everything.
trish6hundred
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#9
I've had ocular hypertension for years, pre-CPAP.

Anyway, I discussed this in another thread a while back. Lemme see if I can find it. I think I linked to some articles in it.

Found it.

http://www.apneaboard.com/forums/Thread-...e-pressure
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#10
(01-27-2014, 11:32 PM)PaulaO2 Wrote: I've had ocular hypertension for years, pre-CPAP.

Anyway, I discussed this in another thread a while back. Lemme see if I can find it. I think I linked to some articles in it.

Found it.

http://www.apneaboard.com/forums/Thread-...e-pressure

Very interesting thread. Looks like you have been dealing with this issue for a while. I guess I'll just relax and see the eye doctor every 3 months and stop worrying. Like you I have no damage yet and they are "watching and waiting." She gave me some drops for dryness as occasionally the Nano will leak a bit when I've moved in my sleep.
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