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I thought it was time for an update. My family doctor ordered a Holter monitor test which confirmed I am in 24/7 atrial fibrillation, but with an acceptable heart rate, and no other red flags. I am still waiting to see my cardiologist.
The most concerning issue to me is the increase in CSR episodes. Very rare previously, they now happen about two days out of three since I entered continuous Afib on September 25. I believe this is true CSR (not periodic breathing) but would appreciate if Gideon and any other experts could weigh in. Please see attached screen shots.
I don’t have any symptoms of congestive heart failure and am able to function normally including fairly strenuous exercise. I do notice a slight increase in “brain fog” after a night with a lot of CSR/CA events. The data from my O2 Ring shows corresponding oxygen drops but SpO2 averages are still not bad.
I found an interesting article from “The Lancet” which may be relevant; also attached: https://www.thelancet.com/journals/lance...3/fulltext Continuous positive airway pressure device detects atrial fibrillation induced central sleep apnoea
Again, I wonder if others on this Forum may have similar experiences, specifically with CSR.
Regards,
Dave H
PS: Many thanks to all that have commented since I last looked a couple of weeks ago.
Just as a gentle trial, try massaging the sides of your neck in various places to get at the Vagus Nerves, but only one side at a time, and see if your heart rate changes.
That was how I confirmed that my own Atrial Fibrillation was almost certainly caused by the tight straps of my ResMed F20 Mask. When I did that over the areas where the strap was leaving deep welt marks in my neck, my heart rate and rhythm improved.
It's at least worth trying.
Even in people who do not use CPAP, it is one of the many self-help techniques that are used to help people come out of Atrial Fibrillation.
Related is to try things like sticking your face into very cold water, to try and stimulate the Vagus Response, or Diving Reflex, which can slow down heart rate, and can help to come out of Atrial Fibrillation.
If these do absolutely nothing, then you can at least rule that out.
On CSR, the one criteria you are close on is duration, and you are close to the 45 minutes I recall as I read 50 minutes. I do believe this "CSR is most likely related to your AFib. Obviously we cannot see the relation on these charts as a proper EKG is not shown.
Your flow limitations are high and in other cases I would suggest increasing EPR, BUT with a strong possibility of AFib actually causing the CSR I'd like to turn EPR OFF (NOT 3) and see if the CSR abates. If not re-enable EPR at 1 and take action toward an ASV. This is purely to minimize the flushing of CO2 from your system. Note this reduction in EPR will most likely result in an increase in obstructive events. In YOUR CASE we want a priority on the centrals, the CSR.
If it remains persistent I consider an ASV may very well be in your future. This is something to begin discussions with your doctor on.
The mechanism is something like this. The Afib is impeeding/slowing your circulation of blood. With this slowing the CO2 is building up as the O2, which you measure is going down. The decrease of CO2 to below your apneic threshold is causing the cebtrals and the repeating waxing and waning flow rate typical of CSR.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter
(10-06-2022, 01:12 PM)mesenteria Wrote: I'm in Comox, up-island from you.
The ER is responsive and I get good care there. It is also exceedingly busy, with everyone dreading their shifts, and not because of COVID or elderly patients, although that demographic is very high here. It's due to drug overdoses. If you present on a Friday night, right after the government cheques have gone out, good luck being seen meaningfully before about three hours have past. The the next walk-by, with me in the hallway last time, will be about the same three hours later. COVID sufferers just make it that much worse. I can't imagine what the local landfill looks like after nearly three years of COVID.
If it makes any difference, the EP I saw is at Western Cardiology, Dr. Paul Novak. He did my ablation at Royal Jubilee. He is well-regarded in the medical community in Vancouver and on the Island. He's also extremely busy.
I live at Shawnigan Lake but recently stayed in Comox on our way to the North Island!
No complaints with the Jubilee ER during my three visits (two on a Sunday morning and one on a Monday morning). Busy, but not crazy - I may have lucked out with timing.
My EP is Dr. Larry Sterns, also at Western Cardiology. I believe it is considered a center of excellence but the wait times are frustrating! No easy answers.
(10-20-2022, 01:08 PM)Gideon Wrote: On CSR, the one criteria you are close on is duration, and you are close to the 45 minutes I recall as I read 50 minutes. I do believe this "CSR is most likely related to your AFib. Obviously we cannot see the relation on these charts as a proper EKG is not shown.
Your flow limitations are high and in other cases I would suggest increasing EPR, BUT with a strong possibility of AFib actually causing the CSR I'd like to turn EPR OFF (NOT 3) and see if the CSR abates. If not re-enable EPR at 1 and take action toward an ASV. This is purely to minimize the flushing of CO2 from your system. Note this reduction in EPR will most likely result in an increase in obstructive events. In YOUR CASE we want a priority on the centrals, the CSR.
If it remains persistent I consider an ASV may very well be in your future. This is something to begin discussions with your doctor on.
The mechanism is something like this. The Afib is impeeding/slowing your circulation of blood. With this slowing the CO2 is building up as the O2, which you measure is going down. The decrease of CO2 to below your apneic threshold is causing the cebtrals and the repeating waxing and waning flow rate typical of CSR.
Thanks Gideon. I will do that and get back in a few days with results.
Machine: Dreamstation BIPAP Mask Type: Nasal pillows Mask Make & Model: Most recent: Airfit P10, Wisp, Pilairo, Mirage Vista Humidifier: Dreamstation BIPAP, but without humidifier, also S9 VPAP Auto CPAP Pressure: 15-25 CPAP Software: OSCAR
SleepyHead
I jut wanted to add a note or two about magnesium.
At ths time I no longer really have afib, that is, the ablation surgery did the trick. Will it come back? Maybe, but I don't let it bother me. A couple years before the ablation surgery they discovered that my heart was cutting out - once for up to ten seconds while they had a monitor on me. They called me in a big panic and said 'get to the hospital ASAP, and don't drive.' I just smiled, because I hd been feeling the symptoms for 30 years; I just didn' know what was causing them. At the hospital they put in an on-demand pacemaker, which has completely solved the problem, but it also reports back to them over the cell network and they monitor it periodically. The report also indicates if I went into afib, and so far nada.
The first time I heard about magnesium for afib was right here, reading everyones' posts above. I never tried it when I had afib. But here's the interesting part: For the past couple of years I have been plagued with muscle cramps while asleep, mostly my hands, but also my ankles. I tried all the remedies that I read about on the net, but nothing worked. Eventually I discovered a recommendatiion for magnesium. I checked the label oin the multivitamin and mineral pills that I have taken for years, and each pill was supplying 75mg of magnesium, which it said was 18% of the recommended daily allowance. (A little math says that the RDA must be 417mg, but that's probably a bit off due to rounding.) So I started taking 400mg of magnesium glycinate daily, which the label says is equal to 56mg of magnesium. My muscle cramps are now gone, and they disappeared right after starting to take the magnesium. Maybe I should take more, but one pill a day seems adequate.
Now, my afib was already gone due to the ablation surgery, so I have no way to tell if the added magnesium has any effect on it. And my sleep apnea continues the same as before; the machine still ranges at the same pressures and the AHIs are running the same as before. I'm going to continue the magnesium supplements just because I can finally sleep all night long without waking up with muscle cramps.
There may be connections between the afib and sleep apnea, and maybe even the muscle cramps and low magnesium levels. But figuring it all out is just about impossible. I have a solution that is working, and my sense of pragmatism tells me to leave well enough alone.
(10-06-2022, 12:37 AM)mamazipp Wrote: Hi RadarRalfs
I read your post and felt I had to respond. I, too, have AFib ( fortunately paroxysmal, not persistent)
and was urged by my former cardiologist to have the sleep study which revealed severe sleep,apnea.
My reason for responding, however, is not to give you AFib info or advice. I live in the Greater Victoria area and know first hand the absolute impossibility of accessing services here. When others advise to change cardiologists, get a second opinion, go to an electrophysiologist, get an ablation, they have no idea how medical care works here.
When the kind and supportive cardiologist I was lucky enough to have previously, left, I was left without one. I was informed that I was “on the list” for a replacement and, despite the fact that I had been under the care of a cardiologist, I had to wait in line as if I were a new referral. I was horrified that I didn’t have a cardiologist to whom I could contact if my needs changed. I waited a very long time before I was assigned one, and I had no choice in the doctor to whom I was eventually assigned. He is not a very informative kind of doctor.
During the period of not having a cardiologist people told me to go to the ER if I had any arrhythmia which would possibly get me fast-tracked to a cardio. Luckily, I never needed to, having no episodes of concern.
But, I would suggest a visit to the ER…..Royal Jubilee, horrendous as the ER is these days with your persistent AFib, which must be very uncomfortable. It might, at least, provide a cardiologist to address your current situation and proceed from there.
Health care is difficult to access here and choice is rarely an option, something our American friends can’t even comprehend. We need referrals to see any specialist, and they are all booked months ahead. I have been on “the list” for a knee replacement for one year and no date has been given as Yet.
Sorry you have to endure AFIB with no doctor to consult with. I’d seriously give the ER route a thought. If you go in with persistent AFib they are likely to get you seen faster without an hours- long wait.
Good luck.
Thanks Mamazipp,
Have been three times now to the Jubilee ER and they were great. The system seems to prefer that you deal with the "Afib Clinic" who will coordinate with your assigned cardiologist. The clinic is quite responsive and informative but there are still questions I have that they cannot answer and it is frustrating to wait months to speak with the specialists! Thanks again for your thoughts.
