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[Treatment] Vitamin C for Central Sleep Apnea?
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Post: #1
Vitamin C for Central Sleep Apnea?
About a year ago I started developing afib events at night. After about 6 months of doctors prescribing the wrong treatment (beta blockers) I found out through my own research (and after a clean bill of health from a cardiologist and hematologist) that I had vagal afib. The condition was instigated in the middle of the night and after acquiring a recording pulse oximeter I was able to determine that I was having instances of low oxygen (and low heart rate) that correlated with the onset of the afib. I have developed a two pronged approach to dealing with the condition (with the cooperation of my family doctor). (Along with the afib we found that I had high levels of hemoglobin - like I was living at altitude - but I don't.)

First some background - I am 58, fit and exercise regularly. I weigh a little more than I would like (10-20 pounds) and am relatively heavily muscled. Vagal afib often impacts men who are endurance athletes and while not in that category I am close enough for it to make some sense. I don't smoke and don't eat anything with gluten or msg as both of these are migraine triggers. I sleep on my side, not on my back. I take a pretty comprehensive suite of supplements including Mg and Vitamin D.

I now take a medication at night to suppress the parasympathetic tone and this has helped to keep my pulse rate in the mid 50s or higher (dropping below 50 seemed to be correlated with triggering afib).

As a chemist I also looked closely at how the chemoreceptors work to trigger respiration. I have noticed that even during the day and especially in the evening if I am sitting quietly I can have periods when I "forget to breath" - best way I can describe it. When I was younger I was an active swimmer and could always swim further underwater than just about anyone I knew - three full lengths of a pool even when I was in my late 40s and teaching life saving - so I figure that I have a poorly functioning chemoreceptor for triggering the breathing response to the pH shift that happens with the build up of dissolved CO2 in the blood. I now take 1 gram of C when I go to bed and another in the middle of the night whenever I wake up to reduce my blood pH. (Vitamin C has a relatively short half life in the blood and that is the reason for the second dose in the middle of the night). This seems to have significantly reduced the number of instances when my blood dissolved oxygen levels drop below 90. I now stay at 94-96 for most of the night whereas without this treatment I was in the low 90s with instances dropping into the mid 80s. I also seem to have had my hemoglobin levels not increase as fast as they were before. I suspect the low O2 conditions at night were pushing them up and the higher viscosity of the blood may have also been a factor in the afib susceptibility.

I am wondering if there is anyone else with this sort of experience? I have also heard of taking vinegar as a way of treating central sleep apnea and it may work via the same blood pH shift mechanism so anyone who has tried that I would be curious to hear from as well.
08-20-2013 04:52 PM
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Post: #2
RE: Vitamin C for Central Sleep Apnea?
Hi dgossman,
WELCOME! to the forum.!
Thanks for the very interesting post.
Hang in there for more responses and best of luck.

trish6hundred
08-20-2013 05:09 PM
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DocWils Offline

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Post: #3
RE: Vitamin C for Central Sleep Apnea?
There is no reliable information on vinegar in use the way you describe - pretty much any red wine would do the same things, but there are great caveats to drinking raw vinegar, so I do not know if that is an avenue to pursue.

Taking that much C is not advisable - you are close to triggering diarrhoea with that amount so close together (we call it bowel tolerance), and it can also have other knock on effects, least of which is that C is a stimulant and actually keep you awake or disrupt your sleep patterns. If you are suffering from blood pH changes, I suggest you contact your doctor to find a suitable treatment. However, unless someone has been doing regular draws the entire night to check on your pH factors, your idea is just a theory, and self medicating on a theory is dangerous, even if short term it seems like it is helping. Your lowered sO2 sats are due to lack of O2 from your breathing patterns, and if it is CA, then the correct PAP device should help you. Your heart medication may also not mix well with self medication, so you should be very careful - many such meds don't mix well with aspirin or C vitamins concentrates, or other of the many supplements you are taking, so please go over the entire list with your pharmacist.
08-21-2013 06:24 AM
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Elen Offline

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Post: #4
RE: Vitamin C for Central Sleep Apnea?
DocWils,

Out of curiousity, how much Vitamin C should you take daily? I eat a grapefruit a day, but I don't think this is enough. Thanks.
08-21-2013 09:12 AM
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dgossman Offline

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Post: #5
RE: Vitamin C for Central Sleep Apnea?
DocWils - there are lots of websites and doctors that advocate the use of vinegar, often apple cider vinegar, for treatment of a wide variety of conditions, Usually about 1 teaspoon is taken once or twice each day diluted in water or juice. I was certainly not suggesting taking it "raw", the acidity could damage the throat tissues. I would not consider red wine to be a good option as red wine contains tannins which are reported to be migraine triggers which I tend to avoid when possible. I am wondering in this forum of anyone has used vinegar to shift blood pH to improve the response of the chemoreceptors that drive respiration. The level of vitamin C I am taking is not triggering diarrhea - I have been taking it for about 6 months with no ill effect. I am aware via my own research of one other prescription based medication that can be used to shift pH but it acts on an enzyme pathway in the kidneys that I am somewhat reluctant to mess with. I will dig up the details when I am back at home and have access to the file. I chose the level of C that I am taking based on the desire to maximize the impact of the shift in pH relative to the short half life of the C in the blood stream and the desire to get through at least half the night on a single dose while staying below levels that are recognized as safe and unlikely to cause any negative side effects. So far that is working. All of this has been done with the full knowledge of my doctor - she asks me for the technical papers now - not the other way around. So far I have found only one doctor or pharmacist who I thought had the background to understand what I am doing. He was a hematologist I consulted and had an undergrad degree in biochemistry which allowed us to actual walk through the chemistry. While I can appreciate the need for some patients with CA to use PAP it is my desire to fix the problem via chemistry not treat a symptom via an electro-mechanical device that has the potential to create a dependency. I recognize that the biochemistry of the human body starts to break down in the mid 30s and only gets worse as one gets older. That is why I take a wide variety of supplements. I am considering this to be just one of those breakdowns and am trying to treat it as much as possible in that way. The prescription I am taking to prevent afib is not, strictly speaking, a heart medication. Vagal afib is not a result of heard disease but rather a toned vagal nerve - usually a good thing for the heart but as with anything else too much of a good thing can be bad. It is propantheline bromide and is an muscarinic receptor antagonist. I tried oxybutinin but did not have good results with that one. A cardiologist in New York came up with this therapy for vagal afib just a few years ago and it is gaining some acceptance in the community of patients (often competitive athletes) with the condition. There is no reason to believe that the C would interfere with the function of this medication. My hope is that I will remain afib free long enough that I can work my way off of the prescription but I don't see any long term way to increase the responsiveness of the chemoreceptors short of the vitamin C. I did have one doctor suggest that the vitamin C might also be acting via its antioxidant effects to essentially scrub the receptors "clean". I am not sure I see that mechanism as likely given the short term effects. All of my doctors get a complete copy of my current supplements whenever I see them. I am curious about your comment regarding vitamin C being a stimulant. I was unable to find anything in the technical literature in that regard. Do you have a reference you can provide? I have trouble seeing how that could happen from a biochemistry perspective. I am aware that C can prevent certain stimulants from being activated or absorbed by the body but that would appear to have the opposite effect. And finally I know that my treatment is based on a theory - and not one that could be dealt with via arterial blood draws for pH and blood gas measurements all night since that would disrupt the sleep cycles and therefore disrupt the validity of any results. Nevertheless the buffering capacity of the blood and its mechanism appears to be fairly well understood and a small shift in the buffered pH value via a mechanism such as vitamin C might be just enough to kick the chemoreceptors into gear when needed. Certainly for me the night time oximeter data that I have suggests it is working. I am always looking for better ideas, none the less. Self medicating with the full knowledge and cooperation of both my doctor and hematologist would seem to be a reasonable option given the lack of apparent knowledge in this area by the medical community in general. If you can point me toward a more effective long term treatment based on the underlying science and not just treating symptoms I would welcome that.

Elen - I also often eat grapefruit but you need to be careful because it can have effects that interact with a wide variety of prescription meds - I only eat it in the morning and never at night because it can inhibit the activity of the propantheline I am taking.
08-21-2013 02:14 PM
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DocWils Offline

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Post: #6
RE: Vitamin C for Central Sleep Apnea?
(08-21-2013 09:12 AM)Elen Wrote:  DocWils,

Out of curiousity, how much Vitamin C should you take daily? I eat a grapefruit a day, but I don't think this is enough. Thanks.

You can take as much as whatever your bowel tolerance is, for most people that is around 1g, but results may vary. However, we are seeing more and more C poisoning as people intake so much continuously that damage is done - on the whole, like most people of my profession, I prefer to advocate healthy eating as the best way of getting your dietary intake of minerals and vitamins, and using supplements sparingly. There is increasing evidence that many supplements actually don't work, as the body is primed to absorb the given mineral or vitamin only in combination with the foods they are normally contained in.

This doesn't mean that you shouldn't take supplements, but that you should take them wisely and be well informed about how they really work.
Unless there is a compelling reason to take extra C, for instance, your grapefruit is already plenty. While C is water soluble and you pee it out pretty quickly, it is not actually a substance that you have to continuously refill all day. Our ancestors were not eating twenty fruits over the entire day - our system doesn't need a constant refresh supply.

Generally I recommend Berocca or Supradyn as a decent supplement, although neither, I believe, are sold in the US in the same formulation as in Switzerland, or I recommend a specific for certain deficiencies, D being a common one, especially in less sunny climes and for people who work indoors all day, and fish oils as a general good practice, but on the whole, I still feel the best way is through a wide and varied diet. That said, used wisely and well, supplements can be your friend, too.

This remains a controversial subject with vociferous advocates and nay sayers, but I tend to prefer well done trials to prove or disprove something's efficacy, so I will follow the more conservative guidelines until data shows me differently.
08-21-2013 04:31 PM
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Post: #7
RE: Vitamin C for Central Sleep Apnea?
(08-20-2013 04:52 PM)dgossman Wrote:  About a year ago I started developing afib events at night. After about 6 months of doctors prescribing the wrong treatment (beta blockers) I found out through my own research (and after a clean bill of health from a cardiologist and hematologist) that I had vagal afib. The condition was instigated in the middle of the night and after acquiring a recording pulse oximeter I was able to determine that I was having instances of low oxygen (and low heart rate) that correlated with the onset of the afib. I have developed a two pronged approach to dealing with the condition (with the cooperation of my family doctor). (Along with the afib we found that I had high levels of hemoglobin - like I was living at altitude - but I don't.)

First some background - I am 58, fit and exercise regularly. I weigh a little more than I would like (10-20 pounds) and am relatively heavily muscled. Vagal afib often impacts men who are endurance athletes and while not in that category I am close enough for it to make some sense. I don't smoke and don't eat anything with gluten or msg as both of these are migraine triggers. I sleep on my side, not on my back. I take a pretty comprehensive suite of supplements including Mg and Vitamin D.

I now take a medication at night to suppress the parasympathetic tone and this has helped to keep my pulse rate in the mid 50s or higher (dropping below 50 seemed to be correlated with triggering afib).

As a chemist I also looked closely at how the chemoreceptors work to trigger respiration. I have noticed that even during the day and especially in the evening if I am sitting quietly I can have periods when I "forget to breath" - best way I can describe it. When I was younger I was an active swimmer and could always swim further underwater than just about anyone I knew - three full lengths of a pool even when I was in my late 40s and teaching life saving - so I figure that I have a poorly functioning chemoreceptor for triggering the breathing response to the pH shift that happens with the build up of dissolved CO2 in the blood. I now take 1 gram of C when I go to bed and another in the middle of the night whenever I wake up to reduce my blood pH. (Vitamin C has a relatively short half life in the blood and that is the reason for the second dose in the middle of the night). This seems to have significantly reduced the number of instances when my blood dissolved oxygen levels drop below 90. I now stay at 94-96 for most of the night whereas without this treatment I was in the low 90s with instances dropping into the mid 80s. I also seem to have had my hemoglobin levels not increase as fast as they were before. I suspect the low O2 conditions at night were pushing them up and the higher viscosity of the blood may have also been a factor in the afib susceptibility.

I am wondering if there is anyone else with this sort of experience? I have also heard of taking vinegar as a way of treating central sleep apnea and it may work via the same blood pH shift mechanism so anyone who has tried that I would be curious to hear from as well.

If you're suffering from Atrial fibrillation and central sleep apnea you should hurry to try an CPAP or ASV machine as soon as possible!

Beta blockers can reduce but not cure the Afib events.

I my case with AF, CPAP almost totally cured my heart symptoms... no more palpitations, agitation, chest pressure, shortness of breath etc.

I still use bisoprolol, but sometimes I just forget to take one in the morning and have no negative effects whatsoever(in forgetting to take the pills.)

You can combine vit C and apple vinegar with the CPAP treatment, but I think CPAP is still superior to all other treatment options.
08-21-2013 04:36 PM
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DocWils Offline

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Post: #8
RE: Vitamin C for Central Sleep Apnea?
dgossman -

I see you have really given this a lot of thought and have good monitoring by your doc. Well done. I have had a look through the literature, but there seems to be a dearth of reliable information about your methodology. It might well work, and I certainly hope it does. Central Apnoeas need to be diagnosed by neurologists, as they are a "brain thing", and there are varying approaches to treatment, but your case is complicated by the heart issue, one that can be more than a little annoying, I should think.

Yes, the body starts to break down after 30. We were not designed to live as long as we commonly do nowadays, but once you hit 60 it really starts to take off. I had lunch today with an old colleague who turned 70, and the talk was all about ageing and death, and the methods we take to forestall it. He hasn't had red meat in 30 years, exercises, looks well after himself, but still in the end it was a door handle surgical consult, as he suspected he had to have something "done". All this tinged with thought of another old colleague who died of a stroke, despite his ultra healthy and ultra fit lifestyle. We keep trying to do the best to live a healthy life (okay, I don't, but I was always a bit of a zhlub that way), but we get sand bagged by a variety of ailments that come out of left field no matter what we do. I suppose this is a long winded way of saying take care of yourself, but don't make an obsession of it, always a good warning it all things.

The stimulant effects of high vitamin C intakes was documented back in the 40s, I cannot think of any specific papers just now, something we learned in med school back when dinosaurs ruled the earth. Mostly it makes for poor or disturbed sleeping patterns, not much else. Why not take a timed release C supplement so you don't have to get up at night?

Apple cider vinegar is still in use here as a common treatment of many things, mostly for dietary needs. Tried it once, found it foul in the extreme.

Blood draws at night for this sort of study are done via a catheter, so the patient isn't disturbed, btw. At least that's how we do it here.

I have heard of the method you describe, but have not seen it in action here. But I might just shoot the idea over to the Unispital to see if anyone might be interested in doing a study - in order to get the Doctor title here, you have to do a research thesis, and I am pretty sure someone might go for this. The idea is interesting, to say the least. So your post may well have moved the bound of medical science forward. Well done again.

And now we get to the heart of the question - a better treatment based on the underlying science and not just the dealing with the symptoms. That, I am afraid, for a case like yours is a holy grail, and I wish you luck finding it. Generally on such cases here we take a multi disciplinary approach, coordinating the specialists via a central "quarterback", usually the GP, and see if the synergy created by the different views of the same problem bring about a good resolution. I suspect that would be very expensive in your neck of the woods. Good luck and keep dropping by with updates. This could be really helpful to some people here.

But, if I may, let me disabuse you of the idea that a PAP device is a device of dependency - it is a tool to deal with a specific set of problems that cannot easily be dealt with by other means, one that is non invasive and relatively safe. As such, one does not become dependant on it. There is neither physiological not psychological dependence on a PAP device - it is a tool that when used alleviates a problem during the usage period - the problem returns immediately when the usage is halted, not because the body or the mind have grown dependant on it, but because it was never a cure, nor intended as one, but, like am artificial leg, there to do a job. Your leg does not grow back if you try to avoid using the artificial leg. Similarly, in most cases of apnoea, the cause of the problem is not cured, it does not "grow back" if you avoid using the device, it simply continues to be the same problem, and the result can be early death at worst, lowered life quality otherwise. That said, if your method works for you, then I am very happy. Due to the complex interconnected nature of your problem, PAP therapy alone probably would not be the way forward, unless a neurologist and cardiologist could together demonstrate is as the best way for you. But I do think it should be something you should consider trying, in the spirit of open minded research. If it helps clear up your afib then it is clear that the trigger is apnoea. If it does not, then apnoea is triggered by the a-fib. It could help to pinpoint the chicken or the egg problem you are faced with here and better effect a cure. Just an idea.
(This post was last modified: 08-21-2013 05:08 PM by DocWils.)
08-21-2013 05:03 PM
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Post: #9
RE: Vitamin C for Central Sleep Apnea?
(08-21-2013 04:36 PM)SilverSleeper Wrote:  If you're suffering from Atrial fibrillation and central sleep apnea you should hurry to try an CPAP or ASV machine as soon as possible!

Beta blockers can reduce but not cure the Afib events.

I my case with AF, CPAP almost totally cured my heart symptoms... no more palpitations, agitation, chest pressure, shortness of breath etc.

I still use bisoprolol, but sometimes I just forget to take one in the morning and have no negative effects whatsoever(in forgetting to take the pills.)

You can combine vit C and apple vinegar with the CPAP treatment, but I think CPAP is still superior to all other treatment options.

If you are suffering from vagal afib and do not have heard disease beta blockers can be very bad! Don't take them and most doctors don't know this. A large study done in Europe showed that afibbers with vagal afib who were prescribed beta blockers made the symptoms worse over time and actually put some of them into permanent afib. Autonomic trigger patterns and anti-arrhythmic treatment of paroxysmal atrial fibrillation: data from the Euro Heart Survey. European Heart Journal, Vol. 29, 2008, pp. 632-39
08-21-2013 06:46 PM
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dgossman Offline

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Post: #10
RE: Vitamin C for Central Sleep Apnea?
DocWils - thanks for the reply. A little follow up on a few issues. The reason I don't take the timed release C is that I don't want to push the low pH all the time - just at night. I am concerned about other impacts of low pH that could be a negative so I figure that just pushing it down at night and letting it go during the day when the respiration drivers are not as dependent on the pH based chemoreceptors as appears to be the case while one is asleep. I do drink lots of plain water during the day to flush things out and help prevent things like gout and kidney stones (both of which I have had many years ago). I have thought about round the clock C to see what would happen but hesitate to "experiment" much at this point since what I am doing is working. Last time I "experimented" I went into afib.

All night in a hospital for continuous blood testing sounds expensive. I am self employed and have a high deductible insurance policy so unless I can find a research physician interested in experimenting on me I can't afford to pay for hospitals and doctors to run the experiments. That goes for sleep studies as well, that is why I got my own pulse oximeter and am considering getting my own portable recording ECG system. Then I have the equipment to get the data whenever there is a need. Walking into a cardiologist's or doctors office with a pile of pulse oximetry reports helps to set the tone that I am not there for them to use to rack up bills for an insurance company (that in this case would not be the party paying anyway). If you do find anyone who wants to experiment let me know! Please understand that while I am not a doctor I am a scientist and have not hesitated to buy a whole pile of medical text books to come up to speed. I also have a brother who is a doctor and a daughter who is a vet to consult with for free and do so often when I run into a lack of understanding on an issue. What I find more often is a lack of understanding in the medical community or some very new research that most doctors don't know about. As mentioned before my GP is getting used to me bringing her research reports with a request to try something.

I have looked on line and still can not find anything on C being a stimulant - maybe they were teaching things in med school in the 40s that were not always accurate?

I think my concern on the dependency of the PAP unit comes from a number of directions. I have read anecdotal information suggesting it is possible and like with any mechanical device that supplements a physical activity the body can become accustomed to the "assist" and by doing so weaken the drive (or the muscle). I have been concerned that all of the effort I expended in my youth learning to suppress the desire to breath for underwater swimming has been a factor in what I am dealing with now. I don't want to make that situation worse. (And that is another reason for not taking the C round the clock.) I am also an outdoors person. I know people who use PAP machines (for obstructive apnea) - they don't do much camping and backpacking seems out of the question. Not a place I want to go unless really forced to.

I will throw out another question here that none of my doctors have been able to answer. Do people with CA experience an increase in hemoglobin as a compensating mechanism? That seems to be something I have experienced and the C treatment has reduced (but not eliminated) the rate of increase in hemoglobin. You have an excellent point about the chicken or the egg issue and it is further complicated by the hemoglobin issue (which was discovered a year ago on my trip to the emergency room for my second bout of afib - where they incorrectly started me on beta blockers). None of the doctors have been able to really address this chicken or egg issue although the cardiologist who gave me a clean bill of health on my heart did want to go to a sleep study as the next step - I had already figured that issue out and was already gathering pulse oximetry data. I moved on at that point to the hematologist to eliminate some rare forms of cancer that could have been increasing the hemoglobin. My experience gathering my own data quickly led me to the conclusion that a sleep study would either find what they wanted to find (ie disturbed sleep from an artificial environment) or would find nothing - even prior to developing my treatment I had good nights with no disturbances in the data at all. In fact at that point I was averaging one afib event per week, all at night - but most other nights were uneventful. Only by having my own pulse oximeter could the full pattern of what was going on be foxed out.

I have been considering consulting with a neurologist as a next step so your suggestion in that regard is much appreciated.
08-21-2013 07:35 PM
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