Vagal Atrial Fibrillation & ResMed F20 Strap Neck

[MoreBeers]

Hello Dave!

Thanks, I will indeed try to get my hands on a Fisher & Paykel Vitera.

In the interim, I will have to make do with the ResMed F20 and modified Rear Pad.

Today I did a lot of gentle neck exercises and some of the techniques to try and ease vertebrae relationship if any near the head have been compacted due to the F20 strap pressure.

I did manage to get the AFib down towards 78-92 bpm but, it wasn't permanently down, and didn't quite get to Sinus Rhythm.

But this does seem to suggest there is some Vagus Nerve issue causing the mix of regular Tachycardia and irregular AFib over 120 bpm, because I can see changes in heart rate linked to neck mobility or neck pressure when I was wearing the previous F20 strap and rear pad.

I'd better climb into my pit and get on with the sleep test of the newly created F20 rear pad!

If it removes the forces on my neck, then it may help towards finding a way out of this Vagal AFib problem via self-help.

Then, if and when I get to see a cardiologist, I can tell him or her all about it!

MoreBeers

[MoreBeers]

Hello Folks!

You cannot see but, I am smiling! Maybe this might help...  

The new rear Foam Pad looks to have worked...I went back into Sinus Rhythm whilst I was asleep, over a 4 minute period between 07:44 and 07:48 BST! By that I mean my heart rate gradually came down over 4 minutes, and then stabilised at a normal resting rate and in a perfect Sinus Rhythm thereafter.

That may suggest the balance between the Sympathetic and Parasympathetic Systems re-established a balance, and finally agreed that I wasn't actually being chased by a herd of Vampires, so didn't need a racing heart beat! The Oximitry trace shows a gentle adjustment down from around 120 bpm AFib to 71 bpm Sinus. Since getting up, that has now settled on a resting rate of between 59-61 bpm, which looks normal, and without any Beta Blocker my Blood Pressure is also now back up to normal at around 110/75.

I have woken without any rear neck ache, and without any deep welts across my face and neck that usually tracked from below my ear and right across the crucial Vagus Nerve skull exit to neck routes on either side.

Sleep was much, much more comfortable and, apart from a spell on my back at around 08:37 to 09:01 when my Oxygen dipped up and down and I probably also had a little nest of Apnoeas, as usual, my Oxygen level was otherwise a nice flat line at around 96%.

Given that most of the night I was in Atrial Fibrillation, my Oxygen would have been higher had my heart been pumping properly.

But I think I may have managed to self-help my way out of this, or at least I have eased the nightly pressure on my Vagus Nerve, so much so, that I reverted to Sinus Rhythm whilst still asleep and whilst strapped in to the F20 and CPAP, which has never happened in any of the other 14 AFib sessions this year.

I had otherwise only reverted to Sinus Rhythm when sat awake and comfortable with any neck pain having eased off.

My heart rate is a little excitable, even thought it is in Sinus Rhythm, it's not yet established in a nice steady resting beat. However, as it has just spent over 9 days in AFib, that is perhaps to be expected!

Early days, and I may not yet be clear of this, and/or there could be other issues adrift, but my gut feeling has been, all along, that there was one big driving cause, and it all kept pointing at a Vagal related driver.

Logically, that almost had to be the F20 Strap, given the neck pain over 12 Months, and the severe rear base of neck pain on 3rd January, that preceded all of the AFib problems thereafter.

The key point being that I was still imposing the exact same aggravation to the Vagus Nerves until early February, and even then, I only eased it a little when I just happened to modify my old rear pad to ease the neck pain, not then realising the F20 Strap could be the cause because of its impact upon the Vagal System.

Thus, right up until only last night, there was still a Vagus aggravation issue going on.

So, if that was the cause, then the Vagal problem was being aggravated, on a nightly basis, up until the night before last night, and was only finally addressed last night.

MoreBeers

[SarcasticDave94]

Ok great, glad it helped. And once you get a Vitera mask, update that info here and e can assist in the strap adjustment. If it fits well, you'll be surprised how low strap tension needs to be for this to work nearly always leak free.

[MoreBeers]

Hello Dave!

I will indeed update when I get hold of a Fisher & Paykel mask. It may take a while but, I do aim to get one.

I was giving this some further thought, and I think I can now see why the Fisher & Paykel Vitera and the older ResMed Quattro FX were better, because I think both have a strap that goes across the forehead, so the whole thing is generally exerting pressure towards the rear of the skull, and not so much impacting the lower rear sides and nape of the neck, as the ResMed F20 strap does.

That's the problem, when you strap up an F20 tight, that pressure is always there acting upon the neck, and the focus of that pressure moves around the neck as one moves one's head when asleep.

Whereas a mask that is secured with forces acting further up and more on the skull itself, retains the same pressure focus no matter where the head gets moved around to when asleep.

In effect, the ResMed F20 is moving the force and in all of the wrong places. No mask should exert such force to the neck and Vagus Nerve areas, so when you think about it, what has happened to me now makes perfect sense, or is at least now better understood once the issue is looked at from a strap load point of focus perspective.

I will make up a similar slightly smaller rear foam pad for my wife, who also uses an F20 but in Small when my strap is Medium (they are different). She needs far less pressure, so does not have quite the same problems. But she does get a degree of neck ache from her F20, which a foam pad will reduce or eliminate.

I will make a MK2 version of my own rear foam pad, as the first one is a bit of a Frankenstein's monster, with additional sides glued on, when next time around I can make the next version all one piece. I need to move the external strap retaining Velcro further out to match the extended sides, so I may as well just make another one.

I may also increase the padded area around the Vagus Nerve skull exit locations below my ears, i.e. where the two Vagus Nerves' are routed outwards from the lower skull before going down the outside of the spine. That was why I extended the sides last night, because when I did my first trial fitting, I could still feel pressure over that area, which was avoided once I added the extra length to the sides. But those were after thoughts, and it would be better if the main base is one single piece of 8mm foam.

I may add another layer of padding there, on the outside face of the pad, so that the straps go over that, to further spread the loading, and so further limit the pressure that can be exerted by the lower straps upon the critical Vagus Nerve areas at each side.

I will update with a new image if so, and will add dimensions in case anyone wishes to make one for their own ResMed F20 Medium.

When I make one for my wife, who uses a ResMed F20 Small, I will update those details as well.

MoreBeers

[SarcasticDave94]

Sounds like a plan. Yes the forehead bar gives the Vitera a leverage point for the top. Also the cushion itself has a bellows design called RollFit.

[MoreBeers]

Hello Folks!

OK, second night with the new Rear Foam Pad 001, and absolutely no neck ache, deep welts in face, or any problems with Vagal Atrial Fibrillation!

Slept like a log, needed it too. Managed over 9 hours, which is a lot for me, and hit a new record of 1:25 Hours of the crucial and restorative Deep Sleep!

Had a nest or two of Apnoeas when on my back and in the worst position for Airway, but that's a separate issue in effect, and not a problem compared to having a ResMed F20 Mask Strap that was causing Vagal Atrial Fibrillation!

I also now do at least daily head and neck exercises to try and help the Vagus Nerves to settle and heal, that's if they were damaged and not just crimped a bit by the strap issue.

These are simple, but may be of interest if anyone else has neck ache or suspects any Vagal complications:

Head & Neck Exercise for Better Neck Mobility and to ease Vagus Nerve issues in Neck:

• Move head shoulder to shoulder 20 times (that's 20 times towards each side).
  
• Move head forwards and backwards 20 times.
  
• Circle head around in as full a movement as possible 20 times in each direction, so left then right or vice versa (so 40 in total).
  
• Turn head far left to far right 20 times (so also 20 times each side).
  
• Keeping head looking straight ahead, try to move it to the left, and then to the right, 20 times (so 20 each direction) - see TAOFit comment below.
  
• Finish with a gentle rotation in both directions a couple of times, mainly just feeling for any clicks and cracks in the neck.
  

If you feel any pain, don't push it, just move until you just feel the pain and either stop, or push very gently into the pain a very small way, and then stop. Over time that can gradually push the point of pain further away until you get full and free movement again.

Similar to Karate stretching, where the aim is to stretch ligaments and tendons gradually to free up tight ligaments and tendons, to obtain a wider range of movement, and need less effort to do so. That then allows more power to be deployed in what ever punch or kick you are using, because less effort and energy is needed to move in that way, so more power can be deployed to the actual target. The trick is to stretch daily, and to push into the pain a little each time, because eventually the range of movement gets better and easier as one does this. It can be frustrating at first, and uncomfortable, but persistence pays off.

Necks are more delicate, so never push hard if you do encounter pain, just nibble at the edges of the pain each time, and see if that gradually improves the issue.

I picked up a tip from the chap on the web who promotes his TAOFit Method, which is a form of yoga I think to help with his Vagal Atrial Fibrillation, and that was to try and move my head to each side, whilst looking straight ahead.

That's quite hard to do and get right, because it's unnatural! Almost looks like the head is not attached so, if it looks weird, you are doing it right!

That's a very relevant movement in terms of the Vagus Nerves at either side of your neck, i.e. where they exit the skull, traverse outwards towards the spot under each ear, before being routed downwards either side of the spine. That exercise can really be felt in that area, so it's an important one to include in the head and neck exercises.

If when doing any of this, you hear lots of clicks, crunches and cracks in your neck, especially towards the rear, that may well mean you could be dehydrated, so just make sure you add an extra litre or so of water per day, and see if that goes away after a few days (it usually takes a day or more to resolve that).

I am Posting this just to help those who may be having similar neck and Vagus Nerve issues.

I will update with a new image when I have created the Foam Rear Pad 002 Model! That will be a tidy up of the first attempt!

MoreBeers

[MoreBeers]

Hello Folks!

Obviously it is still early days, but the Foam Rear Pad 001 for the ResMed F20 Strap has made a massive difference. By taking away the neck pain and the impact of the narrow straps across the sides of my neck and face, I am definitely also sleeping better as well.

Pain in any form does inhibit good sleep, but removing that nagging low level pain has made another difference, and I am now getting far more Deep Sleep than before, last night it was 1:22 hours, when often I'd get none, or just a few minutes of it whilst the ResMed F20 Strap was giving me such monumental grief.

I had a few Ectopic Heart Beats this morning, from the ECG those are almost certainly Premature Atrial Contractions (PAC), which are effectively low level and normal for many people, provided they do not become too frequent or trigger things into Atrial Fibrillation. The ECG shows an early P-Wave, often merged with the last T-Wave, then a QRS Complex firing early, then a delay after that as the Cardiac system knows there has been a mis-fire, so adds a small delay before the next cycle. These are pretty clear to see, and otherwise my P Waves, QRS and T Waves are all in the same synchronisation with no changing relationship. Thus, I am happy these are PACs.

That only lasted 15 minutes or so, and I have no explanation. That happens, and comes and goes, but these are usually days or weeks apart, and are linked to both diet and stress levels, such as lack of sleep or, in my case, onerous lower limb pain.

Having spent the thick end of 3 months in and out of Atrial Fibrillation, it's to be expected that my heart is going to be excitable and not yet fully back into a regular daily rhythm.

Dumping the Beta Blockers have really helped, Blood Pressure and Heart Rate are now normal, rather than low normal and with Bradycardia (slow rate).

I do not have high blood pressure, and last check my heat was structurally normal with no sign of any issues at all.

So far, it does look like the ResMed F20 Straps were indeed causing Vagal Atrial Fibrillation. Since making the Foam Rear Pad 001, it has felt like an AFib switch has been turned off.

Make Your Own Foam Rear Pad for ResMed F20

I could draft a PDF Cutting Guide, but that could be complex given it will be larger than A4, so anyone wishing to print that to scale, could have issues if all they have is an A4 or US Letter Size Printer.

Perhaps a simpler option is just to create a DIY image, showing the basic outer dimensions, and how to create your own Foam Rear Pad by using your own F20 Strap as the guide.

This is easy, you just lay out the Foam and draw a larger than needed oblong box, and then place your own Strap onto the Foam and within that oblong box, and draw around that with a marker pen.

A Foam Yoga Mat 8mm thick or above, is very cheap to buy, and provides plenty of Foam to make several Pads, so you can make the initial oblong box much larger than needed, then cut it down to best fit your own head, neck and face, once the Strap has been aligned and suitable locating blocks glued on to the outer surface.

Best tip is to make it wider than needed, then cut down to fit your face, so that the whole Foam Rear Pad is made from a single piece of Foam. This avoids glue joints which can be felt on the face and neck.

The only materials needed for DIY are:

• Suitable Foam, such as an 8mm thick Yoga Mat (or deeper, the depth just means the Strap Load can be better spread out if the Foam is deep).
  
• Scissors to cut the Foam.
  
• A Hot Glue Gun and Glue Sticks.
  
• A Marker Pen to draw the cutting pattern onto the Foam by drawing around your own F20 Strap, and to draw the little Foam Blocks needed to be added to the external face, to keep the F20 Strap in the right place at night.
  
• Some Velcro suitable for securing a ResMed Strap onto the outer rear of the Pad (not vital but do help to secure everything in place).
  

The Velcro is not absolutely necessary, because the Foam Blocks do a very good job of keeping the ResMed F20 Strap in the right position both for when putting the Mask on at night, and keeping things in place when asleep.

But, adding Velcro really does keep it all together for very easy fitment and removal, and yet everything can still be taken apart easily to wash, if needed.

As I say, I just cut off the Velcro from some older stretched ResMed Straps, cut them down to just the Velcro and a margin around that, and then glued those to the outer rear of the Foam Pad to hold the F20 Strap in place.

I do not now need to adjust my Strap, I just unclip the Magnets, put the whole thing on, get it comfortable on my face and nose, and then clip on the magnets. Job done, feels very comfortable, and I have no leaks and all without any neck or face ache.

I am uploading two better images of my first attempt, that I have just called Foam Rear Pad 001, both showing the F20 Mask and Strap in place, to better show how this works in full.

MoreBeers

       

[MoreBeers]

Hello Folks!

Just a quick update: looks like the Vagus Nerve issue was indeed what was causing the Atrial Fibrillation.

Since making the Foam Rear Pad (please see images above), the AFib effectively stopped that day, and I have been clear now for 27 Days, albeit I had one short session of 2.5 hours 13 Days ago.

That was clearly a neck problem, and probably because my Vagus Nerves had been if not damaged, then at least crushed, so things were going to take a while to settle down.

That 2.5 hours of AFib followed a bad sleeping posture, and I also think the Foam Neck Collar was not helping, so I took that off after that. I also played around with, or without the Foam Pillow Triangle that I also use, and I also played with the number of pillows.

When that short AFib session kicked off, it woke me, and I immediately did neck exercises (as listed earlier), and massaged my neck around the Vagus Nerves, and my heart rate slowed, then went into Sinus Rhythm, then came down to a normal rate. So it was very clearly a Vagus issue.

I have now settled on the Foam Bed Wedge Pillow thing, and two pillows, plus the Foam Rear Pad for the ResMed F20. I have temporarily stopped using the Neck Collar for now.

Indeed, I could probably do with a better Foam Collar, but wanted to give my neck and Vagus Nerves a rest before I started strapping in to anything new.

The aim at the moment is to stay out of AFib, and to let my Vagus Nerves properly recover and heal, or at least de-crush!

I've had more than the usual number of Ectopic Heart Beats, but that feels like a legacy random misfire linked to Vagus Nerve issues. All seems to be settling down, and the Ectopic Beats are becoming less frequent, and only seem to happen later on in the evening.

These are Premature Atrial Contractions I am fairly sure, as it's always a double beat type, then a pause before normal beats resume, and the ECG Trace from my SAMSUNG Watch seems to show a non-standard P-Wave that triggers a premature beat, which the system knows about, hence why it delays the next beat to allow for that.

I do the neck exercises every day that I listed in an earlier Post on this Thread, and that has also helped I think.

One new change to the Foam Rear Pad, I added two plastic panels on the outer part where the Strap goes across the Vagus Nerves, to better spread the Strap load over that crucial area.

I did this because I had noticed that the narrow ResMed F20 Straps were crushing the 8mm Foam a lot so, if left as it was, over time the pressure might well re-start to impact the Vagus Nerve again if the foam crushed and did not go back to original shape.

The extra plastic did the trick, so that now, the loading is even better spread, and the Strap can no longer crush the foam below it. The foam now stays in shape, and looks like it will do so long term.

I cut up a ResMed F20 plastic box to make those small outer panels for that, which seemed rather apt!

I am still using the v001 Foam Rear Pad, which is a bit Heath Robinson, because of the various changes and additional side extensions all Hot Glued on, plus the Plastic Inserts now as well.

I need to cut a new version, next time all in one foam piece. When I do that, I may well extend the area over the Vagus Nerves.

Ironic that the CPAP Kit was primarily intended to prevent Sleep Apnoea related Atrial Fibrillation and Flutter, and then I find that the ResMed F20 Straps actually caused AFib from hell!

MoreBeers

[MoreBeers]

Hello Folks!

Further to all of the above, I can report on what seems to be an interesting, and pretty conclusive, development.

Until last night, I have been using the Foam Rear Pad mentioned and shown above, which completely cured the Atrial Fibrillation being caused by the ResMed F20 Strap biting the back of my neck.

However, whilst this stopped the Atrial Fibrillation, and whilst the Strap Pressure was dramatically reduced by spreading the load over a wider surface area, it still left me with what I felt was low level night-time Cardiac Agitation.

Not caused by Sleep Apnoea, but something that was agitating my heart, making Deep Sleep and quality sleep, elusive. I did wonder if it was simply a side-effect of sleeping with Positive Airway Pressure.

Basically, I get more stress in bed, than I do during the day, which I could not pin point, but kept thinking that the F20 Mask Strap was perhaps still the culprit, just masked by the Foam Rear Pad?

Last night I had a brain wave (often not a good idea), but thought if I can cut and modify a ResMed F20 Strap, so that the lower Straps go over across my ears and are re-attached further up the head band ring, that could alleviate all pressure on the neck, and move it from my neck to my skull, where it will not have any effect on neck nerves.

Initially, for speed, I just did this modification using Staples (pointy bit up, so these didn't dig into my Walnut)!

This seemed to work, and I had full and free head/neck movement, and it felt natural again.

However, during the night, I had a few Mask Leaks from this arrangement so, in my drowsy state, I just tightened the Straps. That stopped the leaks, but actually caused the head band ring to slip down, and again put pressure right on the back of my neck, but this time without the benefit of any Foam Pad to alleviate that pressure.

The upshot was I went into Atrial Fibrillation after tightening the Straps, once the rear slipped down over the back of my neck!

Luckily, I woke up, and got up, and noted I had a problem.

Thankfully, it only lasted around 3 hours, and I could see from my little Viatom ECG (LEAD I) that there was a battle going on as my compromised Vagal Nerve was struggling to bring down my heart rate. The damage was only short duration, so the nerve improved, and I went back into Sinus Rhythm.

OK, but the very interesting thing is when I examined my Viatom CheckMe O2 Logs, and looked at my Oxygenation and Heart Rate, I could immediately see that when the Modified Strap was still exerting pressure only upon my skull, my heart rate was perfectly calm and relaxed, with no night time stress at all!

BINGO!

So the low level Cardiac Agitation was indeed the ResMed F20 Strap, as I was suspecting.

Thus, it has to be the ResMed F20 Strap exerting pressure on the back of my neck that has caused Atrial Fibrillation when that pressure is not alleviated and, even when it is, this still causes Cardiac Agitation via the reduced neck pressure.

Had the Modified Mask Strap not slipped back down when I tightened it, I would have had one of the best nights for Cardiac Stress in the last couple of years since using the ResMed F20.

Obviously, given this, I am now going to design a new head piece, that avoids any Straps going anywhere near my neck.

The first attempt will be a lash up of Foam Padding and Cut Straps, but I will update when I have that made, and will advise if that cures the low level night-time Cardiac Agitation as well.

All being well, I could be heading back towards quality sleep, with no Cardiac Stress!

This may be of interest to anyone who is suffering from Atrial Fibrillation or unexplained night-time Cardiac Agitation that is not obviously linked to Apnoea events.

MoreBeers

[MoreBeers]

Hello Folks!

I had an interesting chat with an old friend, who also uses CPAP.

I contacted him Today because I knew he has been having major problems with the C1 and C2 Vertebrae in his neck. So, after my latest little experiment, I wondered if his CPAP Mask Strap could have caused his neck issues?

He thinks that is indeed the cause, because the Doctors were running out of ideas as to what had caused this, whereas now it all makes perfect sense.

He has used CPAP far longer than me, so has had this Strap pressure acting upon the back of his neck for comparatively longer, such that it could well have pulled his Vertebrae out of alignment. This has resulted in additional issues on top of Pulse effects, such as Blood Pressure changes when he lies down and they pull on the affected area of his neck, plus a year or so ago, Stroke-like symptoms as well, that didn't seem to have been an actual Stroke.

He will also make up a similar new head strap as I intend to do, that totally removes any Straps from going anywhere near the back of the neck.

This may require a Forehead Head Band, and possibly a band going down to a Chin Cup, all to stop any tendency for the unit to slide downwards at the rear when the Straps are being tensioned (and forwards too for that matter).

My modified Strap Test last night absolutely worked to dramatically improve night-time Cardiac Agitation but, it then ultimately failed when the thing slid down and nipped the back of my neck in the usual place.

If it had stayed in position, it would have been a perfect night's sleep, with no Cardiac Stress caused by the Strap pressure upon my Vagus Nerves.

This I think could be affecting many, because so often any Cardiac issues are usually just said to be a common side effect of having Sleep Apnoea.

I wonder how many people have been having stressful and poor nights that are not obviously caused by Apnoea events?

Likewise, how many have seen this go to Atrial Flutter or Atrial Fibrillation, and suffered complications such as Strokes or any of the clot complications that follow from sustained Arrhythmia issues. That's on top of any recent issues caused by the you-know-what (that I thankfully did not elect to have).

OK, I'll update when I have a workable design.

MoreBeers