afib and sleep apnea

[poppypete]

Sleeprider...

In keeping with the request to inform on this Forum, I'm outlining my letter to my doctor, sent yesterday:

Dr (name deleted)…

re: ASV trial - (name deleted) DoB 16/11/44 and “Should I go ahead and purchase my own ASV machine???"

Since seeing you on Thursday 14 June, I have been working with folk on the Apnea Board Forum tweeting settings in response to results…

• ...to the point that for the last two nights I have had excellent results (improving still on what was being achieved previously since beginning this trial a fortnight ago…on 8 June…and which were themselves signifying encouraging progress on ASV as we discussed, better than CPAP).
  

On loan, the machine I’m currently using from (supplier name deleted) I will at some point need to return…

...and in contacting them this morning, (name deleted) will now write to you with the 14 days download report and…

• ...ask if your intention is for me to remain on ASV,
  
• in which case I’ll need to make a purchase of my own machine, to replace my ResMed CPAP auto AirSense 10.
  

Now my Warfarin dosage has stabilised on 5mg with INR readings within the 2-3 range…

…but I expect the cardioversion will not happen for another couple of months (Dr (name deleted) when I saw him on 6 June suggested 8 - 10 weeks).

• Recent results since speaking with you, and your agreeing to the following ’script’= EPAP 8-12 cmH2O; PS 1 min, max 12:
  

Thursday 14 June: 6hr 14min 2.25 AHI (EPAP 8-12 cmH2O; PS 1 min, max 12)
                                                                 11 hypopnea; 3 unclassified apnea

• tweeked PS max:
  

Friday      15           6hr 52min 4.22 AHI (EPAP 8-12 cmH2O; PS 1 min, max 15)
                                                                 24 hypopnea; 5 unclassified apnea

• tweeked EPAP range:
  

Saturday  16           6hr 04min 3.79 AHI (EPAP 9-13 cmH2O; PS 1 min, max 15)
                                                                 14 hypopnea; 9 unclassified apnea
Sunday    17           8hr 03min 4.47 AHI (EPAP 9-13 cmH2O; PS 1 min, max 15)
                                                                 33 hypopnea; 3 unclassified apnea

• tweeked PS min:
  

Monday   18           7hr 39min 8.23 AHI (I misunderstood instruction, and reduced PS min to zero, rather than increasing to 2.)
                                                                 38 hypopnea; 25 unclassified apnea
Tuesday  19           7hr 36min 4.08 AHI (EPAP 9-13 cmH2O; PS 2 min, max 15)
                                                                 29 hypopnea; 2 unclassified apnea

It was suggested to me that I try using a soft cervical collar, which I purchased locally, for this reasoning:
"Although the total number of hypopnea events are up, the UA is just about gone here. I'd like to hold off on pressure changes until I see you try the soft cervical collar/ stop snore or similar positional therapy. Most of your therapy time is quiet and uneventful, and this pattern of hypopnea and apnea events, just over one-hour in is becoming very familiar.

Something you probably didn't notice is your I:E ratio is in the normal range with longer expiratory time. All hypopnea in your last chart are marked as 10 second, which is the minimum for Resmed to flag hypopnea, and may be due to the larger flows that precede them. Resmed flags hypopnea based on a 30% reduction in flow for at least 10 seconds as compared to the 120 seconds prior to the event. While I'd like to see your respiration smooth out, what I'm saying is that these hypopnea may be non-events.”


Wednesday 20       6hr 29min 0.31 AHI (EPAP 9-13 cmH2O; PS 2 min, max 15)…
……………………..with 1st session, 4hr 5min = 0.24 AHI, with 1 unclassified apnea of 12sec duration.
Thursday 21           6hr 47min 0.44 AHI (EPAP 9-13 cmH2O; PS 2 min, max 15)
……………………..with 1st session, 4hr 5min = 0.00 AHI.

Here’s how I commented on the Apnea Board Forum this morning, and please note this important info:
"Oximetry data showing up very well too...high levels of SpO2% and a more resting, less volatile heartbeat in spite of the Afib still.":
………………………...
Sleeprider...

This 'great result' continues for another night, thank you once again:
1st session 
4hr 37min
0.00 AHI

2nd session
1hr 37min
1.38 AHI (2H)

3rd session (resting before rising, fully refreshed...to watch Argintina vs Croata)
43min
1.39 AHI (1H)

Average overall .44 AHI (<.5 = <point 5, not just <5)

Oximetry data showing up very well too...high levels of SpO2% and a more resting, less volatile heartbeat in spite of the Afib still.

Very healing feelings, thank you (Sleeprider). 

Cheers...poppypete  [img]blob:http://www.apneaboard.com/926fcccf-459f-4145-af48-c4f23df1615e[/img]


Attached Files


[img]blob:http://www.apneaboard.com/cd0e372c-3b1c-44fa-9b5c-af1f1120891f[/img]   [img]blob:http://www.apneaboard.com/a34ccbfb-6fa8-4a8c-9851-139ed043aeb8[/img]   [img]blob:http://www.apneaboard.com/c5e159c8-0103-4d85-8d5c-0c65ec201111[/img]


The bottom line then to this note, is…apart from how well I’m feeling during these recent days…is the question:

•  Should I go ahead and purchase my own ASV machine???
  

[poppypete]

Sleeprider...

Last night's results continue to improve on an already excellent progress...

...with my 1st session 5hr 16min for 0.00 AHI and high SpO2% levels maintained, and a more resting (albeit in afib) heart beating with less volatility.

The graphs attached highlight the 'leak effect' towards the end of the 2nd session...and that session began and ended with my luxuriating in my naturally preferred supine position.

Cheers...    poppypete

[Sleeprider]

Looks great again, and hope you continue to see this near-perfect result. I can't imagine you going back to CPAP after you many struggles trying to use that, then finally realising what it's like to be treated and rested.

[poppypete]

Sleeprider...

re: "...hope you continue to see this near-perfect result."

Towards a closure of this thread, I draw your attention to this result last night, for in my humble opinion it resolves the issue also raised in the initial question:
"...whether to continue on APAP (sic) in the early hours of the morning as it seems to trigger adversely with my afib." and
"I can get my AHI<5 for 4-5hrs, but they go upwards of >30 if I continue using mask/machine."

The advice I've received from you has created this complete reverse (last night's 2nd session 4am - 5.45am = AHI 0.00) of those early hours referred to in that initial question...tempting me at those times NOT to continue with the mask/machine.

My one regret is that I'm not able to sync the SpO2 readings into these graphs, for they reveal to me that I need (and now get) that 'extra' period of rest (and with treatment on ASV)...SpO2% levels occasionally dipping to 92%, but mainly as a straight line at around 96-97%.

For this reason now, I think I'll cease posting here on this thread (unless something dramatic occurs after this post), and revert to my other thread ("ChoiceMMed-oximeter-MD300W314"), and attempt to resolve in due course how I can sync these readings into the SleepyHead graphs.

For anyone else who might have followed this thread and offered help, my thanks go to them for their interest.

To you Sleeprider, I can't stress enough how I've appreciated your assistance...and finally getting this result. I can confidently go back into slumber now, at whatever hour, and after any number of session interruptions.

Cheers...    poppypete

[Sleeprider]

Just wonderful you have found a solution to a difficult problem. You owe me a beer, next trip to AU.

[jaswilliams]

Great looking graphs. These ASV’s are magic

[jmjm28]

Sorry for the late reply but I didn't have my notifications on. I am new to sleep apnea so honestly can't follow all the technical points in this thread relating to that. However, I am well versed in afib from personal experience. Electro Cardioversion is only given if you're in permanent afib. If you're in permanent afib then I don't understand how your CPAP machine, or anything else, can "trigger it" or make it worse. You're either in afib or you're not in afib.

I also wonder why the long wait for electro cardioversion? Usual protocol in the U.S. is to either do it right away (within 48 hours) or after several weeks on a thinner. Is this your first afib episode? If not, what is your history?

I also strongly suggest you invest in a Kardia Mobile or Kardia Band afib detector. It's a medical grade device that generates and analyzes an ekg. Works in conjunction with your smart phone and/or Apple Watch. The ekg can then be emailed to your doctor for further analysis if necessary. By taking your ekg at critical points -- it only takes 30 seconds -- you will know for sure what's going on with your afib per what you have been describing. If it turns out that you are in permanent afib, then again I don't see how the CPAP can make it worse, regardless of settings. On the other hand, if you find out that either you're not in afib, or going out of afib, and if the later (going in and out) relates to the CPAP machine, that is another story, both with your CPAP issues but perhaps more important with your upcoming electro cardioversion.

Because if you'e going in and out of afib, the cardioversion is not indicated (you will most probably just revert back). In this case (going in and out of afib) your docs will have to chage/manage your meds (Pill in Pocket and/or daily, ) or consider ablation. But get that Kardia so you know what exactly is going on. My last electro cardioversion failed and they sent me home with some anti-arrhythmics to take for a week before they would try again. I ordered the Kardia that night and two days later it showed I was no longer in afib which was confirmed later that day by my ep doctor. It saved me a week of angst and meds. It also possibly saved me an unecessary electro cardioversion. It's a great relief knowing exactly what your afib status is at any one time especially as symptons and diagnosis do not always match up. For examples, my frequent ectopics (PACs) often mimic afib, but PACs are benign, afib is afib. Remember, an electro cardioversion at your doctor is only a 60 snapshot and does not tell you what is going on the rest of the time.

Lastly, have you been put on a two to four week event monitor? Similar to a holter but it captures events longer term. If not, you should discuss with your cardio or EP. Measure twice, cut (operate) once (if necesssary). Works in medicine as well as carpentry.

Jim

[poppypete]

Jim...

Thanks for your comments...noted and I've taken info out of them.

Not easy to sucinctly reply, but my process is ongoing to resolve my afib issue and how apnea treatment compliments that (both an ongoing education for me).

Regarding the 'trigger' question, it came about because when I resumed CPAP therapy, I was not diagnosed as in Afib. Over several weeks (as detailed in early posts), various settings, sleep test, and oximetry reading was occurring...during which time (6 wks), on a cardiologist visit to ensure there was no 'underlying issue' (the reason I visited my GP), afib we discovered had developed between GP visit, sleep test (clearly stating no afib), and cardiologist routine visit.

Hence the question...what came first, the apnea or the afib? There was indication from SleepyHead data, that early hours CPAP was causing agitation, rather than resolving my breathing during sleep issues...further complicating understanding.

All purely coincidental maybe...but that's my history of Afib.

Why the delay in doing a cardioversion? 

Again the posts describe the why, but put simply, the precautionary check of a TOE beforehand revealed a thrombosis either existed or had previously occurred...so now a treatment to resolve any potential clot before doing a cardioversion is necessary. I am in Australia, and as perhaps our 'urgency' is not as acute as in the USA maybe this is also a factor needing to be better understood.

I have checked out the Kardia device, and I am in process of deciding how best to spend my resources on a device which will help me into the future know what/how my heart is behaving...preferably a waterproof one as I do like to swim, and it's during exercise that I'd like to be aware of heart activity (I am 74 in Nov)...maybe a Fitband will better meet my needs?

So Jim...again thanks for taking the time to outline this, your story, as mine is unfortunately a long one contained in over 17 sections on this Forum.

For the record, I had a most pleasant sleep last night again, nearly 8 hours over 2 sessions, for an AHI reading of .77 (that's <1), with my oximetry download showing good SpO2% levels maintained, and whilst obviously still in afib, the volatility of my heart rate is a lot less than it was in those anxiety periods experienced in past nights, also described in my previous posts.

I'm thus at peace with where and when change is likely to now occur for me...with respect to the afib issue...but sincerely, thanks for these comments.

Cheers...     poppypete

[jmjm28]

That makes more sense. I would still not hesitate on the Kardia because for all you know you are out of afib now or going in and out of it. In either scenario,
electro cardiversion would be contraindicated. It only makes sense if you are in permanent afib. The Kardia Mobile is the most cost effective. $100 USD here. You don't wear it so don't worry about swimming. It's about the size of a large piece of chewing gum. Simply take it out. Open your smartphone app. Press your fingers on it. And in 30 seconds you have a medical grade ekg. The watch band version is $200 plus you have to have (or buy) an Apple Watch. More convenient maybe but both are equally accurate.

As far as your clot is concerned, they would have waited here as well. Given the clot, I would think it prudent to have another TEE right before the electro cardioversion, whether you've been taking thinners or not. A simple and quick procedure that could make a major difference if for some reason your clot was stubborn. It happens.

Your story, and my own experience with CPAP during my split night study is making me a bit anxious about trying the CPAP machine that is going to be sent to me. I was surprised in the lab the amount of air being blown into me and the first thing that frankly came into my mind was that this could be an afib trigger. And you are not the first I've read online to speculate that CPAP caused an afib episode. So even though sleep apnea can impact afib, if the cure (CPAP) can also instigate it...something for me to think about.

Not to belabor the point, but I've read all the tinkering you're doing here so I know you're an investigative, tinkering soul who like many here wants to get hands on with their health issues. The Kardia Mobile is perfect for someone like you. And not to incur the wrath of this forum, I would prioritize your afib issue at this point over your apnea.

Jim

[Tinman53]

Newbie here.  Been reading through the info on this thread and found it extremely interesting to me.  Little background:  I am a heart failure patient with a reduced EF (25-30% based on last ECHO, up slightly from 20-25%).  Had a triple by-pass in 1998 but two of the graphs have since occluded but have some collateral growth allowing some passage.  I have an ICD (Implanted Cardioverter Defibrillator (implanted four years ago) and have been on CPAP for about 10-12 years.  My current CPAP is a very old model with no monitoring or any bells or whistles.  

Have been noticing a reduction in sleep over the past year or so and through a sleep app on my Apple Watch have been tracking my sleep.  Most nights I average 3-4 hours of sleep with less than an hour of deep sleep and many wakeful hours in-between .
Meeting with PCP Thursday to get referral for a new sleep study.  I have not seen a Sleep Doctor since my initial review resulting in the CPAP machine - and even then, I never really met the doctor, just his students!  

Like Jim, I also use the Kardia device and highly recommend it for others who have or suspect cardiac issues.  I do not experience AFib often but do experience a lot PVC's and my implanted device has paced me out of V-Tach on two occasions thus far.  

The information provided within this thread gives me a lot more to think about in regards to my sleep issues!

Thank you for sharing.