Do You Have Sleep Apnea and Atrial Fibrillation? Why Does It Matter?
Posted on October 8th, 2008 by Mellanie
Many of you know that I’m concerned about the relationship between sleep apnea and atrial fibrillation and also about how atrial fibrillation can overwork the heart and lead to heart failure.
Thus, a newly launched study about sleep apnea and heart failure may hopefully provide information useful for those with atrial fibrillation.
What are the implications today for those with afib and should you be tested for sleep apnea?
Read more at Why Afib Patients Must Know Whether They Have Sleep Apnea
Then please come back here to post your comments, thoughts, and experiences.
I have both apnea and afib. Afib used to start with me during the evenings or, oddly to me, at night. Being on a CPAP machine kept me out of going into afib at night. Unfortunately, it didn’t seem to help the progression of the afib, though obviously that is hard to say.
I now use a APAP machine and find it much more comfortable than CPAP.
It was my pulmonologist who had me tested for apnea which was free to me even with lousy insurance. He insists my heart will be healthier if I keep treating the apnea. None of the cardiologists or EPs seem to care. What an odd world we live in!
Hi Judy, have joined this group as my husband has had Afib. (He has been cardioverted ). Prior to this he was diagnosed with sever sleep apnea. He has bonded with his cpap machine, however subsequently went into afib. I asked his EP if he would comment on why this occurred after the introduction of cpap. He could not. I have not heard of anyone remotely associated with cardiology who would not endorse CPAP for those with sleep apnea. I would love to learn what you mean by the progression of afib. I would also be interested in learning about the apap as I’ve not head of this. All the best and thank you!
Melanie,I read the report on a fib and sleep apnea.I was diagnosed 5 years ago about the same time frame.Spent3 days 9in ICU. I received the usual meds for afib in large doses.Not one doctor associated the two as being relatedso I began my own research on both.There is no question the apnea aggravates afib.I have experimented on myself by not usig my machine and always ended in elevated bp and afib the next morning.I took it upon myself to wean off of toprol,cardizem coumadin.The high doses of both causes heart failurein itself by not allowing the heart to beat fast enough to pump .blood.I had a heartrate that would rarely go over45 even during exercise.After having run in a5k race I ended back in ICU with positive tropinin levels.That is when we began to cease the cardizem entirely.With exercise and diet we can control some of the symptoms of the 3 apnea, bp afib. Seldom will a dr tell us apnea could be the culprit.More research needs to be done in this area.I would encourage you to religiously use your cpap at all times even during a short nap.Another helpful tool for afib is deep breathing exercisesto control rate. good luck with your machine. Itmay take some time to get used to but once it is in regular use you will not live without it.Thank you for such an informative site and the work you do to keep us up to date on the new therapies.sincerely Nancy White
Hi Melanie,
I guess I’m fortunate to go into A Fib 2-4 times a year but I also suffer from mild apnea. I am trying to get used to the APAP machine but find it very difficult. I can only get 2-4 hours sleep and then have to take it off to sleep the balance of the night. I am now using a new mask that covers the mouth and nose which in theory should be much more comfortable. As my Doctor has said it a related problem but to what degree ! More study is needed.
I will say that when I excersise I feel much better and sleep longer so get to work and start moving.
Regards,
Jeff
Judy,
That is very strange that, even with afib, your cardiologists and EPs didn’t question whether you had sleep apnea. I think the relationship between sleep apnea and afib just doesn’t register with some doctors.
It’s good that your APAP is working well for you, and that the machine has kept you from starting into afib at night. That’s good to know.
Mellanie
Sally,
Unfortunately, sleep apnea and afib are kind of a checken and egg thing - we really don’t know which comes first, and it can vary from person to person.
An APAP is an automated CPAP in that it adjusts to your breathing and provides different levels during the night. It seems to be more common with those who need a higher setting on their CPAP, though anyone can generally request one. They are a goo bit more expensive.
Good luck.
Mellanie
Nancy,
Thanks for your great comments and good luck with your afib.
I bonded quickly with my CPAP. I started with a full-face mask and slept better from the begining, except for the one night that I tried a nasal mask. I kept ripping it off my face as I couldn’t breathe with it.
I travel with my CPAP, and even showed it on a segment on national TV recently to raise awareness of afib and sleep apnea and their relationship. Please help us spread the word.
You’re absolutely right - more research must be done in this area.
All the best for keeping your afib under control.
Mellanie
Jeff,
I hope that you find the full-face mask to be much more comfortable, and that you can get a good night of sleep with it. I just couldn’t sleep with a nasal mask.
The hardest part with masks is getting them to fit right. That can be so frustrating. Either you don’t get a good seal, or it’s digging into your face. It takes a while to adjust to it.
Good luck to you.
Mellanie
Mellanie
Thank you, actually I just ordered a new nasal only fitting called the pillow with just one strap. Hopefully this will work and sleep will last more than a couple of hours. It’s amazing that the face mask will work for some people(Nancy) and not for others.
I will keep all advised if this new type is successful.
Jeff,
Good luck with the nasal pillow “mask”. That wasn’t an option for me–everything I read indicated that someone with recurring sinus congestion or sinusitis should use a full-face mask. Hope it works well for you.
Mellanie
I also have afib and apnea. I only have afib episodes at night and have never to my knowledge had one during the daytime. I am currently on a CPAP machine for my apnea and have had cather ablation surgery approximatley 6 months ago. I had no episodes for approximatley 6 months and within the past couple of months they have started back. My doctor currently has me on a LifeWatch monitor to verify the episodes. I have not heard from him yet and hope to discuss it with him soon to confirm whether they are are not episodes. When I have these episodes at night it is difinitely scary because with each of my occurances I experience a tingling, numbness and very slight weakness in my left side (arm & leg). Some episodes are worse than others. This has been communicated to the doctor numerious times but does not seem to be of signficant concern to him. Sometimes it takes 24 hours before the sensation goes completely away. I also have a problems finding the right mask for use with my CPAP. I am a mouth breather unfortunately and wear a full face mask. I have already been through approximately 10 different styles, and I am still not crazy about any of them. Have settled on the best of the 10 right now but still have hope that someone will make the perfect mask soon. My doctor did not feel that the CPAP would totaly cure my afib and therefore perscribed the ablation since I wanted to get off of the drugs. I guess that I may end up having the second ablation procedure performed.
Tommy,
I’m sorry you have afib and sleep apnea, but am glad you’re treating it seriously.
That numbness is scary. I’m surprised the doctor wasn’t at all concerned.
We CPAP’ers all know that finding the right mask is the hardest part. Good luck.
I, too, must have a full-face mask as I have occasional sinus infections and congestion. My current mask (Mirage Quattro) is fine–I’ve gotten used to it–but I would love to have one that isn’t made of hard plastic that digs into my face (and sinuses). But, that seems too much to ask. At least it doesn’t leak too much.
I haven’t seen anything to indicate that CPAP would cure afb, just that treating sleep apnea makes it less likely that procedures such as cardioversion will reverse themselves.
Good luck.
Mellanie
My husband was just diagnosed with a- fib in the last year. He is in denial and does not really believe he needs to take his medicine and that if he just loses weight it will “go away.” He went back to Dr. Jung at my request after six months and again wore a holter for 24 hours. He went into A- fib while he was sleeping and the doctor said at one point his heart stopped beating all together for about seven seconds. He is only 52 years old. This scares me to death, since his father also has a- fib and had a stroke when he was in his early seventies. Is my husband at high risk due to all of these factors for having a heart attack or stroke?
I just found you guys and feel a little left behind. I’ve had a-fib (my electrocario calls it a-flutter rather than a-fib) for 7 years now. At first, only rarely. Now most of the time. Then was dxed with apnea about 2 years ago. Love, love, love my apap.
Had an ablation last May and had blessed relief from the a-fib/flutter. Four months later, the fib/flutter came back - about the time I gained back 15 lbs (lost 40 with the apap - did I say I love that machine?) and I found myself startling awake in the night again. Made me wonder if the weight worsed the apnea which put me back out of rhythm. Am scheduled for another ablation, but wonder if I should wait until I get the weight off and apnea back under control. Any ideas?
I have severe sleep apnea and have been on CPAP for nearly 6 years (16 cm). I was apparently one of the lucky ones because I very easily adapted to the machine almost from the first night. I’ve used a couple of different masks and they all work great for me. I wouldn’t trade the CPAP for anything.
I also have afib and every single one of my afib events (probably 50 major events so far) has started at night while I sleep. I had sleep apnea long before my afib started
The time between my afib events is gradually getting shorter. Originally I had an afib event about 4 times per year and after 7 years I now have an event about once per month. The events always last between 10 and 14 hours and I have yet to find anything that I can conclusively say either induces the events or stops them. I can say that using my CPAP definitely does not stop my afib events.
I just started on flecanaide and that seems to help, but I’ve only been on it two months.
I’ve been trying to get my doctors to consider ablation because I am sick and tired of taking a fistful of meds every day. And I am far from convinced that this drug cocktail isn’t having negative long term effects. I would definitely like to know how to convince them to consider ablation. Right now the only response I get is that my afib isn’t severe enough to consider ablation. Not the answer I’d like to hear, obviously. I trust my electro guy to know more about heart rhythm than I do, of course, but I wonder if it isn’t time for me to start doctor shopping.
Peggi,
Has your husband been dianosed with sleep apena? The afib and sleep apnea are very much connected. My afib episodes were just at night. Since I had the cather ablation surgery done at UVA my heart does not go into afib but I am still awakened at night with my heart pounding. Since the surgery I have been able to stop taking the flecanide that was prescribed for the afib. I did not want to stay on the drug not knowing the long term effects. My doctors always told me that afib was not life threatening unless you stay in afib a lengthy amount of time. 10 - 12 hours is what was always communicated to me by doctors and staff as being to long. Your risk of a clot is increased the longer that you stay in it. Can he tell when he goes into afib or is he in it and does not know? Mine would wake me out of my sleep but I have heard of others that were in it and had no idea. If you are interested I can provide you some names and numbers at UVA. They are very good at what they do concerning afib and other heart related issues. They also have a website with contact information.
Peggy,
With a family history of afib and stroke, and having been diagnosed with afib himself, he needs to do something to decrease his risk. It sounds like he may have sleep apnea, which often goes hand-in-hand with afib. If he won’t take action for himself, will he do it for his family? Good luck.
Mellanie
Beth,
Afib and atrial flutter often go hand in hand - afib is irregular heartbeats that can be slow or fast, while a-flutter is fast and regular heartbeats. They are both challenging to live with or get rid of.
We know that untreated sleep apnea can cause afb and flutter to return, but you were treating your sleep apnea. However, if you were startling awake, then the apnea wasn’t totally under control.
I’m not a medical expert and can’t give medical advice, but knowing that untreated sleep apnea can cause afib to return, if I were in your shoes I’d want another sleep study or to figure out what new setting on the APAP it would take to get my apnea back under control. I’d do that before an ablation because I’d be concerned that the afib would come back if I didn’t have my sleep apnea under control. Just my two cents worth.
Mellanie
Charlie,
Has anything changed that would cause your setting (16 cm) to need to be changed?
I can’t tell you if you need a new doctor, but your comment, “Right now the only response I get is that my afib isn’t severe enough to consider ablation.” really says a lot. It makes me ask if your doctor REALLY understands what the afib is doing to you and the toll it is taking. Often they don’t understand and that’s because they haven’t walked in your shoes. A doctor that does understand will often take a more aggressive approach.
Good luck with it.
Mellanie
Tommy,
Thanks for your suggestions and help for Peggy. Congrats on having your afib under control.
Mellanie
dear melanie; i got a second opinion on my a fib and the new dr, sent me for lots of tests and just finished with my sleep apena tests and its linked with my a fib; using a machine and after a month i will probably be ablated again. mask is uncomfortable but i will get used to it; norman welsh
Norman,
I hope you’re used to the mask by now and sleeping well and that your afib is greatly reduced. Wishing you much success with it.
Mellanie
I am 49 and have had a series of very mild afibs, always starting at night. I can get out of it by doing jumping jacks.
I have also been diagnosed with UARS, a lighter version of sleep apnea, but it has the same effect on distrupting sleep architecture.
I have started with the CPAP mask, and don’t mind it too much. I am hoping that this prevents future afib episodes but am a little discouraged after reading some of these posts. Seems CPAP is not a cure over time. I would love to hear if anyone cured their afib with cpap…but I somehow doubt it.
It does seem that sleep apnea related afib responds less well to ablation. That said, Dr Warren Jackman thinks he has discovered a pathway which if ablated can help this specific form of afib. See article posted after the Boston Atrial Fibrillation Symposium 2009. Provides some hope.
Hi -
I am 52 years old and in relatively good health. I have been diagnosed with Hypertrophic cardiomyopathy since i was 28. Also, have had an irregularly irregular heartbeat for years. Have been on beta blockers and had a pretty easy life. The new twist is afib. We think it started about 6 months ago - I stay in it all the time. Started Coumadin and they increased the atenenol - was not easy to tolerate the new dosages (lethargy and weight gain), but that is much easier. Had the first elcectroshock and went out of afib. Lasted four days and been back in it for another four weeks.
Yesterday the results of a sleep study said I have sleep apnea. So now something new to start - do not want this CPAP - but will give it a try. See how this works now - see the top guy at UCSF in a week and see what is next. Tell me it gets better.
I have used a cpap machine for 7 years at least. This last fall-2008- I started to go into afib once a month. My doctor put me on cartia, and until May 2009, this seemed to keep me out of afib. Now I have gone into afib for 4 nights in a row- I wake up with rapid fluttering, can;t find my pulse, feel dizzy. Usually within 1-2 hrs it reverts. I am worried about the reasons and the long term effects. I take an aspirin when I wake up, and sometimes another cartia pill.
I have been using CPAP for sleep apnea about three years now. I was diagnosed with AFIB in Jan. 08. Several here have said they go into AFIB at night. My experience is just the opposite. I go into it during the day, usually afternoon or eve. but always wake up the next morning back in normal rhythm. I had been wondering whether ir was the sleep itself or the CPAP machine that converts it back. I am currently doing this four or five times a week and it happens this way consistantly.
About CPAP, please don’t try just one type machine and give up. I have read lots of comments on sleep apnea site. Everyone seems to have a different choice on what works best for them. I Started with mask over just nose, could never get it tight enough to stop leaks unless it was painfully tight. I called it an “instrument of torture”. Then I tried the nasal pillows. For me, that was the answer. Most of the time now I forget I have it on.
Hi Mellanie:
Thanks for your website.
I was diagnosed with mitral valve prolapse and afib at about 22 years old. It occured a few times a year, controlled then by inderal only as needed. Later, occurance got a little more frequent, so started minimizing caffeine and other obvious triggers (eg., dehydration, alcohol). At 49 had ablation by catheter which kept me out of afib for 4 years. I was feeling some extra heart beats recently, so my cardio doc had me wear the holter monitor. No afib, but he noticed heart stopped at night for 3 to 4 seconds. Had me do sleep study as he suspected i may have apnea. He was right: moderate apnea. Next sleep study was to calibrate PAP with mask, which i really didnt mind using, but the CPAP had to be to high - so they switched to BiPAP. With that, I quit breathing for over 90 seconds and the sleep doctor said i briefly went into afib or similar arrythmia. I think the machine rhythm threw off my breathing rhythm. I decided to not use PAP. A couple of weeks later I went into afib. I dont know if the event with the PAP precipitated it or more likely the caffeine in the chocolate I ate that day, duh. Electrocardiovert did not work, but sotalol did in 24 hrs. My cardio said we could stay on medication, consult the ElectroPhysiologist , or change lifestyle to zero caffeine, very little or no alcohol (a glass of wine only a couple times a week) and see what happens. It was ok for two and a half months, but then I went into afib again. They were going to E-cardiovert me, but the Soltalol finally converted me before the cardiovert appt, altho it took 4 days, this time. I really try to avoid triggers, but I am considering having ablation enhancement or touch up and have called my EP for an evaluation.
I respect my doctors who are ready to help me right away and relate to me what the latest info is. In particular, my cardio offers 2 or 3 choices to proceed and what the risks, pros, cons of each are. I decide, but he gives nudges as to which way(s) he thinks are optimizing. I think i am now going to have to deal with the sleep apnea issue further. I was surprised to learn that i have it. I fall asleep in a few minutes and rarely if ever wake up until it is time in the morning. I used to feel more refreshed when i awoke, but now i dont so much and about mid-afternoon feel tired. Maybe this APAP you mention might be what i need. During the test with PAP, there were some occurences of central sleep apnea, so i think my sleep apnea situation may be complex. I have several aquaintences who use CPAP and BiPAP with no problems.
Anyway, best wishes to you all and just keep at it and I enourage you to confer with your doc(s) to ascertain the best path(s) you can take. After afib-free several years I thought the ablation was a cure, but it seems we are back to managing it for now and that’s ok, because we can be grateful for the opportunity and tools to manage the issue.
Thanks,
Scott
Scott W,
Good luck getting the sleep apnea under control. Some doctors have started not doing procedures until the apnea is under control as uncontrolled sleep apnea can cause a reversion back into afib, even after procedures.
I hope they can figure out how to manage the sleep apnea and get rid of the breathing pauses.
Mellanie
Judy,
That’s interesting that the CPAP seems to bring you out of afib. Though I’ve never heard anyone else mention it, it’s quite likely that CPAP could do that.
I agree about not giving up. It seems that some DMEs don’t know how to help folks pick out the right things and just provide “standard” gear without taking into consideration each individual’s differences and needs. I think that’s responsible for a lot of CPAP “failures”. I wish there were a better way for those with sleep apnea to get exactly what will work best for them. If anyone has “cracked the code” on that, I’d love to know.
I decided to do a huge amount of research before ordering equipment, using online CPAP resources and discussion forums. I spent hours reading reviews of various machines and masks. One particularly helpful resource, at CPAP.com, has you take several facial measurements and recommends which masks will work well for your facial structure.
While I swore I wouldn’t wear a “Darth Vader” mask, and preferred nasal pillows, I soon discovered that for those of us with sinus issues, and thus occasional mouth-breathing, full-face masks are really the best way to go. I tried a nasal mask, too, but ended up returning it (I’m glad I took out mask insurance on it). I also have a hybrid mask, which covers the mouth and has nasal pillows; I bought it for travel since it’s much smaller than a full-face mask, but I just don’t use it as it feels like having a blowtorch up my nose all night.
We’re each different and have to find what works best for us. I encourage anyone who is struggling to research options as the right combination is out there, you just have to find it.
Thanks for your comments.
Mellanie
Jo,
Has it been 7 years since the last sleep study/titration? Has anything changed that could mean that your CPAP pressure setting is no longer optimal and that your sleep apnea is not as controlled as it had been?
Mellanie
Paul,
I hope the CPAP is working for you.
I believe, from what I’ve heard, that afib with hypertrophic cardiomyopathy (HCM) is a very different “beast”. Because of that, we have created a special interest forum in our discussion forums for those who want to discuss the unique challenges of afib and HCM and help each other.
You’ll find it here:
http://forum.stopafib.org/
You’ll be asked to register at the forums in order to post and discuss. I hope it’s of use for you.
Mellanie