Sleep Apnea and Afib

This will be the last of my posts regarding the health issues I have personally dealt with, and I have done these for a reason. I don’t want to be an exhibitionist, but knowing the background helps when I get to where I am now and how I got there.

In this case, back in 2015 my wife and I were planning a trip to Ireland. As you might guess from my name, my ancestors came from the Emerald Isle, and as is the case with most Irish-Americans it was during the famine of the 1840s. I am not Irish, I am American, but most Irish-Americans are proud of their heritage and a trip to Ireland is important to us. But a couple of months before our departure my wife said that I had developed an unsettling habit of stopping breathing when I was asleep. I was totally unaware of this, but talked to my doctor, and as a result got signed up for sleep study.

This was done at my local hospital, and meant I have to bring my pajamas with me and spend the night. It was not a very comfortable night, because they had me wired up to instruments like an Electro-cardiogram (EKG) and then put a mask over my face to blow air at me. I did manage to get some sleep, but not what I would have preferred. In the morning I got up, and the nurse told me that I did indeed have sleep apnea, and then said “Did you know you have Atrial Fibrillation?” That was a surprise, and something of a gut-punch.

With all of the test results in, I went back to my doctor. I now had two more things to deal with. My big fear was that I was about to leave for Ireland, and that he might say I shouldn’t fly or something, which would end that trip. Thankfully that did not happen, though he did prescribe some heart medication, Metoprolol. This is a drug in the general category of “beta-blocker”, a class of drugs used to control heart rhythm, reduce blood pressure, and treat angina. In my case, it was the first of these that mattered, since Atrial Fibrillation is a problem with heart rhythm. In any case, I had my medication, and went on to a wonderful trip to Ireland. While there I did all the things I would have done anyway, including a lot of walking, particularly in Dublin, where spent hours walking through the city. I didn’t feel any different, and to this day I have had no physical symptoms of any kind.

With the Sleep Apnea, the sleep study results had been fairly definitive,so I was sent to a Pulmonary specialist for treatment. Looking at the results, it was determined that my Sleep Apnea was moderate, and the treatment would consist of wearing a CPAP mask on my face when sleeping at night. CPAP is an acronym that stands for Continuous Positive Airway Pressure, and it is a machine that sits alongside my bed, connects to a mask via a hose, and the mask fits over my nose and mouth. It has a water reservoir to help add humidity to the air it pumps into the mask and make it a little easier on you, but there is definitely an adjustment process. I think it took me about six months to really get used to it. At first, it seemed like the mask was always leaking air, and it was loud, and uncomfortable, but I was told it was the key to preventing the Apnea issues and would add years to my life, so I stuck it out. Eventually I got to the point where I just put on the mask, turn on the machine, and go right to sleep. I use the mask every night, and my Pulmonary doctor gives me “gold stars” since a lot of her patients don’t that, but as you might have picked up from my posts so far, I consider compliance with medical orders a very important part of my health plan. The machine has an SD card in it that records usage, and when I go in for my annual visit, I bring the SD card with me for the doctor to review. And like so many of my check up visits, the result is always “You’re doing great, keep it up, and we’ll see you again next year.”

Doing this can take a little planning. I discovered that when I am travelling I get an exemption for bringing it on the plane as an extra item, which is great. But I need to use distilled water for the reservoir, and since I can’t bring it on the plane I need to plan on stopping at a store when I land. And I have gotten into the habit of filling the reservoir and setting up the machine early in the evening so that when I am ready for bed all I have to do is put on the mask and turn it on. That helps a lot with compliance. And you do want to take it seriously. Sleep Apnea linked to other health problems, including Type II Diabetes (which as already discussed I have), as well as heart problems

Then there is the Atrial Fibrillation. As I discovered, the Sleep Apnea probably had a lot do with triggering the Atrial Fibrillation as well, since repeatedly stopping my breathing put strain on my heart. Atrial Fibrillation is a problem of a part of the heart not beating properly. Your heart basically has two sides, and each side has two chambers. Blood flows into the Atrium, and from the Atrium into the Ventricle, which pumps it out again. And you have two sides because the blood has to go on two trips. One is a round trip to the lungs where it can pick up a load of oxygen, and the other is a round trip through the rest of your body to deliver that sweet,sweet oxygen to all of your cells that need it. Atrial Fibrillation (or Atrial fluttering) means that the Atrium does not have a strong beat, but instead vibrates weakly and chaotically. This is not good, but need not be fatal if treated.

So I was sent to a cardiologist, who told me my A-fib, as it is called, was not terribly serious, but did increase my risk for heart problems, and more importantly, for stroke. You see, in A-fib the blood is not flowing strongly through the heart as it should, and this can cause clots to form. If a clot forms, and it flows through your arteries to your brain, a stroke can result if the clot cuts off the flow. The answer is to reduce the chance of a clot forming. This is done through medication that reduces the clotting factor in your blood. In fact, the medicine they use in most cases (Brand name: Coumadin; generic name: Warfarin) was originally developed as a rat poison. The idea was that in high doses rats would simply bleed to death. In the doses given to people like me, though, it should help to keep us alive. The first thing I heard was that I should avoid green, leafy vegetables (they are high in Vitamin K which reduces the effect of the medication), and when I heard that I had a problem. As you may recall, my very successful management of my diabetes is based on eating a lot of salad. But I discussed this with the medical folks, and we agreed that as long as I was consistent it would not be a problem since we would just adjust the dosage level.

This is something that you need to get right. As Paracelsus said “The dose makes the poison”, and too much of the Warfarin could kill me, or at a minimum cause problem with bleeding similar to hemophilia. And too little would raise the risk of a clot and stroke. To make sure I am track I get a monthly blood test to measure my INR (International Normalized Ratio), which is a measure of how long it takes my blood to clot. In my case, my doctor wants to see a number between 2 and 3. As long as I am in that range, they say “Keep it up and test again in a month.” If it is out of that range, we have a talk about whether I have changed anything. For example, one time it was low for some reason, and in discussing possibilities it turned out I had been taking Ibuprofen for some physical pain I was having, and that reduces the effectiveness of the medication. So threw out all of my Ibuprofen, and now I use Acetominophen when I have pain. I can’t use aspirin for the opposite reason, it would make me higher. Sometimes we make a small adjustment how much I take. Since it varies by the day of the week. I bought one of those 7-day pill organizers and every Sunday morning dole out all of my morning pills for the week.

I want again to emphasize that I have never experienced any physical symptoms. If I had not gone in for the sleep test, who knows when the Atrial Fibrillation would have been caught, or how much worse it might have gotten. So one immediate conclusion is that how I feel is not necessarily a good guide to my state of health.

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