Does GERD cause Central Apnea

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Does GERD cause Central Apnea

Postby complex13 » Fri May 18, 2012 2:32 am

does GERD or acid reflux cause central apneas?
I read on a forum that somehow the acid causes the brain to not give the signal to breathe
Last edited by complex13 on Fri May 18, 2012 12:56 pm, edited 1 time in total.
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Re: Does GERD cause Cantral Apnea

Postby robysue » Fri May 18, 2012 10:06 am

No. Gerd/silent gerd can aggravate ordinary OSA by causing low level inflammation of the upper airway, which increases the likelyhood that the upper airway will collapse during sleep since the inflammation reduces the size of the diameter of the upper airway.

But Central Sleep Apnea is a neurological problem: Your brain forgets to send the signal to breathe to the lungs. You quit breathing for 10 seconds or more because you are not making any effort to breathe in the first place. Typically your upper airway does NOT collapse during a central apnea. No air is getting to the lungs because you are NOT making any effort to breathe in the first place.

As I said on a previous thread you started:

robysue wrote:The basic problem in central sleep apnea is what can be described as a Undershoot/Overshoot cycle as far as the nighttime CO2 levels are concerned. That is for whatever reason, you stop breathing as you should. This is the initial UNDERSHOOT side of the cycle. When that happens, the CO2 builds up in the blood stream until your body finally kicks in and restarts respiration. However, since the CO2 has built up abnormally high you start to slightly hyperventilate and blow off too much CO2. This is the OVERSHOOT side of the cycle. You blow off too much CO2, and this reduces the respiratory drive and that sets the stage for another UNDERSHOOT side. On the UNDERSHOOT side of the cycle, your breathing becomes shallower and shallower and may stop altogether---i.e. you have a central apnea. At the end of the central apnea, you start breathing, but you hyperventilate again (the OVERSHOOT), which sets up the next UNDERSHOOT, and the cycle repeats.

The ASV machines are designed to treat central sleep apnea by monitoring how often you breathe and how much air you are inhaling. And it tackles treating the CSA with two tactics.

First, when you have not taken an inhalation in a certain amount of time, the machine will try to trigger an inhalation by rather drastically increasing the IPAP and then (at a set time frame) lower the pressure back down to your EPAP setting. If breathing does not resume, it will continue to try to trigger inhalations at a fixed 'breaths per minute rate' by first increasing the IPAP and then reducing the pressure back down to the EPAP. In other words, the machine will try to make sure that your lungs have enough O2 coming in to maintain your O2 levels while at the same time trying to insure that you will retain enough CO2 to trigger the breathing pattern. Both BiPAP S/T machines and ASV machines have this capability. Regular BiPAPs (including the BiPAP Auto), APAPs, and CPAPs doe NOT have this capability to trigger a patient to inhale.

But the ASV machines go a step further in treating Central Sleep Apnea: An ASV machine will, in essence, try to fix the central sleep apnea by eliminating the repetitive Undershoot/Overshoot cycle that sets up in central sleep apnea. To break this repetitive cycle, the ASV monitors your tidal volume since the tidal volume is a good indicator of how much CO2 you are blowing off with each exhalation. Low tidal volumes indicate that you are starting to drift into the UNDERSHOOT part of the cycle---i.e. you are not blowing off enough CO2. And when the ASV determines that you are not going to meet the target tidal volume on your own, the ASV quickly increases the IPAP pressure over a series of inhalations until it helps ascertain respiration even when you are not breathing as you should. This respiration allows your body to blow off enough CO2 so that you do not kick into the OVERSHOOT side of the cycle. Indeed, the machine is known as Adaptive Servo Ventilation (ASV) because the unit adapts to your breathing style and includes the timed response. They are the only machines designed to treat sleep disordered breathing with this capability.

The downside, of course, to the ASV's ability to break the Undershoot/Overshoot cycle that characterizes central sleep apnea is that the necessary algorithm requires rather dramatic and sudden increases in IPAP pressure. That's why your IPAP is going as high as it is: The machine is trying to do its job and break up the Undershoot/Overshoot cycle that is developing in your breathing pattern while you are asleep. But those sudden increases in pressure also can be very disruptive to sleeping. And it just takes time and hard work---most likely with some help from your sleep doc, to figure out how to sleep with these sudden and drastic pressure swings.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Re: Does GERD cause Central Apnea

Postby complex13 » Sun May 20, 2012 12:43 am

thanks so much! how can you treat it thought? I read on here that taking 30days of theophylline helped someone's apnea so I've been trying it, but hope it doesn't damage my liver.
I still feel exhausted and in a fog after over a month on the resmed asv adapt. it's terrible how this disease has taken over my life
it's strange sometimes the machine blows hard and sometimes the pressure is low so I don't know how to make the pressure low to fall asleep?
anyway I've been trying gaviscon now for my GERD since I'm still nauseous
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Re: Does GERD cause Central Apnea

Postby jamjar62 » Wed May 23, 2012 7:07 am

I had terrible GERD. It would wake me up choking at night. Then I did my sleep study, and found out I had severe sleep apnea.

Since I have started wearing my BiPAP, my GERD has gone away. If I fall asleep on the couch at night time without my mask, the GERD kicks in. I don't know why this works, but it does. My theory is that the air blowing down your throat keeps the passage open only one way - down - so nothing can come up. I have been able to stop taking my Nexium.
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Re: Does GERD cause Central Apnea

Postby weliz » Wed May 23, 2012 9:37 pm

How did you get Theophylline? Did your doctor give it to you? Pubmed says it "is used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe." That is NOT a treatment for apnea. Apnea is when your airway actually collapses, or your brain forgets to tell you to breathe. If your doctor gave it to you, I would be alarmed (unless you do have asthma or one of the other conditions for which the medication is indicated) and tell you to go back and question him about it. If you somehow got some yourself, I would be extremely alarmed and tell you go to your doc immediately!

You currently are using one of the best treatments for apnea--the machine. It is not realistic to feel immediately better after only one month of treatment. Read this site for a while and you will see that some people take a very long time to feel a real benefit to the treatment. Very few feel like a million dollars after just one month. For me, it was several months before I realized a real change, and a year before I had all the bugs truly worked out.

If you are having issues adjusting to the machine and the pressure, you would get better responses by posting a new thread with just one topic -- asking about how to adjust the pressure on your ASV so you can fall asleep. Please do people a favor, however, and add your machine type to your profile so people can see it. And if asking about the machine settings, include it in the post as well.

There are also other causes for exhaustion. But you do need to give the machine a longer try, and work with your doctor or DME to make adjustments (one at a time) if you find things aren't working, and give it some time after each adjustment to see if there is a difference. And you need to work with your doctor on your whole health picture, too. You may have other conditions going on that you're not noticing now, but may notice once you get the apnea under better control.

Which leads me to your GERD question.

Has your doctor diagnosed you with GERD, or did you self-diagnose? If self-diagnosed, please do yourself a favor and go to the doc and let them work this out. They need to rule out other possible causes for your symptoms, and, if it is GERD, work out a treatment plan that takes your other conditions and the medications' side effects into account. If it is truly GERD there are many other meds to try, which a doctor can set you up with.

Take this seriously, because it is serious. Lots of people say "it's just GERD," but that's like saying with sleep apnea that you're just tired. It has real, long-term, serious effects if not treated. Do some searching and see for yourself.

I know this is a lot to deal with, but it is you can do it. Hang in there!
DX 7/22/10, started treatment 8/25/10
REMstar S1 Pro C-Flex+ / Swift LT for Her mask, 9/14/10
RemStar S1 Pro DS 550 Auto 3/20/12
Usual pressure 4-8
AHI before CPAP, 26; now .7
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