By way of introduction - I can tell you THERE IS A RELATION BETWEEN CPAP AND DIZZINESS/VERTIGO/VISION AND EAR PROBLEMS. Not directly but indirectly.

This contribution is very large, but I will try to write it as short as possible. You are welcome to ask for more information / documentation.

Outline:
    My own story
    My Research
    The Problems
    What can you do?

My own story:

For 2 years I have been in CPAP treatment every night (Auto CPAP/Moderate OSA). The first 4 month with extremely success, I got a whole new life. But after 4 month I suddenly stand up from bed and “The whole world rotate”. I came immediately to hospital, and got a lot of examinations. In the first place I got a Meniere diagnosis. Afterwards I got further examinations with more diffuse diagnosis.

For over one year I had a very bad dizziness/Vertigo. I couldn’t go at work at all. From time to time I had attack with extremely Vertigo (especially in the morning), but the most of the time I had a constant dizziness. I also had problems with my vision.

I was sure, that this dizziness had something to do with my CPAP treatment, but when I ask my doctors, they deny that.

Therefore I began to research scientific articles by myself.

My Research:

From the beginning, I decided only to use scientific (evidence based) articles in my research. I have read a lot of articles (several hundred). In the meantime I had contacted some specialist Doctors in Denmark, who was willing to help me in my research. (I can tell that a lot of Doctors wouldn’t help).

In fact you can find all the information on the internet, but the big problem is the specialization of the doctors. I found out, that the problems include at least 4-5 specialist Doctors. I don’t know how it is in other countries, but in Denmark it is difficult to coordinate these doctors.

After about one year I had pieced together the problems, and I have documentation for its all. But still most of the specialist doctors are skeptical.

But since I don’t have any problem with dizziness/Vertigo today, some of them have accepted that I have a point here.

The Problems:

In the first place, I thought that the CPAP pressure goes to my ear through the Eustachian tube. But if you not have an extremely open Eustachian tube, the CPAP pressure can’t open the Eustachian tube. To open the Eustachian tube you need a pressure about 45 mmHG. CPAP pressure of 20 cm (H2O) is only about 14 mmHG. So this pressure CAN’T DO ANYTHING TO YOU EARS.

But the CPAP can worse / give you rhinitis / sinusitis problems. These problems can be unfortunate.

The real problem is not the CPAP but the OSA. But if you already are in treatment with CPAP, how can the OSA affect your ears/eyes?

I Think here is something new for most of you (I only concentrate about OSA – I know nothing about Central SA).

The normal apnea is an inspiratory apnea. This apnea has a snore before the apnea comes. The CPAP machine recognizes this as an upcoming apnea, and set up the pressure so the apnea is avoided. This type of apnea is what the CPAP machine is constructed for. This kind of apneas is therefore well treated. (I presume that most of you have an auto CPAP machine)

I’m sure that most of CPAP users have this kind of apneas.

But there is another kind of apneas – Expiratory apneas. This type of apneas is not so well known, but about 40-50% of CPAP users have this kind of apneas, typically much less than inspiratory apneas. This Type of apneas is also calling the “still apneas” because they have no snoring before the apneas. Therefore the CPAP machine can’t recognize the upcoming apneas. When the apneas come, the CPAP machine wait until the apnea is released, and then it will set up the pressure to avoid another apnea. After 20 minutes the CPAP machine will decrease the pressure again, and new expirations apneas can appear.

Here we have untreated apneas – but only up to 3 times at hours (AI Index). This will not be diagnosed as OSA in traditionally way (Therefore your sleep doctor will tell you, that your OSA is well treated), but this apneas can have a fatal consequence of you health.

Now we need to know some of the consequence of unthreatened OSA.

It is well known, that OSA have influence of the blood pressure and the pressure in the brain. With the normal apnea (inspiratory) there will be a negative pressure in Thorax. This Pressure has no influence of the ears, but will have a great influence of blood pressure and the brain pressure. In Extreme case the Brain pressure can increase up to 90 mmHG (normal is 15 mmHG). This phenomenon is called the Müllers maneuver. I assume that we all are in treatment with CPAP – Therefore I will not comment more on this kind of OSA.

But with expiratory apneas, which are untreated, we have a servere problem. These apneas are initiated of blocking of the upper airways – typically because of rhinitis / sinusitis (worsened by CPAP). This type of apneas gives a positive pressure in thorax (Up to 100 mmHG).

This positive pressure can open you Eustachian tube, which is no problem, if you not have other dysfunctions.

This phenomenon is called The Valsalva maneuver. This maneuver is well known by divers, and here we have 2 problems:

1.
If you have a blocked Eustachian Tube you can get a different pressure between the two ears (More than 45 mmHG). This can activate a phenomenon called “Alternobaric Vertigo”. This will give you a Vertigo, where you can’t stand up – The whole world will turn around. This phenomenon will often disappear after a few minutes. But if your Eustachian Tube are permanent closed, it can give you a chronic dizziness. It’s well known, that CPAP can give problems with the Eustachian Tube.

By the way – a Blocked Eustachian Tube can cause dizziness by itself.

2.
This Valsalva maneuver will increase your pressure in the brain extremely (up to 100 mmHg). This pressure can affect your eyes (Vision) and your inner ear (dizziness).  If you have recurrent expiratory apneas in the night, this can give you permanent daytime dizziness / vision problems.

In combination with a blocked Eustachian Tube, this pressure (in extreme situations) can give you and Perilymph Fistula (A leak between the inner ear and the middle ear). This is also well known by divers.

This pressure can also give Tinnitus, hearing loss and Headache in some situations.

These problems are not known by most of the sleep Doctors. I think it’s because the most of the sleep Doctors are ENT Doctors. The problems described is more known by neurologist Doctors and Diver Doctors.

What can you do?

The problem is, that the normal sleep study will not show if you have expiratory apneas. This demands a measurement of the pressure in Thorax.

But if you use Auto CPAP and your AI is greater than zero, you properly have these expiratory apneas. In this case only AI is important.

If you have no problems with your CPAP pressure, you can set the minimum pressure so the AI = 0. In that case you will have no problems at all.

But if you have problem with rhinitis / sinusitis, this will be a bad idea – because these problems will worsened if you set up the CPAP pressure.

If you have a blocked Eustachian Tube, and have dizziness problems – an ear tube will be a god idea.

In my case, I found out that the problem only occur when I lay on my bag or on my right side. Then I fixate my sleeping position on my left side (with pillows). After that my Dizziness disappears after only 3 – 4 days. Today I am working normally again.

For a more permanent solution, I now waits for a Swedish specialist for coblation in my turbinate’s. This should cure my problems with rhinitis, and maybe the expiratory apneas.

It was a long post, and I am not familiar with writing in English. But I hope you will understand the meaning.

Well...YOue writing in english was excellent (better than some of us who only know english!) and well explained.

Here is the US, Auto Machines are not the norm...yes, many have them but a patient is usually set up on a straight CPAP after an overnight diagnositc Sleep Study and another overnight titration study is performed in a clinical/Sleep Lab setting.  Most of us have private insurance and they do nto pay for anything other than a CPAP in the beginning of treatment, unless we are lucky enough to have a Dr that prescribes the use of an Auto or a BiLevel....and then, most insurance require documentation as to the need for an *advanced* machine.

Theother thing is that here in the US, Sleep Dr's are considered Specialist, have passed a Board Certification for Sleep Science and are usually Pulmonary Dr's or Neurologists.  Most people are seen by the Pulmonary ones.  With that said, ENT's do lead their patients to a sleep study and many General Practioners's do the same.

I now understand why my AHI is at a higher number now being on a BiLevel machine...I do believe the EPAP pressure may be too low...I do find I often make a 'snort' sound when exhaling....therefore could be exhalation hypopnea or apnea if this be the case.

I am curious as to the longevity of replacing an E-tube would be.. the dangers invoved...and if there are any contraindications.

I wonder if the continued fatigue that many experience...or when they say they feel worse now after being on treatment for awhile has any correlation to the pressure causing problems with their sinuses.  I know with myself...I can not *clear* my head...there have been a few times I could get it close to clear...I do not mean mucus but the fullness felt in my ear (s) and the flu type feeling...during these times I feel more awake, less fatigue, able to concentrate more...a more 'snap to it' type abilities.

I will be looking up some things from your post...I find your research interesting.

Thank You for taking the time to post this...and to get it into english when it is not your first language!


_________________

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BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

Thank you for your comments about my english writing. (I spoke and read english very much).

In Denmark the Auto CPAP is the 1. choice. My own is a RESMED S8 Autoset Spirit. I have a minimum pressure of 4 cm and a maximum of 15 cm. My average over nigth is about 8 cm.

I have spoken very much with Resmed in Denmark. And with Auto CPAP the Hypopneas is not important - because the machine records the Hypopnea, but take immediatly action on it. But with a real apnea the mahine can't do anything before the apnea is released. Therefore I only concentrate me about the AI Index. For me it is very important to have an AI = 0, because I got problems with my balance if not.

With rhinitis / sinusitis problems you can have a lot of Hypopneas, but this will not have any influence of the problems with ears and dizziness. But this is for Auto CPAP - I don't now how it's work with a straight pressure.

But of course - if you have a EPAP pressure too low, and you have expiratory apneas, you may have a problem.

I have a E-tube in my ear - thats for the equalize of the pressure between the ears (Alternobaric Vertigo). I Don't need it today, but my ENT tell's me that it will fall out of it self within a month or two. I have had no problems at all with the E-tube.

Henning

Henning, I also suffer from Dizziness, and your post was very interesting.

I have an AutoPap but I find that whenever I use my AutoPap, my AHI #'s increase. I can only control my AHI when I use straight CPAP mode. Does this mean that my Apnea is Exhalatory Apnea? and not Inhalatory?

How would I know whether my Apnea is Inhalatory or Exhalatory?

If an APAP cannot fix an Exhalatory Apnea, then would a straight CPAP fix it? My AHI#s on CPAP is pretty low but I still get dizzy.


_________________
5'9 234lbs 37 years Old Male
Original Sleep Study: AHI = 30

Owner of Remstar Auto A Flex M series
ResMed Ultra Mirage Full Face Mask
Viewer 1.0 Software, Smartcard Reader
Integrated Heater/humidifier
Prescribed setting: 7-10 Cm

The problem is that you can’t know which kind of apnea you have, without a measurement of the pressure in Thorax. A negative pressure is inhalatory apnea, and a positive pressure is exhalatory apnea.

When I use my AutoPap my AHI can vary a lot. But after I have spoken with RESMED I am pretty sure, that the Hypopnea is not so important (when you are in treatment). As mentioned in my last post, that’s because the machine registrate the Hypopnea, but take care of it immediately. With a Hypopnea your airway is not totally close, and the AutoPap can increase the pressure, and eliminate the Hypopnea.

With a real apnea (AI) the machine can’t do anything, because your airway is totally blocked. The machine has to wait for the apnea to release, and then increase the pressure to avoid the next apnea.

In my case I only got dizzy when my AI is greater than zero. An AI at only 0.2 makes me dizzy the next day. I think that’s because the great pressure in Thorax (and in the brain) only appears with a totally blocked airway.

I haven’t found any articles about Hypopnea and which pressure they can do.

You are right; a straight pressure (high enough) will solve the problem. But in my case my nose will swell up, and I have to increase the pressure. My nose will swell more up, and so on.

Henning

I've been using cpap for about a week now.  Every morning since I started using it, I've been waking up with puffy, baggy and glassy eyes.  This lasts all day.  On top of that, my vision has become blurry and gotten worse each day since starting the cpap.  I feel a bit dingy centered around my eyes/sinuses/brain.  My jaw is pushed out each morning so that I don't bite correctly. ie. my lower teeth are forward of my upper teeth.  My inner ear pressure is at about 1000 ft below sea level (I live at sea level).  I'm forced to believe that the cpap pressure is providing a side effect that is somewhat disconserting.  I have to admit that I am sleeping like a log.  A month or so ago I started to use the cpap and it interupted my sleep so much that I stopped using it.  The problem was that every time I moved, the hose would tug on the nasal pillows and wake me up.  My nose got raw from the motion.  A week ago I came across one of these cpap chat areas and learned of that little strap that holds the hose up by the side of my head.  Wow, what a difference.  My nose is no longer irritated, but, I'm having this jaw thing and this vision/dingy thing going on.  I did some extensive research on the web to see if I could find anybody else mentioning vision problems and have failed to find any such info.  Got any ideas?  I'm all eyes! ... ears.  I have no allergies and there aren't any air leaks.  I sleep like a log with the cpap on my back.  My eyes aren't red.  I take no medications.


ResMed Escape S8 (12cm)
with Humidaire 3i
& Mirage Swift II Nasal Pillows
12cm

chokes wrote:

I've been using cpap for about a week now.  Every morning since I started using it, I've been waking up with puffy, baggy and glassy eyes.  This lasts all day.  On top of that, my vision has become blurry and gotten worse each day since starting the cpap.  I feel a bit dingy centered around my eyes/sinuses/brain.  My jaw is pushed out each morning so that I don't bite correctly. ie. my lower teeth are forward of my upper teeth.  My inner ear pressure is at about 1000 ft below sea level (I live at sea level).  I'm forced to believe that the cpap pressure is providing a side effect that is somewhat disconserting.  I have to admit that I am sleeping like a log.  A month or so ago I started to use the cpap and it interupted my sleep so much that I stopped using it.  The problem was that every time I moved, the hose would tug on the nasal pillows and wake me up.  My nose got raw from the motion.  A week ago I came across one of these cpap chat areas and learned of that little strap that holds the hose up by the side of my head.  Wow, what a difference.  My nose is no longer irritated, but, I'm having this jaw thing and this vision/dingy thing going on.  I did some extensive research on the web to see if I could find anybody else mentioning vision problems and have failed to find any such info.  Got any ideas?  I'm all eyes! ... ears.  I have no allergies and there aren't any air leaks.  I sleep like a log with the cpap on my back.  My eyes aren't red.  I take no medications.

Hello chokes!

When you talk about your pressure in your “Inner ear” – I think you mean your middle ear?

There is a connection between your nose / throat and your middle ear – called “The Eustachian Tube”. This tube opens and closes automatically to equalize the pressure in your middle ear.

But if you not have an extremely open Eustachian tube (some few people have a permanent open Eustachian tube), the CPAP pressure can’t open the Eustachian tube. To open the Eustachian tube you need a pressure about 45 mmHG. CPAP pressure of 20 cm (H2O) is only about 14 mmHG. So this pressure CAN’T DO ANYTHING TO YOU EARS.

Can you make a Valsalva maneuver (popping the ears)? You can use this technique to equalize the pressure in your ears.

I think you maybe should have a look on your wrong bite. There is a muscle from your jaw to your middle ear. With a wrong bite this muscle can affect your middle ear and give you pain in the ear (feel like pressure). You also can get sinuses pain and migraine pain. I don’t know if it can affect your eyes, but I think that sinuses pain can affect your vision.

I had the same problem when I started my treatment with CPAP. I think it was an instinctive reaction to avoid leak from my mouth.  I solved this problem with a little NTI device. You can also try a full face mask, but in my case it didn't work before I got my wrong bite solved.

You can read about this device at this link:

(commercial link removed per posting policy)

You need a dentist to make this device.

For me this device solved my problems within a week, and today I only use it a few times a year.

About your vision problems. I know that apneas can affect your vision. Take a look of this link:

http://www.entoday.com/pt/re/entoday/fulltext.01265117-200706000-00011.htm;jsessionid=L3YSfvqfNJLtCQmGdbm22FSqpVGLzpvgJTgnnG3SfS2F2ZJVrGrz!-937178386!181195629!8091!-1?index=1&database=ppvovft&results=1&count=10&searchid=1&nav=search

But in that case you should have had the problems also before your treatment with CPAP.

Henning