Tag Archives: Sleep Apnea

HEART ARRYTHMIAS: “ATRIAL FIBRILLATION” (afIB)

The normal adult heart beats almost as regularly as a metronome, between 60 and 100 beats per minute. I say ALMOST, because when you let your breath out, the VAGUS nerve slows the normal heart slightly.

This is called Sinus Arrhythmia; SINUS because the electrical signal for the heart to contract originates in the usual place, the SINUS NODE.

ARRYTHMIA refers to the irregularity of the beat. Normally, the sinus node originates the electrical impulse, automatically generating the rhythm. The impulse spreads in an organized fashion throughout the Atria causing them to contract and send the collected blood to the ventricles.

Atrial Fibrillation | cdc.gov

The AV node is then activated, and after a slight delay, to allow the ventricles to fill, the impulse spreads to the Ventricles, causing them to contract, The heart is designed to be most efficient above 50 beats per minute, and below about 120. The rate is higher in the young and athletic. Athletes often have an efficient resting pulse in the 40s.

The arrhythmias usually cause the heart to beat too FAST. The most common arrhythmia is ATRIAL FIBRILLATION. In this condition, the upper chambers, the Atria, do not beat in a coordinated manner. The sinus node no longer regularly originates the electrical impulse because the electrical activity is continuously traveling in a disorganized way throughout the upper chambers in a self-propagating manner.

This quivering of the Atria allows the blood to pool in an area called the Atrial Appendages. This stagnant, pooled blood tends to clot, particularly if there is inflammation already present in the heart from vessel damage, obesity, or simply old age.

These CLOTS may find their way into the systemic circulation, and cause a STROKE. Another symptom of Atrial fibrillation is related to the irregular beats, which creates the sensation of PALPITATIONS, which causes you to be AWARE of your heart beating, and can be disturbing.

ATRIAL FLUTTER, and SUPRAVENTRICULAR TACHYCARDIA are other Arrhythmias. Some conditions cause the heart rate to be too SLOW. SICK SINUS SYNDROME is when the sinus node, the PACEMAKER, becomes more and more disordered, sometimes causing the heart to slow excessively, and produce FAINTING, sometimes producing a rapid heart rate.

Atrial Fibrillation Compared to Normal Conduction Useful graphic ...

Heart block is where the signal from the atria don’t reach the ventricles properly, sometimes not at all. The unsignaled ventricles still beat, but more slowly by an intrinsic, “idioventricular” rhythm.

My own experiences with ATRIAL FIBRILLATION will illustrate the problem and it’s treatment. A RAPID HEART BEAT was my introduction into arrhythmias. The rate was 140, and the EKG showed ATRIAL FLUTTER.

My Doctor gave me some PROPAFENONE to attempt a “chemical conversion” but it didn’t work, and i was given a CARDIOVERSION in the ER. The Arrhythmia returned in the form of ATRIAL FIBRILLATION within a couple of weeks. Back to the ER, and another cardioversion.

I was given propafenone, but that didn’t hold me much longer. A RADIOFREQUENCY ABLATION, where the focal points of aberrant electrical activation were isolated kept me in SINUS RHYTHM for a couple of years.

When the Fibrillation returned, Propafenone worked for a while, after which another Ablation, more propafenone, bood level regulation of propafenone to peak at night ( I invariably started fibrillation at night) and so on. With periodic trips to the ER for Cardioversion, I got by for a Decade.

Finally, when regulating the Propafenone couldn’t hold me in Sinus Rhythm longer than a month, I gave up, let myself go on fibrillating, and started taking ELEQUIS to PREVENT EMBOLI AND STROKE. Back when I first started fibrillating I had 2 main reasons for wanting to return to sinus rhythm..

First, I wanted to avoid ANTICOAGULANTS, which initially meant WARFARIN, and regular blood checks. At least, when I finally resigned myself to Fibrillation, Eliquis was available.

The second reason was to avoid medications, including beta blockers,which would be necessary to keep my heart rate in the acceptable range, 80 or below. By the time I gave up on controlling the AF, my rate was in the 70s, going down into the 50s, even while fibrillating.

This good fortune may have been caused another mild heart aberration I had all along, a Partial BUNDLE BRANCH BLOCK, which slowed down the electrical signals to my ventricles. Sometimes you get lucky, and 2 “wrongs” sometimes DO make a “right”. But don’t count on it.

Keep yourself as healthy as possible. Atrial fibrillation is more common with obesity and heart disease. SLEEP APNEA is also a cause, and should be ruled out if you develop Atrial fibrillation. I had a Sleep study, which showed that I had Sleep Apnea, which will be a story i will tell later.

–DR. C

STUDY: “FRAGMENTED SLEEP” INCREASES INFLAMMATION & HARDENING OF THE ARTERIES

From UC Berkeley (June 4, 2020):

UC Berkeley Logo

“We’ve discovered that fragmented sleep is associated with a unique pathway — chronic circulating inflammation throughout the blood stream — which, in turn, is linked to higher amounts of plaques in coronary arteries,” said study senior author Matthew Walker, a UC Berkeley professor of psychology and neuroscience.

Disrupted nightly sleep and clogged arteries tend to sneak up on us as we age. And while both disorders may seem unrelated, a new UC Berkeley study helps explain why they are, in fact, pathologically intertwined.

Some tips to improve sleep quality

  • Maintain a regular sleep routine, going to bed and waking up at the same time each day.
  • As part of a nightly wind-down routine, avoid viewing computer, smartphone and TV screens in the last hour before bedtime, and keep phones and other digital devices out of the bedroom.
  • Engage in some form of physical exercise during the day.
  • Get exposure to natural daylight, especially in the first half of the day.
  • Avoid stimulants, like caffeine, and sedatives, like alcohol, later in the day.

UC Berkeley sleep scientists have begun to reveal what it is about fragmented nightly sleep that leads to the fatty arterial plaque buildup known as atherosclerosis that can result in fatal heart disease.

Read full article

COMMENTARY

“How much sleep do we need”, and “Sleep Hygine” were past topics on this site, and my own sleep fragmentation was mentioned. This study correlates sleep fragmentation in the elderly with increased blood vessel disease compared to elderly people who have no interruptions in their sleep.

The elderly have several obstacles to a good, full night’s sleep, although a fair number of my friends claim the blessings of sleeping soundly. As we get older, we lose the deepest sleep we enjoyed as children, and there is some loss of REM sleep as well. The elderly sleep more lightly.

Diseases begin to accumulate as we get older, and These DISORDERS and their TREATMENT can disrupt sleep. I mentioned My BPH with it’s blockage of flow, leading to incomplete emptying of my bladder. This led to FREQUENT URINATION and frequent arousal at night.

With aging, the tissues in the throat become more flabby, and if you SLEEP on your BACK, your inhalation may be blocked. This may result in OBSTRUCTIVE SLEEP APNEA, where your breathing  and sleep are interrupted repeatedly. The associated SNORING may interrupt the sleep of your partner, or even the sleep of those in the next room.

GERD, where you choke on regurgitated stomach contents, is more common in the elderly.

Chronic Heart, lung and Kidney disease can interfere with sleep.
SLEEP DEPRIVATION leads to a variety of problems, such as the inflammation and Arterial blockage highlighted in the above article.

Sleep is intimately connected with DIET and EXERCISE. As one of the PILLARS of HEALTH,  It s well worth discussing with your Doctor and following her instructions.

—Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #2: NASAL CONGESTION

Chronic nasal congestion, the constant condition of not being able to breathe through your nose, can be a major problem, interferes with sleep (often via sleep apnea), undermining one of the 4 pillars of health (sleep, diet, exercise and intellectual stimulation). Well, maybe a second one as well, since it is hard to function intellectually when you are sleepy all the time.

Chronic nasal congestion in kids is often due to allergy and associated ADENOID (located at the back of the throat) ENLARGEMENT. Adenoids can cause sleep apnea and pulmonary hypertension, ear infections and sinusitis.

If left untreated, the bones of the face don’t grow properly, and the constricted bony structures can lead to later problems. Nasal polyps can be a factor in nasal airflow blockage, and their removal may benefit the blockage.

If associated with sinusitis and aspirin (aspirin is rarely used in children anymore because if Reyes’ Syndrome) sensitivity, the combination is known as “sampters’ triad. Regrowth of the polyps is common and aspirin desensitization may be helpful.

ALLERGIC RHINITIS is treated by avoidance, medication and desensitization. SINUSITIS can cause chronic nasal blockage. Both medical and surgical treatments are useful.

One-sided nasal blockage raises a red flag. One of my young patients had pushed a rock into his nose, which I then removed. Nasal polyps can be on one side, and can be removed, NASAL SEPTAL DEVIATION can cause one-sided nasal blockage, and if severe can be surgically corrected.

The nasal tissues are “erectile tissues” I have a nasal septal deviation to my left side. I SLEEP ON MY SIDE to CONTROL my SLEEP APNEA (more when I get to that subject, which certainly qualifies as a chronic problem), When I sleep on my right side, I don’t breathe as well since my “good side” is down and becomes study.

Those lucky people who breathe freely on both sides, and who sleep on their sides, may possibly be aware that the DOWN SIDE (my good side, above) blocks up. It seems that the nasal tissues are “erectile tissues” body wants to REST one side at a time, and the down side is easier, since gravity pools the blood there.

Nasal tissues are under the control of the autonomic nervous system, decongest (nasal passages are open) with the alarm (fight or flight, “sympathetic”) reaction, and do the opposite (tissues congest, nasal passages close) when the “parasympathetic” takes over after a meal, when you are “vegetating”. in front of the TV