I had another echocardiogram Tuesday, after my blood pressure went screaming up to 189/90 on Monday (don't know why - weight is down, exercise up), along with some other stuff. So, I went to the Doc on an "urgent" basis on Monday, and he ordered an EKG, an ECG, plus one more BP med.

He called me Tues pm with the ECG results - I am still in Atrial Fibrillation, but the heart itself is "strong." However, the blood pressure in my lungs is a bit too high, which might be caused by my general high systemic BP, or by sleep apnea.

I really don't believe I have sleep apnea, but am quite willing to go through the test (how I will ever sleep, I don't have a clue), as if this is part of the problem it is solvable.

Just finished a 5 mile walk, BP is now down, and I felt pretty energetic today. See the doc on Wed next for further course of action. Have found a doc in CO who was in the initial trial of cryogenic ablation, and knows how to do it, but have yet to make contact.

My cardiologist thinks this may be the way to go.

Scary as that is, it's probably not that big a deal. I went into fib 15 years ago, at age 44. At the time I was running 40-60 miles a week, and my times increased literally overnight from 6:30-7 minute miles to 8:30-9. I went through all the tests, tried electrical cardioversion, but wound up solidly in fib, where I've been ever since.
I'd been a casual cyclist anyway, gradually phasing out of running (which I loved) because of sore knees. The slower times (unavoidable) frustrated me, so I switched completely to cycling, where I had no personal records to compare.
You do have to be a little careful with the Coumadin, but it doesn't cause any major problems. I've done everything I want, including several centuries, without any trouble at all. I'm able to keep up with most casual riders my age--I'm certainly not fast, but I wasn't fast before, either, and I'm not the last 50-something person up the hill. This shouldn't wreck your life.

Thanks for your several responses and encouragement.

I appreciate them.

I am a great believer in medication. I take Plavix and a beta blocker myself, and once you get used to staying away from sharp objects, you have it made. I have a resting heart rate of between 50-60, and that's cool unless you sit for too long, then you have a tendency to fall asleep. :D

The up side is that on even the most strenuous rides my heart rate will never go over about 140, which is verboten for me anyway.

They are doing another "trial" under the FDA of cryogenic ablation in March. I have an appointment with Dr. Christopher Cole in Colorado Springs, CO, February 2nd for evaluation for the trial, and have been tentatively placed on the list as a trial participant.

It involves placing a catheter in the pulmonary vein and freezing the offending tissue causing the fibrillation. The great advantages of the cryogenic technique are that,

1. rather than freeze the tissue, they can cool it to see the effect on your fibrillation from each area they cool before finally freezing the tissue. The cooling is totaly reversible; and

2. the catheter will stay exactly in place where they want it because of the freezing

3. it causes almost no scarring, which is a major problem with the older radiofrequency (heat) methodology. The scarring can lead to blood clotting with potential strokes.

Dr. Cole was formerly with the renowned Cleveland Clinic, and was one of three MD's in the US to conduct the original Cryo study this last year.

Yes, as a matter of fact when I was in cardiac rehab they told me to expect that. Eventually your pressure will get lower and stay there.

Next step is evaluation for sleep apnea. Great big correlation between SA and AFib!
http://www.healthday.com/view.cfm?id=520060

Saw the sleep doc today, and I likely have sleep apnea along with AFib. He
looked in my throat and said it is a very narrow opening with an enlarged
uvula (Gosh, I love wiring that word - u v u l a - just sounds a bit strange).
And I have some other symptoms.

Doc said there is a possibility that treating the SA will lower my pulmonary
hypertension along with my hypertension, and may help in reversing the AFib.
I can only hope!

So, why do I wake up energetic, bicycle 20 miles (yesterday) or walk 3-5
miles (today), and feel full of aliveness all day?

Doesn't make sense. People with Sleep Apnea and AFib are supposed to be tired and falling asleep, sluggish, etc!

Anyway, I go to the laboratory for my night of not sleeping for my apnea
study on January 2nd!

Any advice as to how to sleep that night? I am generally a pretty "wired"
type of guy - this will likely push me over the edge and I will be tossing
all night long with all those wires attached. I already plan on getting lots of exercise that morning and eating "regularly." Of course, I am already off of all caffeine, chocolate, alcohol, etc.

For the sleep test you will be wired all over--chest, head, upper lip, finger (O2 sensor), legs, and probably more. I had a thick bundle of wires running down my pajama leg. Because of all the wiring, you will probably leave the sleep test feeling as though you did not sleep much at all, but you will have slept enough. Is your test a split session--4 hours looking for apnea and 4 hours on a cpap if apnea is present, or do you have 8 hours in study and then another session if apnea is present?

You can have apnea and wake up feeling rested. Only the most severe cases would cause you to be exhausted all the time. A friend swears he doesn't feel any different after going on cpap, but his family swears he's much easier to live with. I didn't have the test until I could no longer stay awake, so I felt better after 4 hours on cpap. After a couple weeks I felt wonderful. I did learn in my reading that apnea has a direct and sometimes dangerous effect on the heart.

Do yourself a favor and research cpap machines before your test. You want some information about the different brands and models before a doctor writes you a prescription for one. I would recommend insisting on a heated humidifier unit. Everything I read before I got my cpap suggested that the unheated humidifiers were ineffective. Of course, the doctor wrote a prescription for an unheated one, and I had to make a few phone calls to get him to change it.

Google apnea and cpap, and you will find hundreds of sites. There are a few forums and many on-line cpap merchants. If your doctor prescribes a cpap, your insurance my connect you with a local medical equipment supplier that carries just one brand, and probably just one model of that brand. As far as I can tell, the differences among machines involve how quiet they are and how humidifiers connect to them. Most offer a ramp setting that starts you off with a lower pressure and gradually increases it to your prescribed level. Some have integrated humidifers, and some use free-standing units. I use a Respironics machine with an integrated humidifier.

The most difficult thing about using a cpap is getting used to the mask and the air pressure. The sleep lab should have different kinds of masks you can try. The air pressure is kind of like the wind you get if you stick your head out a car window at highway speeds. You will get used to it.

I also learned in my research that surgery is ineffective at treating apnea. It does work for very few people, but it recovery is supposed to be long and painful. It's just not a good option, especially considering that cpap is highly effective and has no known harmful effects.

When you travel you have to carry your cpap with you. The machine will come with a carry bag. You don't want to check it--you won't want to check it, anyway. I have had no problem taking mine through airport security. They have become relatively ubiquitous. Camping with a cpap is a little difficult because you either have to camp in a site with electricity, or you have to carry a deep cycle battery and the hardware to connect it to the machine. I've camped a couple time in sites with electricity.

Cpap was inadvertently invented in Australia by a group of researchers who were trying to see if apnea could be treated by using air pressure to strengthen the muscles around the airway. They devised air pumps and fashioned masks for their subjects. After a significantly long study, they concluded that the muscles could not be strengthened in this way, so they ended the study. Their subjects insisted that they be allowed to keep the air pumps because they were sleeping well with them. These early cpap machines were so noisy that users would keep them in closets and run the flexible air hose through the door or a wall. Machines today are whisper quiet.

Thanks for the comprehensive response.

I believe that the length of the test will depend upon the results - i.e., if I sleep well the 1st half, then I will be awakened or whatever for some CPap trials. If not, I am scheduled for 8 hours of testing.


My sleep doc seems pretty tuned in to all that you have mentioned, except that he did not mention the option of losing weight and sleeping on the left side. What is your experience with that approach?

No camping for me, thank you! Not any more.

Side note:

The sleep doc easily discerned that my uvula was enlarged.

I had a complete physical in July. Why wasn't it noticed at that time? Seems to me this should be a standard screen, especially for older men with hypertension.

My experience with doctors is that they do not go looking for anything you don't tell them about. Losing weight is supposed to help reduce the number of episodes of apnea, but it probably does not eliminate it.

The uvula is not the sole cause of apnea. I understand that surgical treatment involves lopping off some of the uvula, removing tonsils, and trimming tissue around the uvula. The right amount of trimming may correct apnea in only a few patients, but too much trimming can cause problems that (I'm just extrapolating here) may involve sneezing raisins out the nose, or grapes, chunks of steak, chicken bones...

While an enlarged uvula may not be the only cause of SA. it ought to be a red flag for the physician to ask more questions and check further. Indeed, SA (estimated at 18 million in the USA) ought to be a part of the screen on a physical. And how would one know to mention it to a physician if one did not know they had it?

BTW - BP right now 104/65 :D

Thanks! I really appreciate your kind thoughts!

If you can doze off they can usually tell within an hour or so what degree of SA you have. I waited 'til the last scheduled appointment and then it took about 1/2 hour or so to wire me for the test. They came in after an hour and said, "we're going to start the adjustments on the pressure until you go into REM." I had the most restful sleep that I can remember. I only got four hours that night, but I was RESTED.

My wife says I don't sleep as loudly (no, I don't wear it every night) on my left side. When I wear the cpap (90% of the time) I find it more difficult to breathe when I lie on my right side - something I do not notice when I don't wear the mask. (My wife then wakes me completely with a shot to the ribs and tells me to put on the mask)

I, too, recommend the humidifed unit. If you can sleep in a room that is 65 to 68 degrees, you shouldn't need the heater. Any colder and it would really help to have a heated unit.

Best of luck falling asleep. Make a note that they really don't like you waking up and holding your breath. They get really excited about that for some reason;-)

A Night from Hell!

Okay, last night I went in with a pretty positive attitude for my Sleep Apnea/Disorders study.

Here are some givens:

1. I am the parent of a son born in 1967 with profound mental *********** with a magnitude of perceptual problems that made sleeping (and even living at times) a severe challenge (even flicking a light switch would awaken him), and having stayed up most of the night for several years back then and I was in a constant state of sleep deprivation;

2. Then, my oldest son was totally paralyzed (C-4;C-5) from the neck down in a sports accident in 1986 and I spent years with him helping to rehab him, train aides, stay up all night at times - he is now a successful married lawyer, having graduated from Stanford Law School as the president of his class - but more sleep deprivation;

3. Then (in 1998) having my son (the one born in 1967) fall out of bed and break his back at L-5, having an operation, and staying with him in the rehab hospital practically full-time for three months, and then working with him daily at rehab activities until he could walk again in another year;

4. Over the years I have fought tremendous battles for the proper programs for both sons (i.e., intensive battles with Vocational Rehabilitation for both sons, school system, community agencies, legislatures, etc.)

5. Quitting my career and starting and running a unique program for Andy and others - non-profit, fund-raising, staff, all the stuff, including the extreme tensions of my company being sued for a minor injury to one of our clients.

6. Teaching in a really tough middle school the past four years, with the last year having an absolutely crazy principal.

7. And a whole bunch more of crap.

Anyway, I hope you get the picture. Sleep, and achieving sleep have become real issues for my wife and myself.

We have devised a number of techniques to assist in our attaining sleep, which include:

1. We never answer the phone after 8:00 pm.

2. We do not watch stimulating or horror events on TV - nothing about disabilities, murder, etc., especially after 8:00 pm. (which means there is not a lot for us to watch)

3. We are extremely regular in our pre-sleep routines - my wife always goes to bed at 10:00 pm, and I go to sleep in my big chair at about 10:35, and then transfer to the bed about midnight (well, it works for me), and always get up at 5:30-6:00 am.

4. We get prodigious amounts of exercise, and, in fact, are addicted to exercise, and can't sleep until we have that exercise.

5. And a variety of other techniques which we have devised over the years to protect ourselves from sleep deprivation and to get adequate rest.

And, it has worked pretty well the past several years.

So, all of this brings us to the sleep study last night. During the early part of the day I had walked 6 miles to get my proper exercise.

1. Arrive at the office at 8:45 pm, escorted by the technician to the office where two of us were assigned separate "bedrooms."

2. Immediately told by the technician that I would be there for a "split night" study - this was a surprise to me, I had not been told this earlier.

3. This caused an immediate reaction for me of: "Good Lord, I HAVE to get my sleep done early so that I will have time for the 2nd half of the study, how I do on the CPAP mask." This, tension, of course, had the exact opposite effect - which was to make me even more anxious about sleeping, and the net result was that sleep was nearly impossible.

4. All the time I was being "hooked up" to the machines, I was being "educated" about sleep disorders, CPAP machines, etc., all at bout 9:30 - 10:00 pm, which is my normal "relaxing" time. I also "practiced" the CPAP machine while the other patient was getting "hooked up."

5. The room was hot. I am used to sleeping in a cold room (about 60F) and it was at least 70. There was no way to get it colder. I burned up all night.

6. The TV did not work.

7. So, there I finally am, with 22 leads hooked to all parts of my body, and two extremely tight chest straps, and now the tech say "Good night," closes the door, and I am supposed to go to sleep lying on my back (I never go to sleep on my back), all the while thinking that I HAVE to sleep so that I can do the 2nd part of the study.

8. Every time you go potty, you have to wave your hand (which makes some kind of something on the computer screen) and yell out as loud as possible, "Hello, hello." Then you get unhooked, wires wrapped around your wrist, and carrying a little junction box and dragging wires, you go to the bathroom.

9. Meantime, you have been told that the sensors on your leg are to detect is you kick your legs a lot, and, subconsciously, you are desperately trying to hold your legs perfectly still so that you don't fail that part of the test, also! I kept wondering what the computer screen looked like for all the sensors attached to me.

10. You are not allowed any watch or clock, so you have no clue about the passing of time. About two hours into the "sleep" (of which there has been none) I needed to go potty, waved my hand and yelled "Hello" several times. The tech comes in and says to me, "Having a little trouble relaxing?" Hey, that helped a lot! So, I got through the "potty routine" and went back to bed, where I was supposed to do "relaxing, cleansing breathing."

11. Finally, I guess I slept a bit, as the tech came in and informed me that we would now begin the 2nd part of the test. I was fitted with a CPAP mask, TIGHTLY on my face with straps around the back of my head. By now, my right ear lobe was hurting like heck from the probe attached to the ear lobe, and I couldn't rest on my right side, which is my normal way of sleeping.

12. So, this mask really became uncomfortable. The tech kept coming in and said. "You are grinding your teeth" and similar things, and that I should relax, as if it was my fault. Also, the probes kept coming off of the back of my head, and that again was implied that I had been taking them off. To my knowledge, I never touched my head, but, hey, who knows?

13. My jaw started hurting terribly (it still does) from the pressure of the mask and my response to that pressure. I think I slept a few minutes along the way.

Finally, I yelled out "Hello, hello" again and waved my arm. The tech came in and said I needed to relax more (how am I supposed to do that?) and I stated "I won't be able to sleep any more, so we might as well stop trying." Well, come to find out, it was 5:30 am anyway, and the test was finished.

The tech said that perhaps I needed to come back once more with a "sleeping aid" - she had previously been upset that I had taken a prescribed Restoril before sleeping - am I ever looking forward to that! I got dressed, met my wife, and we went to McDonald's for breakfast and I went home and really slept.

I am supposed to get the results from the MD on Friday. I can hardly wait!

Interestingly, when I first read this thread recently, I read it out of interest. I had had ocassions of arrythmias in the past, but without a change in the heart rate. I had the gold standard, nuclear stress test, and was found to be clean and green by the cardiologist. I had not suffered any but the most transient arrythmia for the last three years.

I am 64, in great shape, with a resting pulse of 44. I can often beat the young studs in the end-of-ride or mid ride sprints, and do a lot of the pulling.

I was sitting in Johnny Rockets the other day having a dinner quite unusual for me. A big chocolate shake and two hamburgers. BTW, I am 5' 11", 154 pounds, with a 30 inch waist. Suddenly, my heart started not only a pattern of arrythmia, but was beating about 150 bpm. After about an hour of this, my fiance insisted that we go to the emergency room. My heart beat stayed in the 130's with the arrythmia. They were about to medicate me through an IV, but the physician left for awhile. I was getting depressed, because not only did I have a great ride planned in the morning, but I was going in for a professional bike fitting in the afternoon. I did not want to be admitted. Finally, my heart rate started coming down, and when the doctor returned, I was showing 62, and my triathlete fiance was clicking along in the 80's :) .

They released me. Told me not to have caffeine, alcohol or chocolate, and to consult with a cardiologist. Of course the diagnosis was Atrial Fibrillation. The next day, I rode three times, 8am, 1PM, & 5 PM. I finished my highest mileage week, and rode all seven days. I have not had another ocurrence (it happened the evening of December 29). I have my fingers crossed regarding future episodes, because the last thing I want is a beta blocker in that I love to hammer on the bicycle.

From my research, atrial fibriallation is actually more common in athletes. The rationale being that there are more heart cells to get out of sync. Also, apparently 10% of the population over 60 has it.

It depends on where you get your statistics. I see mostly 5-10% over 80 yo?

Yeah, I also got hit out of the blue, thinking I was in such great shape and a real stud!

Yes, it doth sucketh to get these brief looks at our mortality! :mad:

ATTN: RONH DO NOT READ THIS POST!





Saw the doc today, have "moderate" sleep apnea.

Need to go for another "Sleep Study" to determine the amount of air pressure required to overcome the blockage. I think this one will be much easier, as we discussed with the doc about the concerns we had and he was open to changes.

They have new masks which are MUCH less intrusive than the previous monsters. The straps of the one I chose to try come nowhere near my jaw, and I didn't have that intense negative reaction.

It will really be interesting to see if the SA treatment helps with the hypertension and the atrial fibrillation, and if so, will I get a return of my former bicycling energy level?

On an overall basis, I think you will feel better once you get the OSA treated. In terms of your biking stamina I can't help but think it willl help. However, in terms of the atrial fibrillation.......it may always impair your overall cardiac performance. (Remember, you no longer have a coordinated cardiac ejection of blood between your atrium and ventricle and thus it does affect your overall cardiac output physiology during excercise).

ATTN: RONH DO NOT READ THIS POST!



Yes, but I have an appointment for review for a cryogenic ablation. That should make a real difference if the fibrillation can be stopped..

And, interestingly, I have had a recent significant increase in my energy level.

I developed afib at Bike Florida 2002. I was cured of it only eight months later. I went to the Cleveland Clinic for a pulmonary vein isolation (PVI) ablation by Dr. Natale. I spent one night in the hospital and the recuperation time was just a few days. Nowadays, I don't have to take any drugs or worry about taking blood thinners. Most cardiologists will not recommend or even tell you about the various cures for afib. They are not up-to-date or don't want to lose a patient. If afib doesn't affect your quality of life, then live with it if you like, but for me, I didn't want to take drugs or be slowed down by afib. Also, afib is probably one of the biggest contributors to strokes.

There are only a few doctors in the US that have a high success rate in curing afib (80-97% cure rates). Find one of them if you want to be cured; otherwise, you will likely be disappointed. I am happy to have my life back. I am 59 years old and ride centuries, etc., and feel great nowadays. Below are some good websites to check out if you want more information on afib. Interestingly, long-distance cyclist and marthoners are four times more likely to develop afib. Oh, and by the way, for those of who have afib, you already know it is NOT a benign condition like most cardiologist will tell their patients. In most cases, it becomes emotionally and physically draining, not to mention the risk of stroke. Afib may be a benign condition if you are a coach potato and over 80 years old; otherwise, think about taking the risk to be cured! The Cleveland Clinic is one of the very best places to go to be evaluated, treated, and cured. They have a great Atrial Fibrillation Center and do maze surgery or ablations on four or five patients per day with very few failures or problems each month.

http://www.clevelandclinic.org/heart...on/default.htm

Go to the following board to talk to others with afib or who have been cured of it. It hasn't been real active lately, but search the archives for tons of info about other people's experiences:
http://www.mddietofutah.com/maze/index.html

This is a website with some good general info on afib:
http://www.a-fib.com/

Whatever you do, be sure to read all you can about afib before making any decisions on how to treat or cure it. If you go for a maze or ablation, only go with a doctor who will give you detailed statistics on the numbers and results of previous procedures he has performed using exactly the same techique he will you on you! (FYI: I haven't read good things about cryo-ablations). Note: a doctor who does one or two procedures a day is far better than one who only does one a week. Lots of doctors occasionally do ablations - avoid them! Likewise, with the maze.

I hope this helps some of you with afib. I meet people at every big bicycling event I go to that are suffering needlessly with afib. I am thankful to be rid of it.

Very informative! I have saved this post if I need it in the future. So far, I have just had one instance - about 11 days ago. I hope that it was my first and last.

ATTN: RONH DO NOT READ THIS POST!



Thanks so much for the input.

Who paid for your ablation at CC?

My doc is very much up on research and is urging me to go for an ablation.

The doc I will be seeing in February re: cryogenic ablation was with the Cleveland Clinic prior to coming to Colorado.

The docs in my previous health care HMO (Kaiser Permanente) insisted that all I needed for my AFib was to take maintenance doses of beta blocker and live my life at a reduced level. They didn't even want me to see a cardiologist. I refused to accept that "solution" and left, seeking more modern medical care.

Also, there is more and more research linking sleep apnea to AFib and hypertension:

I would strongly urge anyone who has not had a screening or a polysomnograph for sleep apnea (SA) to seriously consider so doing.

Typical symptoms/factors are

Sleepiness during the day, falling asleep
Essential Hypertension
Stop and start snoring
Obesity

Interestingly, I did not have any sleepiness during the day - I awake bright and alert at 5:30-6:00 am, and am "ready to go charging through the day." I did have on and off snoring, amd most definitely had hypertension, which has been hard to control, and which I find the highest when I awake, which is atypical. Your blood pressure is suposed to drop during sleep by about 10 points.

SA causes your heart to work much harder all night long, and there is now a strong correlation between hypertension and atrial fibrillation and SA.

Even though I did not present the typical symptoms, my cardio INSISTED that I have the SA test. I was shown to have 18 SA episodes per hour, but I had up to 40 episodes during REM sleep. Despite the rigors and strain for me of the all night polysomnograph study, treatment for SA may prove to be extremely important in improving my quality and length of life. The sleep doc says that it is likely that treatment of the sleep apnea will reduce my pulmonary hypertension, my essential hypertension and my atrial fibrillation.

So, check it out!