In this latest episode of the Afib Podcast, Dr. Steve Ryan of a-fib.com and I discuss the strong connection between sleep apnea and afib, and why it’s so important to have a sleep study if you have atrial fibrillation. Here’s what you’ll learn in this episode:
- 43% of patients with a-fib have sleep apnea.
- Sleep apnea can cause atrial fibrillation
- Skinny people can have sleep apnea
- If you have afib you should have a sleep study
- In-lab sleep studies vs. in-home, or home sleep tests
Travis Van Slooten: Now, I’ve mentioned in previous blog posts on my site and in previous podcasts, about the strong connection between sleep apnea and afib. And, Steve, before we really dive into that topic specifically, and again, the connection between sleep apnea and a-fib, I just want to take a step back, and first talk about sleep apnea in general, for those listening to this that aren’t familiar with it. Because I’m sure everyone’s heard of sleep apnea, but I think, at the end of the day, a lot of people don’t really know what it is. So, with that, Steve, let’s talk about, what is sleep apnea?
Steve Ryan: Yeah, Travis, the technical name is obstructive sleep apnea. Now, what that means is, basically, somehow, the airways are being blocked, when you’re trying to sleep. Your sleep starts, and starts, and you gasp, and… The other one, which we’ll just mention, and then skip over, is central sleep apnea, where the brain is simply not sending signals, the proper signals, for the muscles to control breathing. That’s something we don’t get into very much. Usually, what we have to worry about is obstructive sleep apnea.
Travis Van Slooten: Okay.
Steve Ryan: Now, let me give you an example of what it’s like. My wife has sleep apnea, Patty.
Travis Van Slooten: Oh, she does?
Steve Ryan: Yes. Before she was treated, I’d be sleeping with her, and I’d listen, and she would actually stop breathing. I mean, actually stopped breathing for what seemed like a long time. Then, all of a sudden she’d gasp and start breathing again. And this would go on and on, and this would happen over and over again. And, obviously, she wasn’t sleeping well, and she’d be very sleepy the next day. And, of course, I wasn’t sleeping either, listening to this.
But once she got a CPAP machine, which is simply a medical device, like a breathing apparatus that keeps the airways open, once she started using that, she sleeps like a baby now, and has no more problems. But that’s an example of how sleep apnea can affect you. It disrupts your breathing and your sleeping patterns.
Travis Van Slooten: And for a lot of people that have it, they don’t even probably know they have it, unless they have a sleep partner that is witnessing it. [chuckle] And the other thing is, it’s not just… I think a lot of people have the misconception that it’s all about snoring… It might not be snoring. Like in your case, it sounds like Patty wasn’t snoring. She was literally…
Steve Ryan: Oh, yes, she was.
Travis Van Slooten: Oh, okay, she was snoring too. But the primary symptoms are snoring, and just, like you said, gasping for air. It’s very obvious, if you are sleeping with someone with sleep apnea, and you’re awake, and you witness it, right? It’s pretty obvious.
Steve Ryan: Yes, yes. 43% of patients with afib have sleep apnea. And I’ll tell you, let’s say you’re a guy, and you’re sleeping with your wife, and you get up in the morning, and you’ve got all these bruises on your side. That’s probably because your wife is elbowing you, trying to keep you from snoring. That’s a pretty good sign that you have sleep apnea.
Travis Van Slooten: Yeah.
Steve Ryan: And the good thing about sleep apnea is it’s easily fixed. There’s a number… You can have this mask or you can have these dental devices that can help keep those airways open. It’s relatively easy to fix. Thank God.
Travis Van Slooten: Yeah, absolutely. And you mentioned that the connection, as perfect transition now, into the actual connection here between sleep apnea and afib. Now, you said, what, 43% of people with a-fib have some form of sleep apnea?
Steve Ryan: Yeah. It’s so prevalent, that I went to a a-fib center in Louisville, Kentucky, and I was talking with the doctors there. And then I noticed that when a patient comes in, and they have a-fib, they send ’em down to the next door, and they get a sleep apnea study then and there.
Travis Van Slooten: Oh, wow. Now, that’s…
Steve Ryan: They are so attuned to everyone coming in with a-fib. Most, well, many people who come in with afib have sleep apnea, that they make it part of their center. They won’t treat a patient, unless they go to the center, and have a sleep apnea study done then and there. And a lot of centers will not do a catheter ablation on you, if you have sleep apnea that you don’t take care of.
Why? Because it recurs. It tends to…you tend to have recurrence because you have the same condition that created the atrial fibrillation in the first place is still there. Because basically any time you’re gasping for breath like that, and any time you’re not breathing properly, that’s a tremendous strain on your heart, and on your lungs, and that irritates the pulmonary veins. And that’s what probably brought on the a-fib in the first place, so you really need to take care… If you have sleep apnea, you really need to take care of it.
Travis Van Slooten: So sleep apnea… Are you saying then, that sleep apnea can cause afib?
Steve Ryan: Yes. Yes, indeed.
Travis Van Slooten: Okay.
Steve Ryan: There’s been a study done, where they studied 1,000 patients, so seven different studies. And all these patients were treated with Continuous Positive Airway Pressure, that’s CPAP, which is a mask worn. And CPAP cut the risk of a-fib episodes in half.
Travis Van Slooten: Oh, wow.
Steve Ryan: And people using CPAP were 42% less likely to experience an abnormal heart rhythm, than those not receiving such treatment. Now, we’re not saying that you got to use a CPAP machine. You can maybe change your lifestyle. You could, if you’re overweight, losing that weight would help, quitting smoking. Sometimes, lifestyle choices can get rid of a-fib, but it’s not necessarily… Unfortunately, once afib starts, it’s usually pretty hard to stop without something more radical. But some people, just from eliminating a-fib, are lucky enough that that also gets rid of their… Just by getting rid of their sleep apnea, they also get rid of their a-fib. But don’t bank the farm on that. It’s something that could happen. And it does happen to some people, but more often than not, you need more radical treatments to get rid of the a-fib.
Travis Van Slooten: Absolutely. And so I think the key takeaway here, as far as this connection is, if you have a-fib now, just because you’re a skinny guy or gal doesn’t mean you don’t have sleep apnea. And I made that assumption. I assumed, ’cause I’m not really skinny, and I’m not really obese, or anything either, I’m a normal, average guy weight-wise, but I was like, “There’s no way I have sleep apnea.” And my doctor told me that anybody can get sleep apnea. It’s not necessarily overweight people. Although, that is definitely one of the risk factors, but skinny people can get it as well, right?
Steve Ryan: Yes.
Travis Van Slooten: So, if you’re a skinny guy or gal, and you have a-fib, don’t just assume, if you’re listening to this, that, “Oh, that’s not me. I can’t possibly have sleep apnea.” Yeah, you definitely could, especially if you have a-fib.
Steve Ryan: Yeah. We have a story on our website by Kevin Sullivan, age 46, and he describes what happened to him: “My a-fib seemed to start at night, while I was sleeping. One night, when I woke up, my heart was racing and I felt sweaty. When I asked my doctor about it, he told me that it was unlikely, because I was not overweight and I did not feel tired during the day.” That’s him saying, that’s why he didn’t think he had sleep apnea. “But I went to a sleep lab anyway and it turned out I did have sleep apnea.” And that’s, unfortunately, what happens to a lot of people. Just because you’re thin doesn’t necessarily mean you may not have sleep apnea, or you may not snore, and you may still have sleep apnea.
Travis Van Slooten: Or like you said, that this gentleman wasn’t tired either, which is another common symptom of sleep apnea. Okay, and it’s not common, is it, Steve, for a-fib centers or clinics to automatically have afib people have a sleep study? I mean, we’re not at that point yet, where it’s part of the protocol.
Steve Ryan: We’re getting there, to the point, where most afib centers now, will not even consider you for a catheter ablation, if you don’t have a sleep study, sleep apnea study. Why? Because a-fib tends to recur after an ablation, if you still have sleep apnea. Yeah, a lot of centers still don’t have sleep apnea studies connected with them, but they all are referring people for sleep apnea studies to other centers. So it’s becoming much more… Doctors are much more aware of how important sleep apnea is in a-fib… And they’re making sure that people get treated for it.
Travis Van Slooten: So, if you have a-fib, and your doctor hasn’t suggested or recommended a sleep study, are you saying it’s probably a good idea to demand one?
Steve Ryan: Yes, indeed. And I know there’s an expense involved. If you go to the overnight sleep study, yeah, that’s… We’re talking $1,100 to $2,000. But they have home testing kits now, that do almost as well. For $200, you can get one of these home things and do a sleep study to, at least, get you in the right ball park, where people can figure out whether you actually have something that needs more work.
Travis Van Slooten: Yeah. And with the sleep, or with the home sleep tests, or the in-home sleep tests, are those… And you may not know this, Steve, but are they as reliable as the in-lab sleep studies?
Here’s why I ask, because I had a sleep study a couple of years ago. And my doctor said, “You can have one or the other. You can do the in-lab or you can do the at-home.” And he told me that the unfortunate thing with the in-home studies or tests, is that you get a lot of false positives with them, particularly if you have mild to moderate sleep apnea. He said, “They’re most accurate or they’re most useful, if you have moderate to severe sleep apnea.”
He looked at me, and like I mentioned, I was not overweight. I don’t have a thick neck. These are common things that doctors look at, when they’re assessing if someone may have sleep apnea. So he said, “I don’t think you have sleep apnea. If you do, it’s probably a mild, maybe a moderate form of it.” So he said, “I wouldn’t recommend for you the in-home sleep study because there’s a chance it’ll say you have it, and then we have to do a in-lab to confirm it anyway.” So he said, “You might as well skip it and do the in-lab,” and that’s what I did. Do you know anything about this? Have you heard any other kinds of thoughts on the in-home versus the in-lab, or not?
Steve Ryan: I haven’t read any definitive studies saying one is worse than the other or one doesn’t work. I know there’s a number of different devices out there. And let’s say you get a false positive, big deal, that means that you get it checked out more thoroughly from your doctor, or maybe from going for a home study test.
Travis Van Slooten: Yes.
Steve Ryan: That’s a good thing. There’s two that I know of. One is Itamar Medical’s WatchPAT, P-A-T. This looks like a watch you put on your wrist, and then there’s also something that goes over your index finger, to measure like pulse oximetry, and it detects sleep apnea by measuring volume changes in peripheral arteries. Now, you’re gonna say, “Well, is that the same thing?” No, it isn’t, but it’s an indication.
Another one is the Philips Alice NightOne. And this also is FDA-cleared. You put a belt around your chest, and it has a nasal cannula that you put… It’s a two pronged thing that you put into your nose, and you put it in your nostrils. And you also have a pulse oximeter, which you wear on your finger. There’s many other different HSTs: ARES by Watermark, ResMed, and others. There’s a lot of different things, and the main thing is, $200, you can get a test. Heck, $200 is not that big a deal for most people to determine whether they have sleep apnea.
Travis Van Slooten: Now, do you know what the…sorry, I don’t mean to interrupt you, but with these HSTs, again, we’re talking home sleep tests. Do you have to… You can’t just get those direct, right? Do you still need to get a prescription form? Do you know how it actually logistically works? Do you know?
Steve Ryan: You got me on that. I’d have to…
Travis Van Slooten: Because, well, just the only reason I point it out is because I think, and I could be wrong, I do think you need to have it prescribed, because I was going to do…because remember, when I talked to my doctor, and he said, “You could do the home sleep test?” And I had looked into it at home, because I was looking at some of these devices. And I think on one of the websites, it might’ve been the WatchPAT website, they had mentioned, “You have to have your doctor call it in.”
Steve Ryan: They have a doctor who specializes in this, Dr Joseph Krainin, and he founded singularsleep.com, and he’s like one of the experts on HST. And if you call him, or get in touch with him, I’m certain he can work out whatever you need, to get you hooked up to a HST.
Travis Van Slooten: Oh, perfect.
Travis Van Slooten: Yeah, and the only reason I bring it up, Steve, is just if someone’s listening to this, you may not… It might not be as easy as just going to their website and ordering the device.
Steve Ryan: Right. Exactly.
Travis Van Slooten: And I think you still need to get your doctor involved. But I think, again, this was a couple of years ago, when I was looking into it. I could’ve just called my family doctor and said to him, “Hey, I wanna do this home sleep test, but I need you to call it in.” So it’s not that big of a deal, but it isn’t… You don’t just… It’s not like buying something on Amazon.com. There’s some steps involved.
Steve Ryan: Yeah, right.
Travis Van Slooten: But you’re right, though. For $200 and $300, at the most, you can have the initial test done at home, in the comfort of your home. I went through an in-lab sleep study and it was not fun at all. You’ve got wires all over the place. And I’ll link to my sleep study experience. It’s not painful or anything, but it’s very uncomfortable. So you might actually have a hard time sleeping, which was the case for me. You might actually get a more accurate result, in the sense that, when you’re at your… In the comfort of your own home, in your own bed, you might actually be yourself and sleep better. And so to get a more accurate look, at exactly what goes on when you’re sleeping. So the sleep…
Steve Ryan: It’s more comfortable at home, but even with all those wires and those technicians, they still can get a pretty good reading of whether or not you have sleep apnea. It may sound very… It may feel very uncomfortable, but they still do get good readings…
Travis Van Slooten: Oh, absolutely.
Steve Ryan: In spite of it.
Travis Van Slooten: Yeah, which was the case for me, because I didn’t sleep very well, and I was actually surprised, because when he woke me up, I felt like I didn’t even really sleep. That was the first question I had to him was, “Did I sleep enough for you to get what you needed?” And he said, “Oh, yeah. Yup, we got what we needed.” So yeah, you’re right. The in-lab, it’s like NASA. They’ve got…the technology they have in these labs, they can pick up anything. And so, if you don’t mind going that route, and you have the money, it might be better just to skip the home test, and go right to the in-lab. But, yeah, if you’re tight on money, or you just don’t want to go through that complex of a situation, start with the home sleep test, for sure.
Steve Ryan: Yeah.
Travis Van Slooten: Now, you had mentioned, Steve, earlier, there are some easy ways to treat apnea. What are some of the common treatments, again, for sleep apnea?
Steve Ryan: Well, they have dental appliances that dentists can make for you, to make sure your airways stay open. I’m not saying that that’s gonna be…work for everybody. But it is an option, and it’s certainly a little bit less cumbersome than wearing a CPAP device. And also, there are various CPAP configurations. My wife uses a half one; it just goes over her nostrils. Some people use a full mask that goes over both the nose and the mouth. There’s lots of different variations, and most centers will work with you to find something that’s comfortable for you, that will help you sleep well without being bothered by it.
Travis Van Slooten: And there’s also a third option, and I’ve heard that it’s not a very good option, but there is surgery as well. If you have a real…
Steve Ryan: Oh, yes.
Travis Van Slooten: If you have a really bad form of it, or you just can’t tolerate the CPAP machines, or the dental devices don’t work, surgery is an option, but again, based on my admittedly limited research on it, the success rates of that surgery aren’t that great. But that is also a possibility, because I also… I hear from a lot of people that have sleep apnea, and they just say, “I can’t do the CPAP machines.” And then, I’ll just mention to them, surgery is an option. It’s not something I probably would go for, but that is always an option as well.
Steve Ryan: Yeah. It’s usually considered an option of last resort because they actually go in there, and cut out the muscle or tissue that is blocking the airway.
Travis Van Slooten: Yup.
Steve Ryan: And like you said, it’s major surgery. There’s no doubt about it, it’s major surgery. And it isn’t always as successful as they’d like it to be, but it is an option.
Travis Van Slooten: Yup, yup. Now, and I think you touched on this as well, Steve, but can treating sleep apnea cure a-fib?
Steve Ryan: In some instances, some lucky people can get rid of their afib and have no more… Can get rid of their sleep apnea and be cured of afib.
Travis Van Slooten: Wow.
Steve Ryan: But those people are few and far between, unfortunately. But for some people, getting rid of sleep apnea does cure afib. But, unfortunately, for most people, once a-fib starts, it takes a more radical… Something more radical to get it cured. However, you still need to… Even after you’ve… Let’s say you’ve had a catheter ablation and your a-fib is cured, you still can’t ignore sleep apnea. You still have to keep treating it, keep using the CPAP machine, or whatever device you use. Because if you don’t, that a-fib can recur.
Travis Van Slooten: Well, and not to mention, just the other health issues that might come, as a result of your untreated sleep apnea.
Steve Ryan: Oh, yes.
Travis Van Slooten: Absolutely. Perfect. Any other wrapping thoughts here on this topic?
Steve Ryan: No, I can’t think of anything. Thank you, Travis.
Travis Van Slooten: Alright, Steve, as always, it’s a pleasure and thanks for joining me today.
Steve Ryan: Glad to be here.