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APAP and Eye Pressure

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ter0624 +0 points · about 3 years ago Original Poster

Several years ago I was diagnosed with OSA. I received a CPAP machine and did not take to it well. My apnea seemed to get better on its own after some time (lost weight) and I stopped using it. I know, bad idea. Fast forward to this year and I took a home sleep study and found that I still do have OSA and should use a CPAP machine.

So, I was fitted with an APAP machine and nasal pillow mask (ResMed). I've had no problems at all adjusting. The mask is comfortable and doesn't get in the way, the APAP pressure is like nothing; only raises I guess when I'm sleeping. Rarely goes past 10. So all is well. However, it appears that I have high eye pressure and glaucoma. It's a bit unusual, likely caused by drusen on my optic nerve (congenital, somewhat benign condition) so my eye pressure isn't bad... right now 13/13 taking drops each night.

However, now I've read that CPAP machines are bad for people with high eye pressure. Ironically, I've also read that OSA can cause glaucoma. So, it's like which poison will hurt me less :-(. One thing I was wondering... is there any recent advice on this and also, if I'm using an APAP machine instead of CPAP am I fine? Kind of scared to use it right now.

All in all I'm about to go on a huge weight loss kick either way.

Thanks.

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Sierra +0 points · about 3 years ago Sleep Patron

I am not a doctor, but I did find an article which explored the relationship of OSA and glaucoma, and they do seem to be highly related. What is not so clear is if one causes the other, or are they just caused by similar factors, such as obesity. I will put a link to the article below, and I have only skimmed it. This is their conclusion:

"OSA is the major risk factor for developing glaucoma. Studies show strong association between OSA and glaucoma. Complete ophthalmic evaluation should be advised at every follow-up for patients with OSA. Glaucoma patients with obesity and progressive VF (visual field) damage even under low eye pressure (NTG) should be evaluated for OSA and other sleep disorders. OSA patients treating with CPAP therapy should undergo regular glaucoma screening and IOP (intraocular pressure) monitoring because CPAP therapy may trigger the glaucoma damage and its progression by raising the IOP."

I would read this to mean that CPAP treatment is not necessarily conflicted by having glaucoma, but that you need regular monitoring to ensure the glaucoma and other eye issues are not worsened. It would seem that a regular at least annual exam by a ophthalmologist would be essential.

Glaucoma and its association with obstructive sleep apnea

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ter0624 +0 points · about 3 years ago Original Poster

Thanks. I have been doing IOP screening every three months. It's been stable for some time, but I just began using the machine. I'll check with the opthamologist and see what he says.

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snuzyQ +0 points · about 3 years ago Sleep Commentator

Hi ter0624 and welcome to the forum.

Your eye pressure, with your drops, is actually in the low normal range. And your CPAP treatment pressures are thankfully on the lower end of things. The 2007 study that got glaucoma patients all frightened over CPAP treatment involved 21 OSA patients being treated with CPAPs at a great variety of treatment pressures. These patients were sleeping in various positions, but all lying flat in bed (the supine position is known to raise IOP - intraocular pressure). The researchers themselves indicated that one couldn't draw firm conclusions from such a limited study and recommended that more research be done with a much larger pool of subjects gathered worldwide. Strangely, no such follow up studies seemed to have happened to date. One must contrast this with the tremendous pool of studies that exist linking OSA to glaucoma. People with untreated OSA are ten times more likely than those without OSA to develop glaucoma over their lifetimes.

Research studies all around the globe have demonstrated the association of OSA with glaucoma. What's really interesting is the finding that this association isn't because of IOP changes or changes in chest pressure. Instead, it's most likely caused by the drop in oxygen levels in the blood, which happens when you stop breathing. Routine low oxygen concentration in the blood may contribute to degradation of the optic nerve - potentially leading to glaucoma. This is the current hypothesis.

Healthcare providers have decided to err on the side of caution. They wholeheartedly recommend CPAP as the first, most effective and least invasive treatment for OSA, but throw in this caveat for those with glaucoma...that they get regular IOP screenings every 3 months and ophthalmic check-ups, which is what your caregivers are doing. I really wouldn't worry about your CPAP causing you any harm. You're going to be followed for that. You're going to be OK.

Weight loss has many benefits, but it's not a "cure" for OSA. OSA is a moving target that usually worsens over time, with the occasional seasonal illnesses and as some other chronic health conditions come home to roost. Deciding that your apnea is better is not a good reason to stop CPAP treatment. I don't think I would stop CPAP unless I had another sleep study that proved my untreated AHI (Apnea/Hypopnea Index) was under 5.

Do you have a copy of your sleep study? If not, by all means go get one. You're entitled to it. Consider getting the Sleepyhead application (available for free online) so that you can review your own sleep data on a daily basis. What you learn will amaze you as you see for yourself how your CPAP treatment "saves" you each night. You'll find out if your mask is leaking too much. You'll be able to troubleshoot, with others here on the forum, how to make your CPAP treatment even better and even more comfortable.

So...have at it, friend...and the sooner the better.

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ter0624 +0 points · about 3 years ago Original Poster

Thanks for the thoughtful and informative response. I'm going to continue to use my APAP machine because I think the benefits far outweigh the risks. I have no issues using it and wake up fine in the morning. As my eye pressure is controlled by drops, which I take without fail each night before sleeping, I think the machine wouldn't add to much to it. Especially as I'm using APAP and the pressure is practically nothing when I fall asleep and wake up. So it isn't continuous but apparently only kicks in during apnea events. I'm tired of being tired in the day, and this machine works!

Oh... also my machine gives me statistics each night on how many events I've had etc. It is scary to think how long I've been living with that. My wife would tell me I'd choke in my sleep sometimes, actual choking for air. A slight increase in IOP is one thing, but oxygen deprivation is far worse!

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Sierra +0 points · about 3 years ago Sleep Patron

You may want to consider talking to your sleep doctor about your condition and ask if the pressure settings on your machine could be set to limit the maximum pressure (lower) and minimum pressure (higher). These machines can be fairly aggressive in trying to stop the very last bit of snoring and flow limitation which may need more pressure than what is needed to address the apnea events. On my wife's machine I limit the pressure for her comfort and allow a bit of snoring (which only the machine hears). On the minimum side if it is increased the fluctuation of pressure during the night can be minimized too. May be helpful for your glaucoma condition. If your doctor does not have access to your data wirelessly, you may want to take out the SD card and bring it with you to the appointment so they can see your detailed data.

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Bigmike52 +0 points · about 3 years ago

I was diagnosed with OSA in November of 2016. My wife has been telling me I had it for 25 years before that. I wish I had listened to her, because I never gave it any thought that OSA could have given me problems with my glaucoma. I know OSA can contribute to Heart disease, Diabetes, and a host of other diseases. I just recently went in for my semi-annual exam and was surprised to learn my pressures shot up from 14 (steady for years) to 17. I'm already blind in my right eye and am extremely worried about losing anymore vision in my left. I appreciate ter0624 question and especially snuzyq's response. I am going to check in with my ophthalmologist today to see what I can do. I am sure the venting and leaks that go into my eyes are not doing me any good.

My advise for all you who want to give up on Cpap therapy? Maybe if I listened to my wife 25 years ago I would have avoided a heart attack in 1996, diabetes in 2002, Triple heart bypass in 2004, A fib in 2010, Cardioversion in 2013, prostate cancer in 2015 (not sure if I can blame that on OSA) and now possibly Glaucoma?

Mike

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SleepDent +0 points · about 3 years ago Sleep Commentator

I am a dentist working in dental sleep medicine. It may be worth reiterating that oral sleep apnea appliances work mechanically and not through air pressure. That is to say, you breathe unpressurized room air in the natural way. Maybe something to consider for those folks with OSA and glaucoma. Arthur B. Luisi, Jr., D.M.D.

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SleepDent +0 points · about 3 years ago Sleep Commentator

Actually, my comments were partially based on the study cited below by Sierra. I probably should have cited it, but hats off to Sierra for doing so. Arthur B. Luisi, Jr., D.M.D.

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BGailDemko140 +0 points · about 3 years ago

CPAP does not negatively impact glaucoma, but your sleep apnea may not be appropriately controlled. Sleep apnea can cause increased internal eye pressure related to changes in blood pressure and other pressure changes inside the skull. Normally this is a type of glaucoma that does not respond to medication. Please speak with your ophthalmologist about this situation and the possibility of sleep apnea causing problems. An oral appliance is not something you should consider, if you are using CPAP every night all night long.

B. Gail Demko, DMD

Sleep Dentist Consultant to MyApnea.Org Assoc. Editor of the Journal of Dental Sleep Medicine Expert Advisor to the FDA on Oral appliance Therapy Past President of the Academy of Dental Sleep Medicine American Board of Dental Sleep Medicine

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Sierra +0 points · about 3 years ago Sleep Patron

Have you reviewed the article at the link below which concluded:

"OSA is the major risk factor for developing glaucoma. Studies show strong association between OSA and glaucoma. Complete ophthalmic evaluation should be advised at every follow-up for patients with OSA. Glaucoma patients with obesity and progressive VF damage even under low eye pressure (NTG) should be evaluated for OSA and other sleep disorders. OSA patients treating with CPAP therapy should undergo regular glaucoma screening and IOP monitoring because CPAP therapy may trigger the glaucoma damage and its progression by raising the IOP."

Glaucoma and its association with obstructive sleep apnea

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