Tuesday, February 10, 2009

The Connection Between MVP, MVPS, and Sleep Apnea

To date, there appears to have been very little research into this connection. Yet, I believe these conditions are related more than statistical luck would suggest. Perhaps future studies will support this hypothesis. In the meantime, I would like to present the idea for your consideration, in the hopes that we might prevent further coincidence of these 3 costly diseases.

The connection between MVP and MVPS has been discussed in many places, this blog included. But I believe that each of these conditions has a direct relationship to sleep apnea, and more generally, sleep disturbances.

Sleep apnea refers to the condition in which you stop breathing in your sleep, usually due to a temporary collapse of the wind pipe. After many seconds or a minute, your brain notices the resulting oxygen debt, and shocks your heart with adrenaline. You awaken, gasp for air, and settle back to sleep. In the longrun, if untreated, stroke, cardiac arrythmia, or heart attack may ensue. Fortunately, there are a wide variety of treatments available. (In my case, I had a tonsillectomy to widen my airway, and use an auto CPAP to breathe better at night. As added protection, if I can't bring my auto CPAP with me, I keep a portable pulse oximeter wired to my finger, which blasts an alarm if my blood oxygen drops below a programmable threshold. Trust me, it was worth every penny.) Unfortunately, sufferers may go many years without diagnosis, as the only obvious symptom is fatigue, which can be caused by almost anything. From my own experience, I can confidently assert that apnea episodes become worse when I'm most exhausted. I can't explain why, other than, perhaps, the brain takes longer to send an awakening adrenaline spike when required, leaving me hypoxic for longer.

How MVP Influences Sleep Apnea


How could a leaky heart valve possibly relate to a collapsing trachea? Bear with me...

Here's what happens: MVP sufferers, as we know only too well, experience palpitations from time to time. These palpitations depend on the degree of valve malformation, as well as diet and exercise. They are easy to sense while lying in bed, as their vibrations reflect off of the mattress, and back into our bodies. It's as if someone were constantly tapping us on the chest while we're trying to sleep. It's not painful. But it is annoying, or even frightening in some cases.

As a result, we stay awake for hours, struggling to ignore the signal. And occasionally, a PVC will strike, startling us with momentary disorientation, often resulting in an adrenaline spike -- if not a panic attack -- which is hardly conducive to sleep. Meanwhile, we're getting increasingly exhausted.

Of course, the next work day won't cut us any slack. We still have to wake up at the same time in the morning. So after a bad night of flakey heart beats, we're ready to drop. Our exhaustion level may culminate in terrible apnea episodes for the reasons I suggested above. If you're lucky enough not to have apnea, you will still no doubt suffer from chronic exhaustion. Granted, pretty much every disease in the book can cause exhaustion. But if you're staying awake at night, trying to ignore your heart beat, it's not helping the situation.

I've tried meditation; I'm not good enough to make it effective to ignore the beats. Besides sleep aids, which are inadvisable because they harm the liver and invite bad apnea episodes, only a CPAP seems to work. But if you don't have apnea, I'm not sure if a CPAP would help you (or if you could even obtain one legally). I wish I had a better answer for you, apart from eating right, keeping in shape, and using safe doses of magnesium glycinate to treat the worst spells.



How Sleep Apnea Influences MVP


I alluded to this in my Intro article. Adrenaline spikes blast the cardiovascular system into action, rather like flooring the accelerator of your car. Just as racecar behavior isn't good for the longevity of your engine, I can hardly imagine that constant adrenalization is good for your heart valve (not to mention the rest of your body).

Sleep apnea results in massive adrenaline spikes because, frankly, we might well die of hypoxia without them. While this keeps suffers from dying in the shortterm, it threatens them with stroke and other problems in the longterm. And with respect to MVP, it most definitely increases the hydrodynamic pressure on the valve, rather like rapidly squeezing the water out of a balloon.

As far as I can tell, standard MVP advice is to avoid lifting heavy weights. (They never did tell me what "heavy" meant, but I get the general idea.) The reason for this, it seems to me, is that heavy lifting produces high pressure on the valve. Since the valve in MVP sufferers is already damaged, and abnormally flexible (due to the associated connective tissue abnormality), it is more likely to suffer damage than in a normal person, on account of the pressure induced by heavy lifting.

In this sense, a massive adrenaline spike is equivalent to heavy lifting: it spikes the blood pressure into the stratosphere, and thereby, over time, damages the valve.

As the valve worsens, more palpitations and PVCs occur. This in turn exacerbates the apnea, by the process described above. It's a viscious circle!



How MVPS Influences Sleep Apnea (and Sleep Quality, Generally)


This one is obvious: MVPS suffers are, if nothing else, hyperresponsive to adrenergic stimuli. In other words, if the phone rings, we leap from our chairs in terror, only to realize a few seconds later that the adrenaline spike was unjustifiable.

Since light and sound are adrenergic stimuli, we are easily awakened by nighttime sounds, or the morning sun cracking through the blinds. As a result, we awaken easily. This results in greater fatigue, which as I mentioned above, is a perfect storm for sleep apnea.

One remedy is to do like me, and wear blinders and ear plugs during sleep. Just be aware that some blinders do not "breathe" like cotton because they contain waterproof fabrics inside. In particular, avoid "airplane" blinders. In this case, they may cause your eyes and frontal brain to heat up, resulting in yet more discomfort. A strip of cotton cut from an old T-shirt might make a much more thermally conductive blindfold. Ear plugs are great to, but be sure you can hear your alarm through them. They also obviously need to be replaced every so-often for sanitary reasons. And most definitely, dry your ears with tissue paper before inserting them, in order to avoid harboring bacteria.

Finally, being an MVPS sufferer makes me hypersensitive to heat and cold. I frequently pull up the blankets at night because I'm too cold to sleep. In the morning, I awaken, sweating from the accumulated heat. This is a stress on the heart, but it's difficult to correct. The best I can do is to (1) turn the air conditioner or heater on half and hour before bed to stabilize the bedroom temperature and (2) keep multiple thin layers of blankets, so that I can precisely adjust the temperature throughout the night by adding or removing one at a time.



How Sleep Apnea Influences MVPS


This is perhaps the most disturbing interaction of all. But I've lived through it, so I can attest this interaction most precisely.

As I mentioned, sleep apnea involves periods of hypoxia in sleep. One awakens, gasping for air. (There is also another condition, known as sleep paralysis, which can result in the perception of hypoxia, and even gasping for air, when in fact no hypoxia occurs. This is one reason for the failure to properly diagnose sleep apnea. As I have both conditions -- more paralysis in the past, more apnea now -- you can imagine the test hell I went through, while the doctors played football with the data.) After suffering thousands of apnea bouts, I became deeply aware of the problem at some subconscious level. I got a few panic attacks just by feeling the sensation of my throat closing. The sensation may well have been real. It can be caused, for instance, by an allergic reaction to certain foods. (At the time, I was a walnut binger, but did not know that I was allergic to the skins.) The throat closure never resulted in any significant breathing impedance. It did, however, trigger some visceral memory of apnea episodes, immediately manifesting in a panic attack on these occasions. After all, if you get the sensation that you're being strangled, I assure you that your brain stem will get to work immediately to free you. But when you're not actually being strangled, a panic attack can result.



As a result of the above correlations, I would recommend that all MVP and MVPS sufferers get sleep studies to check for apnea and other sleep disturbances, and conversely that sleep apnea sufferers get echocardiograms to check for valve pathology.

I should caution that sleep studies are hopelessly flawed, in that we all have widely varying sleep quality, whereas these expensive ($2500) tests occur on a single night. Therefore, I always tried to create bad sleep conditions before the study, in order to make my problems obvious in the data. I told my doctor this, so that he would be aware that he is looking at a worst case, and not a typical one. Specifically, I would eat and sleep like a typical American the night and day before: I'd stay up late the night before, drinking caffeinated soda (to utterly ruin my sleep quality). The next day, I'd have pizza with lots of cheese (to create PVCs and sustain my excessive blood sugar level). Then, I'd go out for a run in the evening, to create lots of inflammation and rev my metabolism just before I need to go to sleep.

At one point, my preparations worked so well that I could not sleep at all during the study. They concluded that my failure to sleep was due to my inability to use a CPAP (which was incorrect, and subsequently cost me 2 years of bad sleep in the absence of such). However, thankfully, my doctor concluded (correctly) that I had a horrible case of sleep apnea, and dragged me into the operating room. The surgery brought me back from near-comatose to merely "dazed and confused". At this point, I'm only "tired". One day, I hope to fully awaken again. Until then, I hope I can help a few other people through this blog.

Anyhow, I would bet big money that there's more of a correlation than chance would dictate, among these diseases. Please consider this before you repeat my years of painful ignorance.

3 comments:

  1. I'm a 50 year old female. Is there any connection to several of these: I have diabetis type 2, seems like some kind of seizures in my sleep, have stopped breathing in my sleep, snore, have Asthma, have a mitral valve prolapse, fallen bladder, urinate constantly, always thirsty, drink so much my legs swell, feel like I've had multiple mini strokes and mini heart attacks. The Spokane VA Hosp doesn't do enough tests on me. My heart races, but the docs can't catch it on a monitor. My heart races when it wants to. My blood pressure gets high. I have to take Atenolol and Ativan.

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  2. I have another thought about how sleep apnea may contribute to MVP, when your air way closes and you try to inhale, you create a vacuum and that vacuum may "stretch" the heart creating a potential for a leak.

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  3. I am a medical resident on cardiology and I also wrote a few words about mitral valve prolapse.

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