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A-Fib and Sleep Apnea: At-Home Testing Approved by FDA
Many patients with Atrial Fibrillation also suffer with obstructive sleep apnea (OSA). Diagnosis of OSA and its treatment is essential if you have A-Fib.
What is OSA?
If you have sleep apnea, relaxation of throat muscles combine with a narrowed airway to interrupt breathing. The episodes of breathing cessation can last more than twenty seconds (reducing oxygen to the brain).
Nearly 22 million Americans suffer from sleep apnea, and more than half of cases go undiagnosed.
In-Lab Testing
To determine if you have obstructive sleep apnea (OSA), you must be tested.
Conventional testing for sleep apnea has been done at a sleep lab at a medical center or facility. You have a dozen or so electrical sensors attached to your body. You then try to sleep in a hospital-like environment. The people doing the testing may interrupt you during the night. At the end of the testing (at 6 am), you don’t feel rested at all.
At-Home Testing for Sleep Apnea Approved by the FDA
Home testing was FDA approved in 2022 and available by prescription.
A home sleep apnea test is an overnight, unattended study performed in the comfort of your own home. You pick up the kit or it is mailed to you.
While not as detailed as an in-clinic sleep study (it only measures breathing, not actual sleep), at-home sleep apnea testing can be used to diagnose or monitor obstructive sleep apnea (OSA).
At-home sleep apnea tests are best suited for people who are suspected of having moderate to severe sleep apnea that isn’t complicated by other disorders.
Home testing is available by doctor prescription. There are some testing companies who offer their own physicians to evaluate your test results. (If you don’t have a prescription, I wonder if the cost is covered by the patient’s health insurance.)
Home Testing Not for Everyone
For those with a more severe sleep apnea, an in-lab sleep experience may be required to rule out other medical conditions. Unlike a home sleep test, which looks only for sleep apnea, an overnight sleep study checks for conditions like insomnia, restless legs syndrome, periodic limb movements disorder, narcolepsy, and sleepwalking.
Editor’s Comments:
Personal experience: My wife, Patti, has had sleep apnea for years (but not A-Fib). She’s had in-labs testing and last October 2022 had an at-home sleep apnea test. I went by a UCLA facility to pick up the kit for her.
She carefully read the instructions and watched a how-to YouTube video by her healthcare provider. She set it all up and slept through the night quite comfortably (She’s been sleeping with a CPAP (Continuous positive airway pressure) facemask for years.) I returned the kit the next day. The results were then sent to her doctor.
Home-testing option: The at-home testing for Sleep Apnea may be a major advance in treating A-Fib. It may now be much easier, faster, (and perhaps cheaper) to test for Sleep Apnea which is one of the most common causes or symptoms of A-Fib (comorbidity).
Book Review: The AFib Cure by John D. Day and T. Jared Bunch
Review by Steve S. Ryan, PhD
The AFib Cure by Drs Day and Bunch
The AFib Cure: Get off Your Medications, Take Control of your health, and Add Years to Your Life was written by Drs. Day and Bunch for patients with Atrial Fibrillation. The center theme of The AFib Cure is “Food is the best medicine.”
The AFib Cure Focused on Diet
Their list of food prohibitions is more extensive than even by the most fanatical diet gurus. Though the authors acknowledge that this diet doesn’t work well enough. They admit that “about half of our patients can’t reach a drug-free goal (i.e., being A-Fib free) with lifestyle and biomarker optimization (diet) strategies alone.”
An only 50% success rate isn’t acceptable for most Atrial Fibrillation patients, particularly when it comes at such a cost. The authors require superhuman efforts and absolute dedication to their diet.
Food Prohibitions: The AFib Cure diet prohibits a lot. The list includes:
| • Alcohol • Sugar • Flour, Bread, White Rice • Coffee/Caffeine • Stimulants • Marijuana/THC | • Packaged Processed Food • Fast Food • Meat (wild meat OK) • Fish (limited [5] exceptions) • Supplements |
Is Food a Medicine?
How does the AFib Cure diet work to cure A-Fib? The authors fail to show how physically and/or chemically their diet can cure Atrial Fibrillation. As doctors know, food is not a medicine.
Book Review: “Your Complete Guide to AFib” by Percy Morales, MD
Review by Steve S. Ryan, PhD
I received an advance copy of “Your Complete Guide to AFib―The Essential Manual for Every Patient With Atrial Fibrillation” by Dr. Percy Morales and was asked for a review. The opinions given are my own.
Caveat: $149.95 to be Cured of AFib
Abbreviations for Atrial Fibrillation include: AFib, A-Fib and AF.
Dr. Morales’ book encourages readers to sign up for his “takecontroloverafib.com” program at $149.95 a pop. It’s very surprising to see a medical doctor engage in a direct marketing-type sales hustle. His “Guide to Healthy Living” reads like a Tony Robbins motivational presentation but applied to AFib.
[I personally was very discouraged and depressed reading Dr. Morales’ work.]
Style of Dr. Morales’ Book
“Your Complete Guide to AFib” is written by a working Electrophysiologist (EP). It’s a thin book, 119 pages, without a lot of content. But what’s there is clear and based on Dr. Morales’ own experience.
In terms of style, Dr. Morales’ book is a dull read with too many proofreading errors for such a small volume.
Instead of standard footnotes, he cites actual web sites which doesn’t work well. (Website addresses and pages change every day. As a solo source, they are not a reliable one.)
Is There No Cure for AFib?
A major shortcoming of Dr. Morales’ book is he doesn’t acknowledge that AFib can be cured, that you don’t have to live in AFib. This is discouraging and a turn-off for many readers. He isn’t big on hope.
Causes of AFib
Under “Causes of AFib” Dr. Morales doesn’t discuss or acknowledge Lone AFib where people who are perfectly healthy get AFib and don’t have any comorbidities (around 50% of AFib cases, including me) (p. 16). But on page 99 he does acknowledge that, “some younger patients will be diagnosed with AFib where there is no clear cause for it.”
Most people who develop AFib are not sick with other diseases. And even if one is sick with, for example, high blood pressure, we can’t say for sure that high blood pressure “caused” a particular person’s AFib.
Is AFib Your Fault?
Dr. Morales implies that it’s a patient’s fault that they developed AFib, because they let themselves get sick with “comorbidities” which brought on their AFib (p. 16). … Continue reading this book review..->
Copy of FAQs Coping with A-Fib: Pacemaker for Too Slow a Heart?
FAQs Coping with A-Fib: Pacemaker
“Now my doctor says I need a pacemaker, because my heart rate is too slow and because I’m developing pauses.
I’m an athlete with A-Fib and have a naturally slow heart rate. Since I developed A-Fib, I was put on atenolol (a beta blocker) which really slows down my heart rate. What should I do?”
Get a second opinion. It’s crazy to go through the risks and lifestyle disruptions of having a pacemaker implanted just to be able to continue taking atenolol.
Because you are an athlete, your heart rate is naturally slow. But it’s normal for you.
As long as you feel fine and aren’t fainting from lack of blood flow, don’t be talked into getting a pacemaker. A slow or even very slow heart rate usually doesn’t cause any harm. As for heart rates, “normal” is indeed a wide swath.
In the words of Dr. John Mandrola:
“Do not implant pacemakers in patients with nonsymptomatic bradycardia (slow heart rate).The same holds for pauses, though they are certainly of more concern than a slow heart rate. Nonsymptomatic slow heart rate or pauses don’t justify exposing patients to the risks of implanting a pacemaker.”
Do not implant pacemakers in patients with nonsymptomatic bradycardia. This includes the wide spectrum of sinus node dysfunction (SND), asymptomatic pauses in patients with permanent AF, and young patients with medication-induced bradycardia. Humans exhibit tremendous variation of heart rate, and impressively slow heart rates frequently cause patients no harm. As for heart rates, ”normal” is indeed a wide swath. Unlike the more sinister high-degree AV block, SND is not immediately fatal. In 2012, there exist many strategies for the treatment of arrhythmia that do not include exposing patients to the risks of implanting a permanent intravascular device.
Back to FAQs: Coping with Your A-Fib
Last updated: Wednesday, August 26, 2020
Update->FAQs Coping with A-Fib Stroke: What Your Family Should Learn Now
FAQs Coping with A-Fib: Stroke Action Plan
“In case I have an A-Fib-related stroke, what does my family need to know to help me? (I’m already on a blood thinner.) What can I do to improve my odds of surviving it?
Stroke is the most dreaded effect of having A-Fib. And an A-Fib-related stroke is usually worse because the clots tends to be larger. They often result in death or permanent disability.
Here are some basic facts and steps you and your family can take to prepare for and what to do if stroke strikes any member of your family.
Prepare Your Plan: The 4 Steps
For your own and your family’s peace of mind, you need to create a ‘Stroke Action Plan’.
Step 1: Learn the Signs of a Stroke
Make it a family affair. Discuss the most common signs of stroke: sudden weakness of the face, arm or leg, most often on one side of the body. Stroke may be associated with a headache, or may be completely painless. Each person may have different stroke warning signs.
Step 2―Ask Your Doctor
Discuss with your doctor what actions to take in case of stroke. For example, some doctors recommend aspirin to help avoid a second ischemic stroke (A-Fib). If so, ask what dosage.
Step 3―Locate Your Nearest ‘Certified Stroke Center’
Why a Certified Stroke Center? If a stroke victim gets to a Certified Stroke Center within four hours, there is a good chance specialists can dissolve the clot without any lasting damage.
A certified or ‘Advanced Comprehensive Stroke Center’ is typically the largest and best-equipped hospital in a given geographical area that can treat any kind of stroke or stroke complication.
A Certified Stroke Center will have drugs such as Tissue Plasminogen Activator (tPA) to dissolve the clot. Can use Clopidogrel or acetylsalicylic acid (ASA) to stop platelets from clumping together to form clots. Or use anticoagulants to keep existing blood clots from getting larger.
So do your homework. To find the nearest certified or ‘Advanced Comprehensive Stroke Center’ check these listings:
• Find A Certified U.S. Stroke Center Near You/NPR News
• Find a Certified Comprehensive Stroke Center
Step 4―Post Your ‘Stroke Action Plan’
Write up the three components of your plan (i.e., the signs of stroke, aspirin dosage and location of the nearest Certified Stroke Center).
Also, print handouts with the name and address of the nearest Certified Stroke Center (Advanced Comprehensive Stroke Center) for EMS responders. Keep a bottle of aspirin nearby.
Store your ‘Stroke Action Plan’ in a special binder or post so that family can easily find the information.
If a Stroke Strikes: Work the Plan
1. Immediately call your emergency medical services (EMS)―even if the person having the stroke doesn’t want you to. (e.g., 911 in US and Canada, 0000 in Australia, 999 in the UK.)
Note: DO NOT try to diagnose the problem by yourself, and DO NOT wait to see if the symptoms go away on their own.
2. While waiting for EMS, administer aspirin in the proper dosage (if advised by your doctor beforehand) to help avoid a second stroke.
Note: The emergency operator might connect you to a hospital that gives you instructions based on symptoms.
3. When EMS arrives, tell them to take the patient to your nearest Certified Stroke Center (give them a handout with the name and address).
Note: If necessary, be firm, insist they go to your choice of Certified Stroke Center. (Realize that some paramedics and ambulance services have side deals with hospitals to take patients to their hospitals, even if it’s not the right hospital for stroke victims.)
The Wrap Up
A ‘Stroke Action Plan’ with specific steps is reassuring during a medical emergency and helps everyone stay calm. Your family will be confident they’re supporting you in taking the right action at the right time.
Know that quickly going to a certified or ‘Advanced Comprehensive Stroke Center’ may save you from the debilitating effects of an A-Fib stroke, or even death.
For additional reading, see Ablation Reduces Stroke Risk to that of a Normal Person.
Back to FAQs: Coping with Your A-Fib
Last updated: Wednesday, August 26, 2020
A-Fib Impacts Quality of Life for the Spouse and Family of Patients
Research verifies that the loved ones living with someone in Atrial Fibrillation may be about as stressed as actually having the condition.
In one study the partners of A-Fib patients reported a significant reduction in their quality of life, to the same degree as the patient. (Note: Most severely impaired was a couple’s sex life.)
Educate the Family, Not Just the Patient
One simple solution might be to make sure the spouse comes to office visits, particularly during the early visits around the time of diagnosis, says Dr. Bruce A. Koplan of Brigham and Women’s Hospital in Boston.
Educational programs and other interventions to eliminate some of the unknowns may relieve the anxiety for the patient and their partner leading to improved quality of life for both.
Get all Your Loved Ones Involved
One of the most frequently asked questions I get is from the patient’s partner: “What can I do for my spouse during an A-Fib attack?”
Perhaps, just as important, A-Fib patients should be asking “How can I help my family cope with the stress and anxiety of my Atrial Fibrillation?”
A Momentary Pause: When I talk with an A-Fib patient, I always ask how their spouse or partner is doing―how they are coping. This often elicits a momentarily pause while the patient stops and ponders the impact of A-Fib on their family.
My best advice to patients is to get all your loved ones involved! Knowledge is empowering and reduces stress and anxiety.
Talk with them, answer their questions. To help you, download my free report, “Top 10 Questions Families Ask about Atrial Fibrillation”.
Be Confident & Stay Calm
In addition, for your family’s peace of mind, learn Why & How to Create Your ‘A-Fib Episode Action Plan’. During an A-Fib attack, an A-Fib Action Plan with specific steps is reassuring and helps everyone stay calm. Your family will be confident they’re supporting you in taking the right action at the right time.
Discuss your A-Fib Action Plan with your loved ones and answer their questions. Post a copy in a prominent place where your family can find it easily.
Knowledge Empowers, Reduces Stress and Anxiety
New Research into Alcohol & A-Fib: How Many Drinks are Too Many?
by Steve S. Ryan, PhD, 2017, Last updated: March 2019
While moderate amounts of alcohol appear protective for the ‘plumbing,’ or blood supply to the heart muscle, the benefits of alcohol do not extend to the electrical parts of the heart, or heartbeat.”
Over time, drinking may actually change the electrical signals, triggering irregular heartbeat (arrhythmias).
Risk per Daily Alcohol Drink
A new study found the risk of atrial fibrillation grew by 8 percent for each daily alcoholic drink. The findings were similar for men and women. The authors looked at previous studies that tracked almost 900,000 people over 12 years.
Fibrosis: The study doesn’t establish a direct cause-and-effect relationship. Nevertheless, “cell damage from habitual drinking may lead to small amounts of fibrous tissue within the heart that causes the irregular, quivering heartbeat”, the study authors said.
Post-catheter ablation: The review found that people who continue to drink are more likely to have ongoing irregular heartbeats even after catheter ablation.
Weekly Alcohol Recommendation
Dr. Pater Kistler recommended that those with irregular heartbeat “should probably drink no more than one alcoholic drink per day with two alcohol-free days a week.”
He added they had no randomized data that tells what a ‘safe’ amount is to consume. The study authors called for more research to determine whether avoiding alcohol completely is required for patients who have irregular heartbeats.
New Study Recommends Complete Abstinence If You Have A-Fib
Participants consuming at least 10 standard drinks per week were randomized to abstinence or usual consumption. Abstinence prolonged A-Fib-free survival by 37% and lowered A-Fib burden from 8.2% to 5.6%. Those in the abstinence arm also experienced improved symptom severity, weight loss, and BP control.
Know Your Triggers
Some Atrial Fibrillation patients have sworn off alcohol altogether. Through trial and error, they’ve found that any amount of alcohol contributes to or triggers their A-Fib episodes.
Dr. Kistler’s research is helpful for the balance of A-Fib patients. It offers some research-based guidelines to minimize the impact of alcohol consumption on their A-Fib.
For additional reading, see my article:“Holiday Heart”: Binging Alcohol, Marijuana & Rich Foods.
But once you are A-Fib free as by a catheter ablation, moderate alcohol consumption may not be a problem or induce A-Fib.
It Takes Time to Find the Right Treatment Plan for You: Learn all Your Options
A-Fib begets A-Fib. The longer you have A-Fib, the greater the risk of your A-Fib episodes becoming more frequent and longer, often leading to continuous A-Fib. (However, some people never progress to more serious A-Fib stages.)
Most Atrial Fibrillation patients should look beyond the typical antiarrhythmic drug therapy. These drugs don’t cure A-Fib but merely keep it at bay. According to Drs. Irina Savelieva and John Camm of St. George’s University of London:
“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”
Educate Yourself: Learn All Your Options
A-Fib is not a “one-size fits all” type of disease. You need a personalized treatment plan. To begin, first educate yourself about Atrial Fibrillation, and then review all your treatment options. See Overview of A-Fib, Find the Right Doctor for You and Treatments for Atrial Fibrillation. A-Fib treatments include both short-term and long-term approaches aimed at controlling or eliminating the abnormal heart rhythm associated with A-Fib.
Next, you can move on to the guidelines we’ve posted: Which of the A-Fib Treatment Options is Best for Me? You are then prepared to discuss these treatment options with your doctor. Keep in mind, this should be a ‘team effort’, a decision you and your doctor will make together.
Build a Support System: We Can Help
You are not alone. Many, many others with A-Fib have been where you are now and are ready to share their experiences and insights.
Our A-Fib Support Volunteers: Having someone you can turn to for advice, emotional support, and a sense of hope that you can be cured, may bring you peace of mind. Our support volunteers offer you one-to-one support through exchanging emails and sharing their stories. To learn more, go to our page A-Fib.com’s A-Fib Support Volunteers.
Positive Thoughts/Prayer Group: At A-Fib.com we believe in healing through hope, belief, prayer and in the power of positive thoughts. To learn more about our group and how to send in your request, go to our A-Fib.com Positive Thoughts/Prayer Group.
Build Your A-Fib Treatment Plan: Know All Your Options
Stop Panic Attacks, Use the THOUGHTARREST Technique by Janco Vorster
Janco Vorster is a blogger who shares his heart arrhythmia journey at My Afib Heart. Diagnosed at age 24, he had his first anxiety attack a couple years later. Fear was his closest companion for a while. He writes, “Then as if sent from above I went to see a psychiatrist. He helped me to understand that I cannot be in control all the time.”
In his post, When Panic And Anxiety Wants to Take Over Your World, Janco describes his method for dealing with the anxiety that often accompanies Atrial Fibrillation. He writes that his THOUGHTARREST technique has not only helped him with his panic attacks, but its use and understanding has had a big impact in his life.
THOUGHTARREST
Stop Panic! Arrest Your Thoughts
1. DO NOT DENY OR SUPPRESS IT
Look deep into what you are really fearing in the thought or symptoms you are experiencing. Dismantle the thought.
2. WRITE IT DOWN, OR TALK ABOUT IT.
When you write down your thought you “capture” it. Write down how bad it is or was. Don’t sugarcoat it!
3. WRITE DOWN A “BETTER” STATEMENT.
If you get thoughts of “I cannot breathe” rather write down “I feel as if I cannot breathe but I am.”
4. UNMASK AND EXPOSE THE FALSE THOUGHT.
Now that you have your panic attack or anxiety thought pinned down on paper you can expose it as false, and relax.
About Janco Vorster: He was born with Tetralogy of Fallot (TOF), a birth defect that affects normal blood flow through the heart. After surgery as a child, his TOF (and an enlarged right atria), made him susceptible to heart arrhythmia. His A-Fib was diagnosed at age 24. After numerous cardioversions over several years, he had an ablation (followed by some intermittent episodes afterwards). He lives in South Africa and has been A-Fib free for several years. His blog is My Afib Heart.
Read the Janco Vorster post, “4 Steps Before You Do a THOUGHTARREST” at My Afib Heart. It’s based on a mixture of CPT (Cognitive Processing Therapy), CBT (Cognitive Behavioral Therapy) and his own experience with panic attacks.
Atrial Fibrillation Patients: Guide on How to Get Started with Yoga
In our article, FAQs about Natural Therapies: Yoga and A-Fib, Dr. Dhanunjaya Lakkireddy describes his research with A-Fib patients and how yoga provides a powerful connection between mind and body. “It affects heart rhythm through its significant influence on the [nervous system].” It improves symptoms and arrhythmia burden, reduces anxiety and depression, and improves quality of life (QoL).”
Yoga can be adjusted to any level or intensity. Just start slowly! It doesn’t need much equipment: a mat to prevent slipping and provide padding and perhaps a folded blanket, when needed, to support your knees.
Dr. Lakkireddy cautions that yoga isn’t a substitute for medical treatment, but it can be a good adjunct.
Beginner’s Yoga Guide for A-Fib Patients
We found a great article, Yoga for Atrial Fibrillation, on EverydayHealth.com that offers a beginner’s yoga guide for A-Fib patients.
To get you started, they include directions for seven simple poses each with an illustration. Here’s an example of the instructions:
Yoga for Atrial Fibrillation: Table Pose
This pose helps you warm up and is a starting position for other yoga moves. How to do it:
1. Come to the floor on your hands and knees. Bring the knees hip-width apart, with feet directly behind the knees. Bring palms directly under the shoulders with fingers facing forward.
2. Look down between the palms and allow the back to be flat. Press into the palms to drop the shoulders slightly away from the ears. Press tailbone toward the back wall and the crown of the head toward the front wall to lengthen spine.
3. Breathe deeply and hold for 1-3 breaths.
Special considerations: Place a blanket under the knees to protect them from pressure and stress. Make fists with your hands to reduce pressure on the wrists. Avoid this pose if you’ve had recent or chronic knee or hip injury or inflammation.
For the other six poses and to read the entire article, go to Yoga for Atrial Fibrillation at EverydayHealth.com. According to YogaBasics.com: “By concentrating on your breathing and being present in the poses, you’ll feel the benefits immediately.”
For Atrial Fibrillation patients, yoga can be an effective complementary therapy and a part of your A-Fib treatment plan. Also see our article, FAQs about Natural Therapies: Yoga and A-Fib.
Always consult your doctor before starting a yoga exercise program. For example, if you have high blood pressure, you may need to avoid yoga poses in which your head and heart are lower than the rest of your body, such as the Downward-Facing Dog.Anatomy of Hatha Yoga: A Manual for Students, Teachers, and Practitioners
by H. David Coulter, PhD
