The Confusing Relationship between Blood Pressure and Sleep Apnoea

[@samh6761]

Interesting observation about the air pressure from CPAP potentially increasing blood pressure! In some cases, at least. I still believe it's a life-saving device, but it shows how important it is to get the pressure setting dialed in, not too high, not too low.

[@VikVeerENTSurgeon]

I think it is the CPAP expiratory pressure that is set too high? pushing back on your breathing out i think is the main issue for increasing BP. I think anyone has really done the science on this yet. - thanks for the comment

[@brookbond_vw]

this is an excellent video - I think the hardest part is finding the right people to work and getting access to them. Hope you do some more videos on these topics;

[@jblyon2]

I've been losing weight since I started CPAP (technically APAP since I have an auto adjusting machine). As my weight has decreased my apnea has needed higher pressures to keep it under control. The apnea is caused by a genetic spinal deformity and the excess fat was actually helping to compensate for how the deformity was impacting my airway. It's rampant on one side of the family (the deformity and associated apnea). When I told a previous doctor that I thought I likely had obstructive sleep apnea and wanted a sleep study he told me I couldn't possibly have sleep apnea because my blood pressure wasn't high enough... I've yet to meet a medical professional since then that hasn't had a look of absolute shock on their face when I repeat what that doctor told me!

[@danbance5799]

Thank you. While watching your videos, I often come up with other questions like "why do I only get sleep apnea during REM sleep?" Might make an interesting topic for another video.

[@velvetsound]

Thanks for this it’s helped a lot to understand the complex interactions. My BP got worse and worse as my sleep apnea started and got worse (since May 2020). Had my second trip to the ER with hypertensive crisis last night - this happened while I was trying to get used to my cpap machine for day 7.

[@staceylighton3430]

Thanks Vik, this is such good information and resonates with my own experience. I have noticed that cutting carbs has a beneficial effect on my sleep and you've explained why - cutting carbs (fairly radically) reduces fluid retention and hence probably reduces any sleep apnea.

[@klaracsiki6764]

Cardiologist need to check BP at night, as sleep apnea causes high BP. It's mysterious as daytimd BP is ok and many cardiologists can easily miss the underlying cause.

[@elly535]

Fascinating topic. I discovered by chance that I had severe obstructive sleep apnoea (AHI 43) which unbeknown to me also was cause of (1) dreadful insomnia, (2) GERD and (3) making me visit loo three times a night. But one thing that was always good - low blood pressure. At least during the day. Don't know what was going on at night though! I'm on the list to see you Vic, as do have quite a lot of exhaustion issues despite being an A* pupil. 100% compliant since day one.... should add, Insomnia now rare, GERD gone, sleep through most nights. So although I still have daytime, quite bad, residual tiredness, being on CPAP has been truly life changing.

[@VikVeerENTSurgeon]

So glad that you feel the benefits. It really helps with compliance

[@samfarahani7772]

Research shows sleep apnea as well as alcohol promotes or aggrevates endothelin peptide production. This peptide constricts blood vessels. That is why some sleep apnea sufferres develop resistant hypertension. There is a new drug , just recently approved by FDA, Aprocitentan, which is used for pulmonary hypertension, now can be used for resistant hypertension. I suffer from this nightmare. I look forward to trying that drug.

[@VikVeerENTSurgeon]

I had a big section in the video that i edited out which was explaining why resistant hypertension happens. sadly it seemed too boring watching it back. there are loads of different layers of pathology that seem to play a part. lets hope these drugs are of use - but personally i think fixing the OSA seems more sensible as there is night to night variability and therefore you would need to alter the dose on a daily basis.

[@LaughinLoneStar]

So informative, as per usual, thank you Vik for all you do!

[@VikVeerENTSurgeon]

My pleasure!

[@serenity8145]

I had an NHS sleep study done about 7 years ago, and was put on cpap. Recently my cpap machine was replaced and I just found it difficult to get on with. For some reason, the replacement machine was hopelessley uncomfortable. Mostly in the middle of night I had to take it off, to the point I felt better not using it. Also recently, I had my blood pressure checked and it was very high. After your explanation, I’m thinking perhaps it was due to me not using cpap. Think I’ll have to start using it again.😴 It seems to be a no win situation. 🙃

[@louisestrong1433]

Love this Dr Veer. I’m on two BP tablets. Hopefully will get to see you soon as on the waiting list for London hospital 😊

[@VikVeerENTSurgeon]

Let's see what we can do to sort it out.. thanks for commenting

[@jagsidhu8383]

Great video Dr Veer, I can relate to this after watching this video, I have never suffered from HP but of late it has been so high and I’ve been put on medication. But now it makes sense,

[@VikVeerENTSurgeon]

Glad it was useful!

[@VikVeerENTSurgeon]

Thank you.

[@mikekaraoke]

Very interesting video Vik, thanks for doing it! Regarding you reducing my turbninates been told that will be in late Summer unless a cancellation. When we last spoke we also spoke about my popping/crunching sound in my ears when I yawn/swallow and you said you may do the Eustachian Tube Dilation again as worked for 3 weeks then came back! Also I can hear my pulse in both my ears on/off and is really bothering me-could you please refer me to have an MRI scan of both my ears when I next see you as been going on for a very long time now 🙄 And could be a blockage! Reply when you can, Thanks.

[@timgilpin2774]

15:44 All I would say is it’s “your life in their hands” in the UK we trust and expect our clinicians to be absolutely up to date with the recent research and thinking . I haven’t even been examined by a Dr . Severe sleep apnoea equals CPAP. That’s it - heart arrhythmia, blood pressure , other consequences like CSA are not even part of the equation. I had very modest day time symptoms but because the sleep clinic said it’s CPAP then that’s what I have done .

[@cleonecarter-smith2909]

sadly, I have obstructive sleep apnoea and HBP, am tooo embarrassed, tried to get help so many times, dismal failure. I do not sleep out any where, partner elbows me more times than I can remember, honestly it sounds like I am taking down a forest of timber and partner thinks I am demon possessed. am 66 - no hope.

[@Abdul12_34]

Hopefully I am first again?! An interesting video as always Dr Veer!!

[@VikVeerENTSurgeon]

Yes you are!

[@toneabet6252]

Thanks for the videos Dr. I couldnt seem to find one on vitamins and blood tests you would check. Do you have a video on this?

[@enisagrbesic246]

You are amazing,

[@iDTecKt]

Another very informative video Dr Veer, i really look forward to speaking to you in July about my complex sleep condition and symptoms, a video about the heart and palpitations would be nice, sorry if ive missed it along the way, i feel like im being hung upside down and going to have a heart attack some days after i wake up. Would BIPAP be good if i had upper airway resistance syndrome? my local sleep service is calling me next month to discuss this option, my lung test come back fine but my Doctor has told me my breathing is very shallow regardless, both inhale and exhale, im guessing this is due to narrow airways, or with the mouth a structural issue, narrow palate etc.

[@VikVeerENTSurgeon]

I plan on doing one on atrial fibrillation. Thank you

[@keithharrison1453]

@@VikVeerENTSurgeon Please do.

[@snospmoht3252]

@@VikVeerENTSurgeon Yes please! Looking forward to that. Plus anything on shallow breathers and EDS too.

[@sauvant]

Really interesting video once again. I would be interested Dr Veer if you have any thoughts on people with OSA and insomnia? I’ve been wearing a CPAP for hours every night, but never sleep until hours after I’ve removed it.

[@CruiserZone]

I'd love to hear your thoughts on the effects of OSA/UARS on testosterone in men. From what I understand it's well accepted medically in the States that there is a link between OSA/UARS and low T, with TRT even being offered to OSA sufferers with low T. Conversely, from what I understand, it is not accepted medically at all on this side of the Atlantic that there is a link between OSA and low T however erectile dysfunction and loss of libido are often listed as symptoms of OSA on UK and Irish sites as was the case with my sleep clinic's website. Understanding the importance of sleep for the testosterone cycle it seems to me like common sense that OSA could have a knock-on effect on T levels in some people with OSA. I mentioned this to my GP a year ago or so and she shot it down immediately and told me there was absolutely no link between OSA and low T.

[@VikVeerENTSurgeon]

I'm also doing a video on OSA and fertility. testosterone will be included. look out for it.

[@MrEliavalentini]

I am a non-dipper with increased diurnal diastolic pressure. It took me almost two years to have my GP send me to the pain clinic. I did my first 1-night test at home (of coiurse without EEG) and I am still waiting the results for 6 weeks now. I am hopeless and I wonder if I should do a private consulation for an in depth assessment.

[@ianwakeling4863]

Dr Veer, Many thanks for an interesting topic if at times difficult to follow. I myself have now been using CPAP since 1 Feb this year and believe it is of great benefir to myself, I had an AHI of 50+ when on my back and 19 when on my side. According to my CPAP machine we are now down to a reading of 3. It appears that I have raised BP when done by GP or my consultant but when done at home its within the limits, Query white coat syndrome. The reason for this is to ask if you are aware of any link with raised Triglycerides, BP and sleep apnoea. I had a reading of 4.4mmol/l in January and now after being on Statins it is now 2.02mmol/l but I have notices that my weight has increased since being on statins. Although compared tothis time last year I have a lot more energy. Many thanks

[@VikVeerENTSurgeon]

That's interesting that the statins seem to be helping. i've not heard that before.

[@mariachristinaborges-lutz7157]

I’ve just started (actually 4 days ago) my journey with my CPAP and wonder if my high blood pressure will be better….so far, I am not sleeping better with it, I wake up often, and have a dry mouth as well, what didn’t happen often before…….any suggestions?

[@pepinrdz.]

Disculpa pudo mejorar su anosmia?

[@nurshark10]

What do you think about the new idea of the implantable device. My brother has horrible sleep apnea and couldn’t even keep the mask on for testing. He refuses to wear it at all. Just curious. Thanks.

[@candicorpse9670]

Can sleep apnea cause chronic nightmares? Also, can it cause pvc and pac palpitations? Or at least cause an increase? Ive been having sudden high blood pressure and everyone keeps focusing on my heart but i wake up gasping from nightmares and i cant help but think it could be sleep apnea. I realize i could have 2 separate conditions but i thought it was worth asking. Thanks for your content its very helpful i might show some to my doctor to help me explain my theory. I think they think i just have a panic disorder, but im 38 and never had one before.

[@naju332]

i deal with those issues

[@drdanthelizzyman]

How can Sleep Apnoea increase weight? What's the mechanism? Ultimately it has to affect CICO. Is it indirect - tiredness leads to less activity, more comfort eating?

[@VikVeerENTSurgeon]

I explain it in this video - kzbin.info/www/bejne/qJW1aYaMeMqGgMk

[@Art--Deco]

Just wondering if you can do a video on What do you think about the alternative treatments for OSA like the new medications coming out for sleep apnea, IHL-42X and AD109 or devices like Vivos Therapeutics oral device or the wearable ones that keep your tongue in place? Also wondering what you think about diet and OSA. I have found that the further away my last meal is from going to bed, and the size of that meal dictates on a perfectly sliding scale how good my apnea will be that night. But few people ever talk about the relation of diet and OSA and if there are any studies on it.

[@VikVeerENTSurgeon]

I will do a video on those drugs, but as a spoiler i'm not a fan. i'll do a video on the vivos if there is study which shows that it works.

[@Art--Deco]

@@VikVeerENTSurgeon Thanks

[@ireneang7842]

@Vik Veer - ENT Surgeon Sorry Dr, please reply my another question in the tinnitus video. Many thanks.

[@juliaandrewjuju]

First I was told by my sleep clinic that I had mild OSA 16 months later they told me I had CSA! After a meeting with the nurse I was told I had mixed apnea , obstructive and central. I was told my opiod patches can cause CSA and the nurse thinks that the CPAP is giving me CSA . I’m still on CPAP but I’ve had the air pressure turned down to 4 . Mine is mild but I’m very very tired and wake up shattered. Is that true that CPAP can cause CSA. I was told that the CPAP can be causing me more issues than resolving. The air pressure might be too low to get past the obstruction. ATM I’m being observed by the sleep clinic until I get answers from all the tests you have arranged for me. Is there any link from hypermobilty EDS and sleep apnea. With hypermobility ppl are bendy/stretchty and my epiglottis is very long and touches my uvula when I open my mouth wide. My blood pressure is either normal or low, it’s never high during the day. That’s interesting to learn that BP can go up at night. In the overnight in hospital sleep study would my BP be checked??

[@VikVeerENTSurgeon]

pulse not checked at night - sorry. yes - EDS and sleep apnoea are linked.

[@juliaandrewjuju]

@@VikVeerENTSurgeon I meant, is blood pressure tested during the overnight hospital sleep study not pulse! I Personally I think I have chronic fatigue syndrome, as well as everything else, because when I exert myself I’m totally shattered and it can take a day or so for me to recover, during the time of recovery, I’ve no motivation to do anything. I literally have to force myself to do the smallest of tasks, and I don’t even do that anymore as that just exacerbates the the exhaustion , all I want to do is rest and sleep and when I rest I feel no better initially and it takes me longer of doing nothing to regain a small amount of energy. My memory is mush which I struggle with daily. I have headaches, feel dizzy sometimes.i find it all frustrating as there are tasks that need doing at home and I just have to accept that I can’t do them, and I have to rest and do nothing for a couple of days. After a couple of days with complete rest I feel as if I have a bit more energy, I say only a little it’s not as if I’m brimming with energy!!! If only. So I don’t believe only mild mixed sleep apnea can cause me to feel like I do. Something else is going on. But my gp just plays the blame game. CFS doesn’t come up as there is sleep apnea to blame!! Looking forward to finding out what is going on with me and hopefully find reasons why I’m utterly fatigued. Thank you Mr Veer for your videos, we all learn such a lot from you, which gives us all a lot more knowledge , which can always be a good thing.

[@mariachristinaborges-lutz7157]

How can we know, if we are a dipper or non-dipper?

[@rosemarybirch3655]

Are there other causes for higher blood pressure at night than during the day? - over 200 at 2am and no exciting dreams that i can recall!

[@sandmanjono1239]

Sleep Apnea the gift that keeps giving 🤬🤬🤬😢

[@seattlemarcia2896]

This is so hard to follow!

[@scotam1844]

I agree