DEAR DR. GOTT: Over the years, I’ve been amazed at what I’ve learned from your column. I’m hoping you can teach me something now.
My husband was diagnosed with sleep apnea and has been using a CPAP machine for nearly four years. A year and a half ago a physical showed his blood pressure to be 173-90 and he was prescribed amlodipine. At this time he also had a follow-up sleep study and as a result the pressure setting was reduced.
Over a month ago he suddenly stopped taking the amlodipine. He forgot to take it one evening and was amazed at how much more focus and energy he had the next day. He now takes his blood pressure every morning and for the first few weeks it was fairly consistent, although still high – in the 130s-140s with diastolic numbers in 80s and 90s – not appreciably different than readings he had previously gotten on the medication.
After several weeks it began to climb back and has had several readings in the 170s again with diastolic numbers in the low 100s. After any such high reading he’ll wait five minutes and take it again. It typically shows 20 points lower, so he dismisses it. He is refusing to go back on medication because of how fuzzy and unfocused it made him feel.
Now he’s blaming the CPAP for the high blood pressure because while he did certainly have sleep apnea, he didn’t have the high blood pressure prior to using the machine. He also does not fall into the slow, deep breathing pattern typically associated with restorative sleep.
In talking with friends we’ve uncovered several other men who’ve stopped taking blood pressure medicines because they don’t like the side effects. We don’t know anyone else with a CPAP and I haven’t been able to locate anything on line that suggest such a correlation. In fact, it seems to be just the reverse.
My husband is 48, 6’1” and currently weighs 245 pounds. Once he stopped the medication, he began working out regularly because he now “feels like it”. He won’t try another medication because when he asked the PA at his last appointment, he was told they all react pretty much the same way.
I’m alarmed, not only for my husband, but for the other men we now know are refusing to take medication because of bothersome side effects. I readily agree that my husband is suddenly more energetic and clear-headed than he was when taking the medicine but must I choose between this “happy husband” and a lethargic one that may live longer? Could the CPAP be keeping his blood pressure higher? The out-of-pocket expenses for the test are pretty high but does he need to do another sleep study? Weight is obviously a factor in both diagnoses but not the only cause in either case. Thank you for any light you can shed on this.
DEAR READER: Your husband is playing a dangerous game with his health. Uncontrolled high blood pressure increases the risk of heart attack, stroke, and other cardiovascular problems.
There are three types of sleep apnea — central, obstructive and complex. Central sleep apnea occurs when the brain fails to send proper signals to the muscles that control breathing. Obstructive sleep apnea, the most common of the three, occurs when the muscles at the back of the throat relax and block airflow. Complex sleep apnea is a combination of central and obstructive. Because obstructive sleep apnea (OSA) is the most common form, this is the type I will discuss.
There are several risk factors associated with developing OSA, including the use of alcohol, tranquilizers, sedatives, smoking, being male, being 65 or older, having high blood pressure, prolonged sitting, a narrowed airway, being overweight, and having a neck circumference of 17 inches or more.
Symptoms include loud snoring, morning headache, difficulty staying asleep, excessive daytime sleepiness, awakening with a dry mouth or sore throat, having observed episodes of breathing cessation during sleep (by a partner or during a sleep study), and waking abruptly with shortness of breath (a condition that more commonly occurs with central sleep apnea).
Complications of untreated sleep apnea can be serious, even potentially fatal. These include daytime fatigue, various cardiovascular problems such as stroke, atrial fibrillation, congestive heart failure and high blood pressure, and from sleep medications or general anesthesia. In those with a pre-existing heart condition, repeated episodes of low blood oxygen may increase the risk of sudden death from a cardiac event.
Those diagnosed should avoid alcohol, sedatives or tranquilizers and lose any excess weight they may have. Beyond that, treatment consists of breathing masks, most commonly the CPAP (continuous positive airway pressure); but there are several variations including the BiPAP (bilevel positive airway pressure) and others. Some individuals may prefer to use oral appliances which typically force the lower jaw out to tighten the throat muscles. In some instances, surgical removal of excess tissue in the throat may be recommended, but, as with other surgeries, should only be considered as a last resort.
As I stated above, sleep apnea can lead to hypertension. If your husband’s sleep apnea wasn’t being adequately controlled, it may have lead to his high blood pressure. After four years of using the CPAP I doubt that this is the issue. Also, to the best of my knowledge, CPAP machines do not cause high blood pressure, and in fact, often reduces numbers once the sleep apnea is appropriately controlled.
Your husband owes it to himself to make some lifestyle changes and at least try some other anti-hypertensive drugs. He should lose weight, reduce his sodium intake, exercise daily, and reduce his cholesterol/fat intake as a precaution. Amlodipine is a calcium channel blocker, so he might try another class of drugs such as beta blockers, thiazide diuretics, ACE inhibitors, angiotension II receptor blockers and others.
I don’t agree with his physician’s assistant (PA). Many individuals who cannot tolerate one class of drug, can tolerate a different class. Perhaps the combined lowest dosage of two or, even three, classes may be beneficial. He’s taking unnecessary risks with his health. I suggest you show him my article and express your concerns. At the very least, urge him to speak with his doctor to discuss his concerns.
Readers who are interested in learning more can order my Health Reports “Sleep/Wake Disorders” and “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.
