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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Fresh Research: CH & Sleep Apnea
        
(Message started by: floridian on Jun 10^th, 2004, 1:38pm)

Title: Fresh Research: CH & Sleep Apnea
Post by floridian on Jun 10^th, 2004, 1:38pm

More research on sleep apnea and cluster headache - further confirmation of a link in many people. This study found 80% of the studied clusterheads had apnea.

A link between apnea and clusters makes sense. Oxygen levels go way down in apnea, and oxygen is a good treatment for clusters. Carbon dioxide, which has shown to be a cluster trigger in some episodics, also goes up in the blood with apnea.

One thing being neglected in the discussion: what causes the apnea? Alot of the research deals with apnea as if it were mechanical - correct it with a dental device, by losing weight to increase airway size, or with a cpap device. If it is caused by something neurological, then the mechanical treatment approach won't help many clusterheads - it will keep the airways open, but won't trigger abdonimal muscles to breath in and out properly. People who have very mild apnea might get some relief. Others, none.

There is evidence that apnea may be due to an imbalance in serotonin receptors: when 5-HT(2) receptors are too active and the 5-HT(1) receptors are not being triggered enough, apnea can result. This points to meds like the 'atypical anti-psychotics' and cluster busters, which can turn down 5-HT(2) activity (olanzapine in the short run, clusterbusters for a longer term).

Quote:

Headache. 2004 Jun;44(6):607-10. Links

Obstructive sleep apnea and cluster headache.

Graff-Radford SB, Newman A.

A patient with cluster headache often wakes from sleep. The relationship to sleep apnea has been described. This study sought to confirm the relationship cluster may have with sleep apnea. Methods.-Thirty-nine consecutive patients diagnosed with episodic cluster headache according to the International Headache Society (IHS) criteria were sent for polysomnographic studies. All patients were in an active phase when they were in the study. Patients were told of the proposed relationship and were allowed to choose a sleep laboratory close to their home. Results.-Thirty-one patients with episodic cluster headache completed an overnight polysomnographic study. Twenty-three were male and eight female. The average age was 51 years (range 33 to 78 years). The average weight was 173 pounds (range 117 to 260 pounds). A total of 80.64% had sleep apnea (25/31). Average respiratory depression index (RDI) was 19.0 (SD 14.6) with 6 patients having no apnea, 10 having mild, 11 having moderate, and 4 having severe apnea (RDI < 5 = none; RDI 5 to 20 mild; RDI 20 to 40 moderate; RDI > 40 severe). Oxygen saturation decreased on average to 88.4% SD 4.5. Sleep efficiency was 76.2% (SD 13.4). Conclusions.-The data closely approximate those of Chervin et al, where 80% had RDI > 5. The relationship sleep apnea has in the perpetuation or precipitation of cluster headache is still to be determined. There are some reports that treatment stops the cluster but there is no prospective study. The high incidence (80.64%) seen in this population suggests the cluster patient should receive a sleep evaluation and perhaps intervention with continuous positive airway pressure (CPAP) or an appropriate dental device.

Quote:

Trends Mol Med. 2003 Dec;9(12):542-8.
Serotonin receptors: guardians of stable breathing.

Richter DW, Manzke T, Wilken B, Ponimaskin E.

Disturbances of breathing arising from failures of the respiratory center are not uncommon. Among them, breath holding and apnea occur most frequently as consequences of pulmonary and cardiac diseases, hypoxia, head trauma, cerebral inflammatory processes, genetic defects, degenerative brain diseases, alcoholism, deep anesthesia and drug overdose. They are often life-threatening and fail to respond to existing pharmacotherapies. After extensive research, there is now a reliable basis for new strategies to treat respiratory disturbances by pharmacological manipulation of intracellular signaling pathways, particularly those involving the serotonin receptor family. Specific activation of these pathways effectively prevails respiratory disturbances and can be extended to treatment of life-threatening respiratory disorders in patients.

Quote:

Am J Respir Med. 2003;2(1):21-9.

Serotonin agonists and antagonists in obstructive sleep apnea: therapeutic potential. Veasey SC.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14720019

Title: Re: Fresh Research: CH & Sleep Apnea
Post by Racer1_NC on Jun 10^th, 2004, 2:42pm

Thanks Floridian......this may answer some of my questions on this subject. I have both conditions....dang it.

Bill

Title: Re: Fresh Research: CH & Sleep Apnea
Post by Rock_Lobster on Jun 10^th, 2004, 9:14pm

Good info... hits home for me. Thx Floridian.

Lobstah

Title: Re: Fresh Research: CH & Sleep Apnea
Post by UN_SOLVED on Jun 10^th, 2004, 10:24pm

on 06/10/04 at 13:38:32, floridian wrote:

More research on sleep apnea and cluster headache - further confirmation of a link in many people. This study found 80% of the studied clusterheads had apnea.

Hey !! I mentioned this same thing awhile back (but couldn't back it up cause 'my doc told me') and I believe there were some non-believers. Thanks for the info ! ;;D

Unsolved <Has sleep apnea>

Title: Re: Fresh Research: CH & Sleep Apnea
Post by Rock_Lobster on Jun 11^th, 2004, 12:15am

I have always believed they were tied together.

I am the lad who sleeps in a lazy-boy, half-upright, with a small pillow behind the neck to keep the airway open.
When in-episode, I pop a pair of pseudophed at bedtime to keep the sinus clear.

Yep, I agree with you 100%.

Title: Re: Fresh Research: CH & Sleep Apnea
Post by forgetfulnot on Jun 11^th, 2004, 12:40am

This all makes sense to me except that I have daytime attacks as well, as I'm sure most of you do. If this were the cause this wouldn’t be the case would it?

forgotnot

Title: Re: Fresh Research: CH & Sleep Apnea
Post by floridian on Jun 11^th, 2004, 5:10am

Quote:

This all makes sense to me except that I have daytime attacks as well, as I'm sure most of you do. If this were the cause this wouldn’t be the case would it?

I look at apnea as a common trigger, not The Cause. I eventually get attacks when I am awake, but that is deep in the cycle. At the begining, mine always begin during sleep.

Title: Re: Fresh Research: CH & Sleep Apnea
Post by Kevin_M on Jun 11^th, 2004, 11:32am

Floridian,

I read this post and went to my doctor to get the last printout of my blood tests. All my readings were in the normal range brackets except one. Carbon dioxide. I am episodic and at the time I took the test I was definitely in cycle with a bout of it. He did not mention this to me while the blood test was being discussed and said everything was fine, that is why I went back and asked to see it. Sure enough, acceptable range is 22-30 mmol/L, my blood turned a 31.
I do not have sleep apnea and only sleep about five and a half hours a night, but that was interesting, the only blood reading out of normal was carbon dioxide.
Thanks.

Kevin M

Title: Re: Fresh Research: CH & Sleep Apnea
Post by mynm156 on Jun 12^th, 2004, 11:14am

The Treatment of what is referred to here, as “Neurological" Sleep Apnea or properly referred as Central Sleep Apnea is two. One is called BiPAP. Which unlike CPAP, which is Continuos Positive Airway Pressure, used for Alveolar requirement and yes to maintain an airway. BiPAP has two levels of pressure one for inspiratory or (I) and one for Expiratory or (E). The machine can be set to self-cycle between the I & E thus working like a non-invasive form of mechanical ventilation i.e. creates the breathing cycle itself.

Also the of medications such as Protriptyline; also known as Triptil, Vivactil have been used effectively to manage Central Sleep Apnea.

MYNM156

Title: Re: Fresh Research: CH & Sleep Apnea
Post by brewcrew on Jun 13^th, 2004, 9:09am

Once my apnea was diagnosed in Dec., 2002, I was put on the ol' CPAP machine. It has helped immensely with my apnea - I sleep better, feel more rested, more alert, etc. However, it has not had any effect on the frequency or intensity of my cluster bouts.

Connection/causation would imply that if you could cure one, you'd stop (or greatly reduce) the other. Sorry to report that it hasn't happened here.

Bill