CO2, ERP, conversion, apnea, remission June 07, 2018 06:01PM |
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Re: CO2, ERP, conversion, apnea, remission June 07, 2018 07:23PM |
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Re: CO2, ERP, conversion, apnea, remission June 07, 2018 10:23PM |
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Re: CO2, ERP, conversion, apnea, remission June 08, 2018 04:03AM |
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Re: CO2, ERP, conversion, apnea, remission June 08, 2018 08:41AM |
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Re: CO2, ERP, conversion, apnea, remission June 08, 2018 10:06PM |
Registered: 11 years ago Posts: 4,324 |
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colindo
Great post George,
So the next time I go into Afib I take a deep breath or 2 and hold for 30 seconds or as long as I can.
I must try it.
Re: CO2, ERP, conversion, apnea, remission June 08, 2018 10:11PM |
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Re: CO2, ERP, conversion, apnea, remission June 09, 2018 04:46PM |
Registered: 11 years ago Posts: 4,324 |
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The Anti-Fib
I am not an expert in this, but is seems to me this is pretty basic, that if one holds there breath during Exercise, creating an Acute Oxygen deprivation, that the Atria will stretch out. This can contribute greatly to having an AFIB episode.
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mwcf
George,
Fascinating info.
I'm currently 220lb (6' 4" & 48' chest, 36" waist) and slowly heading back to 205lb where I will be (as I was 20 years ago) at a BMI of 25. I appreciate I still have some way to go after that, but at least - unlike most of my peer group - I'm going the right rather than the wrong way!
In 2008 I was 260lb and experienced a lot of OSA as witnessed by my then partner who noted that I sometimes (presumably she only noticed the times she was awake - and she is a heavy sleeper) totally stopped breathing for a while making what she described as 'hitching' noises before - after 20 to 30 seconds I'd let out an almighty gasp and start breathing vigorously. When I met my current partner I still occasionally did this at which time I was 10-15lb heavier than I am now. It seems for me that anything significantly over 225lb will give me a propensity towards - at least noticeable-by-my-bedmate - OSA.
More than this, I on rare occasions experience sleep paralysis where I'm lying on my front with my head stuffed into the pillow and in my head I become totally aware that I can't breathe but for a most unpleasant 20 or 30 seconds (I think, but could be less) I cannot physically rouse myself awake to do something about it! In my head I start trying to rock myself from side to side, imagine myself falling out of bed, shouting out etc. but to no avail until I suddenly come to gasping for breath.
I'd always thought that it was the O2 deprivation during OSA that precipitated AF, but notwithstanding the chronic atrial stretch (from years of OSA) that does predispose towards AF, it would from your own typically thorough analysis appear that it isn't the CO2 saturation and O2 deprivation during OSA that's the problem but the subsequent reversal once one starts rapidly breathing again afterwards.
I also have life-long nasal polyp issues (that my current partner - a surgeon herself - says I should get sorted out) and had my adenoids out as a child. All that said, I do have AF on my mother's side.... or maybe it's a genetic large uvula and sinus issues that predispose to AF! Overall I wouldn't put my predisposition towards AF entirely (or even anywhere near 50%) down to OSA (most people with OSA don't get AF....or then again maybe they do later in life where they might otherwise have not?) but that said OSA certainly sets the scene for nocturnal AF with 98% of my episodes this last 19 years having occurred between 1 and 6 am.
Maybe I need to get a SPO2 device and see what's really going on whilst I'm asleep OSA-wise. Bot then again my current partner is a very light sleeper and I'm fairly sure she'd notice any breathing difficulties. She's certainly very quick to prod me with her foot on the relatively rare occasions I start snoring! (usually after a bit too much alcohol and/or a late meal - both of are becoming increasingly less frequent lapses in self-discipline).
Part of me says I should get to a BMI of 22.5 and see if that dramatically reduces my nocturnal AF burden, but after nearly 20 years of PAF and episodes increasing in frequency this last year I'm thinking that an ablation sooner or later is still definitely the right way to go where I'm concerned.
Mike
Re: CO2, ERP, conversion, apnea, remission June 29, 2023 03:12AM |
Registered: 2 years ago Posts: 122 |
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GeorgeN
Quick look:
Serum CO2 lengthens ERP, and slows conduction
This may be why apnea creates a risk for afib (slowed conduction after the apnea).
There may be an opportunity to use this to convert episodes without meds (I did this).
There may be an opportunity to put afib in remission (speculation) by training the serum CO2 chemoreceptor to accept a much higher steady state level of CO2.
There appears to be an afib risk period after doing certain kinds of intense breath hold training to reset the CO2 chemorecptor (like apnea).
There has been much written 4x risk for afib (created by external stimulation) over baseline.
[scontent-ort2-1.xx.fbcdn.net]
It was hypothesized in the paper that afib apena risk came after the apnea episode, not during it.
It appears that if serum CO2 could be kept high all the time, it could be protective (my hypothesis). Likewise, it appears possible that a high level of serum CO2 could lengthen ERP sufficiently to terminate an episode. Also that increased serum CO2 followed by a return to baseline CO2 levels would increase afib risk for a period of time.
I searched for and found this paper because I inadvertently (and later intentionally) tested the above.
The breathing center has sensors for serum CO2 (or serum pH) and also O2. The urge to breathe is usually controlled by CO2, not O2. The level at which this triggers can be changed with training. This training periodically presents the sensor with higher levels of CO2 and it will eventually adapt (free divers are an endpoint here). A reason to do this is because of the Bohr effect. Christian Bohr, in 1904, discovered that higher levels of CO2 will weaken the bond of O2 to hemoglobin <[en.wikipedia.org]. This allows more O2 to get into the cells. So paradoxically, the more CO2 (to a point) in the serum the more O2 to the cells (also noted as a right shift in the hemoglobin-oxygen disassociation curve <[en.wikipedia.org] ). Conversely, overbreathing or hyperventilation will reduce oxygen to the cells.
I’ve practiced nasal breathing for many years. I also tape my mouth shut at night (using either 1” 3M Micropore Paper Hypoallergenic Surgical Tape or “Snoreless Tape <[correctbreathing.com] ) so I will nasal breathe during sleep (helps prevent apnea). My control pause (CP) or BOLT score (breath holding time) is OK but nothing to write home about <[www.normalbreathing.com] . Hence I decided to practice strong breath holding during exercise as a way to adapt the CO2 sensor to higher levels.
Three or four weeks ago, I went to the park at lunch and was doing fairly strong breath holds while jogging. Some time after returning to my office, I went into afib. This is very unusual for me. I went home, took flecainide and after a while, converted. Then several weeks later I was jumping rope at lunch, again coupled with fairly strong breath holds. Again went into afib some time after stopping. I started doing pullups on a door molding and converted the episode. When I went home, I told my wife and she said, “then you obviously shouldn’t do breath holds.” I said that was the smart answer, but not the curious one. Later that evening, I found the sheep paper linked above and got the full copy. I noted that I experienced the same risk time that the sheep did, after a period of higher serum CO2.
A week or so later, I’d had a very busy day and managed not to take my magnesium. Usually a trigger for me. The next noon, I went into afib during a phone call because of not taking the mag that day or the day before. I thought it was time for an experiment. I have an app on my phone (iPhisiometer iOS only or Camera HRV both IOS and Android) that, using the camera and light (Kardia device was at home), will show both pulse and pulse wave (which has a very different character in afib). I decided to turn on the app while I did very extended breath holds – exhale and then hold my breath out as long as possible. This converted me in one or two breath holds, which were in the 35 second range (I watched my pulse wave change as I did this). I should note, I’m sure my pCO2 was nowhere near what they gave the sheep. But it still worked. I was ecstatic as this was a nearly instant conversion, predicted by the data, with no medication!
EDIT - Liz recently reported she used this 3 times for successful conversions: <[www.afibbers.org]
So now the trick to test the remission theory is to significantly increase my serum CO2 permanently, but using more “gentle” techniques than strong breath holds.
The whole area of Buteyko Breathing is designed to do just this. There are also rebreathing devices, a mask, the Frolov and Samozdrav devices (available on eBay from Russia), Additionally, author John Douillard promoted using the glottis constriction on the outbreath during exercise (the outbreath part of ujjayi pranayama), never exercising harder than you could do while maintaining nasal breathing with glottis constriction. I’ve found I can do just about everything without causing a risk issue, except hard breath holds during exercise.
Summary for me:
1. strong breath holds during exercise created an afib risk period afterword for me as per the sheep paper.
2. a strong breath hold (or maybe two) was enough to convert me during an episode.
3. for the future, see if I can raise my steady state serum CO2 level to a point that it is protective
My benefits from these practices include a very large reduction in life long rhinitis, I no longer react to pollen or other allergens in the air, as well as the ability to almost never be out of breath. This includes skiing the steeps, off piste at 12,500’ (~3,800m) as well as HIIT Tabatas on a fan rower, breathing through my nose.
Serum CO2 devices and training references:
Frolov rebreathing device – can be purchased off eBay from Russia <[www.normalbreathing.com] I’ve made mine store more CO2 by cutting a 2L plastic bottle almost in half putting the Frolov device in it, putting the breathing tube out the top and taping the two halves back together. This device traps some of the CO2 from the end of your breath thereby increasing the CO2 in your next breath.
Samozdrav breathing device – also can be purchased on eBay from Russia. Same idea as the Frolov. <[www.normalbreathing.com]
Mask to wear at night, which will retain a bit of your exhaled CO2 <[humidiflyer.com]
PDF book about this training, sleep and apnea: < [www.snoring.ie]
First Five chapters of a training manual referencing a lot of the science behind this concept: <[www.normalbreathing.com]
Teacher Patrick McKeown has a number of books and several websites on breathing, including breathing for sport. Book, Oxygen Advantage <[www.amazon.com] His site and listing a lot of his podcasts: <[oxygenadvantage.com] and his YouTube channel <[www.youtube.com]
Teacher Dr Artour Rakhimov ‘s very extensive website: <[www.normalbreathing.com]