Menieres & SleepApnea

[meb2017]

I have Menieres and Sleep Apnea.....I found an old thread on this situation.

I started CPAP and during the first two weeks, when using it 3-4 hours, I would get ear aches. Finally, the 2 nights I used it 7 hours, I wound up with a full blown Menieres episode and was bedridden for 3 days. I brought the machine back.

I am not happy with the information I am getting from strictly a Neurologist and strictly an ENT. I'm wondering if someone was successful in finding a Neurologist with a specialty in Sleep Disorders?

Thank you in advance for your help.

[HoseCrusher]

Coincidence does not indicate cause...

When you review your data what did you see?

Were you able to dial in your therapy to give you the best resolution to your sleep apnea?

[Julie]

Many sleep doctors are neurologists... you just have to find one to get referred to.

[kteague]

I'd not thought of a connection so did some reading and seems thoughts are all over place with nothing concrete. Some think sleep apnea might be a contributing cause of Meniere's, some say CPAP resolved their Meniere's. At any rate, with the proximity of the ears, nose and throat it sounds reasonable that using CPAP could have some effect. The problem is you need to treat your sleep apnea. I'm wondering what type of mask you used. Maybe a different delivery style of the air could be less problematic for you. Maybe even give it another try and see if the same things happens just to make sure it wasn't a coincidence. That said, I had a friend who suffered with this so I've seen how debilitating it can be and I know you don't want to stir things up if you don't have to. If you find you cannot use CPAP with any style of mask, there are some things you can look into to at least mitigate the severity of your sleep apnea. Maybe a dental device is an option. In the meantime, check your sleep study report and see if your apnea is mild, moderate or severe and try to determine how serious it is to get this resolved quickly, like, how bad your desats are. Also see if your events are positional, as in worse when supine than side sleeping. Gotta try to find ways to help yourself without hurting yourself. Good luck with this.

[meb2017]

Thanks for the replies.

I first used a full face mask - that was a disaster. I traded it in for a newer soft nasal mask. The tech also changed the pressure to ramp up. I would get headaches and earaches daily at 3 -4 hours a night and then at 7 hours, I had the menieres episode for 3 days! From the way I felt after this I brought the machine back during the first 30 days.....it was on rental.

I have a neurologist......his bedside manner needs much improvement however, he pointed me to an ENT for the menieres for the episode. The ENT says he dosen't know much about sleep apnea. That is why I'm searching for someone who does.

The ENT says I have positive air pressure going up my eustation tube and that was affecting my middle ear. Does anyone have problems with trying to swallow with CPAP on? My eardrums felt like they were going to pop.

[Pugsy]

The ENT says I have positive air pressure going up my eustation tube and that was affecting my middle ear. Does anyone have problems with trying to swallow with CPAP on? My eardrums felt like they were going to pop.

I can have it on occasion but it is easily dealt with by either doing a big yawn or swallowing. Very similar to what happens when we fly at high altitudes and the pressure inside the cabin changes. Some people have Eustachian tubes that won't close off like they should so more of the pressure enters the inner ear than normally sneaks in and it can create a significant problem for some people. It isn't all that common to have it be severe but it can happen.
I think it has something to do with Eustachian Tube Dysfunction (google it) but I don't know what they might do about it.

I don't know that it actually causes Menieres but the symptoms are of course just like Menieres or even BPPV (Benign Paroxysmal Positional Vertigo) with all the vertigo and it's miserable. I do have BPPV...unrelated to cpap and cpap doesn't make it any worse.

So I have had experiences where my ears "stop up" when I use the cpap but it goes away quickly if I do what I do when I fly in an airplane and the ears act up. I think a lot of us have had that happen. The problem is when we can't equalize the pressure by the yawns or swallowing or whatever works for each person.

[Pugsy]

the do minor surgery on kiddies to relieve that problem in the tubes
fairly common
easily fixed

Those tubes that the kiddies get in their ears are not Eustachian tubes. Those are tubes in the ear canal between the middle and external ear and they usually fall out as the child grows out of them.
Look up Eustachian tubes and see where they are...they go from the nasal cavity to the inner ear.

[TASmart]

Look at Wikipedia and learn. https://en.wikipedia.org/wiki/Eustachian_tube

[kteague]

my doctor called the ones in my ear eustachian tubes

Does your ENT perhaps mumble or have an accent? I can imagine equilization (as in pressure equalization tube) sounding like eustacian tube.

[Sleepytime_1950]

Meb ~ I have Menieres and have had it since 2004. Yesterday I had an episode and have not had one in a year. It's been 20 days since I started CPAP, so not sure if it's a coincidence or not. Today feeling better, less off balance and no spins or vertigo (feeling like I am riding a rollercoaster). I never thought of a correlation between Menieres being triggered by CPAP. However, I had more events per hour the night before I woke up to the spins, but that may have had nothing to do with it. I can clear my eustacion tube today but I had fullness yesterday in that one ear.

We need to stay in touch since we both have Menieres. I do go to a neuro-otologist for my Menieres, but haven't had the need to see him last 4 years.

Debbie

[cands]

I have had Meniere's since the 1990s. I followed the typical stages (if there is such a thing) for one sided Meniere's. I have been in the 'burnt out' stage for several years with impaired balance (especially in the dark) tinnitus and severe hearing loss. I no longer have major episodes(no spinning/vertigo/vomiting), but need to be positionally aware.

I started CPAP just over a year ago. It has not caused any issues with my Meniere's, but then I would not expect it to at this stage of the disease. I remember when the disease was active, trying to identify and eliminate causes of episodes. Nothing I did seemed to help. It seems to have a mind of its own. Just when you think things are going fine a cluster of events brings you to your knees (or flat on your back, except when leaning over a bucket! )

My humble advice would be to stick with the CPAP. For me Meniere's was debilitating and depressing, but Apnoea is debilitating, depressing and life threatening.

[meb2017]

Yes, please keep in touch.....here are some links I found last night. All the doctors told me to go back on it but I'm convinced it triggered it and I'm looking for options. I know my body well enough to know something is wrong. Since using CPAP for several weeks, my ears are ringing so, so loud.... I'm thinking about next steps - possibly a "dental appliance related" sleep specialist. I am scheduled for a cortisone shot to see if that will calm the menieres. Good Luck, I do know what you are going through. This blog is not letting me share links with you I find the first article very interesting.
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#1
The effect of continuous positive airway pressure on middle ear pressure.
Lin FY1, Gurgel RK, Popelka GR, Capasso R.
Author information
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Abstract
OBJECTIVES/HYPOTHESIS:
While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study was to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.
STUDY DESIGN:
Retrospective review of normal tympanometry values and a prospective cohort evaluation of subjects' tympanometric values while using CPAP at distinct pressure levels.
METHODS:
A total of 3,066 tympanograms were evaluated to determine the normal range of middle ear pressures. Ten subjects with no known history of eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 0, 5, 10, and 15 cm H(2)O.
RESULTS:
The percentage of normal control patients with middle ear pressures above 40 daPa was 0.03%. In the study population, prior to a swallowing maneuver to open the eustachian tube, average middle ear pressures were 21.67 daPa, 22.63 daPa, 20.42, daPa, and 21.58 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2) 0, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15 cm H(2)0, respectively. The postswallow Pearson correlation coefficient correlating CPAP and middle ear pressures was 0.783 (P < 0.001).


CONCLUSIONS:
Middle ear air pressure is directly proportional to CPAP air pressure in subjects with normal eustachian tube function. Middle ear pressure reaches supraphysiologic levels at even minimal CPAP levels. Although further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependent. These findings may also influence the perioperative practice of otologic and skull base surgeons."

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#2

From cpapgroup dot com

"As a person whose been diagnosed with obstructive sleep apnea, you know that you experience periods without breath while you sleep. In most cases, this is due to obstruction of your upper airway caused by the partial collapse of your windpipe or a blockage by your tongue or soft palate. But, did you know that not only is your breathing affected, but the function of your Eustachian tubes is also impaired?
Eustachian tubes are responsible for equalizing the pressures in your ear and upper airway. They are easily blocked by the same mechanisms that cause obstructive sleep apnea. When these tubes are obstructed and unable to promote inner ear equilibrium, your inner ear is likely to become swollen and irritated. This can result in feeling like you’re always trying to “pop” your ears, hearing ringing in one or both ears, or even infections. This problem is solved through continuous positive airway pressure, or CPAP therapy.
Can CPAP Therapy Cause Ear Problems?
Despite being the most effective way to treat sleep apnea, CPAP therapy can occasionally be the
cause of chronic inner ear pain or discomfort. If your CPAP pressure is not high enough, your airway may not be opening like it should, meaning your treatment for sleep apnea isn’t completely effective and that your Eustachian tubes are still blocked. Not only frustrating and damaging to your ears, this ineffective treatment means that you’re still at risk for the serious health consequences of untreated sleep apnea such as stroke and diabetes.
On the flip side, if your CPAP pressure is too high, your Eustachian tubes may not be able to keep your inner ear and pharynx at equalized pressures. This means that your tubes will be forced open, making your inner ear prone to swelling and infection but with no way to drain or change pressures.
Should I Quit CPAP Therapy If I’m Getting Ear Problems?
You shouldn’t quit treatment with your CPAP machine because of ear problems. The best option is to discuss your chronic pain with your doctor and follow up with a doctor who specializes in ear, nose, and throat conditions. These specialists see a lot of CPAP related ear issues and will be able to easily determine the cause of your ear discomfort, whether they’re from low or high pressures. While you wait to see a physician, ensure that you’re able to breath out your nose so that your sinuses are free of pressure problems. You might need to take over the counter nasal decongestants or vigorously irrigate your nostrils using a neti pot.
Maybe It’s Your Sleep Apnea Mask
For some sleep apnea sufferers, their sleep apnea mask is the cause of the problem. If you’re experiencing ear issues and are using nasal pillows or a nasal mask with your CPAP machine, a full face mask like the Fisher and Paykel Forma mask may help keep forced air evenly distributed in your airway, lessening the chance of dramatic pressure changes. Talk to your doctor today."



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Meb ~ I have Menieres and have had it since 2004. Yesterday I had an episode and have not had one in a year. It's been 20 days since I started CPAP, so not sure if it's a coincidence or not. Today feeling better, less off balance and no spins or vertigo (feeling like I am riding a rollercoaster). I never thought of a correlation between Menieres being triggered by CPAP. However, I had more events per hour the night before I woke up to the spins, but that may have had nothing to do with it. I can clear my eustacion tube today but I had fullness yesterday in that one ear.

We need to stay in touch since we both have Menieres. I do go to a neuro-otologist for my Menieres, but haven't had the need to see him last 4 years.

Debbie

[meb2017]

thanks for the input....I'm glad it's working for you, stay well


quote="cands"]I have had Meniere's since the 1990s. I followed the typical stages (if there is such a thing) for one sided Meniere's. I have been in the 'burnt out' stage for several years with impaired balance (especially in the dark) tinnitus and severe hearing loss. I no longer have major episodes(no spinning/vertigo/vomiting), but need to be positionally aware.

I started CPAP just over a year ago. It has not caused any issues with my Meniere's, but then I would not expect it to at this stage of the disease. I remember when the disease was active, trying to identify and eliminate causes of episodes. Nothing I did seemed to help. It seems to have a mind of its own. Just when you think things are going fine a cluster of events brings you to your knees (or flat on your back, except when leaning over a bucket! )

My humble advice would be to stick with the CPAP. For me Meniere's was debilitating and depressing, but Apnoea is debilitating, depressing and life threatening.[/quote]