Brief Answer:
Electrolyte imbalance, worsening/under treated OSA

Detailed Answer:
Hello Mr. XXXXXXX
Thank you for your query
I'm Dr. Shuba Hariprasad and will be answering your query today.

Would you please clarify a few things for me?
1)how low were your blood glucose levels? Values?
2) how high was your blood pressure?
3)do you have a history of diabetes, hypertension, heart disease, Thyroid hormone imbalances or high cholesterol? Do you any medications for it or for anything else?
4)do you take magnesium supplements daily? If so, how much?
5) how long have you had the OSA for? Have you checked the pressure requirements (to keep airway open) recently? What pressure are you at now?
6)do you smoke, drink alcohol? If so how much, how frequent?
7)are you generally an anxious person or has these palpitations/arrhythmia brought it on?

Based on your description of the symptoms, I would ask you to see me in person right away.
I would :
- get a detailed medical, family, personal history
-do a complete physical exam with focus on the cardiovascular & neurological systems
- run blood tests (complete blood count, Esr, electrolyte levels, Thyroid function tests, liver & kidney function tests, lipid profile, blood glucose levels )
- do an electrocardiogram, echocardiogram, chest xray.
- a 24 Holter monitoring (to check for arrhythmia) with blood pressure monitoring may be required

Your symptoms would lead me to primarily rule out heart disease, electrolyte imbalances & worsening of OSA.

If not adequately treated, OSA may lead to heart irritability, agitation, confusion, & ironically insomnia.

Although magnesium is essential for many important metabolic functions, too much can cause problems (arrhythmia, confusion) & lead to severe dysfunction.

The answers to the above questions, in association with the clinical findings, will enable me to help you better.

I recommend that you see a physician right away to rule out the above.
In the meantime:
-don't strain your self
- avoid sedatives, caffeine & alcohol close to bedtime
-reduce overall intake of carbonated, sugary, caffeinated drinks.
-try deep and slow breathing exercises and focus your kind on the air moving in and out of your lungs.
-monitor for trigger factors (that trigger your palpitations)

If you experience giddiness, breathing difficulty, chest pain/discomfort, continuous palpitations, go to the ER.

I hope I've been helpful.
Please let me know of there is anything else I can help you with (as mentioned above - with requested clarifications).

If not, please close this discussion and rate my answer.
Hope you feel better soon.
Wish you good health

Regards,
Dr. Shuba Hariprasad

---

Brief Answer:
OSA - ACIDOSIS - VAGAL OVERACTIVE - GERD/ARRHYTHMIAS

Detailed Answer:
Hello,

Thank you for the follow up.

*OSA

An Ahi of 7.5 is mild.
If you had severe OSA to start with & use Cpap every night, you should feel rested.

If not, you'll need to undergo a sleep study once more to make pressure adjustments so that you have a sound sleep and are well rested in the mornings.

I believe that the OSA is leading to hypo ventilation and collection of carbondioxide in your blood leading to acidosis which irritates the vagus nerve.


*Gastroesophageal reflux disease (GERD) - a Hiatal hernia (diaphragmatic hernia that applies pressure on the gastroesophageal junction, heart & lungs depending on its location) may exacerbate reflux, cause palpitations (especially when you eat)

Having a large abdomen, sedentary lifestyle, smoking, alcoholism, excessive caffeine, lack of exercise, lying down or slouching right after eating worsens the reflux.

Acidosis causes or worsens the GERD by increasing stomach acid secretion.
Avoid these triggers. Eat smaller & frequent meals. Chewing food thoroughly will aid in digestion.
Avoid sugary, carbonated, caffeinated drinks.
Avoid water with meals & for half hour afterward. A few small sips are OK. Water dilutes the acid which is required for the digestion while food is in the stomach

*Heart arrhythmia or palpitations.

An arrhythmia is an irregularity in the heart rhythm. It may be fast or slow and can be felt as a palpitations when it occurs.

This must be differentiated from palpitations which are commonly relate to anxiety disorder. The heart rhythm is usually regular and the rate may be fast.

Arrhythmias are usually associated with a correctable underlying cause or a heart pathology that affects the conduction system of the heart.
This needs treatment with anti arrhythmic drugs & blood thinners to prevents clots (which can lead to a stroke).


*GAD (GENERALIZED ANXIETY DISORDER)

If you have noticed trigger factors like palpitations, for instance, treating it will help to relieve anxiety.
Maintain a diary, get your thoughts on paper. Also note down when your palpitations occur & try to correlate it with the thoughts or feelings that lead to it.

Our brain is unparalleled in level of function. Medicine has still not completed its understanding of the brain. There is a reason that we have anxiety.
Some thought or thought processes that repeat itself consciously or subconsciously which triggers a cascading process in our brains leading to the physical responses (increased heart rate, palpitations, cold extremities, clammy skin) similar to those of fear.

For instance, on seeing a cockroach, some people freak out and others don't. It is important to figure out that trigger/s.

Once you do, analyze why it makes you anxious. This step itself relieves the anxiety in some cases.
If it still makes you anxious, try to mentally and physically deal with (for instance, in the cockroach situation, looking at photos of the roaches or facing dead ones, telling yourself that the fear is not warranted repeatedly on multiple occasions will reduce fear of it.)

I hope this helps. Only our brain is capable of dwelling in its own depths.
I recommend you see a physician to rule out Arrhythmias and do a sleep study to make adjustments in the Cpap to minimise the AHI

Please let me know if there is anything else I can help you with.
If not, please close this discussion & rate my answer.

Wish you good health.
Regards,
Dr. Shuba Hariprasad

---