Thoughts on What Happened?

[Macpage]

All,

Hope everyone is doing well. I was looking for some feedback on some recent issues.

With the help of everyone here, I hit my 1 year mark the first of this month with 100% compliance. I was really making strides. I noticed some tangible health improvements and was starting to sleep better. I could go 5 hours and then sleep through some morning wake-ups quite easily. I was really enjoying the REM rebound and dreams espcially in the morning hours. We took some short trips over the summer, and I really felt almost like my old self. I hadn't had any serious GI/anxiety issues since January and was successfully off acid reducers over that time. A lot of good things were happening. I was even thinking that the day might come to post to the success stories.

My 6 month AHI has been around 1.14 with the obstructive component less than .61. My leak average is 1.52. The 95% flow limit ranges from 0-.02 and the 95% snore .04-.06. I think these numbers should be good, but I still see some junk in my graphs. I know these numbers are crazy better than where I was untreated at the start of 2014. I still have trouble trying to understand why it's not a major diference maker yet.

In any case, I had trouble getting back to sleep a few mornings and then it became insomnia pretty quick. I can't see anything different or note anything that would start this anxiety. I'm having full panic response just like before I started therapy. I get full on anxiety every time I lie down that has nothing to do with Xpap. The only thing I can think is that gastritis triggers this. It's the only other condition that has been diagnosed. I've had to resort to Ambien this time to try and fight off whatever is going on. Any lttle noise at night triggers an instant jolt in the abdomen while lying awake and feeling my heartbeat is common without associated events. It's almost like that when I get close to normal I slide right back to this point.

I'm not looking for an internet medical diagnosis, but I would appreciate any thoughts on what to look into or ideas. I'm on no medication besides the ambien for 3 nights and supplement B12 and magnesium, plus recently vitamin D. No other major stressors besides health. Sleep hygiene is pretty good and hasn't been a real factor that I am aware of. I'll listen to all and really appreciate it.

Best,

Mike

[Julie]

" I'm having full panic response just like before I started therapy. I get full on anxiety every time I lie down that has nothing to do with Xpap. The only thing I can think is that gastritis triggers this. It's the only other condition that has been diagnosed."

I would not assume that gastritis (which I have, tho' now latent vs previous big problem) is triggering your anxiety, etc. What happens to you when you lie down may have nothing at all to do with it and is as likely to do with e.g. a new cycle of anxiety trouble, or some other (? Neuro) problem as anything else, and I'd want to talk to my MD about it, though don't know how clued in yours could be (not to Cpap necessarily, but otherwise). Your symptoms are not typical of gastritis by a long shot.

[PoolQ]

More seasoned vets will respond soon. Until then some of what you says sounds like some of my experience.

"I get full on anxiety every time I lie down that has nothing to do with Xpap." well maybe right then, but I can tell how well my CPAP is going by if I am avoiding to go to bed, I really do not like feeling like I am not getting enough air and if that is happening during sleep some part of me remembers it the next night and I dread going to sleep.

"without associated events" is this from looking at your data or what you are thinking at the time? Personally I don't have a good history of remembering what happens at night and if it happened while I was asleep I nave no memory of it

[Jay Aitchsee]

I Mike, of course I have no idea what your problem might be - but worrying about sleep can become a major stressor.
I would suggest you Google Sleep Hygiene and Sleep Maintenance Insomnia for some ideas that might help. Don't settle for sleep hygiene that is "pretty good". Make sure it is excellent. Also make sure you are getting plenty of exercise.
I think, if you are going to supplement, you should monitor what you're trying to do with blood tests. See what you need. I know from personal experience that too much Vitamin D can be a problem with a negative impact on sleep. My opinion is that one should try to maintain a Vitamin D3 level somewhere around 50-60 and try not to exceed 80. Most people say that excessive B12 intake is not a problem, but, if your level is above 500, it's probably not needed. (Sorry I haven't included the units for these levels, I'm too lazy to look them up
Anyway, that's a couple of thoughts.

J

[Macpage]

" I'm having full panic response just like before I started therapy. I get full on anxiety every time I lie down that has nothing to do with Xpap. The only thing I can think is that gastritis triggers this. It's the only other condition that has been diagnosed."

I would not assume that gastritis (which I have, tho' now latent vs previous big problem) is triggering your anxiety, etc. What happens to you when you lie down may have nothing at all to do with it and is as likely to do with e.g. a new cycle of anxiety trouble, or some other (? Neuro) problem as anything else, and I'd want to talk to my MD about it, though don't know how clued in yours could be (not to Cpap necessarily, but otherwise). Your symptoms are not typical of gastritis by a long shot.

Yes. Most physicians including mine agree with you that that my level of gastritis "shouldn't" be significant. However, I think that some folks with GI issues can attest to them creating havoc with their sleep, which then leads to anxiety/stress. Thus, more of an indirect factor than a cause so to speak. I've also been told that soft tissue injuries in the rib/sternum can also cause the same.

Perhaps, it's just lack of sleep, but I don't see anything in my numbers that indicates going from improving to such a regression. It certainly could be a host of other issues. Just trying to get ideas on where to start.

Best,

Mike

[Macpage]

"without associated events" is this from looking at your data or what you are thinking at the time? Personally I don't have a good history of remembering what happens at night and if it happened while I was asleep I nave no memory of it

Yes, it is from looking at my data. It all seems to be the same as when I was doing better. I note no events, but there still might be issues with the sleep. Perhaps, the arousals have gotten higher.

Best,

Mike

[Macpage]

I Mike, of course I have no idea what your problem might be - but worrying about sleep can become a major stressor.
I would suggest you Google Sleep Hygiene and Sleep Maintenance Insomnia for some ideas that might help. Don't settle for sleep hygiene that is "pretty good". Make sure it is excellent. Also make sure you are getting plenty of exercise.
I think, if you are going to supplement, you should monitor what you're trying to do with blood tests. See what you need. I know from personal experience that too much Vitamin D can be a problem with a negative impact on sleep. My opinion is that one should try to maintain a Vitamin D3 level somewhere around 50-60 and try not to exceed 80. Most people say that excessive B12 intake is not a problem, but, if your level is above 500, it's probably not needed. (Sorry I haven't included the units for these levels, I'm too lazy to look them up
Anyway, that's a couple of thoughts. J

Thanks. The only thing that leads me to believe there might be something else at play is that I was doing really well. I'm sure my intial anxiety in 2014 came from the untreated sleep apnea and worring about why I felt so bad. Funny thing. Ever since I first got sick I rarily have the feeling of being sleepy. Not that I would, but I have no shot of sleeping during the day or napping. I know sleep would make everything better.

I'm just puzzled as to why it happened so fast. I had some nights that weren't great sleep, but it never ended up here. The anxiety seems to be just as bad during the day as well and of course increases with the corresponding effects of anxiety.

Agree with the supplements. I should be at the right levels but haven't had the B12 tested again yet. It was normal but not above 500, and the vitamin D is lower dose.

I guess it could also be related to therapy as even though my numbers look good. It still looks like lots of mini events are going on. I just don't know what to make of them, but again I know that it is orders of magnitude better than before.

I can work the sleep hygiene better, especially not laying in bed awake. It's just I hate to get up in the night as it plays havoc on my muscle fatigue.

Best,

Mike

[Julie]

Last question - have you gain weight recently? Even 10 lbs can make a diff. to Cpap results, and then how you feel.

[Macpage]

Last question - have you gain weight recently? Even 10 lbs can make a diff. to Cpap results, and then how you feel.

No my weight has been +/- 5 lbs for the last few months. I did lose 40lbs in 2014 with the issues and looked like a skeleton. Put it all back on after starting Xpap. Clearly SDB was putting me down and destroying my systems.

What was your experience with gastritis? I know you said it was rough. What worked for you?

I took 2X PPI all of 2014 and super restricted diet. I had no problems in 2015 on no medication with a less restricted but healthy, low acid diet. However, the recent lack of sleep is taking it's toll. Feels just the same as before as far as GI. A lot like gastritis with/or NERD.

Best,

Mike

[Jay Aitchsee]

I'm just puzzled as to why it happened so fast

Here's a story:
Last summer I felt a little funny so I took my blood pressure. It was quite high for me. It scared me, so I started taking it quite often. It came down but would spike back up. I kept taking it and it remained high. I went to my PCP and it was high. I kept taking it. The pressure came down from a scary high but remained high for me. Finally, after about a month, my appointment with my cardio came up. She took my blood pressure and it was high. I said, "See?" She said, "Yes, quit worrying about it. There's nothing wrong with you". I stopped taking my blood pressure. About a month later, I was curious and took it. It was fine

[Macpage]

"See?" She said, "Yes, quit worrying about it. There's nothing wrong with you".

I wish it were that easy for me, but the GI stuff is real. My wife shrugs off hearburn all the time even if it wakes her up. Apparently, with my fractured sleep, I get it, and it sticks around like velcro.

Hopefully, I can knock it back and get back to work on the sleep, which is the root of all.

Best,

Mike

[BlackSpinner]

Have you tried elevating the head of your Bed?

[Macpage]

Have you tried elevating the head of your Bed?

Yes, I did while on PPI's before starting Xpap. It was the only way I could sleep probably due to the OSA. Unfortunately for me, I was also flat on my back making the SDB much worse I presume.

After starting Xpap, I made every effort to sleep on my side. I noticed that with this set-up that I had some aerophagia. It seemed to lessen and I slept better when I lowered the bed. However, I also was off the PPi for 7 months with no hint of reflux or GI issues. Of course, this doesn't mean that nothing was occuring. I can only assume that my sleep changed or my daily effort increased faster than my sleep improved. Thus, sleep debt and the chemical factors that cause anxiety came back.

It could be the other way, chicken or egg. GI issues could have disturbed the already fragile sleep. I'll try it again if I can't get things manageable again.

Best,

Mike

[kteague]

I don't know what means you used to raise the head of your bed, but since you said you were on your back I'm thinking maybe a wedge? I am most comfortable side sleeping, but can't do that comfortably on a wedge. What worked for me was folding a comforter to lay across the head of the bed between the mattress and box springs. This way I was inclined but my sleep position felt comfortably natural. You don't want the elevation to be high enough for you to slide down, just a few inches is all. Some say sleeping on the left side is preferable with reflux or GERD. Everyone's reflux is different so comparisons can leave one perplexed. Makes a differences whether the gastric juices irritate the esophagus or vocal cords or even aspirate. When I first started here I remember reading how someone's reflux caused vocal cord spasms. I had a couple incidences of that and it was anxiety producing. Is your anxiety primarily at night or in the daytime too? Hope you sort through things and get to feeling better.

[Julie]

PPI's have got a bad rap lately (and I stopped them 20 yrs ago, but restricted diet by a lot) and now I take 1/2 a small Tums right before bed and it makes quite a difference. I'm also careful with my diet, but have re-intro'd a lot of things I was afraid of for so long. Personal stress of 20-30 yrs ago also made a big difference as might untreated apnea of back then.