Post Traumatic Stress from Apnea

[Thomas F.]

In October 2010 I had sucessful surgery for apnea. The procedure was UPPP in combination with hyoid advancement. Since the surgery I have periodically monitored oxygen levels using an oximeter. Always my O2 levels are 94% or greater.

My problem is that I continue to wake up at least once or more times per night. Typically, I wake up during REM sleep because am dreaming. First wake up is usually around 1:30 - 2 am. Falling back to sleep usually involves reading something for 30 minutes or so. Could this be the after effect of struggling with apnea/cpap treatment for many years?? For many years my brain has been on high alert during REM sleep --- to keep me alive--- and now it continues to be hyper-vigilant even though it does not need to be??

I'm doing much better than prior to surgery, but these awakenings rob me of a full nights sleep for which I pay a price in mental focus, tiredness, etc.

My question: Have other's experienced a sort of Post Traumatic Stress Disorder (PTSD) after resolving the apnea through the use of CPAP or Surgery? How long before the awakenings subsided? It' s been 4 months since surgery so maybe I'm expecting too much too soon. Any experience/help I can gleen from others is much appreciated.

[Pugsy]

There are any number of reasons for waking up in the middle of the night. Could be REM related event sneaking in. Even people without OSA diagnosis will have events from time to time. Could be unrelated to OSA. Pain. Meds. Could be a little insomnia. Could be..that it does need more time.

If you feel less than optimal perhaps would be good thing to talk to your doctor about. It would be a shame to continue feeling less than optimal for a long time when there might be something else that could be worked on to help you feel more rested.

[jbn3boys]

Have you had a sleep study post-surgery? It might be that while your sats are good, that you are still having episodes. I would want to get a sleep study post-surgery just to make sure everything is resolved.

[DreamDiver]

Have you had a sleep study post-surgery? It might be that while your sats are good, that you are still having episodes. I would want to get a sleep study post-surgery just to make sure everything is resolved.

+1

[sister]

Please do have a sleep study done,I had the UPPP in 2007, Dr. said I was fine,I thought I was,no sleep study was ever done.

Never really rested good but I had not found the wonderful people on this forum,I really thought I was doing ok.
Finally last december I had my grandaughter sleeping with me and she kept waking me up all night long,saying grandma,'you're not breathing'. I had no idea!
So i went back and insisted on a new sleep study and sure enough,my apnea was much worse than ever!

I really hope you will have another sleep study done soon and not have to suffer the way that I have.
GOD BLESS YOU!

[mars]

Hi Thomas

I think you will have to look elsewhere for answer to your problem, as it does not appear to be PTSD -

http://en.wikipedia.org/wiki/Posttrauma ... s_disorder

I think the other posters above have got some good ideas on what it might be, and the sleep study is certainly a good idea.

Good luck

Mars

[DreamDiver]

Hi Thomas

I think you will have to look elsewhere for answer to your problem, as it does not appear to be PTSD -

http://en.wikipedia.org/wiki/Posttrauma ... s_disorder

I think the other posters above have got some good ideas on what it might be, and the sleep study is certainly a good idea.

Good luck

Mars

At the Atlanta CPAP group, of which Thomas and I are members, we've been discussing the concept that some people may develop long-term symptoms that look an awful lot like PTSD. I've always had sleep apnea - I'm sure of that, because I can remember waking from childhood gasping for air too many times. Night after night for forty years, your body tries to find ways to cope - including introducing nightmares to wake you when nothing else will. It can get to the point that any sufficiently loud noise or close call in traffic can send your whole body into adrenaline overdrive. While I'm not a doctor, I wouldn't discount entirely the possibility that successive years of incomplete sleep might be enough cause PTSD-like symptoms. Low-level chronic exposure to the same little threat every two minutes night after night. It seems entirely worth a study to me. I wonder if it's part of the reason why some of us get so supersensitive to some sights, sounds, and tactile sensations.

Another consideration: now that Tom is off cpap entirely, his body may still be 'wired' to react as if his body is expecting the apneas are still uncontrolled.

[mars]

While I'm not a doctor, I wouldn't discount entirely the possibility that successive years of incomplete sleep might be enough cause PTSD-like symptoms. Low-level chronic exposure to the same little threat every two minutes night after night. It seems entirely worth a study to me. I wonder if it's part of the reason why some of us get so supersensitive to some sights, sounds, and tactile sensations.

Another consideration: now that Tom is off cpap entirely, his body may still be 'wired' to react as if his body is expecting the apneas are still uncontrolled.

Hi DreamDiver

I can see what you are getting at, but I think it would be stretching the understanding of what PTSD is, to include Thomas' symptoms. And looking in the wrong direction for the cause of symptoms has caused many of us a lot of unnecessary distress.

My view of PTSD would pretty much fit in with -

http://www.anxietyaustralia.com.au/anxi ... atic.shtml

cheers

Mars

[Thomas F.]

Thank you for the feedback. I do plan to schedule a follow up sleep study. Regards, Tom

[mstevens]

I'm speaking purely from my own opinion (as a former psychiatry professor now in private practice), but my concept of PTSD requires a "traumatic stress." Old PTSD definitions required something that was "outside the range of normal human experience," though that's been removed. However, I still think of having a gun put to your head, cleaning up body parts after a plane crash, surviving a car crash, watching your child die and similar things as single events that could cause such trauma and ongoing physical, sexual, or severe emotional abuse as ongoing things that might. Having a crappy job or a mean wife, scraping to get by financially, being told off by a neighbor, or using CPAP would certainly not count.

PTSD symptoms are, by definition, intrusive and fairly pervasive. Although they include things such as "sleep disturbance," keep in mind that there are many different meanings of such a phrase and what most of us with OSA go through is nothing like the sleep disturbance that PTSD sufferers go through.

[lcosborn]

It seems very plausible to me that sleep apnea could be a "traumatic stress." With each apnea, the sufferer is essentially suffocating, drowning. A near drowning would certainly qualify as a "traumatic stress." And our bodies certainly go into fight-or-flight mode. From what I understand, apneas are resolved when the body sends out jolts of adrenaline and cause us to breath again.

If an outside agent were to deliberately do to us the equivalent of what apnea does to us, it would violate the Geneva Conventions. If someone placed a pillow on my face hundreds of times a night for an average of 22 seconds, it would be considered torture. If they partially or completely woke me up every 60 seconds for nights on end, it would be considered torture. Partial drowning is considered torture (aka, waterboarding). Sleep deprivation is a well-known torture tactic. REM deprivation can lead to madness in short order.

It may be the case that because we are not being assaulted from without, apnea is less traumatic than these classic torture/trauma scenarios. But maybe not.

It may be the case that because these suffocations occur outside of our conscious awareness they are less traumatic. But maybe not.

[chunkyfrog]

Old thread, but a very good point.
Maybe not the classic PTSD definition, but it could shed some light on mask anxiety and insomnia.

[mstevens]

It seems very plausible to me that sleep apnea could be a "traumatic stress."

Not by the above definition as something outside the range of normal human experience. It's also worth keeping in mind that very large numbers of people suffer from apneas without even being aware of it - awareness (and overwhelming fear) is a central aspect of PTSD. No abject terror, no PTSD. Given those large numbers of patients, if apnea were the sort of traumatic stress that triggered PTSD we should see lots more OSA patients with PTSD, yet this is not a common problem.

A near drowning would certainly qualify as a "traumatic stress."

Normally it would not, unless the near-drowning were the result of a murder attempt. I've never actually treated a PTSD patient whose traumatic even was a near-drowning. That might lead to someone's avoiding lakes, but none of my near-drowning survivors has PTSD. I do have a patient with PTSD from watching her son drown in front of her when his foot got caught underwater and she was unable to rescue him.

And our bodies certainly go into fight-or-flight mode. From what I understand, apneas are resolved when the body sends out jolts of adrenaline and cause us to breath again.

Epinephrine ("adrenaline" was an old brand name for epinephrine) is almost certainly not the cause and epinephrine levels do not typically rise during an apnea. OSA patients often have ongoing elevated levels of cortisol, an adrenal cortical steroid hormone often elevated with chronic stress, but this is very different from epinephrine. The arousals are more likely caused by increasing carbon dioxide levels triggering brain respiratory drive followed by mechanical arousal due to failed breathing attempts. Have a look at http://www.ncbi.nlm.nih.gov/pubmed/9351134. Epinephrine can cause bronchodilation but doesn't "jolt" anyone into breathing or even into awakening.

It may be the case that because these suffocations occur outside of our conscious awareness they are less traumatic. But maybe not.

There's no "maybe" here. Something occurring outside of consciousness is not less traumatic, it's completely non-traumatic. There is no recorded case of PTSD caused by anything of which the sufferer was unaware, and no theoretical mechanism by which it would be possible. There are recorded cases of PTSD being triggered by something that wasn't actually at all risky but was perceived by the sufferer as terrifyingly dangerous.

[MaxDarkside]

I had a near death experience ("Significant Arrhythmic Event", aka heart likely went into v-fib) that my neurologist / sleep doctor chalks up to Sleep Apnea. I hope he's right, because I've got treatment. If he's wrong, I could drop dead again any moment because it came on totally unannounced. I would say that it was not traumatic either. In fact, it was very very nice. I'd like to die 2-3 times that way, certainly not in my sleep, in pure white euphoria, no pain, just God's warm embracing love.

[chunkyfrog]

My dreams with untreated apnea were both disturbing and traumatic,
The scenarios would make me anxious for days afterward, even though they were "only dreams".
I was irritable, and easily moved to tears.
Perhaps there is some kind of gray area?
Not that it matters any more; I'm much better now.