Night panic -- arousals

I'm not sure how to describe this, so bear with me. Hopefully someone else here has similar experience. I've been struggling with CPAP for years. It's ironic and depressing because my apnea is almost totally corrected. My AHI is, at the most, .5 when I'm on therapy. If I'm off, it's about as bad as it gets.

Every night about 3 hours into sleep, I wake -- almost like clockwork. My breathing steps up as I tear my mask off. Often a panic attack will settle in a few minutes after. My heart pounds, I hyperventilate a bit, I start to freak about about unknowns (skipped heart beats and so on -- a product of the panic attack). It's very, VERY difficult to slow this mechanism down because when I wake, everything that happened before is a mystery and my brain is just trying to catch up. On the worst night, I shoot out of bed really trying to catch my breath -- heart pounding like crazy.

Here's what I know. My sleep metrics (I use Sleepy Head) look normal. In fact, they look great. Every now and then my tidal volume starts to go up near the time that this happens, but otherwise, in three years, I've never seen an apnea or hypopnea of any kind in the minutes or even hours before this takes place. Everything looks normal, and the readings stop where I took my mask off.

Something biological is happening to trigger these. I know I have the tendency to "air trap" -- I learned this in college when I was an athlete and hooked up to VO2 max machines. I also know that I'm very sensitive to C02. If I breath a little fast on purpose, I can trigger a panic attack. However, this rarely, if ever, happens during the day when I'm lucid.

I'm confident there is a panic mechanism going on because if I'm desperate, I'll take a Xanax and everything slows down on its own. I just hate the feeling it leaves the next day.

Oh, I also notice that the worse the reaction, the more bloated I am. I often eat late -- which made me think about undetected GERD or something dietary. I'm finally getting in to see an MD next week, but I'm trying to gather my thoughts and the experiences of others to help explain this a bit better.

Any input would be much appreciated!

bump

While I have not experienced those exact symptoms, I can't say that I haven't had my sleep disrupted by anxiety attacks. Come to think of it, many people have - sleep, including falling into and coming out of it - is a state that tends to reveal the inner workings of our unconscious. It is also a positive-feedback system in that the more you worry about it, the more it is affected. I know - catch 22! This is why so many are affected - because while we all have a similar fundamental structure of the mind, various environmental (family being the main) factors influence it in so many different directions, and a small negative effect can be amplified into a big problem.

While it is true not just in baseball that 90% of it all is mental, while the other half is physical (Berra), we often tend to misinterpret how that works. I feel that the most damaging factor is when someone expects they can "be fixed". Working with a therapist is mostly an acknowledgement of the problem and the commitment to try and get out of it. This is why I avoid simply suggesting "it is all mental, get help". Empathy is a small step but it's better than nothing, so I'll give it a try.

I was diagnosed with moderate OSA many years ago but I feel that I also have UARS, or whatever exhibits in a similar manner; one important factor is that the smallest disturbance will wake me up. If it is small enough, I don't quite come completely out of it (consciously), but I've had bigger ones. The difference from the OP is that I quickly found what it was: my GERD was causing a small amount of stomach acid to touch the larynx and literally paralyze it shut - luckily, for a short time. But long enough for me to realize after only the second or third instance what it was. That did two things: I changed my eating habits to avoid the reflux episodes, and knowing what it was, the fear of it reoccurring became manageable. In the OP's case, the lack of this knowledge is probably at the heart of the strong anxiety attacks he's getting. So, while it is important to find out what is causing those "clockwork" episodes, it is also as important (if not - more so) to find a way to manage the resulting anxiety. I, too, am very sensitive to lack of oxygen / excess of CO2 - I believe that is where the UARS is rooted in. Maybe because of years of untreated OSA. And the anticipation of such issues is often enough to cause or at least exacerbate the underlying cause. FDR only reformulated a well-known maxim: "[...] the only thing we have to fear is...fear itself". Knowing that is not terribly helpful by itself, but acknowledging it is a good start. Sometimes our expectations are too high (that sounds dark when it comes to health and life, I know), other times it's a symptom of a deeper issue. But very frequently, it can be worked out. And a good therapist can be very instrumental in that process.

I wish you good luck at the appointment - hopefully, you find out what it is and you don't have to deal with the side effects.

McSleepy