Central Sleep Apnea All of the Sudden?

[NeilA77]

I am a young man in my early 30's - in pretty good physical shape - not obese, and don't have any chronic diseases as far as I know. All of the sudden about a week ago I started having some serious breathing problems while falling asleep (or should I say TRYING to fall asleep). As I am drifting off it's like I forget to breathe and then instead of falling asleep I am jerked back awake by an involuntary jerk and I take a deep breath. Then I'll try to go to sleep again and the same thing will happen repeatedly. After a few times the sudden jerk doesn't happen, I am just awoken (not fully asleep yet though) by the urge to breath, realizing that I haven't been breathing for a while. This repeats until I feel faint and weak (like on the verge of passing out), and my hands will even feel numb if it happens long enough. I hardly ever snore, so I don't think it is obstructive. It's not that I'm having trouble breathing - I am literally forgetting to breathe as I fall asleep. It can take me several hours to fall asleep since this started happening, and when I finally fall asleep I do have dreams but if I am woken up (like by my girlfriend getting up and going to work) it is hard for me to fall back asleep because it happens again.

The thing that is strange about this is that it seems to come and go. It started last week, happened 3 nights in a row (put me through hell, I was like a zombie for two days with almost no sleep), then miraculously it went away (what a relief I thought), it was gone for 2-3 days, and now I just had a spell of it again. When this happens to me I feel as though I could literally pass out and not wake up; that is how faint and weak I get from not breathing. Someone said I might be hyperventilating to compensate but the weak feeling is not like being lightheaded from hyperventilation, and it starts to subside as soon I take a few deep breaths. It feels the same way you feel when you hold your breath for as long as you possibly can in a pool, like you're gong to blackout if you don't breathe. My hands even get kind of numb and weak until I get some good breaths in me. It is not like a lightheaded dizziness, it is like a full-body weakness/feeling like you're going to faint from lack of air. Also, since this started happening I notice that sometimes during the day I forget to breathe as well and have to take a deep gasp or yawn, but it is not nearly as bad as when I am falling asleep and it only happens occasionally. I should note that I have been under a lot of stress lately with work and irregular sleep hours, and one of my close family members being in the hospital.

Can Central Sleep Apnea appear all of the sudden like this and come and go? Could it be stress or anxiety-related? I'm not having any panic attacks and I am not thinking about it all it just happens by itself when I am on the verge of sleep. What are the chances this is related to something serious with my brain, heart, or nervous system? Any input would be appreciated.

[woodworkerjunkie]

My very first comment is to go see your family Dr. as soon as possible! You don't have to snore to have Sleep Apnea, and yes what you are feeling is your Oxygen levels dropping due to not breathing. I would suggest you go discuss with your Dr. about having a sleep study done for Sleep Apnea as soon as possible. It could be that your airway is being blocked and you don't realize it or it very well could be a clear airway event. They can do a sleep study on you and find out what is causing the problem and from there, they will set you up with the proper equipment to treat it.
But, try to get in to see the Dr. tomorrow if possible, even if you have to take the day off from work!

[Xney]

I'd really talk it over with your doctor first ASAP - they need to check a few things.

[kteague]

Much of what you describe I could have said about myself several years ago, but it all went away a while after my obstructive apnea was effectively treated. Not sure what was behind it all, central or obstructives or just everything being so out of kilter from years of oxygen and sleep deprivation. Whatever your cause is, it is not normal to experience what you're feeling and I agree that your doctor should be looking for answers for you. Do let us know what turns up.

[JohnBFisher]

... All of the sudden about a week ago I started having some serious breathing problems while falling asleep (or should I say TRYING to fall asleep). As I am drifting off it's like I forget to breathe and then instead of falling asleep I am jerked back awake by an involuntary jerk and I take a deep breath. Then I'll try to go to sleep again and the same thing will happen repeatedly. After a few times the sudden jerk doesn't happen, I am just awoken (not fully asleep yet though) by the urge to breath, realizing that I haven't been breathing for a while. This repeats until I feel faint and weak (like on the verge of passing out), and my hands will even feel numb if it happens long enough. I hardly ever snore, so I don't think it is obstructive. It's not that I'm having trouble breathing - I am literally forgetting to breathe as I fall asleep. It can take me several hours to fall asleep since this started happening, and when I finally fall asleep I do have dreams but if I am woken up (like by my girlfriend getting up and going to work) it is hard for me to fall back asleep because it happens again. ...

No, it's not likely that it happened "all at once". What's more likely is that it's slowly gotten worse until it reached a "critical" point that you could no longer ignore it. In other words, I suspect this has been a long time in the making. It sounds as if it is central sleep apnea. More correctly phrased, it's sleep onset apnea. Most people have some apneas as they fall asleep. But they don't last so long that you awake gasping and tingling and with headaches and ... When it gets that bad, it must be addressed.

You describe almost perfectly what happened to me over years. However, when you have such severe apneas as you fall asleep it will eventually lead to uncontrolled high blood pressure. Worse yet, it will resist drug treatment ... until you get the apnea under control.

So, please go see your doctor and request a sleep study. Ask for a reference to a neurologist that specializes in sleep medicine. And try to find one that is really good in his field. You need to stress how hard it is to sleep when you constantly stop breathing as you fall asleep.

Please keep us updated.

[Julie]

Hi - There's another thing that could be going on... you might not be crazy about what I'll say but it's not uncommon at all, especially if people are under particular stress at some time, or possibly getting adjusted to something new (like Cpap), and it's really a kind of panic attack, only it happens to be happening to you (IF that is what's going on and of course I don't actually have any way of knowing) just as you're trying to go to sleep... but because of being dx'd with OSA and being on Cpap - how long has it been? you're suddenly conscious of your breathing and the numbness and all that is due to low 02, but not because it's a serious issue, but because it's scaring you and that feeds right back into the cycle.

If you can get hold of a small paper bag tomorrow, take it to bed with you and when the symptoms start up, breath into the bag and only into the bag (inhale back whatever goes in), and see if you feel any better. You may not, but it might be worth a try... can't hurt.

[The Sheikh]

What they said. Good advice.

As John B. said, you have described my situation too.

I remember telling my doctor that I "forgot" to breathe during the day and felt faint sometimes. He looked at me puzzled and let it go. I even bought a small alarm that went off every two minutes to remind me to breathe.

The real trouble started when I tried to fall asleep, stopped breathing, and woke up in a suffocation panic. This went on for years. There were nights I had to go outside and walk down the street from these "panic" attacks. It was my brain telling me to stay awake or else.

Bottom line is I got a sleep study done and found I am one of the 5% of apnea people who have severe central apnea. If I can give you any advice, it is this... Once diagnosed, they will probably start you on a standard CPAP machine. This could make the centrals worse, as it did for me. If this is the case, insist you want to try an ASV machine as soon as possible. At least be aware of this option so that you don't get frustrated and give up if the CPAP machine does not work for you.

Your carrot is this: The first night on the ASV machine I had a perfect night's sleep - no centrals at all and AH=0. Since then my health has gone back to normal and healthy. It's like a I got a free pass out of hell. For many of us central folks, an ASV machine is a miracle machine.

Keep us posted and keep reading.

Tom

[NeilA77]

Thanks everyone! This is the most helpful and caring forum I have ever posted on! To clarify, I have never been diagnosed with OSA, this is all new for me, although I am open to the possibility that it could have been developing all along as John B suggested.

Also, Julie I think you may be onto something (I actually HOPE you're right - I would rather be dealing with plain old anxiety) because like I said it went away for two nights and on those days that it didn't happen I didn't work and had a good time with my friends. I guess I'll try the baggy method you recommended if it happens again (I'm hoping it just goes way like it did a couple days ago). I'm also having other symptoms that I've heard are associated with anxiety -- feeling like I can't catch my breath while awake etc -- so maybe that's all this is! I did not know there was a type of panic attack that happens as you're falling asleep! Now let me ask you, these panic attacks that happen when you're falling asleep, do they cause you to stop breathing and jerk awake? Because I am not really hyperventilating or having any other symptoms that I would associate with panic attacks. Its just like my brain is forgetting to tell my lungs to breathe as I am falling asleep.

Could this be OSA? I mean I read that the airway closes up and then what, do you actually stop breathing or do you just have labored breathing? I suppose my airway could be closing up and then because I m dozing off I just don't have the energy to force a breathe in so the breathing stops completely and when I run out of breathe I am prompted to wake up. The only thing is, I'm not really a snorer...?

Sheikh, thank you for your elaborate post, I appreciate you taking the time! Although I am not crazy about the idea of needing a machine to get a good night's sleep, your post gave me some relief that there is a treatment that works if I do have the same thing you have. How old were you when this started happening to you, and how long have you been on the ASV machine? Did they ever find out what might have caused the onset of your condition? Do you have any suspicions as to what might have brought on your condition?

Thanks everyone that posted!

[Todzo]

I am a young man in my early 30's - in pretty good physical shape - not obese, and don't have any chronic diseases as far as I know. All of the sudden about a week ago I started having some serious breathing problems while falling asleep (or should I say TRYING to fall asleep). As I am drifting off it's like I forget to breathe and then instead of falling asleep I am jerked back awake by an involuntary jerk and I take a deep breath. Then I'll try to go to sleep again and the same thing will happen repeatedly. After a few times the sudden jerk doesn't happen, I am just awoken (not fully asleep yet though) by the urge to breath, realizing that I haven't been breathing for a while. This repeats until I feel faint and weak (like on the verge of passing out), and my hands will even feel numb if it happens long enough. I hardly ever snore, so I don't think it is obstructive. It's not that I'm having trouble breathing - I am literally forgetting to breathe as I fall asleep. It can take me several hours to fall asleep since this started happening, and when I finally fall asleep I do have dreams but if I am woken up (like by my girlfriend getting up and going to work) it is hard for me to fall back asleep because it happens again.

The thing that is strange about this is that it seems to come and go. It started last week, happened 3 nights in a row (put me through hell, I was like a zombie for two days with almost no sleep), then miraculously it went away (what a relief I thought), it was gone for 2-3 days, and now I just had a spell of it again. When this happens to me I feel as though I could literally pass out and not wake up; that is how faint and weak I get from not breathing. Someone said I might be hyperventilating to compensate but the weak feeling is not like being lightheaded from hyperventilation, and it starts to subside as soon I take a few deep breaths. It feels the same way you feel when you hold your breath for as long as you possibly can in a pool, like you're gong to blackout if you don't breathe. My hands even get kind of numb and weak until I get some good breaths in me. It is not like a lightheaded dizziness, it is like a full-body weakness/feeling like you're going to faint from lack of air. Also, since this started happening I notice that sometimes during the day I forget to breathe as well and have to take a deep gasp or yawn, but it is not nearly as bad as when I am falling asleep and it only happens occasionally. I should note that I have been under a lot of stress lately with work and irregular sleep hours, and one of my close family members being in the hospital.

Can Central Sleep Apnea appear all of the sudden like this and come and go? Could it be stress or anxiety-related? I'm not having any panic attacks and I am not thinking about it all it just happens by itself when I am on the verge of sleep. What are the chances this is related to something serious with my brain, heart, or nervous system? Any input would be appreciated.

Hi NeilA77!

Time to prepare to see the doctor:

1. Write out your symptoms – you have started here. I see:

- breathing problems while falling asleep
- TRYING to fall asleep [insomnea]
- jerked back awake by an involuntary jerk [possible hypnic jerk or limb movement]
- faint and weak (like on the verge of passing out)
- my hands will even feel numb [numbness]
- full-body weakness/feeling like you're going to faint from lack of air [potential hypercapnea (CO2 too high) and/or
- hypoxia (O2 too low) – {potential result of an Obstructive Apnea??}]
- sometimes during the day I forget to breathe [potential blunted breathing reflexes]
- have to take a deep gasp or yawn [see above]
- I have been under a lot of stress lately with work
- one of my close family members being in the hospital [more stress]
- irregular sleep hours [likely to exacerbate any symptom]

Taken as a whole it does sound like a serious reaction to stress. Some of the symptoms (numbness, faint and weak) are simply the kind of thing you should not ignore!! Yes, ya just gotta call the Doc – we all hate it but it is better than meeting him in the hospital bed.

I prepared the above list to help you. I would take the list with you and add to it as the time to the appointment nears. Stress has a way of making the memory useless. Paper is good to help with that!

Sending good energy your way!

Todzo

[Julie]

Hi again - the jerking is called 'hypnagogic' (http://sleeping-disorders-help.blogspot ... jerks.html). It's not happening to you as you're going to sleep because it's an odd kind of panic attack, but because that's when your body finally 'let's go' of it's anxiety, etc.... everyone's different. But my 2 cents are from working in a neurologist's office for many years, not being the doctor, so of course do talk to your doctor.

[JohnBFisher]

While I agree this might just be anxiety attacks on the part of the OP, please understand that what The Sheikh and I describe feels EXACTLY like a panic attack .. because IT IS!!! There is nothing quite like awakening from light sleep realizing that you DESPERATELY need to breathe.

Imagine you are falling asleep. Just as you are about to drift off to sleep something pokes you HARD with a very sharp needle. And they do it over and over and over and over ... It's not long before you absolutely DREAD falling asleep.

That is exactly what it feels like to have central sleep apnea (CSA). It's nothing like obstructive sleep apnea (OSA), where you snore or obstruct. The problem as The Sheikh points out is that most doctors just dismiss it .. because they don't understand it. Unfortunately, untreated CSA leads to the same cardiovascular problems as OSA. I developed pretty severe Type 2 Diabetes as well as damage to my kidneys because it took years for me to get a doctor to finally listen to the symptoms and LOOK at the raw data of the sleep study. Then he finally realized I stopped breathing for minutes at a time. Doh!!!

So, sorting out an anxiety attack from CSA might be a little more difficult than you might imagine.

[jjlady]

I had the same thing happen for awhile, minus the numbness. There were times I thought I might faint (but never did), it is very scary. I never thought I had sleep apnea either but was getting unusually tired everyday and 1 doc gave me a home oxomiter to check my oxygen levels and it was ok so he never suggested SA. I had a friend who had SA and described kind of what you are describing (also minus the numbness) and suggested I do a sleep study and low and behold I have severe sleep apnea, and after 2 months on a regular CPAP, it turns out I am having a lot of centrals, so now I am one an ASV machine (just started).

So definately get a sleep study.

[JohnBFisher]

Yup. I had exactly the same symptoms. Unfortunately at the time I had a really hard time getting any sleep doctor to pay attention to it. They exclude sleep onset central apneas from the scoring. But when you fail to breathe for more than a minute, it should NOT be excluded.

Numbness, Almost a Panic Attack when I awaken. Talk about an adrenaline rush! It was like that time after time after time after time .. night after night after night ..

But it's pretty damn serious.

I had uncontrolled (and uncontrollable - no medication helped) high blood pressure. I would awaken with the WORST headaches you can imagine. I used Ibuprofen to tackle the headaches. Unfortunately, with high blood pressure, Ibuprofen damages kidneys. I now have Chronic Kidney Disease. It's stable, but I must now be REALLY careful that it does not advance.

Gee, thanks, doctors! You should have LISTENED!

I even had one doctor tell me that I could not have central sleep apnea because it was so rare. I asked if I had symptoms of central sleep apnea. He then told me that didn't matter. It's so rare that I could not have it. IDIOT!

It is VERY serious. Get a sleep study. That's a LOT cheaper than dialysis or a heart attack or a stroke or ... Get a sleep study.

[Xney]

"You can't have it because it's rare" - best medical argument evah!

Bonus obvious bizarreness: you very obviously have major central apnea issues from your graphs.. I'm stunned they'd say you don't.

It's one thing if you have like 3 or 4 centrals per hour...

[JohnBFisher]

In their defense, this was before ASV units. But other options (S/T and oxygen) were available. I could just not get the doctors to pay attention to it.

I finally switched to my current neurologist, based on some recommendations. After one very miserable BiPAP titration, I ended up finally falling apart in tears when my current doctor suggested that I go back for yet another BiPAP titration sleep study. I explained that it's impossible for me to get to sleep because I stop breathing as I fall asleep ... and I stop breathing so long that my machine turns itself off (the Respironics Model M BiPAP Advanced had an Auto Off feature that was enabled at the time). I know I had mentioned it. But he had relied on the lab to score my sleep study - normal procedure. He went back and looked at the raw data and observed "Well, there's your problem!". Sigh! But based on what he saw, he scheduled an ASV titration study and readily created a letter of medical necessity for my insurance company. No argument on their part.

But the pain/suffering I went through is something I try to help others avoid. I am certain I was very close to a serious health problem (heart attack, stroke, etc) due to the really poor sleep. I was getting less than two hours of sleep per night. So, if I can help others, I try to do so.