Apnea related or something else

[Nathan M]

Hello, I was diagnosed with osa a few weeks ago and have been on the cpap for a week and a half now. I love using it and have been feeling great, but last night I had an "attack" as I like to call it. It's the same thing my doctors keep telling me is anxiety. They've done ekg's, holter monitor, x-rays of my chest and heart and they say everything is normal. Let me give a rundown of what exactly happens during these episodes.

I woke from a dead sleep about 2 hours after having went to bed. Once I woke up, I felt as if I was extremely weak, very sick to my stomach, and my heart rate was 105 (resting heart rate is normally low 50s to upper 60s for me) and my bp was 169 over 106. At this point, im feeling so bad that I feel like I could pass out. I forgot to mention that my mouth has become so dry during this also. I got up, took a couple baby aspirin and an Ativan (which I only use in situations like last night) and after about 20 minutes or so, it subsided enough for me to lay back down. I put my cpap back on and went back to sleep. I woke up this morning still feeling the after effects of the attack though. I just feel meh.

I am at a loss because ive been having these "attacks" for quite some time now and its hindering my job performance when I can go to work. Anybody know anything about this or having this happen to them also? Thanks.

[49er]

Hello, I was diagnosed with osa a few weeks ago and have been on the cpap for a week and a half now. I love using it and have been feeling great, but last night I had an "attack" as I like to call it. It's the same thing my doctors keep telling me is anxiety. They've done ekg's, holter monitor, x-rays of my chest and heart and they say everything is normal. Let me give a rundown of what exactly happens during these episodes.

I woke from a dead sleep about 2 hours after having went to bed. Once I woke up, I felt as if I was extremely weak, very sick to my stomach, and my heart rate was 105 (resting heart rate is normally low 50s to upper 60s for me) and my bp was 169 over 106. At this point, im feeling so bad that I feel like I could pass out. I forgot to mention that my mouth has become so dry during this also. I got up, took a couple baby aspirin and an Ativan (which I only use in situations like last night) and after about 20 minutes or so, it subsided enough for me to lay back down. I put my cpap back on and went back to sleep. I woke up this morning still feeling the after effects of the attack though. I just feel meh.

I am at a loss because ive been having these "attacks" for quite some time now and its hindering my job performance when I can go to work. Anybody know anything about this or having this happen to them also? Thanks.

Hi NathanM,

Welcome to the forum.

Can you please use the link in my signature to fill out your equipment profile? That way, forum members can better target their advice to your situation.

I am wondering if you treatment is optimal. Hopefully, you will have a data capable machine that will enable you to access software in which members can assist in analyzing the data.

Hang in there.

49er

[khauser]

Hi Nathan,
That sounds very typical of apnea events, but since you are already on CPAP, we're going to need some more information. It is possible you need a higher pressure, though.

As 49er asked, we need to know your equipment. We need specifically to know exactly which CPAP machine you have. Hopefully it is a machine that captures data for you to understand your sleep and treatment efficacy.

So lets start with that. If we get the machine and find it to be data capable, you'll get help on retrieving the data and interpreting it.

If it isn't data capable we can go a different direction (not so easy though).

One thought is that if you are waking up with a dry mouth it likely means your mouth opened during the night. Once that happens all the CPAP pressure goes right back out and you can apnea again. So first step for you MIGHT be to get a chin strap, or try taping (with medical tape) your mouth closed overnight.

BTW, I used to get anxiety attacks pre-treatment too. It was "all in my head" also. Well, maybe it was all in my neck, as it turns out!

[jnk]

My OSA was very severe. So, during the time that my apneas were going untreated, my body learned to keep some (what I like to call) panic juice handy for all the times it needed to jar me awake to get me breathing again.

Once I was on PAP therapy, it still took a good while for my body to learn not to make all that stuff and have it ready with a hair trigger to shoot down apneas all night.

In fact, at first my body seemed to assume it was somehow missing the apneas and would fire off some panic juice for no reason at all a few times a night. I considered the increase in panic to be a good sign that my PAP therapy was working.

In fact, I even had some odd anxiety during the day for no reason for a while after starting PAP therapy. It went away on its own after many months. I found I had to cut way back on coffee, though. I used to need it. Now I don't. So I have to remember that when I drink it I am drinking it for pleasure, not to stay awake and energized, and I have to cut way back on the amount so that I didn't get the jitters, have anxiety, or feel panicked.

Sleepiness and tiredness can, in a sense, mask anxiety. So once you take away the sleepiness and tiredness, the anxiety is left over in a way that can be felt in a way it hasn't before. I decided to stay the course with PAP to see if it balanced out after a while. It did. PAP allowed me to feel life more, and life has its anxieties that I had to find constructive ways to deal with. I found that putting every ounce of my newfound energy into cardio to sweat out the panic juice did just the trick, especially early on in my therapy.

But hey, that's just me. Something else entirely may be going on with you that you and your doc may need to figure out.

[Nathan M]

Thanks for replying guys. I followed the link and posted my equipment. Does it show up on its own or do I need to something for it to show up? Thanks again!

EDIT: NEVERMIND I see it now haha

[Pugsy]

Could you please confirm the model number of your machine?
It should be on the bottom of the blower unit on a little sticker....a 3 digit number and probably has DS or REF in front of the 3 digits.
The machine you have linked to in your profile is a basic entry level machine and has no useful data on that SD card because all it gathers is hours of use...compliance hours of use to satisfy any insurance requirement needs.
If that is what you have...you have a "brick". See this blog.
http://maskarrayed.wordpress.com/

Now if you just made a mistake on the choice of machines then maybe you have a full data machine...but the model number must be 450 or higher to have any efficacy data available. Anything below that only gathers hours of use.

[Nathan M]

ref number for cpap is 220p

[Pugsy]

ref number for cpap is 220p

You have a machine that doesn't collect anything but hours of use on that SD card.
There's no way to evaluate your sleep to see if anything happened during the night that might explain your "attack".
Since you are relatively new to therapy there's a good chance you could still get the machine swapped out for a full efficacy data machine in case this happens again. If you don't ask the answer is always "no".

[oak]

What kind of doctors have you seen? If it were me, I would go to a specialist, either a sleep doctor who is a pulmonologist, or a cardiologist. SOMETHING is happening in your sleep that shouldnt be ignored.

It could be a panic attack (not likely if you dont have them in the daytime also), a heart related issue, or an apnea related issue. I have had all three, at different times in my life.

your doctor hasnt done enough tests yet to rule out heart problems, because a holter monitor, chest x-rays, and ekgs dont tell enough to know that. you need a chemical stress test and an echo cardiogram or an angiogram to know for sure.

and your current doctor sure cannot know if its apnea related with a brick machine like you have.

so I would ask for a referral to a specialist or two, AND a machine that records full data. good luck!

http://www.cornellcardiology.com/pat_vi ... e2=3Active

[Nathan M]

Well, ive only been to my family doctor, ER doctors and my sleep doctor. With my insurance I need no referral to see a cardiologist, just learned that today. I do go back to my sleep doctor tomorrow and he wants me to bring my sd card (not sure why if my machine doesn't record data). I have a full mask that someone gave me. Should I try it tonight or should I stick with what I have now? I am also going to make an appointment with a cardiologist also.

[oak]

I would ask the sleep doctor to help you get a machine that reports data that can help figure out what is going on. That would be a Resmed S9 Autoset or a PR System One. I wish you luck at your appt. Are you comfortable with your sleep doc?

[Nathan M]

I would ask the sleep doctor to help you get a machine that reports data that can help figure out what is going on. That would be a Resmed S9 Autoset or a PR System One. I wish you luck at your appt. Are you comfortable with your sleep doc?

Yes I am comfortable with him. I wonder if this episode is a nocturnal panic attack? I know they can be brought on by sleep apnea, so it might be worth mentioning. I was on Vibryd for anxiety, but I actually quit taking it like a month ago. Could be the culprit also, but I dont get the attacks during the day. I used to but now its 99 percent at night.

[oak]

Nathan, if you have anxiety and have had panic attacks, it is very difficult to separate from the apnea for you and for the doctors. Believe me, I have been there. I also have taken Vibryd and other meds, and its very hard to know with these things what comes first, the chicken or the egg, as they say. I personally have had a great reduction in anxiety and depression since I learned of my apnea (my panic has been gone for about a year, though), and since I have started CPAP treatment I feel a piece of mind I haven't had in a long time--i believe the effects of sleep deprivation on both the body AND the mind cannot be underestimated. you may have both apnea and panic attacks going on right now, or your episodes could be made worse by any psychotropic medicines you already take. Trust the docs to help you sort it out and keep plugging away at getting the best CPAP outcomes you can.

Keep us posted. You will get there.

[Nathan M]

Nathan, if you have anxiety and have had panic attacks, it is very difficult to separate from the apnea for you and for the doctors. Believe me, I have been there. I also have taken Vibryd and other meds, and its very hard to know with these things what comes first, the chicken or the egg, as they say. I personally have had a great reduction in anxiety and depression since I learned of my apnea (my panic has been gone for about a year, though), and since I have started CPAP treatment I feel a piece of mind I haven't had in a long time--i believe the effects of sleep deprivation on both the body AND the mind cannot be underestimated. you may have both apnea and panic attacks going on right now, or your episodes could be made worse by any psychotropic medicines you already take. Trust the docs to help you sort it out and keep plugging away at getting the best CPAP outcomes you can.

Keep us posted. You will get there.

Thank you much. I will keep everyone posted!

[KylaManhattan]

Hi, Nathan. While the idea of a nocturnal panic attack is plausible, I think it's worth talking with a cardiologist about this. If you do a "search" on the forum you'll find at least one other thread -- and I suspect more! -- in which various kinds of heartbeat abnormalities are linked to apnea.

I myself have a condition called Supraventricular Tachycardia (SVT) in which my heart will suddenly start racing at about twice its usual rate. Sometimes it subsides without intervention; sometimes a self-help maneuver (Google "Valsalva Maneuver") is sufficient; sometimes I need to take medication. I've had bouts of SVT for 25 years or more although they became more frequent as I got older, and I've only been under a cardiologist's care for about a decade.

I check in with my cardiologist every year to get an EKG and ensure that my condition is stable. Two visits ago, I mentioned to him that my internist had recommended I get a sleep study because I felt so tired all the time, etc., and he said it certainly couldn't hurt to do that. In the course of the conversation, I mentioned that I had recently realized that about half of my bouts of SVT seemed to arise just as I was waking out of sleep, either in the middle of the night or as I was reacting to the alarm in the morning.

He was visibly startled by this new information and told me I needed to schedule that sleep study ASAP. It turns out that one of the ways the heart reacts to intermittent periods of oxygen reduction and/or deprivation is by starting to race! In other words, my heart was racing because I wasn't getting enough oxygen.

Since I started using CPAP (a very rough first few weeks followed by slow increment improvements in both my ability to tolerate the machine and the way I felt), I have not had a single episode of SVT arising out of sleep. I still have the occasional episode but can usually trace it to an obvious cause like too much caffeine or fatigue or stress. But I have not awakened with a racing heart at all.

Anyway, if you can afford to do so, I think it's worth talking to a cardiologist about this. There are a variety of heartbeat abnormalities that can occur along with apnea, and it's not clear to me whether apnea causes them or they cause apnea. But getting it checked out would be smart either way; there are different ways of treating the various problems, ranging from life style changes to medication to self-help maneuvers to surgery, but it's important to know what the abnormality is, precisely, to determine what approach would work best. (And if it turns out that there is nothing whatsoever the matter with your heart, then isn't that a nice thing to have confirmed?!)

Good luck to you, and let us hear how you progress.