I may have become a science experiment

[techno-snoreus]

for my neurologist / sleep doctor. Had a re-titration study on July 10, and this came back on my report.

"Sleep related tachypnea was demonstrated by consistent increase from wake related 12 breaths per minute to sleep related 24 breaths per minute, with abrupt onset"

Apparently this condition is very rare, as this was about all the information I could find about it:

http://web.uni-marburg.de/sleep//enn/da ... /def49.htm

The International Classification of Sleep Disorders
Sleep-Related Neurogenic Tachypnea

ICSD: 780.53-2
ICD-10: R06.8 (Other and Unspecified Abnormalities of Breathing)
DSM-IV: 780.59 (Breathing-Related Sleep Disorder)

Sleep-Related Neurogenic Tachypnea
is characterized by a sustained increase in respiratory rate during sleep, which occurs at sleep onset, is maintained throughout the sleep, and reverses immediately upon return to wakefulness.

Prevalence:
Very rare

Keywords:
Sleep-related tachypnea, polypnea during sleep of neurogenenic origin.

My neuro seems to be quite excited about it. She now wants to send me to a pulmologist and get an MRI to start with.

Good news is I'm getting a new APAP from my insurance, which is covering it at 100% with no co-pay.

[timbalionguy]

Very interesting. My respiration rate also goes up when I sleep, but only 20-25 percent. I doubt that could be called Tachypnea. Have others experienced this? I seem to hear most people's respiration rate goes down.

I Also have began to notice a correlation between NRI's and tidal volume. On nights my tidal volume is lower, I tend to have more NRI's.

[dsm]

techno-snoreus

Yes that is interesting and unusual. Almost like a trigger in your brain switches modes. Sleep = RR of 24, wake = RR of 12.

That waking of RR = 12, do you vary this if walking faster than normal ?. It seems a slow rate unless you don't move around much.

Good luck & enjoy the fun

DSM

[techno-snoreus]

techno-snoreus

Yes that is interesting and unusual. Almost like a trigger in your brain switches modes. Sleep = RR of 24, wake = RR of 12.

That waking of RR = 12, do you vary this if walking faster than normal ?. It seems a slow rate unless you don't move around much.

Good luck & enjoy the fun

DSM

I do breathe a bit faster if I'm walking faster than normal, but I'm a pretty sedentary kinda guy. I told my wife about the report and all she said was "yeah, you've always breathed faster when you sleep. Figures you'd have some weird disorder. Freak."

gotta love her.

[Muse-Inc]

ohmigoodness, that's a new one...keep us informed.

[LinkC]

If I were you, I'd change my name to "freakofscienceamongus"!

I've never heard of that, but it's an interesting read.

[old64mb]

Keep in mind one of the definitions of outright respiratory distress is a breathing rate over 25 per minute, so you are waaaay up there with something in your brain telling your body to try to get more oxygen at night even if you're getting enough. Kinda cool, actually. Like centrals on steroids but presumably (and hopefully) without the desats.

Good news is I'm getting a new APAP from my insurance, which is covering it at 100% with no co-pay.

I suspect you may be able to sell that model on cpapauction in the next few months, since something tells me you're gonna be getting help in having your breathing regulated down/deeper a bit.

The true good news is that when you get something this funky and rare that actually gets properly diagnosed (versus them grabbing at straws misdiagnosing the underlying cause), you are going to get more attention than you'd believe doctors could ever give. OSA is actually fairly boring and routine for most MDs who specialize in sleep, but when you run across a case out of a textbook an MD's eyes will start to light up regardless of specialty - which is why so many take less pay to stay in academic medicine, because that's where you see the really challenging cases. Try not to let her gush over you in presentations.

Let us know how it progresses.

[techno-snoreus]

The true good news is that when you get something this funky and rare that actually gets properly diagnosed (versus them grabbing at straws misdiagnosing the underlying cause), you are going to get more attention than you'd believe doctors could ever give. OSA is actually fairly boring and routine for most MDs who specialize in sleep, but when you run across a case out of a textbook an MD's eyes will start to light up regardless of specialty - which is why so many take less pay to stay in academic medicine, because that's where you see the really challenging cases. Try not to let her gush over you in presentations.

Let us know how it progresses.

I'm not real sure I'm gonna let her do all these tests she's wanting to do. All I want is to get my new machine, and get back to sleeping properly. I only went back for re-titration because I was having some really bad episodes of excessive daytime sleepiness, and felt that something wasn't right. It appears that my Remstar may not be functioning properly because they titrated me at 16cm, which was what I had my machine set on. I started using my backup machine, and I have seen a big improvement. I don't like using my backup machine (a Goodknight 420) since I don't have a humidifier for it. (On a side note: No, my machine is not data capable which I didn't think made that big of a deal. I have since been proven wrong, and am making sure my new machine will be fully data capable and will start managing my therapy more proactively.)

All the testing would not cost me anything if deemed medically necessary (I've got REALLY good insurance, and have no co-pays for any testing), but I don't know that I want to take any time off from my job for testing that would just satisfy my doctor's curiosity and not really benefit me. I would be more than willing to do it in the interest of science if 1.) it would be done after work hours, and 2.) she was willing to foot the bill.

[megdor]

I see that this is a *very* old thread.But on the off chance the OP is still on it--I learned today that I'm having a very similar phenomenon according to the CPAP data my respiratory therapist/DME provider showed me. I consistently breathe 10-12 bpm while I'm awake/falling asleep, then it abruptly changes to 25-30 bpm and stays there very consistently until I rip the mask off (this has been happening nightly since I started CPAP a couple of weeks ago--on the rare occasions when I wake up while pulling off the mask, it feels like I'm in the midst of a panic attack).

A sleep doc at the clinic spoke with me about this today--he'd gotten a quick summary but hadn't yet seen the graphs. His only guess was possibly panic--it's hard for me to imagine that this pattern is happening every single night I have the mask on, and my rapid breathing is so sustained, with panic being the explanation. That said, I do have significant anxiety with the mask being on.

Anyone know anything more about this? Should I be pushing the sleep doc to investigate more? He suggested I come back in 8 weeks.

[Janknitz]

Well, 8 weeks will give you some time to get used to the machine and reduce your mask anxiety. If it's still occurring they can't continue to blame it on anxiety.

You may be what is known in medicine as a "zebra". Doctors are taught that when they hear hoof beats, they should think of horses, not zebras, because chances are it's going to be a horse. Works great if you're a horse, but sometimes you ARE a zebra. So if you are still having the issue in 8 weeks, your job will be to get your doctor to recognize she/he has a genuine zebra on hand, or find a doctor who knows something about zebras.

I don't think there's any problem waiting 8 weeks as you've probably had this problem for a very long time--but without data there was no way to tell unless you have a bed partner who observed it.

[megdor]

Janknitz--thank you for that very reasonable feedback & advice! Unfortunately, I am sometimes a "zebra" since I have autoimmune issues and other stuff all tied up in it, so I often worry about docs writing things off too quickly. You're correct, though, that if it's neurogenic or otherwise not panic-related that it's probably not new at all. My bed partner has never reported anything re rapid breathing, but he's a far sounder sleeper than I am. Thanks again!