Help Needed! Scary episode last night. required ER visit.

[MrStein]

I am a newb here, so a little backstory.....I am male,50, in fair health, 25lbs over ideal weight, 32yr smoker....since teen yrs never slept more than 4hrs a night, always a nightowl...3rd shift worker, ect........I have suspected sleep apnea for yrs and never sought help. This summer in June, I had pneumonia symptoms and was treated by a pulmo...CT showed large mass in right lung. Yes very scary cancer concern! Doc said quit smoking,( but I did not), and treated me with steroid and antibiotics. This didnt clear and the mass was getting larger! I had 2 biopsy's, broncoscopy and needle. Both were inconclusive, so I went in for a surgical biopsy of the lymph node near my right lung. My lung was so full of fluid and pus, that I didn't breathe when extubated..Yep! Woke up in CVICU on ventilator and Ng tube....the fluids were removed from my lung and after 9 days(and breathing treatments every 4hrs) in the hospital and heavy antibiotic regimen, I was diagnosed with a severe bacterial pneumonia,(NOT cancer!!!), and almost certainly sleep apnea!

Long story short, I am pretty much over the pneumonia now, mass is way smaller, and i have 2 more weeks of antibiotics to do. Upcoming Ct scan in December should put this nasty episode to a welcome end!!.....I no longer smoke..PERIOD as of Aug 27!!! I am now officially diagnosed as moderate COPD and some spotting of emphysema. I am on Spireva and Symbicort and home o2 at 2LPM while sleeping. While in the hospital my sleep doctor came to see me and during the last 4 nights in the hospital he put me on a bipap with full mask, (I am a mouth breather). I got used to it quickly and was able to sleep with it, although each night I had apnea incidents....and the nurses came in to wake me each time. Maybe because I was sleeping on my back because its hard to sleep on your side in a hospital bed. Last week I completed my 1st night of sleep study and have not heard anything yet.

Now, on to my issue that maybe somebody can explain to me....I normally have these little glitches (as I call them), where I will suddenly take a quick deep inhale breath, kind of like the 2nd half of a hiccup. It is totally random and seems to happen more as I age. Is this related to apnea? My cardiologist says my heart is good and I do have bradycardia when I have apnea episodes. But this glitch happens when I'm awake!?!?!? Can anyone tell me what this is?

Last night I went to sleep on my side (with o2 at 2 lpm) and within an hour I woke up Gasping for air violently and felt like a big pressure from my neck down to my navel.
I was dizzy, confused, and a little nausea. I felt like it was a severe panic attack (which I have had 10yrs ago). My wife took me to the ER, and they did enzymes blood test and ran ekg strip. pulse ox was 98, heart rate was 113 when I got there and tests showed no signs of heart damage or anything like that. ER doctor said this was probably an apnea event and it probably scared me into a short panic/anxiety attack.

This was by far the scariest thing ever to me. I literally thought I was having a heart attack or stroke. Now I am scared to sleep and I don't know when the 2nd sleep study is going to happen. I do have a Respironincs BiPaP Pro 2 Biflex bipap machine that my father gave me, and I have the face mask that I used with the hospital bipap. My doctors are both on vacation this week, so I can't communicate with them.

Seriously, I am really tired, and I am scared to sleep, and I wonder if I should just go ahead and use this bipap. Is there any danger in this? If not what settings to use? Any advice will be welcome here. Thank you.

[BlackSpinner]

If you can find out your pressure that they used in the hospital then set it to that. If not then start at 6 cm minimum and keep a log. Also figure out how to read your data. You may need to buy a data card and reader if your computer doesn't come with a smart card reader and download the software.

You used it in the hospital and it worked for you, however your lungs are compromised so you have to be careful with the pressure.

[Janknitz]

Last night I went to sleep on my side (with o2 at 2 lpm) and within an hour I woke up Gasping for air violently and felt like a big pressure from my neck down to my navel. I was dizzy, confused, and a little nausea.

With no medical findings, it might have been an episode of apnea induced reflux. When you have an apnic episode, your body stuggles to get air in. That creates a vacuum in your airway that can pull stomach contents into the airway, and then you can aspirate them. The way you describe is often how I felt with a reflux episode during the night. It may be how you developed the bacterial pnuemonia in the first place.

For me, the CPAP eliminates those episodes as long as I am using it--but others find that it causes them to have reflux, especially at first when there is a bit of a learning curve to learning to sleep with the tongue on the roof of the mouth to close off the airway from the stomach so you aren't swallowing a lot of air (aerophagia). Some people find the pressure relief of the Bipap helps reduce the aerophagia, too, but the settings have to be fine tuned for you.

As for getting your own machine and making adjustments, ordinarily it's not unsafe for people to self-titrate, but because you have COPD and it sounds like you recently suffered some form of pnuemothorax, you should be very careful to use the BiPap only as medically prescribed. I think that there is a danger for you that does not exist for the rest of us without such lung problems. And remember, the pressure on a BiPAP goes higher than a CPAP/APAP. So be very very careful.

BTW, congratulations on quitting smoking. Sorry that you had to have this severe medical consequence to finally convince you, but at least you've finally done it!

[chunkyfrog]

Most doctors have associates who cover for them when they are unavailable.
You might want to contact that individual.
Substitute doctors are sometimes the best thing that can happen to you.
My mother-in law was being blown off repeatedly by her regular doc.
She got sick when he was gone, and his partner SAVED HER LIFE.
The regular doc was totally clueless!

[The Sheikh]

[Never mind....]

[JohnBFisher]

I tend to agree with Janknitz on this one. It does sound as if you had an obstructive event that pulled some reflux up toward your esophagus.

But that it's a panic attack. Damn! I hate it when doctors do that. They have no clue, so they blame the patient. I now have permanent kidney damage because a set of doctors completely ignored the symptoms I described to them. Gee, thanks!

If you continue to have problems like this, you might want to:

(1) Discuss it with your sleep doctor.
(2) Consider lifting your head in bed. Possibly using a wedge to lift your head higher. Or possibly bricks under the feet at the head of the bed.
(3) Restrict what you eat and drink before you go to bed.

While you might have had a central apnea, the description of the "big pressure from my neck down to my navel" sounds a whole lot more like reflux than it sounds like a central sleep apnea. Been there, done that. Got the T-Shirt. Wore the darn thing out. Got a new one. Wore it out too! .. Watching what you eat before bed can help improve this.

Also, congrats on quitting smoking. I know how hard it can be.

[SleepyBobR]

Regarding the glitches as you call them, small involuntary inhalations at random times, I had these too and they were very disturbing. Mine occurred as I was going to sleep. They turned out to be one of many withdrawal symptoms I had as a result of taking two different sleeping pills (Zopiclone and Triazolam) over a period of a month or so and then suddenly stopping. You did not mention if you were taking any medications but if you have been and recently stopped then this could be the cause of that particular problem. Mine lasted a couple of months then stopped. They were scary and annoying for me but ultimately of no concern. I also had nocturnal panics prior to getting my CPAP but they stopped immediately once my sleep apnea was controlled.

[JohnBFisher]

... I also had nocturnal panics prior to getting my CPAP but they stopped immediately once my sleep apnea was controlled. ...

Good point!

It's surprising how little doctors really understand what it is like to awaken as a result of a bad apnea episode. Imagine you are lying in bed, sound asleep. Someone slips into your room and puts their hands over your mouth and nose. You can't breathe. You WILL awaken in a PANIC. You know you MUST breathe. It's frightening more than just about anything anyone can imagine. "Oh, it's just a little panic attack." DUH! How the heck would you feel if someone tried to strangle you when you fell asleep? A little panicked? I should think so!!

[slogalz]

Well you are not alone pal! You are going through sleep apnea events. I too had the same problem laying on my side with oxygen. It happened 2 times and I thought I was having a heart attack! It is harder to breathe on your side because your heart is having more weight from your lungs put upon it. (That is what I was told at the ER) I have been on bi-pap for 5 weeks now and I'm sleeping so much better. I do have to sleep on by back though because of the mask. I went to a pulmonolist who has dealt with my apnea without success. I finally went to Stanford Medical Center and they fixed me almost immediately! Other than you being a male, we could be identical twins! Same age and history. Get to a sleep clinic ASAP! Good luck!

[purple]

Not a good idea to just try to self titrate with a machine. Be different if you have numbers from when you were in hospital. and knew how to set the machine correctly.

You could try to sleep sitting up, which pretty much stops apneas.

[MrStein]

Thanks for the responses. Update....I am doing well, and have completed sleep studies and on prescribed auto pap.
I am doing very well with it. This forum and it's members have helped me into my xpap life.
I think we can end this thread now.....

[chunkyfrog]

Resurrection was by a guest.
Your success is ours--darn, that's the cutest chimp!

[sleepnasta]

... I also had nocturnal panics prior to getting my CPAP but they stopped immediately once my sleep apnea was controlled. ...

Good point!

It's surprising how little doctors really understand what it is like to awaken as a result of a bad apnea episode. Imagine you are lying in bed, sound asleep. Someone slips into your room and puts their hands over your mouth and nose. You can't breathe. You WILL awaken in a PANIC. You know you MUST breathe. It's frightening more than just about anything anyone can imagine. "Oh, it's just a little panic attack." DUH! How the heck would you feel if someone tried to strangle you when you fell asleep? A little panicked? I should think so!!

I agree. Just about the scariest feeling. I had these all the time before I was diagnosed and would up in a panic. It was so awful I started to wonder if I was being abducted by aliens

[purple]

f I was being abducted by aliens

Some people have all the luck.

[MrStein]

Resurrection was by a guest.
Your success is ours--darn, that's the cutest chimp!

Thanks Chunkyfrog....I do love my monkey!