Forget to breathe while falling asleep; heart rate jacks up

[wakeasisleep]

Hello guys sorry to make a thread asking for help as my first post but you guys seem to be a great community.

I've been seeing doctors and stuff for the past... 6 months now? I had a sleep study done in June and got a CPAP MONTHS later (thanks DME supplier) and this hasn't really helped me with my main problem so I'll explain it here.

It seems like right when I'm transitioning off to sleep... I forget to breathe and I wake up take a HUGE inhale and my vision gets all kinds of stars and dull lights around the sides of my vision, and my heart rate is JACKED. This happens probably 3-4 times over the course of 2-3 hours before I finally get to fall asleep for 4-5 hours before I wake up for work. I usually check my resmed after waking up and it'll say something like "Time used .2 hours" "AHI: 50"

Its really weird this is how it happened.

Jun: Get sleep study. They diagnose me with severe sleep apnea (mixed both Obstructive and Central)
August 15th: Start noticing this problem falling asleep and forgetting to breathe.
September 1st: Get CPAP, which fixes problem
September 15th: Start having the breathing problems again.

Also really strange to note is

1) If I stay up late on the weekends and fall asleep around 12-1 a.m. I don't have any problem falling asleep. In fact last weekend my AHI according to my resmed was 1.7 after falling asleep at 1 a.m. and waking up around 10 a.m.

2) Sleeping pills used to help (ambien + lunesta) and they would often lower my AHI according to my resmed to around 5.5 AHI. But just the other night I took my 5 mg on an empty stomach and still had this problem falling asleep due to forgetting to breathe.

Can anyone offer me some advice on how to deal with this? The main thing that is strange to me is that this only started happening to me 2 months AFTER i had already been diagnosed with severe sleep apnea ( i went 2 months + however long before I was diagnosed without having this problem).

After getting a 2nd sleep study for the diagnosis of central apneas (I was 20/6 i think?) I am getting a bipap soon but I am not hopeful it is going to work...

Do you guys have any experience with this sudden waking up immediately after falling asleep coupled with the need to breathe deeply, lightheadedness, and a super strong and rapid heartbeat?

Thank you guys very much!

[jnk...]

The sensation of forgetting to breathe when transitioning from wake to sleep-breathing is common. That is because it is common to have little harmless sleep-stage-transition centrals when falling asleep or when going from one sleep stage to another. The body sort of switches gears in how it regulates its own breathing when it changes some sleep stages, so an occasional pause can be a perfectly natural thing for some. So, it may be that your heightened awareness of your own breathing after diagnosis may be part of why you are noticing those sort-of centrals and are being disturbed by the sensation. As your body adapts to PAP therapy, it may go through stages of readjusting its breathing mechanisms, so your doc may suggest just giving it time. If so, that may not be a cop-out; it may be a choice based on observed reactions in others.

That said, without other information that is readily available to your doctor, it is impossible for anyone else to guess accurately the significance, or the insignificance, of what you describe, especially if accompanied by heart rate changes and vision changes. So although the "forgetting to breathe" sensation is common, that is no reason to hide the info from your doc. Centrals can be completely harmless or can be one of many symptoms of other health issues. So even common experiences can be significant to a doc when evaluating the experience in context with other health conditions.

Hope that helps. Feel free to ask further questions if you need to on this or other matters. I have no medical experience, myself, so maybe something you say will lure in those who have some.

-jeff

[chunkyfrog]

You could also mention the visual effects to your eye doctor.

[jnk...]

One other thing. Some find that using "ramp," or any feature of their PAP machine that lowers pressure until later, makes obstructive apneas occur for them when transitioning to sleep. The heart-rate change may imply that you are experiencing obstruction, even though it feels as though you "forgot to breathe." It is sometimes a combination of the two that happens.

Features that keep pressure low at the start of sleep are comfort features, but they backfire for some of us in that they make us have obstructive apneas that keep us from falling asleep and thus make us less comfortable, not more comfortable. Comfort features are usually designed for the patient to control them, so you may have control of that on your machine right now if that feature is on but you want to try falling asleep with that feature off. Your DME, doc, or people here may be able to help you figure how to try that, should you choose to do so.

[ChicagoGranny]

sorry to make a thread asking for help as my first post

That's what the forum is for. Welcome to you.

They diagnose me with severe sleep apnea (mixed both Obstructive and Central)

Please state the breakdown of central and obstructive events during your sleep study.

Also, state your machine settings - pressure settings, ramp.

We also need to know what equipment you are using. It's best to go to User Control Panel and fill out the equipment section so you don't get the question again.

[chunkyfrog]

Granny is right.
Your event breakdown and model of machine will reveal much.
Sometimes insurance companies or suppliers will sell a patient the WRONG MACHINE for their condition.

[JDS74]

What you are describing is a fairly significant central event. The correct machine for that condition is an ASV machine.
Do you also have any sort of heart failure or ejection fraction condition? That might preclude prescribing the ASV CPAP Machine.

Post your machine type so we can tell the difference - if it is a ResMed ASV it won't show and you will need to put in the comments section.

It is important to tell your doctor about these events and how severe they are.
I'll

[wakeasisleep]

Thank you everyone for responding so quickly to me!

I cannot grab all the information you guys wish to know at the moment but I will when I get off of work.

For now the information I can remember off the top of my head is:

I have a CPAP ResMed S9 Auto, I believe I turned ramp off and the pressure starts at 6 and goes to 20. I use 3.5 humidity and 70 degrees F for temperature.

To the best of my knowledge I do not have any heart failure (and this is the first time I've ever heard of Ejection Fraction), although I have never been tested. I brought this up with my PCP as a concern that it was a potential cause of my CSA when I first met him and he didn't bother testing it since he said it would be extremely rare in a 27 year old.

I don't know the exact number of my event breakdown, I can get my old sleep study results later on but the most recent one I will have to request specifically from my doctor. Best I remember is he said that there were about 20 centrals over 6 so I'm guessing 20 over 6 hours.

As far as telling the doctors... they don't seem to care haha. Either that or they simply know better than I do and they want to go through all the necessary protocols before prescribing me an ASV. At any rate I was hoping you guys would have advice or similar experiences with adrenaline rushes and heart pounding events at the sleep onset but if it is normal (albeit annoying) that I react to them this way then all I can do for now is wait for my bipap to see if that will help anything.

Thanks for all the help so far!

Thank you everyone.

[Goofproof]

6 to 20 is almost a failed treatment range. You would be better off based on the avg pressure you run at according to the data from the machine. 2 under to 2 over is more realistic, try a few days reaccess. Jim

[chunkyfrog]

---" . . . Data from the machine"
Hopefully, your "Auto" is an Autoset, rather than an Escape Auto.
Fingers crossed for you. (Oops, doggone webs!)
Welcome to the forum.

[jnk...]

If you tell the sleep doc you think you are having obstructive events at sleep onset, he may suggest raising your start pressure higher than 6cm H2O, or the DME or you may want to turn off other comfort-breathing features that may be letting obstructives slip through.

On the other hand, if you tell him the "events" feel like "I forgot to breathe," then he might suggest leaving pressure(s) right where you have it/them.

Personally, I would never ask for a machine aimed at central/mixed events (such as an ASV) until I had given CPAP / APAP (auto) / BPAP (bilevel/autobilevel) all a full shot. But that's partly because I had a good number of centrals and mixed events myself, but they went away once my severe OSA was fully addressed. Your mileage may vary.

The statements above are not meant to be medical advice. They are meant to pass on information I think I may understand as a fellow patient who has read for a while at sleep apnea forums.

The more info you post about your overall health and about the findings of your sleep study (doing so in a way that protects your privacy and the privacy of your doc), the more likely you are to get helpful info from the most people here.

Goofproof makes a good point about APAP set at a wide range versus APAP set at a narrower range. Some people even find that they feel starved for air when their pressure is lower than 8cm H2O.

[Cereal Killer]

Thank you everyone for responding so quickly to me!

Just be aware that the people giving advice don't know what your diagnosis was, don't know what machine you are using, don't know what mask you are using, don't know your machine settings and don't know what the data from your machine is showing.

The two ladies did well -

Granny is right.
Your event breakdown and model of machine will reveal much.
Sometimes insurance companies or suppliers will sell a patient the WRONG MACHINE for their condition.

All of the men - not so well.

Thank you everyone for responding so quickly to me!

Feel good when you get many questions, not when you get instant "answers".

[jnk...]

. . . don't know what your diagnosis was, don't know what machine you are using, don't know what mask you are using, don't know your machine settings and don't know what the data from your machine is showing.

If you read the thread, you would know that the diagnosis was mixed, that the machine is S9 Auto, that it is set 6 to 20, and that the question was about "forgetting to breathe."

But thanks for the attempt to offer something constructive to the conversation, anyway. If that's what that was.

[Chevie]

I'll vote with the ladies on this one. The information is sketchy at this point. We are not sure exactly what machine he has and we are not even 100% sure he was diagnosed with complex sleep apnea.

It's best to let him get home and provide more information. Understanding the problem comes before solving it.

I cannot grab all the information you guys wish to know at the moment but I will when I get off of work.

[jnk...]

I admit I find it entertaining when rooster/roster uses his identities to commend himself and even to call himself one of the ladies.

Crazy guy.