I choke awake immediately sleeping supine or sitting up - is this unusual?

[kersey]

I can give a lot more details (ossified anterior longitudinal ligament, long standing nasopharyngeal reflux), but I'd like to keep it simple at first just so I can find out how weird my condition is. Also, I am wrestling with my CPAP now daily but don't have much info to report yet due to massive aerophagia.

So, as the title states, the very instant I fall asleep either in the supine position or sitting up, I choke and immediately wake up.


How unusual is this?? I am planning to see an ENT, but I think it would be a good idea to be informed beforehand.

On my side, AHI is slightly over 30.

Thanks for any help!

[Julie]

What model of which machine do you have? And what are your pressure settings - could be the culprit. but can you manage to sleep on a side? And why sitting up?

Do you take any meds for any reason any time close to bedtime?

[kersey]

Hi. thanks for your reply!

I should have been much clearer. I mean WITHOUT the cpap, my airway totally closes as soon as I fall asleep either on my back or sitting up.

I can fall asleep on my side, and the sleep study showed an AHI of a little over 30 on my side.

[Julie]

We're not doctors (and know zero about you at all) so I think you need to ask your Q from one of them. It's not something I have heard before though and have worked in hospitals for years. Maybe you need some kind of a scope?

Would like to help, but need some info (as per above).

[chunkyfrog]

I have no idea.
I would never consider sleeping without my cpap.

[kteague]

Without CPAP I will experience apneas when falling asleep sitting upright if my head drops either forward or backward. I use a c-shaped travel pillow worn backward so my chin can rest on it and have no trouble with events when sitting. Everyone is different as to exactly where they obstruct so will respond to positions differently. Got a friend who is in obvious distress as soon as he dozes sitting up. Can't speak to laying down sleeping without CPAP. In 15 years of using CPAP I've never done that. I won't even lay on the couch and watch TV unmasked because of the fear of dozing off. Some of my events pre CPAP were scary - made a believer out of me.

[kersey]

We're not doctors (and know zero about you at all) so I think you need to ask your Q from one of them. It's not something I have heard before though and have worked in hospitals for years. Maybe you need some kind of a scope?

Would like to help, but need some info (as per above).

Hi!

So,

1) I have reason to think that I might have some unusual anatomical issues contributing to the sleep apnea ... About 7 years ago I had a very major flare of Ankylosing Spondylitis. It attacked my thoracic and cervical hard. When the flares were over and the disease process was under control (thanks to Humira) I was left with severely limited range of motion in my neck. Limited motion in every direction. My head is also slightly hunched forward (If I lie down on my back my head is about six inches off the floor). All of this damage is almost certainly permanent . Also, and this may be important, my anterior longitudinal ligament in my neck is fully ossified. Technically this means my neck is "fused."

2) Another possible complicating factor is that I get occasional Nasopharyngeal Reflux. I haven't been officially diagnosed with this yet. I'm just starting to deal with long standing health issues. Over time my GERD seems to have become silent reflux. Now when I eat or drink too much at the wrong times I get a burning pain in my right ear. I also sometimes get a rash under my nostrils. Dr. Google says this is Nasopharyngeal Reflux. Sounds like something I should have addressed long ago.

I just got a referral for an ENT and I'm planning to address both of these issues.

I also hope to get a "sleep endoscopy" at some point.

In the meantime, I'm wrestling with my CPAP and trying to get used to it during the day.

Okay, Thanks for any insights you might have!

[Julie]

Great that you'll see an ENT, but... I do hope it's someone who won't tell you that you need e.g. an immediate tonsillectomy, or uvulectomy or whatever surgery he comes up with to pay for his new house... inow I know that sounds awfully cynical. but it also happens a lot around here so we generally suggest, if it comes up, that you at least get a 2nd opinion. Hopefully though, whoever you do see will be educated about OSA as WELL as whatever neurological connections there can be in your case that may affect both of your conditions and how to deal with them. We're not doctors, don't have your med info here but I know what AS is (have worked for neuros) and you seem to be philosophical about it, which is great! Let us know what happens - be sure the ENT has your xrays, etc. from the AS and once you have a better idea of what's what, maybe we can then help in some way.

[kersey]

Great that you'll see an ENT, but... I do hope it's someone who won't tell you that you need e.g. an immediate tonsillectomy, or uvulectomy or whatever surgery he comes up with to pay for his new house... inow I know that sounds awfully cynical. but it also happens a lot around here so we generally suggest, if it comes up, that you at least get a 2nd opinion. Hopefully though, whoever you do see will be educated about OSA as WELL as whatever neurological connections there can be in your case that may affect both of your conditions and how to deal with them. We're not doctors, don't have your med info here but I know what AS is (have worked for neuros) and you seem to be philosophical about it, which is great! Let us know what happens - be sure the ENT has your xrays, etc. from the AS and once you have a better idea of what's what, maybe we can then help in some way.

I appreciate the feedback! Didn't even think about getting my x-rays and mris ready for the ENT. Duh.

Really just knowing that the choking immediately thing isn't normal is super helpful and tells me I need to figure out what's going on.

No, I don't think that''s cynical at all. I've read a fair amount about surgical options and none of them sound like a good risk/reward ratio to me.

Yes, I'm fairly philosophical about it now ... but it took me many years and I'm still not 100% at peace with it all. on the other hand, I've hit an age over 50 where I realize who even knows how many years I have left if I don't start dealing with the things I can control.

I'll keep posting on this and also on my progress with the CPAP. I'm having major aerophagia issues that I'm trying to work out.

Thanks again for your help. This is a tough journey and it helps to discuss these things with someone.

[Janknitz]

Your "choking" definitely sounds like not-so-silent GERD. I choke and have apnea if I fall asleep without my CPAP, even if I am sitting completely upright.

GERD and sleep apnea often go hand in hand. One reason is that when you can't breathe, your body struggles to pull in air. That creates a negative pressure gradient that pulls stomach contents up into the airway (and in your case, all the way to the nose).

The third leg of this stool is often asthma. That's because the stomach acids irritate the airway, can cause swelling and even aspiration of stomach fluids into the lungs.

Each triggers the others. Irritated, swollen airways increase apnea and breathing issues, apnea pulls stomach contents into the airway which irritates the airway, and so on.

You need to address both apnea and GERD and reactive airways/asthma if that's also an issue for you. You can't expect to treat just one of these if the others are present too.

The biggest problem with GERD is that the standard treatment is suppression of stomach acid. But we NEED stomach acid, in part because the pH is what triggers the sphincters to close to prevent reflux. Norman Robillard, author of Fast Tract Diet, Heartburn, theorizes that the GERD is caused by bacteria out of place in the small intestine, which ferments food and emits gas that pushes up into the stomach and pushes the sphincters open. His low fermentation fast tract diet--very close to a keto diet--has helped me immensely with the GERD. Once you start acid reducing medications which are only meant for very short term (i.e. 2 weeks) you produce less acid and it gets harder and harder to not have GERD. They used to think these drugs were benign, but they are not. So it's worth looking in to the dietary approach to avoid having to be on these medications long term.

And NO SLEEPING WITHOUT CPAP. That helps the GERD too.