Breathing stopping while falling asleep

[Linda3032]

You're welcome (and not given often ).

DSM mentioned 02 dip. Maybe you should ask your doctor for an oximeter (is that the right word? - I don't use one) to wear one night. Maybe your oxygen is still going too low.

But remember, if you take off your mask, you should also remove the oximeter. Otherwise you would get a false reading.

[StillAnotherGuest]

Assuming that the obstructive events are properly managed, then the likelihood of these being sleep-onset centrals is fairly high (you'd need PSG to be 100%) and those things are pretty much a normal event.

Jean Krieger in her chapter on Breathing During Sleep in Normal Subjects in Principles and Practice of Sleep Medicine by Meir H. Kryger summarizes the incidence of central apnea/periodic breathing at sleep onset from 40-80% of normal subjects, and lasting from 10-60 minutes. The trigger is hypercapnia, as opposed to the hypocapnia that creates all the cental apnea havoc in CSBD and CSR. Chemosensitivity and apnea threshold also change (sleep onset is a busy time).
SAG

[dsm]

I'll admit I don't know much, but I just can't believe it's normal for your brain to fail to tell your body not to breathe, and to need a jumpstart to wake you up so you can breathe on your own. I think you would be wise to research central apneas...that's what I'm doing, cause I have them too.

BGF,

I tend to agree with you on this. I wondered for over a year if there were centrals occurring in my own sleep esp when these slowing & stopping breathing situations were occurring & then emerged again 4 or so months into therapy.

There is a big difference between a Central that is caused by no signal from the brain to breathe vs someone slowing & stopping breathing for some other reason. I'll try to explain some scenarios (hopefully some of our other members can add more).

Centrals are a very complex part of breathing disorders. In my case my 1st sleep study showed none. 2nd sleep study done 2 weeks back appears to be the same. So as far as doing a PSG - I don't have centrals & accept that is the case. My breathing did show very distinct flow limitations leading to hypopneas (slowing breathing & causing SpO2 to drop) & based on these alone was allocated a new titration of 12. My last sleep study had almost no OSA events (obstructions).

Centrals can be pressure induced & one thing I discovered in my own case was that just under 2 years ago the sleep clinic erroneously told me to set my machine at 15 when it was meant to be 13. That may have contributed to some of what I observed during some parts of the past 20 months, but it is iffy. (I wouldn't put a bet on it ).

There is a reported variant of SDB (Sleep Disordered Breathing) called 'Complex Apnea' which put simply, says that cpap therapy itself can cause centrals in some people when previously there were none. In fact the definition of 'Complex Apnea' is that it is immune to (straight or single pressure) cpap therapy. But if this were happening in my case, this should have shown up as Centrals in my last sleep study but I understand none did.

Another factor that may have something to do with slowing breathing is the CO2 component of one's breathing which is a study unto itself.

Sometimes we don't need to breathe continuously & our body will allow us to slow breathing if it is dealing with incorrect levels of CO2.

I don't fully understand this issue of slowing & stopping breathing, just, in the minutes before sleeping. I think there are some longer term members here who do understand what is behind it. So maybe some others can dig up some papers or reports on the phenomenon.

But, concluding this particular phenomenon (stopping breathing just at sleep onset & just before waking) is based on Centrals, may be erroneous.


DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP

[NightHawkeye]

Jean Krieger in her chapter on Breathing During Sleep in Normal Subjects in Principles and Practice of Sleep Medicine by Meir H. Kryger summarizes the incidence of central apnea/periodic breathing at sleep onset from 40-80% of normal subjects, and lasting from 10-60 minutes.

SAG, aren't such long central apneas often followed by rigor mortis? .

Regards,
Bill

[StillAnotherGuest]

aren't such long central apneas often followed by rigor mortis?

Not to worry, your AHI would only be 1.0.
SAG

[dsm]

Jean Krieger in her chapter on Breathing During Sleep in Normal Subjects in Principles and Practice of Sleep Medicine by Meir H. Kryger summarizes the incidence of central apnea/periodic breathing at sleep onset from 40-80% of normal subjects, and lasting from 10-60 minutes.

SAG, aren't such long central apneas often followed by rigor mortis? .

Regards,
Bill

Bill,
very observant - what your are showing is how restrictive our spoken language is in getting data across - ambiguity seems endemic

DSM

[dsm]

Bluegrassfan,

There you have it - a definition of

"Sleep onset centrals"

- usually normal and not to be concened about (unless an individual central lasts for 60 or so mins )

DSM

[inpjs66]

That happens to me when I first start to fall asleep sometimes. I only know I am not breathing because I kind of awak suddenly with a dizzy feeling in my head like there is no oxygen. It's acutally quite scary.

[bluegrassfan]

What I can't figure out is why it doesn't happen when I am going to sleep without the machine....I'm talking about the feeling that I am forgetting to breathe. I never had that problem before I was told I had central apneas...I don't have any obstructives. I'll admit I am confused, but I do dread bedtime now. I got to get over this! Without the mask I'm asleep in 5 mins after my head hits the pillow.

[Liam1965]

I'm sure one of the techs will chime in here - but it's actually quite common to stop breathing as you fall asleep. These are "central" apneas because they're brain related, but they're not anything to worry about. Everyone does it, including non-apneacs.

They are if, like with me, they go on too long.

That was the last offensive my opponent went through each night as I tried to sleep with the CPAP on. Tough to get to sleep, tough to get relaxed or stop thinking, tough to stop thinking about fighting against the machine as I exhaled...

But invariably if I DID get close to sleep, I'd wake up gasping because of a central apnea that refused to stop until I woke up. Often after that I felt so claustrophobic in my mask that I simply had to turn off the machine, remove the mask and be done with that night's try. It honestly felt like to keep the mask on for one minute longer would be to consign myself to suffocation.

So I know exactly what the original poster is going through. I just wish I had a solution better than the one I came up with: quitting.

Liam, who has better reasons than CPAP to breathe heavily.

[Liam1965]

What I can't figure out is why it doesn't happen when I am going to sleep without the machine....I'm talking about the feeling that I am forgetting to breathe. I never had that problem before I was told I had central apneas...

I wholeheartedly agree. If I have these things without the mask on, they don't bother me enough to notice them. WITH the mask on, I wake from that just-about-to-go-over-the-precipice-into-sleep state gasping and feeling like the air I'm getting from the mask doesn't have enough oxygen in it... and like not only am I not breathing, but like I can't breathe. Like even being aware of it now, I have to force each breath in and out...

It's not a good feeling, and I never did figure out how to get past it. Clearly a lot of other people have, so best of luck!

Liam, the poster child for how NOT to treat your apnea.

[Snoredog]

Jean Krieger in her chapter on Breathing During Sleep in Normal Subjects in Principles and Practice of Sleep Medicine by Meir H. Kryger summarizes the incidence of central apnea/periodic breathing at sleep onset from 40-80% of normal subjects, and lasting from 10-60 minutes.

SAG, aren't such long central apneas often followed by rigor mortis? .

Regards,
Bill

Bill,
very observant - what your are showing is how restrictive our spoken language is in getting data across - ambiguity seems endemic

DSM

People die in their sleep and that is also considered "normal".

I have the same thing but it happens much less for me with cpap than without. Without cpap, I cannot even take a nap, the closest way I can describe it is like I forget to breathe.

Once I realize I haven't been breathing then the startling back to awake begins. It is like having one hypnic jerk after another then the heart pounding begins. I may have 20-30 of these bouts before I ever get to sleep (several tossing and turnings in between). Mine seems more severe when trying to fall asleep on the right side than any other position.

I don't have the onset problem now when I use cpap (or don't think I do), but I know I will have them if I let the pressure get above 9.5cm. My 420e will be here on Friday, I'll play with the FL settings and the A=10 settings and see what the reports show. When I had my last 420e, no one knew what those extra parameters were for because they weren't covered in the clinical manual. I'll need to drop the A=10 to A=9cm on mine.

[NightHawkeye]

I wholeheartedly agree. If I have these things without the mask on, they don't bother me enough to notice them. WITH the mask on, I wake from that just-about-to-go-over-the-precipice-into-sleep state gasping and feeling like the air I'm getting from the mask doesn't have enough oxygen in it... and like not only am I not breathing, but like I can't breathe. Like even being aware of it now, I have to force each breath in and out...

Very interesting description, Liam. Before I embarked on xPAP therapy I regularly had to deliberately control my own breathing also. Otherwise, I'd simply hyperventilate. My reaction sounds like it was just the reverse of yours, Liam.

As I have come to understand things, the respiration drive is controlled by CO2, not O2. In my case, it seems obvious to me now that my own hyperventilation tendency resulted from apnea swinging my own CO2 levels wildly. (For those interested, my own hyperventilation was in fact verified by ABG analysis.) Hyperventilation was simply an overcompensation mechanism, and it was worst in the "wee" hours of the morning, exactly the time when I'm prone to the most REM apnea.

For me, all that extra CO2 available at low CPAP pressures was simply a god-sent blessing. Naturally, I took to CPAP therapy immediately, long before CPAP really controlled my apnea events. I remember well, my surprise when I heard folks, like Snoredog, vehemently decry using CPAP at 4 cm or 5 cm pressure.

It's not a good feeling, and I never did figure out how to get past it. Clearly a lot of other people have, so best of luck!

Quite the opposite of my own reaction. The sleep techs here probably think in terms of hypercapnia, or an over-abundance of CO2.

Liam, I have to wonder . . . Did you ever try C-flex? I ask only because when I first started therapy I couldn't stand C-flex. Others have called it breath-stacking, but I'm pretty sure what happens is that C-flex simply forces a little bit of hyperventilation. The exact opposite of what I needed, but since your breathing pattern seems to be the opposite of what mine was . . .

Regards,
Bill

[dsm]

[quote="Snoredog"]
<snip>
I don't have the onset problem now when I use cpap (or don't think I do), but I know I will have them if I let the pressure get above 9.5cm. My 420e will be here on Friday, I'll play with the FL settings and the A=10 settings and see what the reports show. When I had my last 420e, no one knew what those extra parameters were for because they weren't covered in the clinical manual. I'll need to drop the A=10 to A=9cm on mine.

[dsm]

duplicate