Choking when falling asleep

[kuda]

I am another one that is choking out when falling alseep. Seemed to come out of the blue, but I have been a heavy snorer for many years.

39 yo male. 240lbs. 6'0. I work on a PC all day (in IT). I have a crap diet and I know it. I blame genetics I was super thin as a kid and then became overweight after college.

Anyway - this is for those of you that are dealing with this and reading forums at 4:00AM becuase you are completely freaked out.

I would choke out once or twice every 30 minutes. I would race out of bed, grab my chest, take deap breaths, numb hands, etc. I was a mess. I was averaging 3 hours of sleep a night. Horrible. I was all over the place. I went in for a sleep study and failed that too. I couldnt sleep and choked out 2 or 3 times there as well.

I got frustrated at the lack of urgency from my medical professionals, so I bought a CPAP machine on Craigs list for 150 bucks. I couldn't wait to get it. I had to be driven to buy it from the guy because I was too tired to drive.

I had 1 good night sleep with it after figuring out how to configure it myself ( I don't reccomend this by the way). I'm technical and I do a lot of research so I was confdient (and pretty clueless though about what I was doing).

I got a Respironics RemStar M series with heated humidifier. On night 2 I still was waking up choking out.

I went into the ER as well because I was starting to develop what I thought was a heart condition. Essentially, I paniced because I was sleep starved and stressed out with the whole thing. My chest felt heavy, and I was having difficulty breathing.

Fast forward to results: panic. That's all it was. I was just panicing. I do have high cholesterol though and I take meds for that.

Fast forward - Time for sleep study #2. I went in on 2 hours of sleep and was completely destroyed and frustrated. I choked out for the first 2 hours during a Titration study while they were dialing me in for "optimal" settings on the CPAP.

I almost started crying because I felt like I was broken. I went in at 7:30PM and was still choking at 10:00PM.

Finally, she dialed me in correctly....she switched me to BIPAP. After I told her I was broken and she was never going to get this correct, she set me at 11 / 7 on BiPap, I put my head on the pillow after 10:00PM and woke up with them over the intercom talking to me at 6:00AM the next morning.

OMG best sleep ever.

I forced my DR. to speed up the delivery of the unit and I just got it yesterday.

I got a Resmed S9 VPAP machine with settings on 11 / 7 and the nose pillows. I had 8.9 hours of sleep last night (I did wake up gasping twice - one of which i don't remember but wifey said I did). The unit said AHI of 0.9 and normal is 1 - 5 so I'm pretty stoked.

It's been 3 weeks since I've slept in my own bed. I tried chairs, flat, hard, incline, sitting, stomach everthing and choked on ever position.

I hope this helps someone that is going through this. I think the choking now is part panic as well as part OSA. I am starting to get excited about sleeping again now that I know that better times are ahead.

Hang in there.

[The Sheikh]

Kuda,

Did you finally get a sleep study that showed if you had central apneas when falling asleep? A number of us here suffer from this problem. It is the brain failing to continue sending signals to the lungs. I used to stop breathing for up to 95 seconds and wake up gasping too. I had panic attacks which was probably the brain telling me NOT to fall asleep and suffocate.

If you do have this problem, then the solution may be an ASV machine. Do a search here on "ASV" and read the stories. If they sound like you, then talk to your doctor about it and see if they can focus on this next.

BTW, an S9 Auto APAP actually made my centrals worse and I could not go to sleep without passing through this severe apnea minefield lasting about 20 minutes. It took the ResMed Adapt ASV to completely treat my problem. I have zero apneas now almost every night. Like a new world for me. An ASV will help pace your breathing when the brain stops firing a signal to breathe.

This may not be your problem, but it is worth exploring with your doctor, considering your symptoms.

Tom

[kuda]

Good info. I have now been researching that as well. I'll have to give this a couple of weeks to see how I do. The choking at night is very scary. I slept great during the sleep study #2. I'm waiting for the results of that study now. I should get them by next week.

I just loaded up my stuff into Sleepyhead.

Day #1 on ResMed VPAP S - Clear Airway Apnea - 6 events; Hopopnea 1 event; Unspecified Apnea 1 event.

I see around 3:00AM (when I choked out) that the Expire time shot up to 10 seconds.

I also see that there is a high leak rate at that time too. I wonder if if the mask leaked and then I choked out. I remember ripping off the mask as I shot out of bed too. I always sit up or get up immediately and start breathing really heavy. Ugh, it sucks. Like I woke up from a nightmare. Half the time my hands are numb, and I feel like I have no 02 in my system and I'm gonna suffocate.

[greatunclebill]

do you also get a bad taste in your mouth? if you do it's probably acid reflux. whether you do or don't it's worth it to try an otc zantac before bedtime to see if it helps. it really won't hurt you.

[The Sheikh]

"Day #1 on ResMed VPAP S - Clear Airway Apnea - 6 events;"


Six CA events doesn't "sound" bad until we realize that these events are so severe they are causing you do jump out of bed with a panic attack. I had the same problem, so understand where you're coming from.

Certainly if your mask sprung a big leak and you were having an OSA event, this would be a problem. But no so much if it were a CA event when using a CPAP machine. In fact, my CA events were much lower when I ran the LOWEST CPAP pressure, as expected. MY ASV min is set lowest notch for best results. I have almost all CA events, no OSA.

Try this: Expand your flow rate chart and look closely at these centrals. (CA) How long do they last with zero breathing?

Can you post your S/H charts for us to look at? Even if they are short events now, it does not mean your brain hasn't experienced longer ones in the past and you are now hypersensitive to this type of event, even when shorter. My brain wouldn't let me go to sleep when it knew I was about to or actually having bad CA's.

Tom

[kteague]

Before I was on CPAP and while it was yet noneffective I experienced episodes like you describe. It's frightening indeed, enough to cause anyone to panic. I hope whoever told you it was panic wasn't saying it was a panic attack without saying something brought on the panic. Some people have panic attacks that don't have readily identifiable physical influences. That's different from being in a medical crisis and panicking in the midst of it. Any type of interruption to your breathing is enough to cause a reaction. As you sort through everything, keep in the back of your mind that reflux and/or vocal cord spasms could be added to the list of suspects. There's a kinda domino effect on some things, but all you can do is address issues as they become known to you and then see if there are any residual symptoms.

[Janknitz]

Good for you telling the sleep tech how important this was and what your fears were. Sounds like you got an excellent titration.

There are a few more things you need to do.

The "choking" sounds like Gastroesophageal reflux (GERD). It might be solely due to sleep apnea (when the airway closes down, the struggle to breathe creates a "vacuum" effect that sucks stomach contents up into the airway) or it may have another cause which needs to be looked into. You may find symptom relief with CPAP, but you could be continuing to have "silent reflux." That could be an issue because all that acid coming into your esophagus over time damages the lining of the esophagus, and can cause a condition known as "Barrett's Esophagus". That, in turn, can lead to cancer.

This needs to be evaluated and treated if you do have GERD. The doctor may prescribe medication meant to reduce acid and heal the esophagus. You should avoid eating at least 3 hours before bed. Dietary changes may also be in order--unfortunately most doctors don't understand that one of the best dietary changes you can make is to eliminate grains, especially wheat from your diet--this really helps most people who try it. Instead you may be told to avoid spicy food, chocolate and alcohol--these dietary changes usually don't help much.

[kuda]

I think I do have GERD. I haven't had acid in my mouth for a long time, but I belive i do have it and I'm on Prylosec twice a day. I just started that about 5 days ago. Here are some interesting charts from my data.

Typical Clear Airway Events:

Here was the bad one that shot me out of bed.



Here were the leaks at that time:



If I am reading it correctly, I think a leak made me choke out.

I see a leak starting at 3:10AM 25 Secs. By the time it's at 30 secs, it's a gusher. I have highly volatile mask pressure and flow rate at the 26 second mark. By 3:10:35 I'm in the the throws of a full apnea episode and not breathing for a full 40 seconds. I remember shooting straight up gasping, and ripping off the mask so i could breathe.

Thoughts?

[greatunclebill]

i've had hiatal hernia with bad reflux for 40 years and have alot of experience with all the meds. it is likely prilosec hasn't really taken over yet. as i said before take an otc zantac before bedtime and don't eat much in the evening. don't be afraid to take another if you wake up with reflux. you need to re-visit the doc because prilosec by itself may not be enough or you may need to step up to nexium. the reason i say zantac is because it is pretty fast acting as opposed to some of the others like prilosec.

i hope you're taking the prilosec at 12 hour intervals and not together in the morning because its basically a 12 hour medicine.

its important to keep a food diary so you can see what the food triggers are. after a while you'll see what you are eating that is causing it. we are all different, so what affects one person may not affect the next person. you can google for a list of bad foods to have a starting point in determining what might be triggering you.

[Todzo]

I think I do have GERD. I haven't had acid in my mouth for a long time, but I belive i do have it and I'm on Prylosec twice a day. I just started that about 5 days ago. Here are some interesting charts from my data.

Typical Clear Airway Events:

Here was the bad one that shot me out of bed.



Here were the leaks at that time:



If I am reading it correctly, I think a leak made me choke out.

I see a leak starting at 3:10AM 25 Secs. By the time it's at 30 secs, it's a gusher. I have highly volatile mask pressure and flow rate at the 26 second mark. By 3:10:35 I'm in the the throws of a full apnea episode and not breathing for a full 40 seconds. I remember shooting straight up gasping, and ripping off the mask so i could breathe.

Thoughts?

Hi kuda!

To prevent or at least reduce GERD naturally I raise the head of my bed several inches (about three inches) using a couple of concrete bricks I got from a building supply place (less than $5!). It may also help with what they call Rostral Fluid Shift, a tendency of fluids to move from our feet to our nose, and, once there cause more inflammation and respiratory disturbance. It is something recently noted in OSA patients.

The "CA" events you show do have the characteristics of actual hypocapnic central apneas, and seem to show a periodic breathing characteristic between the CAs. Our breathing system is often compared to an oscillator system where the usual is negative gain and therefore good control. If muscle strength + sympathetic nervious activation + current stress level (see previous) + PAP pressure + currently unknown factors -- add to a point where the "system gain" is above 1 the system tends to run away - we breath so much we too severely reduce our CO2 stores and wake ourselves up (arousals or awakenings). When we wake up the brain notices that the breathing thing is way out of hand and so shuts things down to restore more normal CO2 levels. "Periodic Breathing" is actual oscillation as the system tries to find proper levels - if gain is a bit lower (unlikely due to the recent awakening which raised the stress hormone levels) then it will -- if gain is raised you will soon see another event - which you do.

Hypoxia is one thing. Its affects are usually blunted by hypercapnea which tends to open up the circulatory system and facilitates oxygen transport - so the cells tend to get fed if in a somewhat acidic enviornment. But, hypocapnea tends to close down the circulatory system and even if there are oxygenated blood cells to work with they do not have the normally CO2 supplied H+ to make the chemical transaction to move the O2 from blood cell to hungry cell. The cells tend to starve. The brain actually starts invoking a "let Peter starve to let Paul live" circulation strategy.

So what do I do about it (I have this tendency too) - well:

1. I take time during the day to learn to breath quietly with my CPAP. A large part of this, espically for a newbe, is that your breathing reflexes need to come to terms with the presense of the PAP pressure. Many times, simply time will allow this to happen. I spend time laying awake in bed breathing quietly, at my desk, and some time with distraction such as a book, quiet music, light (think non-violent) television - all while wearing my CPAP. The idea is to develope some reflexes during the day - and look at how mask fit and all are going - so things during the night have some daytime info to work off of.

2. If at all possible reduce stress. Take some time off - see a friend. Stress seems to be the greatest factor I have found which affects this kind of tendency for breathing to run away.

3. If possible, do aerobic exercise with some interval training. You need to be careful with this, especially the interval part. Talk with doc first and all - read up on the kinds of training involved, get the heart monitor (and perhaps pulse oximeter mentioned later) and know how to use them. Know, understand, and do not go past your limits. This is not a race, this we hope to get enough hot burning CO2, and O2 need involved to kind of "re-set" and train your breathing system to work properly. Think long term use here - it really needs to be. The interval trining, I find, does wonders at night and the less weight and higher energy levels during the day are such a kick!

4. Watch what you eat near bed time. Stimulents, simple carbs - not so much please. Anti-inflammitory and anti-oxidant foods during the day are recommended.

5. I suppose no one else will ever do this but I use a pulse oximeter to help me find optimal breathing levels. My thinking is that lowest heart rate at a given exercion rate indicates that the system is working as well as it can - so I vary my breathing rate to find the lowest heart rate as I hold exercion constant. With a pulse oximeter the SpO2 reading fast becomes an indicator of when you are likely close. Right now a reading of 95% SpO2 at my desk will be close and 96% if doing moderate exercise. FWIW - when I first started doing this (I wore my pulse oximeter almost constantly for the first three months) exercise tended to be a time I over breathed. I was amazed at how much more I could do without fatigue breathing less. Now looking back it all makes sense but at the time it was a bit of a shock. I just pulled my $50 pulse oximeter from it's belt pouch and - just as I thought - thinking about this has be breathing faster than I should so the reading was 98% and I started the process of slowing the breathing down. I think I will be re-learning breathing for a for years. Like learning to play an instrument I suppose.

May we find good rest!

Todzo

[Spektor]

You need one thing -- exercise.

If you don't get serious and lose that weight, no pill, no do it yourself cpap machine and no wedge under a bed is going to help you. The underlying problem is the weight. Which is also a strong contributing factor in GERD. And unless you make the decision, yourself, you are going to do something to fix the weight problem, then everything else is not going to be effective.

Waking up gasping and choking should have been your wake up call. The next one could be worse, like a heart attack.

Hopefully you will have great success in dealing with these issues in your quest for better health.

[Todzo]

You need one thing -- exercise.

If you don't get serious and lose that weight, no pill, no do it yourself cpap machine and no wedge under a bed is going to help you. The underlying problem is the weight. Which is also a strong contributing factor in GERD. And unless you make the decision, yourself, you are going to do something to fix the weight problem, then everything else is not going to be effective.

Waking up gasping and choking should have been your wake up call. The next one could be worse, like a heart attack.

Hopefully you will have great success in dealing with these issues in your quest for better health.

Well, let me see. It is known that diet and exercise as a means of weight reduction work for 5% of the people to maintain a 5% weight loss for 5 years. That, of course, is for the general population.

Those with un-treated or under-treated Obstructive Sleep Apnea (OSA) have thier appitite hormones increased, satiation hormones decreased, and activity levels considerabley frustrated by tiredness. Perhaps one in five are able to deal effectively with weight (that is, not gain it) - so I guess we can expect that your approach will work for 1% of those with OSA to maintain a 1% weight loss for 1 year. Your advise sounds good but comes from a lack of understanding indeed!

Those with OSA need good effective treatment for thier condition.

Todzo

[cherylgrrl]

Spektor wrote:You need one thing -- exercise.

If you don't get serious and lose that weight, no pill, no do it yourself cpap machine and no wedge under a bed is going to help you. The underlying problem is the weight. Which is also a strong contributing factor in GERD. And unless you make the decision, yourself, you are going to do something to fix the weight problem, then everything else is not going to be effective.

I disagree.

In a perfect world, yes, you would eat right, become the perfect weight, and have no health problems. In the real world, there are lots of obstacles. I have overcome the same symptoms, having also been diagnosed with hiatal hernia during an endoscopy to figure out why I had chronic heartburn. I also had episodes where I would wake up feeling like my throat was paralyzed and I could not breathe. I finally ended up in the emergency room one night and had an episode while lying down on the examining table while the doctor watched. He said, "oh yeah, you have acid reflux." It was a pretty casual thing to him, not at all out of the ordinary. He told me not to worry about not breathing, because once I became unconscious I would automatically start breathing again!

The answer, already contributed by others, is to take Prilosec every morning when you get up. For the rest of your life. That's what my gastroenterologist prescribed, and my GP concurs. It's just a little pill and fixes it. My weight fluctuates, but the pill fixes the acid reflux. And an xPAP machine fixes the sleep apnea. So don't let anyone tell you you can't be be healthy unless you lose weight. It's a good idea, but not possible for everyone. Or actually, for 95% of people who try.

I've been interested in the relationship between GERD/acid reflux and sleep apnea. It seems there is a correlation.

[Xney]

Ahh yes, the sleep apnea stereotypes will never die.

You should exercise because it's good for you, not because it will magically fix things.

The suggestions in this thread are good ones. It will take a while for things like GERD to be reduced doing the right things. The pills that help with them really do help in most cases. There's a few different types, as well, if one doesn't work.

[vze2363v]

I also see that there is a high leak rate at that time too. I wonder if if the mask leaked and then I choked out. I remember ripping off the mask as I shot out of bed too. I always sit up or get up immediately and start breathing really heavy. Ugh, it sucks. Like I woke up from a nightmare. Half the time my hands are numb, and I feel like I have no 02 in my system and I'm gonna suffocate.

I had a problem with choking and panic, but I found they were related to the PAP machine shutting off, even though it didn't show up on the reports. The girl at the doctor's office told me some PAP machines can be a little hinky. I only found out it was turning off by itself because I was trying to meet compliance so I was awake sitting up in a chair and could look at the machine display when it happened. It hasn't happened again since they replaced my machine. FYI in case you don't find out why you are having the choking problem.