Panic Attack and Rain

I have been successfully using my CPap since I started a little over a week ago. Unfortunately, last night I experienced a panic attack where I felt I could not catch my breath to the point of hyperventilating. It felt like I was fighting my machine to breathe. I know this is in my head but I also know my machine has "a-flex" which can help with this feeling. However, the menu says "disabled" and I could not figure out how to enable it. Does anyone know how to do this? The manual says the provider sets this but wondering if I can do it. Will it affect the data being collected for my "compliance" period? On another topic, I wrapped the hose with some flannel I had (as Pugsy suggested) to prevent "rainout" but I still had problems with it.....think I may have to wrap the short hose from the mask? I got most of the water out, put the tube under the blankets and was able to get back to sleep. Thank you!

Yes, you might need to insulate the short hose.

AFlex or CFlex might help and won't harm your data at all. You need to go into the clinical setup menu to turn it on and choose which setting suits your needs and I suggest that you test them all.
Once it is turned on there is a demo available under the Flex menu so you can play with 1, 2 or 3 without having to go into the clinical setup menu each time.
Using the Flex option doesn't affect compliance reporting or anything like that and to be honest...I doubt if the DME even notices. Not a problem if they do though.

This explains how to get to the clinical setup menu if you don't know already.
http://www.apneaboard.com/pr-system-one ... structions
Once in there just change the Flex type selection from "None" to whichever you want to try...this enables the Flex box on the LCD screen to let you try it.
When it is set to "None" it is disabled. Making any selection effectively makes it available to you on the LCD screen without having to go into the clinical menu each time.

Thank you so much, Pugsy! That was very easy to do and will try all that is available! Have a wonderful day!

jaye8898 wrote:I have been successfully using my CPap since I started a little over a week ago. Unfortunately, last night I experienced a panic attack where I felt I could not catch my breath to the point of hyperventilating. It felt like I was fighting my machine to breathe. I know this is in my head but I also know my machine has "a-flex" which can help with this feeling. However, the menu says "disabled" and I could not figure out how to enable it. Does anyone know how to do this? The manual says the provider sets this but wondering if I can do it. Will it affect the data being collected for my "compliance" period? On another topic, I wrapped the hose with some flannel I had (as Pugsy suggested) to prevent "rainout" but I still had problems with it.....think I may have to wrap the short hose from the mask? I got most of the water out, put the tube under the blankets and was able to get back to sleep. Thank you!

I believe that what you are describing could be called inappropriate air hunger.

Now if I wake up breathing at much higher levels than one would expect for being at rest and in bed, with my heart beating out of my chest, likely with a very dry mouth and aerophagea I immediately start a simple regimen. First I start to reduce my breathing level (volume of air used) and the frequency of my breathing. Then on an exhale at it's normal end I stop breathing for ten seconds. Then I take three slow volume limited breaths and at the end of the last exhale as above stop for ten seconds. I repeat a second time and then possibly a third.

It is interesting to note here that at my desk normally a thirty second pause in breathing after a normal exhale does not result in a strong urge to breath. I can do the exercise as mentioned above and the urge to breath will be modest during the third pause. But even starting to reduce the breathing after waking up finding myself over breathing with high heart rates and all the other symptoms will be met with a strong urge to breath?! The first session will be kind of like what I used to experience as a snorkel diver at the two minute mark (I was good for two to three minutes under water) – a very strong urge to breath. But likely after the second session the strong urge to breath will recede. Indeed I will feel the blood going back into my feet and a general sense of warmth and well being. My heart rate will move rapidly toward normal levels, the moisture will come back into my mouth, in a few more minutes of breathing at normal levels for being at rest in bed I will often feel my stomach relax and realize that it had been in a knot.

I have not experienced such a high level of long term potentiated over breathing for a couple of years but I do still sometimes wake up breathing more than I should with some of the other symptoms mentioned and find that less aggressive eucapnic breathing methods are sufficient to bring the breathing levels back to normal.

In the general sense I believe this has a lot to do with breathing control.

Dr. Stasha Gominak has noted that many areas of the brain which are involved in the control of breathing are sensitive to D3 levels. She also reports that when D3 levels are raised from low to within 60-80 ng/mL Sleep Apnea sometimes goes away. Those who are working with D3 (e.g. Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All believe that a level lower than 50 ng/mL is not good.

Please check with the Vitamin D Council for a description of the proper assay.

For me here up north the sun is just beginning again to be a source for vitamin D and I think that, very carefully managed (no pink!), is the best source since it likely produces other things as well that are good for us. However, we have a bad diet here and are not used to the sun. Those with employment exposure do not seem to develop cancer. I believe that is because they become acclimated a very little bit at a time each day. It probably also has to do with the activity level of those whose employment regularly takes them outside.

Over the years I have come to find my best friends to be my CPAP data (reviewed twice a week), my pedometer (and my Personal Trainer) and my “eating well” books (and dietitian when I had one). Simply pursue metabolic health.

Todzo!

Newbies come here, often with very specific and definite questions pertaining to particular issues. They are unaware of who's who when it comes to getting advice and may not understand yet that some of it is absolutely irrelevant and nonsensical in relation to their questions.

You keep pushing your crazy agenda to everyone regardless of what has been asked or who asks it, and I think you need to quit, or at least save it for those of us who've been here long enough to understand it for what it is - and isn't!

All you're doing is confusing things for those people and I seriously doubt they will be helped to deal with their largely mechanical problems by e.g. taking Vit. D. Just leave it alone for a while, or else wait til the newbies at least have some real answers to their questions - maybe they'll stick around longer and feel that they've gotten the help they need and not be sent down to la-la land.

Jaye, the panic attacks will subside eventually, Your body is so used to panicking because of apnea that it takes a while to adjust. Every time you have an apnic episode, your body secretes stress hormones. It takes a while to get the apnea under control and wash those out of your system.

Meanwhile, when you have a panic attack in the mask, try this:
Square Breathing: Breathe slowly in for the count of 5 and then breathe slowly out for the count of 5. Repeat. If you feel like you're not getting air, put your hand in front of the vent to check.

If you can't calm yourself down enough for the slow breathing, promise yourself you can take the mask off AFTER you've counted slowly to 10. Then if you still feel panicky, remove the mask, calm yourself down, and then PUT THE MASK BACK ON (very important!). Practice the Square Breathing until you fall asleep.

In a few weeks these panic attacks will be a thing of the past, but you have to get your body acclimated to this thing. Hang in there, it does get better.

Thank you, Janknitz, I will try the square breathing. Last night I did try to breathe slowly to calm myself but it just didn't work. I did not give up and just got rid of the moisture, did a little bit of mindfulness to relax and put the mask on and got back to sleep. I did avoid taking any Ativan which I use for the bad panic attacks so I am very pleased. Thanks again for the encouraging words!

I guess I did not post my reply to Julie and Todzo. Hmmm.....thought I did.

Thank you, Todzo for the interesting information. I live in Washington as well and since we are starting to get some sun, I just asked my doctor to check my vitamin D level since I've been taking a supplement for quite a while and need to see if I still need it.

Julie, thank you for looking out for my interests as well as all the other newbies. It's obvious that all of you care when you take the time to responsd and it's a blessing to have found this forum.

Janknitz wrote:Jaye, the panic attacks will subside eventually, Your body is so used to panicking because of apnea that it takes a while to adjust. Every time you have an apnic episode, your body secretes stress hormones. It takes a while to get the apnea under control and wash those out of your system.

Meanwhile, when you have a panic attack in the mask, try this:
Square Breathing: Breathe slowly in for the count of 5 and then breathe slowly out for the count of 5. Repeat. If you feel like you're not getting air, put your hand in front of the vent to check.

If you can't calm yourself down enough for the slow breathing, promise yourself you can take the mask off AFTER you've counted slowly to 10. Then if you still feel panicky, remove the mask, calm yourself down, and then PUT THE MASK BACK ON (very important!). Practice the Square Breathing until you fall asleep.

In a few weeks these panic attacks will be a thing of the past, but you have to get your body acclimated to this thing. Hang in there, it does get better.

This will work and is a good practice, the way I stopped my panic was to un buckle one side of my mask. That way I didn't feel trapped, I did this until the panic stopped. Now if I feel nervous I do the breathing, it will go away in time.

Thanks, Janknitz! I am using the Airfit PS10 so can't unbuckle one side............good idea, though. The urge to breathe is extremely powerful for it to cause panic attacks......I'm learning so much on this site and do appreciate everyone's help so much!

For the Panic Attack you may want to try either Paxil or Xanax. "Shrinks" deal with it routinely.

jaye8898 wrote:Thanks, Janknitz! I am using the Airfit PS10 so can't unbuckle one side............good idea, though. The urge to breathe is extremely powerful for it to cause panic attacks......I'm learning so much on this site and do appreciate everyone's help so much!

I think you may well find the technique I mention in my post above most helpful to quench that strong urge to breath.

If the "attacks" continue you might well do good to discuss EERS[1,2] with your doctor.

[1] Gilmartin G; McGeehan B; Vigneault K; Daly RW; Manento M; Weiss JW; Thomas RJ. Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS). J Clin Sleep Med 2010;6(6):529-538.

We hypothesized that manipulation of arterial carbon dioxide levels might provide an alternative treatment strategy. Specifically, keeping PCO 2 just over the apnea threshold would be predicted to buffer chemoreflex influences and make the disease more purely obstructive in physiology, thus remaining responsive to positive airway pressure treatment. Central apneas and periodic breathing can be generated when the arterial PCO 2 level falls below that required to stimulate respiration, a setpoint that is unmasked during sleep. 11 Preventing hypocapnia is a powerful stabilizing influence on sleep respiratory control.


[2] David M. Rapoport, M.D. Stabilizing Ventilation in OSAHS with CPAP Emergent Periodic Breathing Through the Use of Dead Space . J Clin Sleep Med. Dec 15, 2010; 6(6): 539–540.

“Ventilatory instability” in OSAHS can be understood as an intermittent “overshoot” of ventilation, thought to be due to two factors. At the end of apnea/hypopnea, there is a simultaneous relief of airway obstruction and a transient increase of ventilatory effort that is part of the arousal. Together, these produce a transient hyperventilation and consequent drop in alveolar and arterial PCO2. Perhaps due to excessive overshoot, mechanical reflexes or “chemosensitivity” to CO2, this transient fall in CO2 initiates repetitive cycles of “central” hypopneas/apneas and hyperventilatory intervals. While usually transient, these cycles of respiratory oscillations appear to persist in a subset of patients despite removal of the obstructive component. Clinical consequences and loss of benefit from CPAP may result as the obstructive cycles are replaced by central ones with similarly disrupted sleep, and poor CPAP compliance and clinical outcomes are not surprising. Many of the patients in the current report had this presentation.

Appreciation of the role that “instability” may play in periodic breathing suggests that blunting respiratory “overshoot” should be helpful—even if the original pathology was predominantly obstructive and is now treated with CPAP. Two approaches have been taken to “stabilizing” ventilation: adaptive servoventilation provides a variable “boost” to ventilation in the form of pressure support, thus damping the expression of varying respiratory drive; adding dead space to the ventilator circuit blunts the effect of hyperventilation on CO2 and thus stabilizes ventilatory drive itself. Either approach effectively provides a “shock absorber” that reduces oscillations of effective ventilatory output and thus prevents the initiation of cycling.

One thing that sometimes helps me is to open my mouth and let the air gush in through my nose and out through my mouth. It sort of helps me convince myself the air is blowing. You can also consciously inhale deeply and feel the air flow in and out through your nose.