Any other anxiety sufferers here? Effect on AHI?

I guess I knew it would come sooner or later, and I had been dodging it for 4-1/2 months so far. Up until last night anyway.

Anxiety is a very insidious disease that can manifest itself in many ways, and I've had it for more than 50 years now. One of the things that happens to me fairly infrequently is that I can be breathing very naturally and just at the moment I go to fall asleep I'll all of a sudden have to take a very deep and prolonged breath, which puts my body on high alert. Feels almost like I'm smothering. So it happened last night for the first time in a long while, and although I only actually slept about an hour and a half last night I laid there with the mask on for more than 4 hours. The result was an AHI of 8.6 with 0 large leaks and PB of 2.3. There were zero OAs, over 4 CA events and the rest Hypopnea.

This normally becomes a self-fulfilling sort of thing for a few nights when it first happens, which I hate because I have a sleep doc appt. tomorrow. Xanax would help but then I don't sleep at all.

I think that this phenomenon may arise from a basic fear of falling asleep on my part.

Anyone else have and issues with anxiety affecting their sleep apnea?

old dude wrote: I think that this phenomenon may arise from a basic fear of falling asleep on my part.

I think you hit the nail on the head there. I notice after CPAP that I am gradually learning to "trust" that I will be able to breathe and my insomnia symptoms are going away. I do have occasional bad nights, still, where I can't get to sleep for a couple of hours. Here's hoping you have a good night tonight.

+1

old dude wrote:although I only actually slept about an hour and a half last night I laid there with the mask on for more than 4 hours. The result was an AHI of 8.6 with 0 large leaks and PB of 2.3. There were zero OAs, over 4 CA events and the rest Hypopnea.

Wake breathing (even when it's "wake breathing trying to get sleep") is not the same as "sleep breathing". When you are awake your breathing is controlled by the same part of the nervous system that controls your voluntary muscle movements. When you are asleep your breathing is controlled by the same part of the nervous system that controls your heart.

When you are asleep, breathing is supposed to be extremely regular and even. All breaths are supposed to look pretty much identical. Sleep breathing also tends to be at a constant level: All inhalations are about the same size and length; all exhalations are about the same size and length. The respiratory rate (breaths per minute) does not vary much from minute to minute.

Wake breathing, on the other hand, is much more irregular. We take a deep breath now and then. We sigh. We momentarily hold our breath while concentrating on something (and it can be as simple as turning over in bed.) We decide we need to swallow or cough or talk. All these things affect the individual breaths in numerous ways. The size of the inhalations varies, sometimes quite a bit, from breath to breath. The length of time from the beginning of one inhalation to the next varies---particularly if we're prone to momentarily holding our breath while concentrating. The respiratory rate varies much more when we're awake. And if we're awake and highly conscious of our breathing, the very fact that we're paying close attention to it can alter our breathing patterns quite dramatically. When we're focusing on our breathing, it's apt to become slower and deeper for most of us, but as soon as we're distracted, it will speed back up and (typically) become a bit more shallow simply because we're not monitoring it quite so closely.

All of this can affect the machine reported AHI if you are lying in bed for hours while awake with the mask on. Machines often get tricked by normal wake breathing patterns since the machine does NOT know when you are sleeping and when you are awake. The machine's event detection algorithm assumes that if you are using the machine, you are indeed asleep. And many normal wake breathing patterns resemble ragged sleep breathing patterns. Holding your breath for about 10 seconds is not uncommon when you're awake, but all the machine sees is a drastic drop in airflow and so it thinks it is seeing an apnea or hypopnea and it scores an event. Concentrating on your breathing for several minutes may establish a "base line" in the machines data of deep regular breaths, and when you quit focusing on your breath for a few seconds, your wake breathing becomes more shallow; but all the machine sees is a drop in flow that meets the criteria to flag a hypopnea or possibly a RERA if you suddenly take a deep inhale for some reason.

In other words, before trying to figure out what that AHI = 8.6 actually means, you need to locate the part of the night where you are most confident you were asleep and discount all events that are scored during periods when you know for sure you were awake.

Old dude, IMO, anxiety should NOT have a bad effect on AHI. If you believe that it does and you also believe that AHI is a good indicator of the level of OSA treatment then why not take anti anxiety medications. I myself take Paxil and Xanax but NOT b/c of hi AHI.

See my treatment data for the last year:




Also check:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?
http://www.respiratoryreviews.com/sep02 ... Index.html

.
.

robysue wrote:

old dude wrote:although I only actually slept about an hour and a half last night I laid there with the mask on for more than 4 hours. The result was an AHI of 8.6 with 0 large leaks and PB of 2.3. There were zero OAs, over 4 CA events and the rest Hypopnea.

Wake breathing (even when it's "wake breathing trying to get sleep") is not the same as "sleep breathing". When you are awake your breathing is controlled by the same part of the nervous system that controls your voluntary muscle movements. When you are asleep your breathing is controlled by the same part of the nervous system that controls your heart.

When you are asleep, breathing is supposed to be extremely regular and even. All breaths are supposed to look pretty much identical. Sleep breathing also tends to be at a constant level: All inhalations are about the same size and length; all exhalations are about the same size and length. The respiratory rate (breaths per minute) does not vary much from minute to minute.

Wake breathing, on the other hand, is much more irregular. We take a deep breath now and then. We sigh. We momentarily hold our breath while concentrating on something (and it can be as simple as turning over in bed.) We decide we need to swallow or cough or talk. All these things affect the individual breaths in numerous ways. The size of the inhalations varies, sometimes quite a bit, from breath to breath. The length of time from the beginning of one inhalation to the next varies---particularly if we're prone to momentarily holding our breath while concentrating. The respiratory rate varies much more when we're awake. And if we're awake and highly conscious of our breathing, the very fact that we're paying close attention to it can alter our breathing patterns quite dramatically. When we're focusing on our breathing, it's apt to become slower and deeper for most of us, but as soon as we're distracted, it will speed back up and (typically) become a bit more shallow simply because we're not monitoring it quite so closely.

All of this can affect the machine reported AHI if you are lying in bed for hours while awake with the mask on. Machines often get tricked by normal wake breathing patterns since the machine does NOT know when you are sleeping and when you are awake. The machine's event detection algorithm assumes that if you are using the machine, you are indeed asleep. And many normal wake breathing patterns resemble ragged sleep breathing patterns. Holding your breath for about 10 seconds is not uncommon when you're awake, but all the machine sees is a drastic drop in airflow and so it thinks it is seeing an apnea or hypopnea and it scores an event. Concentrating on your breathing for several minutes may establish a "base line" in the machines data of deep regular breaths, and when you quit focusing on your breath for a few seconds, your wake breathing becomes more shallow; but all the machine sees is a drop in flow that meets the criteria to flag a hypopnea or possibly a RERA if you suddenly take a deep inhale for some reason.

In other words, before trying to figure out what that AHI = 8.6 actually means, you need to locate the part of the night where you are most confident you were asleep and discount all events that are scored during periods when you know for sure you were awake.

Eloquently written and easy to understand; thank you very much!

I guess my immediate issue is not whether or not to dismiss the wake events myself, but rather I'm concerned about how it might impact my sleep doc's thinking tomorrow. While I know I can (and do) easily set my own pressure I would prefer that he concurs and "allows" me to keep the same lower pressures that he authorized a short while back. And I hate to get crosswise with yet another doctor this early in the game.

I guess my immediate issue is not whether or not to dismiss the wake events myself, but rather I'm concerned about how it might impact my sleep doc's thinking tomorrow. While I know I can (and do) easily set my own pressure I would prefer that he concurs and "allows" me to keep the same lower pressures that he authorized a short while back. And I hate to get crosswise with yet another doctor this early in the game.

You said it well here...just explain it to the doc the same way and I bet he/she will concur. I wouldn't think the doc would make settings changes based on a couple of bad nights anyway--hopefully he will look at long term trends. If I am not mistaken I think you previously had posted about a lot of leaks? sounds like you are getting that under control and thats great! good luck with your appt. I bet it will go just fine.

avi123 wrote:Old dude, IMO, anxiety should NOT have a bad effect on AHI. If you believe that it does and you also believe that AHI is a good indicator of the level of OSA treatment then why not take anti anxiety medications. I myself take Paxil and Xanax but NOT b/c of hi AHI.

See my treatment data for the last year:




Also check:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?
http://www.respiratoryreviews.com/sep02 ... Index.html

.
.

Anxiety of course comes with different symptoms for different people. It may or may not impact you this way but it does seem to in my case. I do indeed take Xanax but it seems to be disruptive to sleep so I try not to take it at bedtime.

As far as the efficacy of AHI numbers being in dispute, perhaps so. But we must have some measure by which to know if we're progressing and as of this writing I sure don't know of a better one. I can only imagine the look on my doc's face if I sprang this one on him!

I don't have OSA but occasionally as I'm just dozing off in between wake and sleep,I'll awake with a start with heart beating a little faster and an anxious feeling which lasts for a few minutes. I'm sure that phenononem has been discussed here (and may even have a name for it) so if I can find it I'll post it or maybe someone else knows what I'm talking about.

Dori , is this what you are referring to?

http://www.nbcnews.com/health/why-do-we ... eep-785736

Thanks Oak, see I told you! Now see if you can find the old thread where the pros here talk about it! I'll give you a gold star!

Well, I am not sure this is what old dude is talking about. It doesn't sound like he is experiencing the "jerk" sensation but rather a feeling that he needs to breathe more deeply? Anyway, I just did a site search for "hypnic jerk" and all sorts of threads come up. This is a fairly recent one: viewtopic/t92004/viewtopic.php?f=1&t=80 ... pnic+jerks

What is interesting to me is that the news article made it sound like something very common and yet the people in the above thread are frightened by it.

Anxiety about sleeping is a very difficult thing to deal with. I experience a great deal of anxiety about sleeping and even took medication for it about 5 years ago--little did I know it was because I was stopping breathing in my sleep and my brain and body unconsciously knew it.....fast forward 5 years to apnea diagnosis. It is just astounding to me that many many people are having problems in life which possibly are apnea and it is being missed..........

anyway, hopefully old dude will come back to the thread and try to explain more about what he is experiencing...

oak wrote:Well, I am not sure this is what old dude is talking about. It doesn't sound like he is experiencing the "jerk" sensation but rather a feeling that he needs to breathe more deeply? Anyway, I just did a site search for "hypnic jerk" and all sorts of threads come up. This is a fairly recent one: viewtopic/t92004/viewtopic.php?f=1&t=80 ... pnic+jerks

What is interesting to me is that the news article made it sound like something very common and yet the people in the above thread are frightened by it.

Anxiety about sleeping is a very difficult thing to deal with. I experience a great deal of anxiety about sleeping and even took medication for it about 5 years ago--little did I know it was because I was stopping breathing in my sleep and my brain and body unconsciously knew it.....fast forward 5 years to apnea diagnosis. It is just astounding to me that many many people are having problems in life which possibly are apnea and it is being missed..........

anyway, hopefully old dude will come back to the thread and try to explain more about what he is experiencing...

I'm here!

It's similar to the hypnic thing in that it's just at the moment you fall asleep, but instead of a jerk it's more of a feeling that you are suddenly about to suffocate and must take a deep, prolonged breath. Nothing triggers my anxiety more than any type of respiration compromise; sometimes even a stopped up nose will do it. And I've always had an unnatural fear of falling asleep, thinking that perhaps I won't wake up. Don't even ask me about general anesthesia!

I suspect that a lot of this has to do with undiagnosed sleep apnea starting in my late 20s, and I'm now 64. Particularly if I'd had a drink or two, in those days I would abruptly awake with an inability to exhale that was absolutely frightening. I was smart enough to know it was likely sleep apnea but thought I had it covered by stopping drinking and sleeping on my side. With an AHI of 131 at titration a few months ago I don't think I quite had it covered, did I?

Anyway, irrational fear fueled by anxiety is a perfect equation for poor sleep.

old dude wrote:
I'm here!

It's similar to the hypnic thing in that it's just at the moment you fall asleep, but instead of a jerk it's more of a feeling that you are suddenly about to suffocate and must take a deep, prolonged breath. Nothing triggers my anxiety more than any type of respiration compromise; sometimes even a stopped up nose will do it. And I've always had an unnatural fear of falling asleep, thinking that perhaps I won't wake up. Don't even ask me about general anesthesia!

I suspect that a lot of this has to do with undiagnosed sleep apnea starting in my late 20s, and I'm now 64. Particularly if I'd had a drink or two, in those days I would abruptly awake with an inability to exhale that was absolutely frightening. I was smart enough to know it was likely sleep apnea but thought I had it covered by stopping drinking and sleeping on my side. With an AHI of 131 at titration a few months ago I don't think I quite had it covered, did I?

Anyway, irrational fear fueled by anxiety is a perfect equation for poor sleep.

I'm not sure how irrational you were being with an AHI of 131!! Your brain knew something was amiss...Here's hoping your appt goes well tomorrow.

old dude wrote:. One of the things that happens to me fairly infrequently is that I can be breathing very naturally and just at the moment I go to fall asleep I'll all of a sudden have to take a very deep and prolonged breath, which puts my body on high alert. Feels almost like I'm smothering. ?

There is a thing called sleep transition centrals. I get them too. Knowing what they are made a huge difference to me. No it is not an anxiety attack, it is sleep apnea. I get my breathing and heart beat settled down and then go back to falling asleep.