Reassurance Maybe? Cant be Apnea, can it?

I had some mild anxiety problems that cleared up with CPAP.

Last fall I had lunch with a friend I had not seen in four years. She told me about panic attacks that started over 10 years and grew really bad. She finally got a CPAP and the attacks went away almost immediately.

We have to remember this and warn our friends who are having problems.

Thank you Christine, I woke up this morning in a full blown intense panic attack and was convinced I wouldnt survive the morning (perhaps my apnea is CAUSING my nocturnal panic?). Normally I can deal with Anxiety / Panic, but, when I get this run down (presumably by apnea) - I just dont have the energy to see things for what they are. The panic takes over and the cycle takes hold - which makes it all the more difficult to crawl back to normal. Thanks for your comments, gives me hope that CPAP might be the stepping stone to recovery!

Well, I had a horrible morning (and therefore a horrible day) and I could'nt wait any longer for the sleep doc to give me the results so I called them. Doc says that a CPAP pressure of 10.0 controlled my apnea. Thankfully, I already have a nice CPAP but the question is, should i set it as a CPAP at 10.0, or leave it in APAP mode with a pressure of 10 to 12 or something like that? Anybody had any experience with CPAP vs. APAP?

For anyone who didnt see it in the first post, I do have some Apnea (Mild OSA @14.4, Supine @ 27.9 and Supine REM @ 47.2). I know that anything above 30 is severe - but not sure how impactful this AHI is if its only during REM sleep.

thank you!

If your machine is already in APAP mode, I would leave it in that mode, but set the range
for a centimeter below your titrated pressure to a couple above.
Then you want to use a combination of your data reports and how you sleep/feel
to find a happy medium between good sleep and good numbers.

SilverSleep wrote:Well, I had a horrible morning (and therefore a horrible day) and I could'nt wait any longer for the sleep doc to give me the results so I called them. Doc says that a CPAP pressure of 10.0 controlled my apnea. Thankfully, I already have a nice CPAP but the question is, should i set it as a CPAP at 10.0, or leave it in APAP mode with a pressure of 10 to 12 or something like that? Anybody had any experience with CPAP vs. APAP?

For anyone who didnt see it in the first post, I do have some Apnea (Mild OSA @14.4, Supine @ 27.9 and Supine REM @ 47.2). I know that anything above 30 is severe - but not sure how impactful this AHI is if its only during REM sleep.

thank you!

I would set it 10 to 20 APAP. It won't go any higher than 10 unless you need the additional pressure. (If you are afraid of your doctor, set it to CPAP 10.)

Quit fretting over the diagnosis. You might have severe apnea. People usually sleep "lighter" in the sleep lab as compared to home. So what is measured about breathing in the lab often understates the case.

None of it matters anyway if you are determined to treat yourself well with CPAP. Your treated AHI is what matters. Forget the untreated numbers.

Here's a study which describes a potential effects of OSA on the vestibular system (KEY WORDS: OSAS, Dizziness, Vertigo, Imbalance, Disequilibrium.) A connection makes sense in the respect that apneic events generate a large amount of inflammatory cytokines, leading to both local and systemic inflammation (leading to a whole lot of potential issues).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146317/

I would also add that there are many sequelae that can potentially be associated with osa, possibly some of the issues you describe. You can check yourself (google sleep apnea and anxiety for example.)

As far as feeling worse with initial treatment, one suspects that as you optimize your pressure settings (good advice hereabouts on that) and procedures (eliminating leaks, for example) you might see more favorable results.

Stick with it, and good luck in getting good results.

.

Captain_Midnight wrote: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146317/

I would also add that there are many sequelae that can potentially be associated with osa, possibly some of the issues you describe.

Very nice Cap'n.

Yes, apnea can damage anything and everything. As has been pointed out on the forum many times, every cell in the body uses oxygen to generate energy. When oxygen is low, a cell will have a rough time.

OHM, I agree about cellular oxy deficit causing "rough times".

Also please consider the role of resultant inflammation. For your reading pleasure, an editorial summary from 2004...

Inflammation and Obstructive Sleep Apnea Syndrome: How Many Ways Do I Look at Thee?

http://journal.publications.chestnet.or ... id=1082648

.

For the dizziness, have you ever seen a "vestibular therapist"? This is usually a PT or OT who is specially trained in techniques to treat vestibular disorders. If you haven't tried this, it's worth looking into.

As for anxiety, I was having increasing anxiety and panic attacks before CPAP, and for a while they got WORSE as I was adjusting to CPAP. The mask made me feel claustrophobic, sometimes waking up with air blasting in my face sent me in to a panic. BUT, once I got used to CPAP, the panic attacks and anxiety levels went down so much. Before CPAP it was getting to the point where I was having difficulty driving across bridges because I'd have a panic attack that something would push me off the bridge. Since CPAP I'm doing much, much better. It took a while, so hang in there.

RE: your question about the pressure--your doctor recommended a fixed pressure of 10, you have your APAP set 10 to 12, and someone suggested 10 to 20.
It's my thought that maybe the pressure changes are contributing to your panic. You might want to try the fixed pressure at 10 for a few nights and see how you do with a steady pressure and no fluctuations. I would NOT suggest raising the top pressure to 20. For one, it may I cause more pressure changes that can set off your panic, and secondly, if there's too wide a spread your machine may end up "chasing apneas", which makes it use more pressure than would be needed otherwise. If 10 or 10-12 isn't enough, you'll see that in the data, and/or you may feel you're not getting enough air. In that case you could try slowly and carefully raising the pressure within a very narrow range until you hit that sweet spot where the pressure isn't triggering panic attacks AND you are getting optimal treatment.

Firstly, thank you everybody for your responses - I read every article cited and I really appreciate it. After talking with the sleep doc this afternoon, I setup my S9 to the specs he recommended and will give it a shot - fingers crossed.

Regarding the dizziness, my father actually owns a series of PT companies and hooked me up with vestibular therapists in his practice. Sadly, after a few months of work, there wasnt any real progress. Tonight I will setup the S9 for APAP, 10-12 and check the results in the morning - hopefully that will be a good starting place (little anxious as I have a meeting with the board of directors tomorrow morning to present a project proposal). Thanks again to everyone - I will certainly update this thread as I go along and hopefully have some good information to share with others in the future!

Increasing the minimum pressure from 5 cm to 10 cm with EPR of 1 (that's what it looks like you were using on your posted report) may be a bit of a large pill to swallow. If it is, you might try increasing that EPR to 2 or 3 and see if that makes it a bit easier to get use to 10 cm minimum.

SilverSleep wrote: Regarding the dizziness, my father actually owns a series of PT companies and hooked me up with vestibular therapists in his practice. Sadly, after a few months of work, there wasnt any real progress.

I hope you will tell your father that these idiot doctors should screen each patient for sleep apnea.

Best wishes and betting that all your problems are rooted in sleep apnea,

DeadlySleep

Increasing the minimum pressure from 5 cm to 10 cm with EPR of 1 (that's what it looks like you were using on your posted report) may be a bit of a large pill to swallow. If it is, you might try increasing that EPR to 2 or 3 and see if that makes it a bit easier to get use to 10 cm minimum.

Close, it was set to 5 - 15 EPR 2, I changed it to 9.6 - 12 EPR 2 and had an AHI of 0.75 the first night and 1.38 last night. I certainly felt more coherent and less anxious after the first night but it may have been a bit psychosomatic as I feel pretty normal (bad) this morning. Thanks for the advice!

I hope you will tell your father that these idiot doctors should screen each patient for sleep apnea.

He has kept up with my issues since the beginning (and he has Apnea as well with a CPAP) - but honestly - I still believe the vestibular issues preceded the apnea. If the CPAP fixes my vertigo, I will certainly have a talk with the therapists - but I believe that the vertigo was present long before my apnea started. Thank you!

For all of you that have been PM'ing me about progress...

Stats have been very good (AHI of 0.93 last night) but my anxiety has skyrocketed. I think its due to the chest pain from starting the machine (I hope thats what it is - this freaks me out as I had some issue with chest pains recently) and the Airophagia (sp). My abdomen is screaming in pain each morning. I reduced the pressure a bit (and there was no increase in AHI) and set the EPR = 3 - but it seems its still as bad as when the pressure was at 10 and EPR = 2. Funny thing though, SleepyHead says my EPR was changed to 0 even though the machine says 3. Hopefully the chest pain goes away and I will drop the pressure a bit again tonight.

Thank you for all of your suggestions and interest - I will post a follow up in the next few days.

Early on I experienced chest pain that seemed to be musculoskeletal, more of a soreness type of pain and It resolved in a few weeks. ( I was checked out so I could relax about it and was assured it was not cardiac.) At the pressure I used then, I had no trouble with air in the belly. As the years passed and I needed a bit more pressure, I found out what others were talking about with the gas pains. Just through experimenting I found certain sleep positions made air in the belly worse. Maybe you can figure out which side is best for you, etc and help yourself out a bit. You are on the right track - targeting the lowest pressure at which you can get the best results for you. It may be worth letting a few events come through during the night if they are short in duration if that pressure helps you avoid belly pain. You'll figure it out. You are well on your way in this journey, doing better than some without the anxiety element. Be encouraged that you have found the fortitude to tackle these challenges which I'm guessing will one day seem more like molehills than mountains in your future CPAP experience. Hang in there. I'd love to see you succeed and be one of those who can one day share their experience with other new users also facing anxiety issues.