Anxiety and intermittent awakenings

[HalfAsleep]

The doctor i visited said i didnt need cpap. Just weight loss. Im posting the PSG below. The doctor is a well known and trusted chest physician and i do trust him. What i cannot deal with is the anxiety after each awakening. I cant help but obsess about things like what if its central apnea? what if i need more than 1 nights study to get more accurate results? what if the study was flawed? 

The doctor advised against titrations and cpap. joked that I was sleeping better than him!

I am sorry your doctor is being un-empathic. In fact, you might be sleeping a lot better than him, 'cos he might have the apnea from hell and not be willing to address it!

Also, "feeling rested" and having a good experience with sleep are individual experiences. IMO they're not things a doctor can evaluate.


Like you, I have high anxiety when I wake up. I often choke and gasp when I wake up, too. It has nothing to do with my BMI. I am not on CPAP....yet. But, like you, I'm guessing that CPAP will help me with some or all of that; whatever it doesn't handle, I'll address next.


But, yes, absolutely work on the sleep "hygiene". It's part and parcel of sleeping healthy: CPAP is just one piece of the sleep picture. My advice: start work on this ASAP. Start a thread on this if you have questions on how to get going or how other people have addressed it.

[HalfAsleep]

It sounds like some posters above (e.g. Sleeprider) have a fix on your sleep study and what might be needed. Are you able to get a machine such as they recommend in your home country? Are you able to get one shipped there without it being stuck in customs for months? Is there someone who can pick one up for you in the US (or elsewhere) and bring it in their luggage?

[taha]

I'm really glad I joined this forum. I'm overwhelmed at how you guys are willing to help and give your good time to helping people like me who would be at a loss without such help. I'm already getting answers and feeling better. I'll reply directly to each of your suggestions tomorrow God willing but for now I just want to say thank you from the bottom of my heart.

[srlevine1]

My sleep hygiene is extremely poor. I have always been a late sleeper. But since an acute episode of severe clinical depression in 2014 which lasted exactly 30 days and disappeared as quickly as it had appeared, i deal with my anxieties by binge watching tv shows and settling into a night time routine. I also take 0.5 mg klonopin to help me sleep (with prescription of course) and no i dont think this is causing apnea, as ive been taking this for nearly 3 years without any incident and my apneaic episodes (if thats what they are) have worsened only in the last 3 months. I dont understand why they have worsened so suddenly, as I have not gained much weight. I have now lost 4 KGs through a change in diet and the episodes are still there, if not worse.

I looked at your PSG study and could see nothing alarming or majorly worrisome. But, then again, I am not a physician. However, I was thinking that perhaps you may want to visit your doctor and consider alternatives to Klonopin or recalibrate your dosage. This particular drug has a number of side effects that can promote symptoms that correlate with anxiety. (mood changes, changes in heart rate, etc.)

Again, best of luck.

[HalfAsleep]

My sleep hygiene is extremely poor. I have always been a late sleeper. But since an acute episode of severe clinical depression in 2014 which lasted exactly 30 days and disappeared as quickly as it had appeared, i deal with my anxieties by binge watching tv shows and settling into a night time routine. I also take 0.5 mg klonopin to help me sleep (with prescription of course) and no i dont think this is causing apnea, as ive been taking this for nearly 3 years without any incident and my apneaic episodes (if thats what they are) have worsened only in the last 3 months. I dont understand why they have worsened so suddenly, as I have not gained much weight. I have now lost 4 KGs through a change in diet and the episodes are still there, if not worse.

I looked at your PSG study and could see nothing alarming or majorly worrisome. But, then again, I am not a physician. However, I was thinking that perhaps you may want to visit your doctor and consider alternatives to Klonopin or recalibrate your dosage. This particular drug has a number of side effects that can promote symptoms that correlate with anxiety. (mood changes, changes in heart rate, etc.)

Again, best of luck.

Great thought. Check in with your prescribing MD. Perhaps on a regular basis. Tell him/her that you are actively addressing sleep issues. Perhaps their recommendations could be coordinated with that knowledge?

You may find that apnea treatment makes it easier for you to sleep AND relieves the anxiety. So many positives can come out of getting a good rest where your body has air it can rely on.

You may have been having apnea symptoms for waaaay longer than you are aware.

[SarcasticDave94]

Hi taha, and  

Well, you've got step one taken care of. I'm not saying this arrogantly or any such like thing, but you've joined us on Apnea Board. Bravo on the first step. Now I see you've been given great advice already. Sleeprider has mentioned the chart with info, and others have chimed in too.

HalfAsleep (I think it was) said take things one step at a time; this works wonders really. That is how I had to win my medical battles; one symptom, illness, treatment at a time. Your choice how or what to focus on, but I chose the worst thing first. The thing that you absolutely can't ignore may need to be first. I can't answer that, it's for you to decide what that is.

Maybe as was suggested, address with you doctor the medication and modify it via dosage or replacement. Again a maybe, focus on the weight issue. No offense as I was heavier than you. 1 year ago, me: a male at 5' 11", weighing 300-pounds and a BMI of 41; THIS had to be addressed.

Mind you, I had just tried a CPAP and couldn't breathe out or so I thought. So I returned the CPAP and, with my primary care doc, I addressed my overweighted status by going through qualifying for insurance to pay for my bariatric sleeve surgery. BTW they paid for all the estimated $21,000 of that. Last September 19, 2016 I went to the hospital to get cut up a bit so the surgeon could remove 75% of my stomach. 6 months later, I was trimming down below 225 pounds and right now for over 3 months, the weight is down to between 201 - 205 at the home scale. BMI of 23-28.

Thought I was done, but apnea was still there, although down from 70+ AHI, 40+ AHI still wasn't going to cut it. I went to get a new sleep study and was assigned a BiPAP machine. Was I done yet? Oh NO of course not. For me a BiPAP causes central apnea; so enter the ASV machine path go I. All this and dealing with very bad back pain, arthritis, and fighting to get disability payments from Uncle Sam. That's our nickname for the federal government here in the US. AND on top of those things, zero income for 3 years! I still say, NEVER QUIT!

OK sorry it's long everyone...So in that above path a new symptom arises. I'm having breathing problems all day every day. A few tests and boom I've got a diagnosis of COPD to go with the Apneas.

I forgot about my back: I'm getting a spinal stimulant trial installed, temporarily of course, late this year to help with constant pain for over 3 years.

So again I say choose which thing to battle and when to fight it. After reading my above story, and it's all true and honestly my own story, you should understand why I HAD to choose which thing to battle first. I had to start somewhere, tackling all at once wasn't a doable thing.

Once again make a decision which thing MUST go first and conquer it. Step up to the plate again and conquer number 2 and so on until you're done.

2 last things: winners never quit and every journey, whether it's one mile or a million, starts with step ONE. Like I said, you did step one.

Best success,

Dave B. 

[taha]

Taha, your sleep study shows simple obstructive sleep apnea, with considerable oxygen desaturation, lots of snores and a moderate AHI. You have a lot of respiratory event related arousals (RERA). Nothing in these results suggest central or complex apnea should be a problem. It is not unusual not to recall or be aware of arousals or snoring.   You should benefit CPAP, and I would encourage you to not overthink this too much, but to get on good quality therapy, and if there is a problem with that, we can go from there.  Getting an auto CPAP with data should be your first priority.

I know you have a lot of anxiety whether these results are representative, and whether you might have problems not identified in the study.  Having looked at many studies and seeing the results, it is my opinion you will do very well. There is always a rare possibility that exposure to CPAP could raise issues with central apnea, but again this is unusual.  You should get an auto CPAP like the Resmed Airsense 10 Autoset and be pretty confident it will fit all your needs.  We'll be glad to help.

Hello Sleeprider. thank you for your review of my sleep study results; and I do appreciate your advice. Lately I have been obsessively thinking that this could be Central. My reasoning is as below:

1. Since childhood I have had tics which would manifest in my breathing cycle. I would breath in, hold my breath, click my ears a few times, then release my breath slowly, while making a humming/low growl in my larynx and repeat. This doesnt happen all the time. I barely even notice it. It has never affected my ability to work, sleep or exercise. I never took this seriously, as it never affected my life. Maybe I am being delusional but now I feel it has something to do with a breathing or neurological disorder.

2. I wake up suddenly and first thing i notice is that I am breathing out strenuously and then take 2 to 3 quick breaths which are deeper than usual, like hyperventilation.

3. Never hear myself snore before I wake up. I try to go back to sleep but a part of my mind is trying to monitor how I am breathing. Its like I am trying to pretend I have 2 brains, and 1 can monitor how the other is doing. Its silly. I am probably manufacturing symptoms by being over vigilant.

4. Most of my awakenings happen at or after dawn. I cant remember ever waking up before sunrise.

5. The apneas happen no matter what position I am sleeping in. I could be on my back, on either side or prone. It happens.

6. The onset of these symptoms was very sudden. Initially it would happen about 2 or 3 times a month. But about 1 month ago, it started happening 2 to 3 times a week. Now its daily. How could Obstructive sleep apnea get worse so suddenly. I have not gained any more weight. In fact I have lost about 4 kgs since i started trying to lose weight.

7. I have been taking Clonazepam at low doses every single night for the past 3 years and I feel this may have messed up my brain chemistry and caused central apneas.

8. When the Sleep study was performed, I never had an awakening, so I feel like it missed the central parts and showed only the mild OSA. At the time I was only awaking about once every 2 to 3 nights. Now for the past week to 10 days its almost every single day.

Now I know (and hope) the points I mentioned above can probably all be explained away with the diagnosis still being Obstructive SA. All the above points are probably delusions and a result of overthinking on my part and I certainly hope they are. 

I am basically just looking for some expert to tell me, don't worry, its still obstructive. I know this is not always possible, but I can only hope. Meanwhile, every night feels like i'm on a battlefield and there are bombs going around me, but I am required to sleep, knowing full well that in 3 to 4 hours I will be waking up, short of breath.

Would you still recommend I get an APAP?

[Sleeprider]

Taha, yes I would continue to recommend auto CPAP. We have no evidence that your problems might have CNS (central) origins. Clonazepam does not have the potential of opiates for CSA but Benzodiazepines can aggravate such an underlying condition. This would not contravene starting an individual on CPAP, especially when primary diagnosis is obstructive sleep apnea. I simply cannot imagine the circumstance that would recommend that you to start using a machine five-times more expensive than auto CPAP in the absence of any evidence of a specific need or benefit. While no decision like this is risk-free, I don't see you as having a higher risk of central sleep apnea, or CPAP induced complex apnea than anyone else. That risk is about 8% from what I have read, with a range from 3 to 15%.

I think the benefits of CPAP treatment at this point, outweigh the stress, delay and investment needed to obtain ASV. If your CPAP data demonstrates a lack of efficacy and need for ASV, you will know that fairly quickly; however there is no way that the existing evidence supports recommending an investment by insurance or yourself in the much more expensive ventilator.

[HalfAsleep]

Taha, your sleep study shows simple obstructive sleep apnea, with considerable oxygen desaturation, lots of snores and a moderate AHI. You have a lot of respiratory event related arousals (RERA). Nothing in these results suggest central or complex apnea should be a problem. It is not unusual not to recall or be aware of arousals or snoring.   You should benefit CPAP, and I would encourage you to not overthink this too much, but to get on good quality therapy, and if there is a problem with that, we can go from there.  Getting an auto CPAP with data should be your first priority.

I know you have a lot of anxiety whether these results are representative, and whether you might have problems not identified in the study.  Having looked at many studies and seeing the results, it is my opinion you will do very well. There is always a rare possibility that exposure to CPAP could raise issues with central apnea, but again this is unusual.  You should get an auto CPAP like the Resmed Airsense 10 Autoset and be pretty confident it will fit all your needs.  We'll be glad to help.

Hello Sleeprider. thank you for your review of my sleep study results; and I do appreciate your advice. Lately I have been obsessively thinking that this could be Central. My reasoning is as below:

1. Since childhood I have had tics which would manifest in my breathing cycle. I would breath in, hold my breath, click my ears a few times, then release my breath slowly, while making a humming/low growl in my larynx and repeat. This doesnt happen all the time. I barely even notice it. It has never affected my ability to work, sleep or exercise. I never took this seriously, as it never affected my life. Maybe I am being delusional but now I feel it has something to do with a breathing or neurological disorder.

2. I wake up suddenly and first thing i notice is that I am breathing out strenuously and then take 2 to 3 quick breaths which are deeper than usual, like hyperventilation.

3. Never hear myself snore before I wake up. I try to go back to sleep but a part of my mind is trying to monitor how I am breathing. Its like I am trying to pretend I have 2 brains, and 1 can monitor how the other is doing. Its silly. I am probably manufacturing symptoms by being over vigilant.

4. Most of my awakenings happen at or after dawn. I cant remember ever waking up before sunrise.

5. The apneas happen no matter what position I am sleeping in. I could be on my back, on either side or prone. It happens.

6. The onset of these symptoms was very sudden. Initially it would happen about 2 or 3 times a month. But about 1 month ago, it started happening 2 to 3 times a week. Now its daily. How could Obstructive sleep apnea get worse so suddenly. I have not gained any more weight. In fact I have lost about 4 kgs since i started trying to lose weight.

7. I have been taking Clonazepam at low doses every single night for the past 3 years and I feel this may have messed up my brain chemistry and caused central apneas.

8. When the Sleep study was performed, I never had an awakening, so I feel like it missed the central parts and showed only the mild OSA. At the time I was only awaking about once every 2 to 3 nights. Now for the past week to 10 days its almost every single day.

Now I know (and hope) the points I mentioned above can probably all be explained away with the diagnosis still being Obstructive SA. All the above points are probably delusions and a result of overthinking on my part and I certainly hope they are. 

I am basically just looking for some expert to tell me, don't worry, its still obstructive. I know this is not always possible, but I can only hope. Meanwhile, every night feels like i'm on a battlefield and there are bombs going around me, but I am required to sleep, knowing full well that in 3 to 4 hours I will be waking up, short of breath.

Would you still recommend I get an APAP?

It really doesn't sound like you're delusional, just needing feedback from others with a similar category of experiences.

Your current symptoms may not be recent at all. You could have had them all along. It's normal to not know what your body is doing during sleep. Many apnea sufferers are not clued in to how much they are struggling just to breathe in the night.