Apneas just as falling asleep?

[Nancy S]

Hello, I was just wondering if anyone knows what it means when you get the apneas literally the minute you fall asleep,
every single time without exception.

This has been happening to me for about 10 days, and I have a sleep study arranged, but need ideas for how to cope in
the meantime, or any ideas about what on earth could be going on.

It's like, when I sleep closer to horizontally, the minute I fall asleep I am awoken by a sound in my throat, plus the
feeling that something in the throat is becoming unstuck, plus a whoosh of air intake. This goes on the entire night,
until I sleep from exhaustion sometime after 6am. If I sleep propped up on an incline, I still have the same sudden
whoosh of air just as falling asleep, but the throat disturbance is less or even absent.

I know these are signs of apneas, but why would they happen every single time without exception, and only start last 10 days?

Some background: I am female in my late forties, with a bmi of 27 and no history of snoring. Also, no medications, smoking, etc.,
but definitely lots of anxiety in the past, along with pretty bad sleep habits (sleeping very late and not consistent times).

Thank you in advance to anyone who reads this... Any ideas at all would be more than welcome!!!

[Sleeprider]

Nancy, sleep transition apnea is not uncommon, and it is usually central apnea as the voluntary respiration hands-off to the autonomic. Here is an article from the Journal of Sleep Medicine that explains the phenomenon. It's not something to be concerned with, but if you experience other symptoms of sleep apnea, then a sleep study might be in order. https://www.e-jsm.org/journal/view.php?number=91

[Nancy S]

Thank you Sleeprider, I'll look into sleep onset apneas. Does that mean it's not common for people to have OSA the exact minute
of falling asleep, especially that consistently? Still, am a little troubled by a feeling that something is "popping" the moment
that I suddenly breathe in, so it's confusing. Well, the sleep study is scheduled anyway, but I really appreciate the insight,
and will check out the link. Thanks again...

[Sleeprider]

Most common that the apnea is central, especially if you don't have other indications of obstructive sleep apena like snoring, nocturia, fatigue and daytime sleepyness. It's not really something that anyone treats as a medical condition unless the centrals persist beyond sleep onset. It's uncomfortable, but is usually transient. Obstructive sleep apnea can similarly arouse you in early stages of sleep, usually with a gasp or sharp inhale. I get this if I try to nap in a chair or sleep with out the assistance of positive pressure. We just don't know without doing some testing, or looking more closely at the big picture.

[Nancy S]

Okay, thank you for the information, much appreciated.

[Mogy]

Hi Nancy S,
A similar thing happened to me when I first became aware and concerned with my sleep apnea. I was listening to my breath too closely as I was falling asleep. Almost like I was meditating on my breath. Then just as I was going asleep I would stop breathing for a bit, then my next breath would wake me up. I would cycle like this for about 10 times before I got to sleep.
What got me past this was 'white noise'. Enough noise so it is not easy to hear your breathing. You shouldn't be listening to your breathing as you go to sleep.

[Nancy S]

Thanks, Mogy, good idea about the white noise. Were those initial apneas obstructive, right as soon as falling asleep? Everything points to mine
being centrals, except that I'm pretty sure I can feel (and hear) something popping open in the throat together with the sudden breath. Either way, the white noise is a great idea!

[Mogy]

Before I had my sleep study I was sure I had Central Sleep Apnea. Mainly due to what I just described, also I didn't snore and I wasn't obese. I then got my diagnosis of OSA, but I also went through treatment-emergent complex apnea. The first couple of months were confusing.
One other thing I would like to mention is that in the semi-conscious state between wake and asleep a person's concept of time can be very incorrect. When I got my machine there where a couple of times I was sure I was having these apneas just as I was going to sleep. The next morning I looked at my data and there were no apneas scored by my machine in this time frame. This helped me quiet my anxiety alot.
My advice would be to try and not worry, and to not listen to your breath.

[Nancy S]

Yeah, I keep reading that snoring is connected to OSA, but then it seems like there are people who have OSA without snoring. This is all very new to me and it's taking time to understand how it works. Thank you for the advice, I appreciate it.

[Sleep2Snore]

Hi Nancy,
I used to get both central and obstructive apneas when just falling asleep and this is when I had a cpap with high pressure, just as I was falling asleep or had just fell asleep. however, I have a new machine now, a ResMed Airsense10 Autoset set to 11 and 20 and this is no longer a problem.  This came up at a conference I was at in Scotland and a show of hands showed it was normal for this to happen, even with cpaps set at higher pressures, though it was mostly centrals, obstructive apneas were mostly with the apap users while using ramp, though they did appear when cpap users when using ramp.
All I can say is they must be quick going to sleep if they fell asleep during the ramp function!
However, it is quite common and it was found that the earlier apaps didn't quite catch the first apnea before the user realised they were having an event.
This is quite a long time ago though and modern apaps are a lot better and quicker at reacting to the users needs, however, if you are using the ramp function this may stop the machine from responding until ramp is complete.
Since I got my new machine I have not noticed any events while falling asleep or just after falling asleep.
With the old machine I sometimes used to wake with a start and physically jump.  Used to scare the pants off the wife  
But it was not funny as I would be trying to gasp against the high pressure of the machine.
Once I was fully asleep it was not a problem for me, but this is quite common, though a modern APAP without ramp or EXP turned on should catch any event.  My machine ramps up from 0 to 11 quite quickly even though ramp is off, but it is so quick it is not really ramp, it is just a comfort thing.


Hope this helps answer your question.

Maybe it has just added to the confusion?