Daytime Apnea?

[DocWils]

idaho-dan

I am afraid, insurance or not, you HAVE to see a doctor, even a G.P. for this. This isn't something you can figure out for yourself. If your fingernails or lips turn blue or grey, or you have shortness of breath , chest tightness, or wheezing when you breath, see the g.p. Emphysema is something that can be "managed" if caught early enough, as can other forms of C.O.P.D. (which emphysema falls under). If it is advancing you might start developing a "barrel chest" which is sign of the disease. Either way, you don't have much choice if you want to live with some comfort for much longer - get thee to a healer.

[archangle]

idaho-dan

I am afraid, insurance or not, you HAVE to see a doctor, even a G.P. for this. This isn't something you can figure out for yourself. If your fingernails or lips turn blue or grey, or you have shortness of breath , chest tightness, or wheezing when you breath, see the g.p. Emphysema is something that can be "managed" if caught early enough, as can other forms of C.O.P.D. (which emphysema falls under). If it is advancing you might start developing a "barrel chest" which is sign of the disease. Either way, you don't have much choice if you want to live with some comfort for much longer - get thee to a healer.

I don't have a lot of faith in the "medical mafia," but I agree with DocWils on this.

Some of us might be able to manage sleep apnea on our own, but even that is risky.

Daytime breathing problems like this are definitely something that needs professional medical attention. Of course, it's still a good idea to educate yourself on the conditions as well.

The advice on this board that is good for sleep apnea is probably not very helpful for your daytime breathing problems.

[DocWils]

"medical mafia" huh? Gee, t'anks. Us guys in da Nosocomio Nostra gots sometimes da smarts. Summa us even is Wise Guys.

[arlinee]

This could be obesity hypoventilation syndrome. It used to happen to me before I lost a lot of weight.
I think it used to be call Pickwickian syndrome.

It you're not overweight, it's probably something else though. In any case, your doctor might be able to help.

[jgjones1972]

"medical mafia" huh? Gee, t'anks. Us guys in da Nosocomio Nostra gots sometimes da smarts. Summa us even is Wise Guys.

I like to refer to it as the "Mediceen Cartel" (Medellin Cartel). No offense intended...I like to say "no offense intended" when I know I've said something offensive because that makes everything ok.

[DocWils]

Ya know, we don't have a cartel - just science to back us up (I know science is a dirty word in some parts of the US) and laws to protect the people from quacks and snake-oil salesmen (which I see is still a massive industry in the US).

Arlinee, Pickwick Syndrome would require several conditions, including extreme obesity, not just being overweight (you sort of have to look like Pickwick) as well as a form of COPD. Curiously, a few women who have had extreme breast enlargements have suffered from something similar, leading to the conclusion that the problem lies far more in moving the weight of the chest in and out for breathing than the obstruction from fat of the neck and chest. I encountered one lady in my practice who had similar problems brought on by her naturally overly generous endowment, and yes, breast reduction surgery actually brought it under control.

My father suffered from a condition similar to Pickwick's, but in his case it wasn't that he was overweight (he was) but because he had had his nose broken as a child, leaving him with a permanent blockage that made his breathing heavy and belaboured. He still managed to live up until a few months shy of 80, and in the last two years of his life life, on just 15% heart function, a fully active life (running up and down five flights of stairs around thirty times every day in his store for 30 years left him in incredible cardiac shape, despite his weight).

Either way, the advice remains the same - this is nothing you can solve on your own, you need to see a member of the Nosocomio Nostra. Don't forget to kiss the ring and bring a token of your respect. We like that, and it keeps Guido and Bruno from tearing your arms off in a friendly like way of teaching you about respect for da established order.

[idaho-dan]

Maybe more info is in order here as I don’t want to get anyone alarmed!

I’m a 60 year old male, moderately overweight (5’8” tall, medium frame, 200 LBS), have never had allergies of any kind nor allergic to anything I’ve yet discovered. I worked as an electrical engineer for 30 years, had great insurance and regular bi-yearly checkups with all the recommended tests (colonoscopy at age 50, etc) and took reasonable care of myself although I did smoke for 15 years, off and on, from my late teens to early 40s. Other than having my tonsils out in the late 1950's and a moderate motorcycle accident at age 20, I have never even been more than an outpatient at a hospital.

I took voluntary early retirement when my company made it available in late 2006 but they bit the dust in the “Great Recession” and other than what survived in my 401K, all pension and insurance disappeared. But before they completely disappeared (I could see the writing on the wall) I had a lot of medical testing and “preventative maintenance” work done. Here is what was learned:

I don’t have any of the classic symptoms of emphysema or COPD. Apparently, knock on wood, I have so-far dodged the bullet for my stupidity of smoking. X-rays are clear, no bronchitis or lung capacity issues, I was a lifeguard and swimming instructor in my youth and had developed excess respiratory capacity that may have offset the losses caused by smoking. Everything came back negative on all the testing that was done (except an unexplained cognitive issue mentioned below).

My symptoms started 10 years ago as occasional but increasing nights of rotten sleep - waking up repeatedly with a panicked feeling but not remembering, at least for the first year or so, the accompanying suffocation symptoms. One morning after my wife informed me that I had stopped breathing for long periods during the night, I kind of put two and two together and went to my primary care physician with the theory that I might have Sleep Apnea. He referred me to a sleep clinic in Salt Lake City which eventually brought me in for a recording/observation session. What came back was interesting in that although I did exhibit profound Apnea events, the instrumentation and electrodes hooked to my chest indicated that my brain was frequently not sending “a strong enough signal” to my diaphragm muscle causing a progression from very shallow breathing to no breathing at all. Then I would wake up and gasp. Once this began, it continued to get worse throughout the test period. They even came in mid-test and re-arranged the electrodes to get more detailed readings on the intercostal muscles and added a second “elastic band” sensor to my abdomen (I already had one around my chest) to detect if any respiratory muscles were even trying to move at the times when those nerve signals got very weak. When all was said and done, the 2 doctors who evaluated the results had somewhat different opinions: One said I had Sleep Apnea and recommended that I be prescribed a CPAP machine. The other said my results were “A-typical” and recommended a ventilator as my Sp02 was dropping “dangerously low” and there were no indications of airway obstruction or intermittent soft tissue collapse. Remember, this was back in 2006 and the concept of “Central Apnea” was just beginning to appear.

I realize this reply is getting too long, so I’m going to skip stuff and wrap it up.

So with no insurance and lower income from what remained of my fixed-income investments paying Bernanke’s sub-one-percent return, doctors became a carefully-metered expense and I began the task of figuring out what was going on. But things rarely stay static and my “disease” began to get worse. I began to have more apnea events during the day – mostly when my mind was either “zoning out” while watching TV, reading or driving or if I had to concentrate on something else. If I was talking or walking/moving around/working, my breathing happened without mental intervention. About here is where I broke down and bought my first basic CPAP and it cut down the number of nightly wake-ups by about half. Soon after that my nephew loaned me his “new kind of machine” to try and although I thought it would be a waste of time it was WONDERFULL! It was the machine I am currently using at night, ResMed 36005 AUTOSET with the 904 firmware load and the next day I had one overnighted-in. What a relief to be able to sleep at night! Yes the mask/pillow thing was a bear to get used to, but the alternative felt infinitely worse. All I can figure is that the pressure profile algorithm of that machine, where it significantly increases the air pressure at the moment it senses you have stopped exhaling, gives my body a small “jolt” and helps my lungs expand a little and nudge the respiration muscles to begin a contraction that the wimpy nerve signals alone are not enough to initiate. That’s my guess, anyway.

Within a few months I increasingly had to force myself to “think” about that next breath while awake – not the exhale (that part always works fine) but once my mind gets distracted I just stop inhaling and the cycle repeats over and over until it’s time for bed and I can strap on my AUTOSET and go right to sleep and escape the suffering.

Now daytime is getting to be what my nighttime used to be: A pain in the a$$. I bought a wristwatch-like recording pulse oximeter and the nights never dip below the high-80s but the days are now dipping down into the low 80’s and sometime into the high-70s. It’s as if when I first wake up and am nicely rested (8-9 hours of real sleep per night) I can do the “remember to keep the feeling in my chest on my mind” thing pretty well and not let the lapses in breathing go too long. But as the day wears on (or I just get zombied-out because of the lowered average oxygen level?) I get less successful at remembering and the gasping gets more exaggerated as I’ve gone deeper into oxygen deprivation before snapping out of it and taking that damn breath.

Note the tone of the last part of that last sentence – I was going to edit it out but it is EXACTLY how I end up feeling towards the end of a typical day: really getting upset with myself (my body?) every time that it/I can’t even “remember” to do the most basic/simple of things such as taking a stupid breath!

OK, that’s enough. Sorry to rag-on so long. But really - I'm OK, just wanted to compare symptoms with nuttnhunee as I've been Google-ing for years now, trying to see if anyone else is experiencing the same thing.

[DocWils]

Well, your description of the night time side of things is mostly Central apnoea (that is when the brain isn't sending the breathing signal - OSA or Obstructive (classic) Sleep Apnoea is when something is blocking the breathing tube). The question is, if this is happening during the day, why? You mention zoning out - is there a risk of high function narcolepsy or catalepsy that could trigger a CA event? These need to be cleared up with a neurologist. Since you stopped smoking a fair while back, the risk of emphysema is actually rather mild, but, again, a chest thump and maybe an x-ray would rule it out altogether or confirm it. I rather wish you had mentioned all this history at the outset. It would have avoided blind alleys of speculation. At best we can set out a few different scenarios for you to examine, see if any fit the symptoms.

In addition the above, which follows the logical scenario you set out, a few other thoughts. Are you a nose or a mouth breather? If the former, is there a possibility of some nasal obstruction or collapse of the nasal walls, restricting O2 intake? This is a far more common problem that one would think ( I have it, which is why I must wear nasal pillows with my CPAP). Also polyps or a deviated septum?

Is your posture of the nature that you may be crowding your chest or diaphragm when upright, thus rendering breathing more difficult? Do these breathing difficulties when awake still occur when you are supine? Are they positional? What are specific triggers to events or is there no discernible pattern? Are you on any medications? Have you examined your blood sugar and monitored it during the day especially after an event? The "zoning out" may be due to hypoglycaemia or pre diabetes, for instance. Do you exercise regularly, and if so, does your routine include or cover deep breathing and thoracic work outs?

In order to pin-point the nature and cause of the problem, these are the sort of questions you have to ask yourself (don't tell me! This site is not a diagnostic site, nor may we attempt to diagnose on this site).

Either way, you have to do this through medical channels - it is impossible for me or anyone to tell you what is up over this distance, and although I am one of those white coat guys (actually I never where one, despite it being regulation here), this is a general forum for SA. Nor is it possible to self diagnose or treat this. You need to head to a hospital, probably a polyclinic would be your best bet. Your g.p. can rule out certain problems (emphysema, diabetes, hypoglycaemia, for instance) but neurological disorders are a whole other level of expertise and technology. Try and ask yourself all the above questions, find the pattern and write it all down. Use that to help inform any doctor you see so he can get as thorough a history as he can.

[Zomglawlz]

I suffer fom a very similar condition. I've noticed over the past several months there were times that I would simply forget to breath, or that's how I felt, when I notice it. This happens when I'm awake, normally zoned out or distracted similar to what you describe. I was just recently diagnosed with OSA. I was referred to the sleep clinic because of severe sleep disturbance, stemming from a TBI about 10 months back. The sleep study report discovered I now have OSA, but what was interesting to me, was that they also recorded central apneas. I am 36yo male, active duty military. Not overweight, underweight if anything. I have a follow up with the sleep clinic soon and was planning on mentioning this to them since they are still occurring. After readin this, I may need to mention it to my neurologist. I never even thought to mention it to him. I guess I only thought of him as my migraine doc.

At any rate Idaho-Dan, you are not alone with this one. I'll try to remember to come back on here if they figure something out for me.

[idaho-dan]

DocWils,

I mostly am looking for others (if there are any) with some similar symptoms in the hope that: 1) If any exist, then maybe the medical establishment has seen something like this before, and 2) Maybe that someone could provide a lead that I could investigate via the internet (I am fairly proficient at internet research). I don’t want anyone to depart from any forum’s rules or the norms of common sense in attempting to diagnose me. Just looking for “directions” for me to look into.

I find it helpful to answer/add information to a post such as yours by embedding my responding text into the original. Please bear with me as I do this with yours. My text will be preceded and followed with four asterisks (****) and be in ALL CAPS for easy differentiation.

Well, your description of the night time side of things is mostly Central apnoea (that is when the brain isn't sending the breathing signal - OSA or Obstructive (classic) Sleep Apnoea is when something is blocking the breathing tube). The question is, if this is happening during the day, why? You mention zoning out - is there a risk of high function narcolepsy or catalepsy that could trigger a CA event? **** I HAVE NEVER RESEARCHED THESE – WILL DO SO TOMORROW. BUT FOR CLARIFICATION THE ZONING OUT FEELS MORE OF THE KIND OF TEMPORARY MENTAL STATE ONE HAS WHEN TIRED OR CONCENTRATING ON SOMETHING ELSE. I'VE ALWAYS HAD A VERY ONE-TRACK MIND AND I CALL IT 'ZONED OUT' WHEN I'M CONCENTRATING HARD OR ELSE LETTING MY MIND REST. OTHER THOUGHTS ARE THEN BLOCKED FROM MY ATTENTION**** These need to be cleared up with a neurologist. Since you stopped smoking a fair while back, the risk of emphysema is actually rather mild, but, again, a chest thump and maybe an x-ray would rule it out altogether or confirm it. ****I STILL DO GO TO MY DOCTOR, BUT ON AN AS-NEEDED BASIS – NO CHECKUPS/ETC. THE THUMP AND STETHOSCOPE LISTENING HAVE BEEN DONE AT LEAST YEARLY WITH NEGATIVE RESULTS SO FAR, BUT NOT THE CHEST X-RAY**** I rather wish you had mentioned all this history at the outset. It would have avoided blind alleys of speculation. ****SOMETIMES SPECULATION LEADS IN A NEW DIRECTION – HELPS ME THINK OUT OF THE BOX**** At best we can set out a few different scenarios for you to examine, see if any fit the symptoms. ****EXACTLY WHAT I DESIRE!****

In addition the above, which follows the logical scenario you set out, a few other thoughts. Are you a nose or a mouth breather? ****NOSE**** If the former, is there a possibility of some nasal obstruction or collapse of the nasal walls, restricting O2 intake? ****MY UNDERSTANDING OF ALL THE TESTS AND DIAGNOSTICS RESULTS WHILE I STILL HAD INSURANCE (AND MY DOCTOR OFFICE VISITS AND ADDITIONAL TESTS SINCE) IS THAT THERE IS VIRTUALLY NO CONNECTION OF AN OBSTRUCTIVE NATURE. ALL THE WAY FROM THE NOSE/MOUTH TO THE ALVEOLI, EVERYTHING LOOKS GOOD EXCEPT THE MOTOR NERVE SIGNALS TO THE RESPIRATORY MUSCLES. TWO SEPARATE SLEEP SESSION TESTS, THE LAST ONE WITH ADDITIONAL (AND SOMEWHAT EXPERIMENTAL I GATHERED) INSTRUMENTATION TO DETECT ANY NEGATIVE PRESSURE IN MY TRACHEA WHICH WOULD INDICATE AN ATTEMPT TO INHALE WITH AIRWAY BLOCKAGE, WERE NEGATIVE. THERE WERE EVEN TWO ACOUSTIC SENSORS (BASICALLY TINY MICROPHONES) TAPED TO MY THROAT AND STERNUM TO DETECT ANY GURGLING OR TISSUE FLAPPING OR OTHER POSSIBLE INDICATIONS OF AN OBSTRUCTION. THAT TESTING DETAIL IS PARTLY WHY I WAS SO SURPRISED WITH THE EVALUATING PHYSICIANS’ ONE-DIMENSIONAL RECOMMENDATIONS. I CAN ONLY GUESS MY SPECIFIC SYMPTOMS ARE “ATYPICAL”**** This is a far more common problem that one would think ( I have it, which is why I must wear nasal pillows with my CPAP). Also polyps or a deviated septum? ****NO KNOWLEDGE, WILL RESEARCH****

Is your posture of the nature that you may be crowding your chest or diaphragm when upright, thus rendering breathing more difficult? ****WHEN I WAS A TEENAGER MY PARENTS WOULD TELL ME TO QUIT SLOUCHING, AND I BEGAN PAYING ATTENTION TO MYSELF IN MIRRORS/WINDOWS AND HAVE HAD GOOD POSTURE SINCE**** Do these breathing difficulties when awake still occur when you are supine? ****YES****. Are they positional? ****NO**** What are specific triggers to events or is there no discernible pattern? ****I AM BY NATURE VERY ANALYTICAL AND HAVE BEEN TRYING TO SPOT A PATTERN OR CAUSE/EFFECT ACTUATOR SINCE MY RESEARCH BEGAN. SO FAR, NOTHING**** Are you on any medications? ****HEY, I’M 60! YOU BET! NOT EXCESSIVE OR UNUSUAL BY MY OBSERVATIONS OF OTHERS MY AGE AND OLDER**** Have you examined your blood sugar and monitored it during the day especially after an event? ****YES, BECAUSE SINCE I DEVELOPED A MILD INSULIN RESISTANCE A COUPLE YEARS AGO AND DOC SAID TO LOSE SOME WEIGHT AND EXERCISE. THAT HAS WORKED WELL AND NOW I ONLY CHECK MY GLUCOSE LEVELS EVERY WEEK OR SO**** The "zoning out" may be due to hypoglycaemia or pre diabetes, for instance. Do you exercise regularly, and if so, does your routine include or cover deep breathing and thoracic work outs? ****ANSWERED THE EXERCISE ABOVE, BUT NO ON THE BREATHING WORKOUTS. WILL RESEARCH THAT****

In order to pin-point the nature and cause of the problem, these are the sort of questions you have to ask yourself (don't tell me! This site is not a diagnostic site, nor may we attempt to diagnose on this site). ****YIKES! I HOPE YOU OR ANYONE ELSE READING THIS UNDERSTANDS I’M JUST SHARING MY INFO IN THE HOPE THAT SOMEONE ELSE WITH MY SYMPTOMS CAN LEARN FROM MY EXPERIENCES AND/OR LEAD ME IN A NEW RESEARCH PATH. I DON’T WANT ANYONE TO OFFER ME HARD DIAGNOSTIC HELP****

Either way, you have to do this through medical channels - it is impossible for me or anyone to tell you what is up over this distance, and although I am one of those white coat guys (actually I never where one, despite it being regulation here), this is a general forum for SA. Nor is it possible to self diagnose or treat this. You need to head to a hospital, probably a polyclinic would be your best bet. Your g.p. can rule out certain problems (emphysema, diabetes, hypoglycaemia, for instance) but neurological disorders are a whole other level of expertise and technology. Try and ask yourself all the above questions, find the pattern and write it all down. Use that to help inform any doctor you see so he can get as thorough a history as he can.

****YOU MENTIONED NEUROLOGICAL DISORDERS, and I currently believe that is the most promising avenue for research. I’ve read many articles/blogs/research papers that tend to point, based on my particular set of symptoms, in that direction. In the process of elimination, all the other causes I’ve explored have one or more conflicting symptom/diagnostic result that probably should eliminate them from consideration. Interestingly, I read a post a few weeks ago from a lady who asked if anyone had her specific set of symptoms which, of the 3 or 4 mentioned, matched mine perfectly. They began after she had a concussion. But the thread was a few years old and had gone dead. One current search focus is on how the oxygen sensors in the aorta, the CO2 sensors in the extremity nerves, and the PH sensors in the brainstem may be working together to create a multi-sensor-correlated closed loop feedback system controlling autonomous respiration. That one looks promising for me to follow because, ironically, during my career there was a project where I had to become competent in the electronic version of such a system for an aircraft navigation system upgrade project I was assigned to. There I learned how correlated sensor systems can behave when one or any subset of the sensors cease sending data or provide false data. If, and that’s a BIG if, there are similarities with the body’s respiratory regulator setup, it might point me somewhere new. Possibly it could take as few as one of those “biological sensors” failing to muck up the works. Sorry for the technospeak, it’s my past life showing through. And THANK YOU for your ideas. I frequently get thinking in circles and different perspectives often help break that cycle.****