Daytime Apnea?

[idaho-dan]

Zomglawlz,

First off, I commend and admire you for your service to our country and this world. I wish you luck and God’s blessings to get through this and return to family and civilian life as undamaged as possible, maybe even a little better than before in some aspects. I pray for those blessings on all our servicemen and servicewomen.

Secondly, what a shock to read a TBI preceded your symptoms. Please read the previous post as it mentions a lady who got these symptoms after a concussion.

The OSA diagnosis is puzzling, especially with your weight. DocWils would be very knowledgeable on this whole thing if he chimes in.

And PLEASE post any progress on finding a cause or treatment as the sheer number of TBI injuries the DOD has treated in the last 10+ years likely will likely provide some new insight as those medical records are analyzed over time. It may well be more than coincidence our symptoms are so close.

Godspeed, Zomglawlz

[DocWils]

This 'multi-sensor" setup is only one of many the body has - there are massive feedback and reporting systems in the body (did you know you have "sensors" in your ankles for balance that work directly with the balance apparatus in your brain?) and so of course, when one sensor set is "out" or providing false information, it mucks up the whole system that it is supposed to deal with - case in point is Meniere's disease - because one balance organ is giving the brain false reports, the brain cannot process the information well against the reports from the other balance organ (there are the semi-circular canals in the inner ear) and so interprets that as dizziness, hence, you feel dizzy with Meniere's. There are similar analogues in the breathing feedback system. EEG can often sort the source of this.

I should point out that it is not unknown for people who are given to extreme concentration to enter into periodic breathing phases, meaning, in this case, the pattern shallows and bottoms, with intakes happening far fewer times and often with long pauses between.

As for medication, there are many medications, when, either by themselves or when in combination with others, will disrupt the breathing pattern and cause breathing cessations.

[Iblackmore]

@idaho-dan @nuttinhunee
I hope my reply will at least help you guys figure out what is going on with your body because i know it can be confusing. After 3 years of waking up feeling HEAVILY sedated no matter how long i sleep for, ive finally come across a diagnosis that makes sense.

I have the un-common type of sleep apnea named Central Nervous System Apnea, as opposed to Obstructive Apnea. Notice i do not use the word "sleep" because that is irrelevant, its just that most people experience this event during sleep. I do not. It seems like neither of you do either. If you do not snore but still have apneas periodically, you probably are having Central Apneas. This basically means that your brain has forgotten to send the signals to your diaphragm nessecary for respiration. My brain is TERRIBLE at sustaining my autonomous breathing at night AND during the day. I have noticed for this entire 3 year experience that my breathing was not constant, but the sensation was so strange i had no idea how to describe what i was feeling to a doctor.

This being known as a fact, everyone who answers "you cant have an apnea during the day because its called sleep apnea" is grossly uninformed. I have apneas around the clock. Seems like you guys both have apneas around the clock.

Now let me tell you how to fix this. In Ayurvedic medicine there is a body force called Prana, which means Life Force. It is literally the force that keeps you breathing automatically as opposed to manual breathing. My Prana Force is incredibly low, thus my autonomous breathing is very shallow and at times non existent. I would say i have fixed this serious issue in my life 99% with two practices:

1- PRANYAMA is an excersize for your Prana. It feels a lot like hyperventilating, but you are literally exercising your diaphragm and flooding your body with much needed oxygen. Oxygen powers 90% of your vital forces, so it is not bad for you to hyperventilate, just do not do it while operating a vehicle until you are experienced with this breathing exercise. Just like you need to exercise your heart with Cardio to keep it beating smoothly and healthy, your autonomous breathing will benefit from pranyama. Simply search google for a few pranyama exercises. Do your own research too!

2- Oxygen therapy. Like i said before, oxygen powers 90% of your vital forces. You simply cant feel healthy without plenty of oxygen. It is our gasoline as human beings. I use a Devilbiss oxygen concentrator set to 4 liters per minute flow rate. This oxygen concentrator is my best friend because even when i am breathing shallow im getting super concentrated oxygen. It has increased my quality of life and restfulness 100 fold. Listen... Do not attempt to ask any establishment western doctor for any form of oxygen therapy. Any western doctor i have encountered is completely uninformed on who could really benefit from this therapy (which is a vast array of conditions). In order to most easily obtain one of these machines, contact any Eastern medicine practitioner, such as Ayurvedic medicine, wholistic medicine, so on. They understand that a CPAP is like a bandaid that simply covers up the problem you have which is cessation of breathing. A form of oxygen supplementation can literally prevent you from having 70% of those apneas in the first place.

I honestly wish everyone who read this far the best of luck with their condition because i know what it is like to feel super confused about what is going on inside my body and i never want someone else to have to feel the same way i did.

[wubisnotanabbreviation]

I was diagnosed in May with central apnea. At the time, I considered it a sleep disorder, but I began thinking about how it was explained to me.

What I was told is that breathing is unique in that it both autonomic and voluntary. In other words, you can't decide to hold your breath till you pass out, because the autonomic system will kick in and force you to breathe. But as someone said above, this autonomic system is best at getting you to breathe out. This is because what the central nervous system monitors is the rise in CO2 in the interval after your last breath. When you breathe involuntarily, usually your blood pO2 is still reasonably fine. So those of us with central apnea just don't get the signal to breathe in a timely manner due to poor response to accumulating CO2.

This started me thinking about whether I might have breathing problems in the daytime, since sleep state is irrelevant to the blood CO2 level. And I am aware that there are times when I realize that is has been "a while" since I breathed - just sitting quietly, absorbed in something. I'm not as advanced at this as other folks in this thread, but I just bought a pulseox to start doing some daytime tracking of my O2 levels.

I got diagnosed because my cardiologist wanted an explanation for my atrial fibrillation. She finally sent me for a sleep study. I muttered all the way in that I was not the apnea case, it's my spouse who snores like a sawmill and periodically stops breathing at night (not often enough for a diagnosis, though - only mild apnea in the study). I was absolutely stunned to learn I had apnea. But if this apnea does not have a direct correlation to sleep, and could happen during the day, when exactly did it start? I've always been an afternoon napper. At least since college days. But I wasn't always a poor sleeper at night. How did I gradually or suddenly stop responding to CO2 levels? Should I expect to gradually or suddenly worsen? If I wasn't always this way, what triggered the change?

Frankly I wonder how may other folks around me are as benighted as I was to the possibility that they may have apnea?

[srlevine1]

You may also want to consult a cardiologist and wear a Zio patch to detect arrhythmias like Atrial Fibrillation and other issues like Congestive Heart Failure -- both can affect oxygenation and breathing. Best of luck.

[PaulaO2]

This being known as a fact, everyone who answers "you cant have an apnea during the day because its called sleep apnea" is grossly uninformed. I have apneas around the clock. Seems like you guys both have apneas around the clock.

Wow. You revived a 3yr old thread. Not a record but close.

As one of those "grossly uninformed": In none of my research have I found cases where Central Sleep Apnea happens during the daytime (unless one is napping). Well, I correct myself. There are those who go to higher elevations than usual that can experience brain malfunctions due to the oxygen/CO2 mix. And some heart conditions can also muck with that mix due to not enough oxygen being circulated. Hypopneas are more common during the daytime for those who have musculoskeletal diseases (Muscular Dystrophy, ALS, MS, etc) and conditions that weaken the chest muscles. Patients who have TBI and other brain stem problems may have hypopneas and even central events during the day.

Central Sleep Apnea is always referred to as Central SLEEP Apnea. And it is called that for a reason. Because it is a SLEEP disorder. Just because a person has been diagnosed with CSA during a sleep test does not mean they are experiencing problems during the day.

TL;DR : IF a person has a brain stem injury (you would know); or
IF a person goes to a higher elevation that normal (again, you would know); or
IF you have a heart condition that is messing with the O2/CO2 mix AND the brain gets confused by this:
YES, you can have Central Apnea events during the day.

[wubisnotanabbreviation]

This being known as a fact, everyone who answers "you cant have an apnea during the day because its called sleep apnea" is grossly uninformed. I have apneas around the clock. Seems like you guys both have apneas around the clock.

Central Sleep Apnea is always referred to as Central SLEEP Apnea. And it is called that for a reason. Because it is a SLEEP disorder. Just because a person has been diagnosed with CSA during a sleep test does not mean they are experiencing problems during the day.

I realize I have no standing other than "patient", but I feel that the only reason the word SLEEP is so important in this name is that the sufferer cannot voluntarily take a breath during sleep as he or she would when awake. For obstructive apneas, sleep is also brings the overall lowering of muscle tone, which does not happen during wakefulness, and which facilitates the airway obstructions that give that variant its name.

And I have caught myself sitting very, very quietly when concentrating on someting - and being vaguely aware that it has been some time (much more than 10 seconds) since my chest moved when I last exhaled. It does not happen very often, but I know I do this in the daytime. And with the awareness comes the next inhale, because I am awake and can voluntarily breathe.

What would be the name for "forgetting" to inhale?

[idaho-dan]

I was surprised to get an email notification that this thread had become active again. It’s been over 3 years since I last read or posted here. Since I am quite “wordy” I’m going to TRY to gloss over my experiences/learning during that time in case it may help anyone else battling this affliction:

1. Finally got medical insurance - thanks to Obammacare. I’ve have had the US Government pay for a significant chunk of testing/diagnosis from the medical establishment. What has been learned?

A. heart/lungs/liver/kidneys/pancreas/thyroid/pituitary/PSA/A1C/lower GI/ and much more were tested and are fine for my age. Another sleep study in 2014 found I had become “mixed” or “complex” apnea (whereas symptoms were purely CSA before) due to the 20+ pounds I had put on since my first one. Over the next 5 months I lost 23LBS and no more obstructive elements have been observed/recorded. Have held that weight since.

B. That second study found that my Resmed S9 VPAP wasn't really working very well because it didn’t have the higher pressure settings needed to “jump start” my breathing when the 20-40-per-night severe “events” happened (SpO2<79%). So insurance and I paid for a Resmed S9 VPAP ST-A Ventilator which is designed to provide full assisted ventilation when required. That machine was both a blessing and a curse:

Curse: The damn thing can not work with a nasal pillow (Swift FX) or such “lighter-touch” device. You must use a full-face mask with a tight seal. WHAT A PAIN TO HAVE TO ADJUST TO. And almost as bad, unlike the straight S9 VPAP which has a smooth/linear ramping up and down of the air pump’s pressure - the ST-A is much more of a ON/OFF feeling with each breath cycle. It was much more disturbing to get used to and hard for the wife to deal with (she had to use ear plugs or go sleep on the couch). But compliance has never been a problem with me since the last 5 years I have been absolutely 100% compliant because without something assisting my breathing I wake up with a gasp 100+ times per night -Ie: no restful sleep at all.

Blessing: No longer did my Sp02 dip below 90%. That machine absolutely would not allow it. In fact, if the mask was leaking or for whatever reason the O2 dropped below 88%, an audible alarm would sound from my bedside and wake me up (to fix the leak or whatever) and thus prevent those very low O2 excursions the other VPAP had not been able to. The benefit of that was not immediately recognized, but would later become the best thing to happen in years to my nightly and daily health and comfort:

*** Within 3 months on that ST-A machine, I noticed a decrease in my DAYTIME APNEA event numbers! So then, even though dealing with the very uncomfortable characteristics of my nighttime appliances, I started to become enthused and optimistic something good was happening to me.

After 6 months, the decrease in total events and especially the severity of them was SIGNIFICANT.

It seemed as if stopping the frequent oxygen starvations was “healing” something!

Please note that I was not returning to the sleep center for additional analysis or titration as even with the health insurance my Co-pays were > $700.00 per overnight session. I was now back to tweaking my own settings on the machines

After about 9 months of continued improvement, I noticed that my significantly-reduced memory and other mental faculties were also improving! Nothing super great, but it was nice to lessen the worry about the rate that they had been declining over the last decade (I’m in my mid 60s).

And finally, at probably the 10-11 month timeframe, on a hunch, I set up my old original straight S9 VPAP on the nighstand for a test and - Hurray! It (and the comfortable nasal pillow headset) were able to provide a full - SUPER RESTFULL night’s sleep with no excursions below 90% ! Within the next week I tweaked the pressures down until I found a much lower pressure profile that still kept the O2 high. I have been sleeping much much better - better than anytime over probably 10 years! And my daytime apnea events are virtually gone, too! They still happen but much less often (I notice 1 or 2 on a typical day but a bad day might have 10 or so) and usually even they don’t seem to progress so long before I vaguely realize my lungs feel starved, thus taking a breath was semi-automatic with just a hint of conscious though involved. Actually it’s mostly like what I detect is that I DID take a breath autonomously, but then recognized it was overdue because of how good it felt upon inhaling. Weird, eh?

So to wrap this all up - I strongly believe that oxygen deprivation causes damage that then (because of the inherent positive-feedback loop) causes even more damage, not only to some part(s) of the physiological system of respiration - but to the brain’s cognitive and memory component(s).

And as a second hypothesis, my experience makes me believe that whatever can be done to eliminate ANY low excursions of SpO2 can - over a time frame of a few months - bring back substantial improvements in the diaphragm-actuating respiratory subsystem AND bring very noticeable improvements to cognitive impairments that are related to neural degradation caused by brain oxygen starvation. Who knows? Maybe a substantial part of the expected mental/physical decline associated with old age can be lessened or at least delayed by having all old farts checked yearly with an overnight SpO2 recorder? I wish I hadn't gone the probably 8 or more years just thinking my worsening nighttime sleep was no big deal... How much damage could have been prevented?

Sorry for the wordyness.

*****WARNING - I am not a doctor so check with your doctor before taking ANYTHING I say as fact - These are just my opinions - Dan

[0rangebear]

I'm becoming more concerned over my breathing. I've had chest xrays and they are clear. My doctor recommended I take a allergy product daily to see if it makes my breathing better. It's been six months and it didn't help. Is it possible to have apnea during the day? I seem to be gasping and deep inhaling every ten minutes or so. It has nothing to do with activity, it is actually worse or I notice it more when I'm just sitting. I haven't had any studies for sleep apnea because this is during the day.

This is a confusing issue, I had the same experience when I first started therapy. I would notice I stopped breathing while sitting in the recliner. My doctor called it wake apnea and said it was not a concern because I was awake. I was not content with that answer so I ask for a (PEST) Pulmonary Exercise Stress Test to determine the effectivity of my lungs and heart.

What I learned was; the apnea events that had occurred during my sleep when I was untreated created inflammation in the soft tissue in the back of my throat, When I was up and moving around or exercising, the tissue expanded and I would breath well.

However, when I would sit still the inflammation was impeding the passage of air through the trachea, much the same as it does during an obstructive event.

The pulmonologist also thought that my brain had learned to anticipate these events and I was hesitating to breath similar to central apnea.

His diagnoses was; positive airway pressure over time will reduce the inflammation and the condition should go away after a period of compliant therapy.

He was correct; I have been on therapy now for 202 days and the "Awake Apnea" has disappeared.

[PaulaO2]

I realize I have no standing other than "patient", but I feel that the only reason the word SLEEP is so important in this name is that the sufferer cannot voluntarily take a breath during sleep as he or she would when awake. For obstructive apneas, sleep is also brings the overall lowering of muscle tone, which does not happen during wakefulness, and which facilitates the airway obstructions that give that variant its name.

And I have caught myself sitting very, very quietly when concentrating on someting - and being vaguely aware that it has been some time (much more than 10 seconds) since my chest moved when I last exhaled. It does not happen very often, but I know I do this in the daytime. And with the awareness comes the next inhale, because I am awake and can voluntarily breathe.

What would be the name for "forgetting" to inhale?

Concentration. Meditation. Zen. Flow. Pick one. It happens to everyone. Hook a machine up to a gamer and I bet they are holding their breath all over the place. Or a monk who is meditating and has been practicing for a while. When I was a potter, I often would start seeing stars because I was so into my craft, I wasn't breathing.

When we breathe, we are breathing in O2 and breathing out CO2. The lungs and heart work together to do this. The brain monitors the chemistry mix of the two and regulates breathing based on this. Feeling like you are hyperventilating? Do the paper bag trick where you are exhaling and re-inhaling CO2 to balance back out the blood chemistry. Going for a jog? Brain wants air NOW! And then there are those who, for whatever reason, as they sleep, the brain gets confused and says "the mix is fine, stop breathing." so they do. No struggle, just compliance. One thought is it happens more at night because we are already breathing shallow. (it is no where as simple as I am implying here. there is so much much much more going on)

OSA is when the muscles in the throat relax so much, they collapse the airway. Kinda like when we fall asleep sitting up and we suddenly fall over. The muscles in our throat for talking and swallowing are voluntary so when we fall asleep, they go off duty. Add in the other tissues and fat in that area, and obstructive apnea event happens.