Predictable panic attacks

[chd3143]

I'll try my best to explain this ... I'm a pretty consistent CPAP user despite nightly difficulties. My problems happen like clockwork, so I'm not sure how much is related to OSA or related anxiety. What do you think?

Here's the way it works. No matter when I go to sleep, I wake up about 3 to 3.5 hours into sleep with a racing heart rate, disoriented head, etc. ... basically feels like the beginnings of a panic attack. I used to dip pretty quickly into a full blown attack. Now I have a routine, calm down, and go back to sleep. Thing is, it won't happen again if I sleep the rest of the night. Sometimes I try to go to bed tired/late, sometimes early. Doesn't really matter and is so predictable I almost don't want to use the CPAP ...

MY AHI stays consistently below 1. I suppose these could be significant apneas, but it seems strange how timely they are to that part of my sleep. Other predictable symptoms. I'm always bloated, gassy, and typically need a bowel movement. Once these are resolved, I calm down pretty quickly, get tired, and go back to sleep. Not sure if these are related in as much as they are common symptoms. Thoughts?

[readyforsleep]

Welcome to the forum and the roller coaster ride of cpap. I have not had this issue
yet, but I'm sure you will get good advice from those who have had this problem too.

what has your doctor advised?

[chd3143]

Nothing really. I've had three sleep studies, but I don't sleep well -- well enough to titrate but not well enough to see a full night's sleep.

[Sleepster]

I'll try my best to explain this ... I'm a pretty consistent CPAP user despite nightly difficulties. My problems happen like clockwork, so I'm not sure how much is related to OSA or related anxiety. What do you think?

I think I understand what you're going through. I have had some of the same symptoms.

Here's the way it works. No matter when I go to sleep, I wake up about 3 to 3.5 hours into sleep with a racing heart rate, disoriented head, etc. ... basically feels like the beginnings of a panic attack. I used to dip pretty quickly into a full blown attack. Now I have a routine, calm down, and go back to sleep. Thing is, it won't happen again if I sleep the rest of the night. Sometimes I try to go to bed tired/late, sometimes early. Doesn't really matter and is so predictable I almost don't want to use the CPAP ...

When we humans have this affliction we call obstructive sleep apnea (OSA) it does strange things to some of us. Think about the routine your brain goes through. You fall into a deeper level of sleep, your airway collapses, your brain realizes something is wrong and wakes you up just enough so that your voluntary muscles can open your airway, you breathe, eventually fall back into the deeper sleep, your airway collapses, and the entire process repeats itself.

Perhaps dozens of times per hour, all night, every night.

Maybe your brain gets used to this and establishes this as the new normal after doing it for years or probably even decades. At first when you were younger maybe it happened only on occasion, but as you got older it happened more and more often. Now it's the new normal for the body you inhabit.

After a while the sleep deprivation gets to be too much and your brain lets you sleep too long with a collapsed airway. When this happens you wake up with a jolt. Your heart rate was already elevated before you woke up because the low oxygen level made your heart beat faster trying to get oxygen to your body. It feels like a panic attack.

Then you get a CPAP machine and your brain has to adjust to this new normal. Now it's safe to let you sleep because your airway doesn't collapse like it used to, but your brain has been trained by decades of that old routine and it still repeats that behavior of raising your heart rate and waking you up even though it no longer needs to. It just hasn't gotten the message yet that it's ok to let you stay asleep.

MY AHI stays consistently below 1. I suppose these could be significant apneas, but it seems strange how timely they are to that part of my sleep.

Get some software so you can zoom in on your breathing pattern and see how long those apneas last. The AHI is based on only a count of the number of apneas, not their length.

Other predictable symptoms. I'm always bloated, gassy, and typically need a bowel movement. Once these are resolved, I calm down pretty quickly, get tired, and go back to sleep. Not sure if these are related in as much as they are common symptoms.

That's just the way your body is reacting to the stress. It shows up in your GI tract. For some of us it shows up instead in our muscles as muscle tension, usually tension headaches. For others it shows up in the circulatory system.

Thoughts?

You said your CPAP use is "pretty consistent". And you said that sometimes you "almost don't want to use your CPAP".

First and foremost you have to get it through your head that CPAP use is not an option. When you sleep without it your brain is being trained to behave in the old way where it has to keep waking you up. Then you sleep with the CPAP machine and your brain is being trained in the new way where it doesn't have to keep waking you up. Which way is the training going here? Towards the old way or towards the new way? This is no way to train. Training involves consistency and training is what you must do.

Other things that will help are basic sleep hygiene strategies. You can work on those, like getting regular exercise, but until you start by using your CPAP machine all the time every time you'll never overcome this problem.

[chd3143]

Yes, the only time I don't use it is when I accidentally fall asleep. This is rare. I recognize the importance, so I accept the symptoms. There's really no difference in the way I feel after a night's sleep "without" the CPAP and one with the CPAP -- even despite the negative side effects.

Very interesting perspective. So, you think it's possible that this is a routine my brain is working through? That would explain how it's so perfectly timed to hit at the same times. Like going through a routine to get over a panic attack, my brain is possibly doing the same ... interesting.

Question about software. Is this something that loads onto the compact flash card in the machine? My CPAP currently tracks AHI and that's about it.

[justMongo]

See if you can get the software and start tracking your data. Most newer machines have an SD data card (smaller than the CF card.)
I am not familiar with your model CPAP --- so, I don't know what detail it might record to a data card.

Perhaps you are not at optimal pressure; and you spike epinephrine during an apnea; which then feels like panic.
Any other medical conditions? Diabetes? Some diabetics drop in blood glucose during the night; which also releases epinephrine.

For the majority of people, 3AM is the nadir of their daily biological cycle.

The bloating is likely the pressurized air getting into the esophagus -- it's called Aerophagia. Some people get it; and some don't.

[Sleepster]

So, you think it's possible that this is a routine my brain is working through?

Absolutely. I've seen reports here from lots of people who slowly, and I mean at a snail's pace, improve. I've been CPAPing for a little over 2.5 years and I'm still improving. You may not notice any difference from day to day, but you look back a month or a year you definitely see a difference. Some days are good, some aren't. The good days increase in frequency and the bad days decrease. It's a process, not an event.

Question about software. Is this something that loads onto the compact flash card in the machine? My CPAP currently tracks AHI and that's about it.

The software is loaded onto your computer (EncoreBasic or SleepyHead). The computer then reads the data from the SD card.

[chd3143]

Hey Sleepster thanks a lot ... I downloaded SleepyHead ... No clue this was even available after two years on and off CPAP. I'm staring at a ton of data that has always just been sitting there on the SD Card ... now I just need to figure out what I'm looking at

Any pointers on what I should be looking for? Seems like I average 15 to 20 vibratory snoring events (which is surprising) ... 1 - 3respiratory effort related arousals, a hypopnea from time to time, a clear airway apnea every couple of days, one obstructive apnea here and there (not always when the session ends which surprised me ... figured that was what was waking me up), and a pressure pulse from time to time.

[eviltim]

Big ole' leaks, AHI over 5, anything abnormal really.

I understand as I tend to wake up about 3.5 hours into my night. I don't have panic attacks regularly although I have had that happen several times during times of great stress in my life. Do you have an anxiety disorder or other stuff going on during the day?

[chd3143]

Well, I've always had panic attacks, yes, but they don't happen during the day any more. When I wake up hyper aroused, it's a matter of a few minutes. But, I know how to breathe throught them ... then, once I'm really awake, I'll calm back down pretty quickly. I was hoping that the data from the software would show some kind of crazy breathing right before the mask comes off, but it doesn't seem that way at all. Session just kind of end even when I know I've woken up aroused ... makes me wonder if these aren't something else sometimes -- blood sugar drops or something. I need to definitely learn more about reading these reports.

My AHI is low -- below 1. See comment above ... Leaks do seem to be a problem, though.