Hi everyone,
When I was suffering from this several times over the last two years it was scary as hell. And that's why I just wanted to chime in to share my experience getting over it, which happily I was able to do.
The worst thing you can read is that maybe you have "central sleep apnea" and that your brain is somehow broken and not sending the appropriate breathing signals to your lungs. Happily, I found this was not at all the case and that this possibility is indeed an unlikely scenario.
Like a lot of people here, I would be drifting off to sleep and then suddenly jerk awake feeling that I wasn't breathing. First things first, I have had several experiences in my childhood where I was either actually near drowning or choking on something, so breathing has always been on some subconscious level for me associated with a bit of fear. It came to a head when other lifestyle factors compounded my overall anxiety in my adult life (I am now 42) and this sleep onset apnea began occurring. I can't say for certain it was the driver, but this transitional apnea only ever occurred after having experimented with cannabis (for anxiety). I had never smoked, and I think on some level the awareness that had grown of my lungs (because smoke irritates them -- I had never smoked before) was contributing to my breathing anxiety, which I believe spilled over into more generalized anxiety, which again compounded the breathing anxiety. It wasn't pretty.
Let me just say that for the most part I have gotten over both my anxiety and my transitional apnea, and I don't think that's a coincidence, nor impossible to do despite how you may be feeling right now. But I take no medication anymore for anything, no pharmaceuticals, no cannabis, and I drink much less overall and especially before bed. This is significant because I believe the onset apnea is highly linked to the fear of it happening again. Instead of brushing it off I began thinking something was wrong with me. I then began fearing dying in my sleep, "and what about my family", and the rollercoaster began.
One of the things about anxiety is that it's both exasperating because we wrongly believe it is meaningful and indicative of real problems in our lives, but it is also treatable through rational exercise within the mind. The first step I believe is to make changes in your life to reduce anxiety. Maybe slow down the work schedule, tie up some loose ends, put an end to fixable issues that are bothering you (and learn to A.C.T. your way out of the ones you can’t fix), do relaxing things like yoga and stretching, and make it an important focus to learn to breathe properly. There is an amazing book that I chuckle about now because I actually returned the audiobook edition once before finally finishing it a month later. I read about nose breathing and its importance, then went on a ride on my indoor bike trainer, breathing entirely through the nose, and it set off a panic attack that I was suffocating. It was at that point I realized how attached my anxiety had become to my breathing. Several days later I redownloaded the "Breath" book (by James Nestor), and, with several grains of salt, finished it.
After two months of breathing exercises, yoga, stretching, physical exercise (always breathing through the nose), and subsiding almost all possible drugs, I have had only one recurrence of the “jumping up unable to breathe” nighttime scenario, and this occurrence was wholly attributable to a dream I had woken up from where “something was in my throat”. Old fears can die hard, but we don’t have to attribute meaning to them more than they deserve. Using A.C.T, which I have become accustomed to and practice daily, I told myself “I am having a dream that I could not breathe”, then fell back asleep promptly. This is highly different from the thought “I am gasping, what is wrong with me?”. Therein lies the beauty of Acceptance and Commitment Therapy. You learn to live with things and shrug them off, mentally downgrading the importance of things that are bothersome or frightening, never running away from them which legitimizes and "upgrades" them. I highly recommend “The Happiness Trap” by Russ Harris. Practice this daily and you will very likely see gradual improvement.
Breathing exercises were even more important however, I believe. Please read “Breath” by James Nestor and practice the exercises in the book. What I found was that I had a very low tolerance for CO2 in my bloodstream. This is one of the only other factors in the human mind outside of the amygdala response that can cause true panic. And I believe it is highly linked to why we can wake up gasping, as well as being on edge the entirety of the day feeling like the world is ending – your brain erroneously can believe you are “out of air” when you are most definitely not. Breathing harder and faster throughout the day makes it worse, not better, expelling too much CO2 and altering for the worse your blood chemistry and CO2 tolerance. You must slow your breathing, especially your exhalation.
In short, the brain stem receptors that tell your lungs to work are guided by CO2 concentrations in the blood, not O2 which they are completely blind to. The good news is that it is highly unlikely you are actually short of air, but your mind may believe you are. This is trainable, and I have been doing it successfully. Using the Wim Hof method I, daily, at least twice a day, breathe in and exhale 10 large, full, fairly fast breaths, entirely through the nose to inhale, out of the mouth to exhale, then I exhale one more time and hold my breath for as long as I can. Two months ago I could only do this for 30 seconds before the lungs said “Breathe!!!” then forced me to do so. Two months later I have gradually worked up to 2 full minutes, holding my breath on empty lungs. It has been a game changer. Slowly training breathing through my nose on the exercise bike at higher and higher levels has taught me that it is a snap to do it all day. When I first began, it literally caused a panic attack. Then I could only do it to about 120 heart rate before I felt suffocated. Then I learned to breathe slowly but fully through the nose, not quickly and shallowly as we tend to do through the mouth. I get big, full respirations through the nose now, and I can do this up to near maximum heart rate of about 165bpm (max is around 178bpm for me, and I hope to train up to this point as well, taking my time). My sinuses are almost always clear now, my lungs stronger (breathing fully through the nose tones the diaphragm, which brings breathing confidence which is the opposite of breathing anxiety), and anxiety has almost completely disappeared – something I have battled much of my adult life.
I don't know what else I can add. It was scary as hell, living through the experience, which was on and off over some two years. I just want people to know what it was for me, and what it might be for them. Doctors don't seem to be more than pill pushers these days, and I don't blame them -- who actually follows lifestyle change advice? Well, I set out to beat this problem and I feel like a new person and I hope you can too. I wish you all well on your journey to feeling better.
It is a puzzling condition, and one I have never experienced. A number of people have posted here asking for solutions, and I can't offer much. I usually ask them to use SleepyHead or OSCAR to track their sleep with a CPAP and then post the expanded graph of when they think they have them. Can't recall seeing one on a graph, but I may have forgotten.
My wife does what she calls Yoga Breathing when she is having a hard time going to sleep or wakes up in the night. The routine is to hold your breath three times in a row for a substantial amount of time. When I review her results in SleepyHead I can always easily tell when she does it as this breathing shows up as major obstructive apnea events. It blows her apnea index score out of the water for the whole night. She usually is well under 1.0 for AHI. However when she does the Yoga Breathing routine a few times, it can bump the score up to 1.5 or 2.0, well above her average. It always makes me wonder if there is a net benefit to the nights sleep when you artificially create obstructive apnea events...
You may be interested in this article in the Blog section of this site about Complex apnea and how artificially raising the CO2 levels may be effective in treating it.
I'm just curious if this is still working for you? And if you have found other exercises that help. I have a similar situation.
I posted this thread here, similar to this one, and tried the technique mentioned: https://myapnea.org/forum/sleep-onset-transitional-central-sleep-apnea
The Wim Hof breathing has worked - I'm pretty sure it trained my mind & body to not be terrified of a higher CO2 level for those few seconds on the wake/sleep border, and the wake-up-gasping symptom went away. Initially I was doing the breathing exercise 3-4 times per day, but I haven't done them for a few weeks now, and my falling asleep has remained normal. All I can say is - give it a try! For me it was a godsend.
nice! ... do you mean the 10 breaths and then one hold? ... i had tried some more intense wim hof multiple rounds and it was leading to tinnitus, so i'm a bit hesitant.
Yes, exactly. Tinnitus? Wow...I also suffer from that but it wasn't impacted by the breathing. You can trim it down - 3 breaths instead of 10. I was doing 3 reps of normal inhale, big exhale, then one additional exhale to empty the lungs, then hold as long as possible. I used the timer on my iPhone to track my hold progress. When I got to about 45 secs the sleep onset transitional apnea stopped. I was so relieved, I thought I was in for an ongoing night time horror.
Dear Abc123:
There is another possibility. You may be awakening in the midst of an apnea that has not yet resolved. That has happened to me on several occasions. And it can happen even while you are using PAP, if you don’t get the residual AHI to zero or something very close to it.
If you wake-up and can’t inhale, it is truly frightening….but after an apnea, you have to be awake or in stage 1 sleep to take the next breath. You won’t able to do so until your throat muscles release, which they will usually do pretty quickly, but you may awake even more quickly and try, unsuccessfully, to inhale. Not a fun experience!
Hello abc123, Thank you so much for sharing your experience. I am struggling with sleep onset apnea and your post is giving me a lot of hope. As your post is 2 years old, I was wondering what is your current status? Looking forward to hearing from you. :) Thank you in advance.
As I have suggested earlier the first thing I would do is look at the breathing pattern when going to sleep using OSCAR. It may give you a clue as to what is happening. Below is an example of my going to sleep pattern. The green vertical cursor is probably about the time I went to sleep. There is a minor glitch in breathing but nothing like an apnea. As far as preventing them, and assuming they are obstructive apnea events, I would keep the start ramp pressure up as high as is comfortable. I have mine set at 9 cm.
Hi KK, I've been lax about the Wim Hof and honestly my sleep hygiene has gone down lately, but for the most part I do not have these events any longer at night -- they are very rare. When they do happen, I know how to deal with it, which for me is to shrug, let it go, and I usually fall right back asleep. Once per month maybe these days, which I consider manageable and not worth big interventions. That being said, Wim Hof is easy to do and this thread is a reminder that I've been failing to do it (we get comfortable, don't we).
I've had a greater reoccurrence, however, napping during the day. First, about my lifestyle -- I am a heavy exerciser. I run 25km per week and cycle daily, sometimes near threshold. And I do a lot of yoga, several times per day. So I am often bordering on light exhaustion, what with also running a small business and managing two kids and a house as well. I think underlying stress plays a role in all of this. I don't drink alcohol any longer, nor do I smoke anything. I have, however, developed a bad habit of napping during the day to cycling races. It's relaxing for me to watch, and I slowly drift off, then wham, I often wake up gasping. More often in the last couple months than prior to that. This does not happen at night, I believe because there is relatively little noise, and my body is also prepared for sleep with natural melatonin production at night. I strongly believe now that there are two things going on during the day.. 1) melatonin is low, because your body is not prepared for deep sleep. 2) my bad habit of having the tv on when I drift off means there are constant cues to waking, which I react to, and which seems to trigger the event. A few days ago I decided to try napping at noonish in my room with the shades pulled and it was nice and dark and quiet. No event! I napped like a baby for nearly 45 minutes. A few years ago, much of these breathing events started when I would fall asleep at night to music. This never happened when I was younger, but it seems to now. We become more sensitive to poor sleep hygiene as we age, most likely.
Note that light plays an important role in our sleep cycle, and blue light in particular. Have a look at articles about sleep hygiene on Healthline and such, and change your lightbulbs to warm white (2700K) if you can -- avoid daylight/cool white (4100K) spectrums in your home if possible. It's an easy change to make.
Anyway, I think it has something to do, in my case, with time of day combined with lots of wakeful events, like tv chatter, light, poor conditions for sleep..
It's a minor work in progress. I had a very long stretch before and after starting this thread where I had zero events, even napping during the day. Which leads me to believe stress plays a large role. I am a pure type A personality -- go, go go! Get things done. Lists. Order. For a while I was in bliss as I had beaten this thing completely, and totally let go of other stress, like in my business. I just stopped caring for a while. Then we get comfortable, and slowly I've reverted to my type A tendencies. It has shown, and I am aware of it which is a good start.
Regarding tinnitus and Wim Hof. I also get this but only during the breathing exercises. It can get quite strong for about 10 seconds -- a big long heavy ring -- then it completely melts away and I can hear more acutely for a few minutes, I believe, than when I started. It really is a fascinating experience, and I have gone for a record of 3 minutes holding my breath. You see many colours, flashing lights, a lot of things that can stress out the beginner. When you finally breathe in again after the long hold at bottom, it truly feels like you are on the verge of oxygenlessness, and it has an element of fear that accompanies it. Which is why it is good to start slow, and become acquainted with the experience. You may become very frightened. But this is precisely what is needed to be faced -- that feeling and that fear together, and "surviving" it (you will). This is the basis of Cognitive Behavioural Therapy -- facing your fears and noting what happens vs what you are afraid will happen. It's always less that we imagine. That's stress, that's the "chimp" brain.
It may seem counterintuitive to do this just prior to sleeping at night, but I have had positive results. I wear a Garmin watch with heart rate monitor 24/7, and it always registers a much lower heart rate for near on an hour after Wim Hof breathing. The stress meter on the watch also bottoms out to near zero. Pay for his course if you can. Cold showers have a similar effect to the breathing exercises. Done just before bed, a cold shower preps your body for very deep sleep. Cold showers also reduce heart rate all on their own, which tells your body it is time to relax. It all can be made to work together.
I don't think I mentioned the book "Chimp Paradox" by Steve Peters, but I'm also throwing this in with my recommendations. The reality is, while I've had some relapse lately, part of why I am lax about fixing it is I have kind of stopped caring a bit. Which might sound bad, and maybe it is on some level (I would like to fix the problem), but it is also because worrying about it too much is what was actually keeping me awake before. If stress were at the base of it, then stressing over it itself will make it worse. Which it did several years ago in my case (I was literally afraid to go to bed at night for fear of dying... I didn't). Stress reduces natural melatonin production. Try and "let it all go" if you can, while also implementing meaningful changes to your daily routine where possible.
I hope this helps. You can do it.
Thank you very much for your detailed response ABC. Reading your and other comments, along with some research on published medical evidence I am convinced that two things work:
Wim Hof Breathing Exercises (Here is a guided video on Youtube: https://www.youtube.com/watch?v=tybOi4hjZFQ)
Daily endurance Training or running for 30 min
I am just starting to follow this and it has worked for the last few days. For others, if you are reading this for the first time please practice the above two. You WILL be back to your normal self. This issue is only transitional and it will be in the past soon. You got this!!!
Great posts ABC. I started having the same problem 5 days ago. It is impossible for me to fall asleep until I've been up for over 24 hours. I drank a lot of alcohol yesterday and went straight to sleep. Not a good long term solution though!
My sleep hygiene and overall health is terrible. I'm trying to look at this as a positive motivator to improve those parts of my life. I am really worried about this continuing though because it is debilitating.
I'm going to get a trial CPAP machine today - I needed one anyway. Hopefully I am lucky and it will help. I'm also going to the doctor today to get bloods and baseline measurements done.
Hats off to everyone on this forum who puts in the effort to help others.
Hope things are getting better. I’m going on about 2 weeks now. I had this before and used Xanax to get past the episodes. When it would wear off , about 4 hours, it started back up. It actually went away for about 10 years, and I came down with Covid 3 weeks ago and it’s back. ABC123 breathing exercises are on my top priority to try.
I have had TSA for maybe a month. I got a CPAP machine as I have OSA anyway. I find that the CPAP machine helps in that when I am jerked awake by the TSA, I don't really feel out of breath and am able to get a deep breath in with the assistance of the CPAP. This usually happens 5 or so times and I fall asleep within 30 minutes. At the moment the CPAP starts at 6cm - I think if I get that increased to 10cm it would be helpful.
It's a very strange feeling. Sometimes I will hover between sleep and wakefulness for ages. It's sometimes actually really pleasant - I don't know quite how to describe it.
I am really curious as to why is started. My feeling is I always stopped breathing for a few seconds as I fell asleep, but up until the past month my brain switched into sleep mode just a few seconds earlier, so it didn't register the need for a breath. Similar to how I don't actually notice waking up when I have OSAs through the night.
I am going to start with KK's suggestions of the Wim Hof Breathing and the running.
Yes, I agree that if the apnea is obstructive in nature then an increase in the pressure when going to sleep can be helpful. With a ResMed A10 or A11 that is easiest done by increasing the Ramp Start pressure and using the Auto Ramp feature. It holds the pressure constant until you fall asleep.
Hi I was just wondering if anyone had any updates? I've been doing the wim hof breathing twice a day for over a month now, and can now hold my breath for up to a minute on an exhale and I'm still jerking awake all the time. I am also on beta blockers which was another suggestion. I've been trying to exercise while breathing through my nose but haven't managed it as much as I would like. It's a lot to do and I'm starting to think it was all for nothing, nothing has changed. I just feel like nothing is working and am starting to lose hope It seems like it worked quite quickly for all of you? Or I just expecting too much?
Becca17, I see that you, like me, still don't have this thing beaten yet. I'm frustrated as well.
I came across a very helpful post from user Velacook on this thread: (https://myapnea.org/forum/sleep-onset-apnea-01/1#comment-28352).
Maybe you haven't seen that yet. The role of nutrition was something that struck a chord for me. The poster believes "adrenal fatigue" is a prime culprit, and recommends bolstering intake of magnesium, calcium and potassium. I know there are also many supplements that are specifically formulated to restore adrenal health. I once suffered from frequent bouts of heart palpitations and taking magnesium pills and Vitamin D solved that issue for me almost overnight, so I am a believer in the power of the vitamins. The post also recommends eliminating caffeine, chocolate and sugary foods. I suspect that my coffee drinking, limited as it is, might be a causative factor in my TSA episode. Coffee and/or caffeine have a strong effect on the sympathetic nervous system, and transitional sleep apnea might be a symptom of an overactive sympathetic nervous system.
Best of luck and don't give up!
