Have you had any panic attack-like symptoms due to your sleep issues?

Over the past couple of months I've started having "panic attacks" of some type for an unknown reason. Two put me in the ER at first, a couple of days apart. They thought I was having an heart attack. 173/90 blood pressure and 140+ heart rate. Got worked over for virtually every kind of blood test. All normal. Multiple EKG's were normal at two different hospitals. Stress Echocardiogram at the Cardiologist was normal. It typically happens around 10pm or 11pm at night just a few times a week. I'll be getting ready for bed or just sitting around relaxing and my heart will start racing, I'll feel lightheaded, sometimes will feel short of breath, etc. My GP doctor did all kinds of blood work, physical, tests, etc. Nothing. They've chalked it up to 'anxiety' and put me on 25mg Metoprolol (beta blocker) to lower the heart rate and blood pressure when I have episodes. I don't have them that often, like just 2-3 a week or so. Sometimes it is right after I eat or drink something. I will also get a shaky/trembly feeling where it is almost like I'm about to freeze to death with chills or something, but I'm not cold. I'm also not stressed about anything that I am aware of. This came out of nowhere at 37 years old and my general health itself puts me in the odd category when it comes to a sleep apnea diagnosis. I don't fit the sleep apnea profile.

Previous in-lab sleep study was 4.7 AHI and 18 RDI. 50 RERA's in just under 3 hours. About 7 minutes of total REM sleep in all of that. A follow-up home study that I requested showed 5.2 AHI an an apnea as high was 80+ seconds with apnea/hypopnea averages of 20-30 seconds. A warning came with the home sleep study that said that symptoms could be way worse than what the basic home test checks for. The in-lab study noted that my oxygen levels didn't drop below the lower 90's and the same thing was true for the home sleep study. With the longest apnea on the home study being 80 seconds, I'm confused about that.

I'm doing my best to hold out for signing up for my employer's health insurance in March and it activates on April 1. I'm on APAP already. Min 7.6 and Max set at 12. The 12 is overkill just in case and the most I have seen it go up to is 10, with 9 being the average max. EPR on 3 and set for ramp only.

The other day, I had something odd happen...it was like I couldn't breathe properly when I was upright during the day. If breathing through my nose, I felt like I wasn't getting enough oxygen. If I opened my mouth and took deeper breaths, I felt better. Not sure why my upper airway felt so 'closed' randomly out of nowhere like that. I've had deviated septum/turbinate reduction surgery in the past after a CT scan of the head. My airways are otherwise clear as far as I know.

The medicine helps sometimes with taking it when I feel one of these events coming on, but it simply covers the symptoms. Can't find the problem. I have also had some odd intestinal/bowel/bladder issues lately. My family has just gotten over a bad stomach bug last weekend and I have felt something odd in my lower stomach ever since. Sort of like a "full" feeling in the lower intestine/bladder area. Doc chalked it up to maybe a little inflammation. Nothing wrong showed up on the MRI of the abdomen and I simply get a bladder full feeling. Could be intestinal swelling from the previous sickness (feels similar to last week), but I also tend to have some general GI issues going on sometimes. I've read that sleep apnea can sometimes have a hand in causing that because the body isn't functioning properly as a whole.

Could sleep issues/UARS be causing all of this? I seem to toss and turn every 15-30 minutes all night long, sometimes popping awake for no reason as if wondering where I'm at.

I am not a medical professional and the sum total of all the issues you are having is way beyond my understanding of heart and lung issues. That said, I think your APAP is set up as well as it can be set up, and most likely sleep issues and UARS are not likely the root of the problem. I think I have suggested it before, but my doctor believes bisoprolol is a better beta blocker than metaprolol. You may want to ask your doctor what they think and if you could benefit from a switch. Here is an article to read about beta blockers. I think one of the issues with beta blockers is that they should be introduced slowly and taken away slowly so they do not cause a rebound effect. The other difference between them is in how uniform they act during the 24 hour period. Bisoprolol tends to be more uniform than metaprolol. And that is about all I know about it!!