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!
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!
ABC123 - any updates? How is your TSA now? I had it 8 years ago, went away, now dealing with it all over again. I’m convinced six months on Ambien knocked my breathing back on schedule. It seemed my brain and lungs were just out of wack for some time. Wondering if you, or anyone else, also experience sleep paralysis. That sort of reminds me of TSA since your brain and lungs sort of become out of wack in that sense too. Also, the dream you had about choking is somewhat of a classic sign of apnea. Often people dream that they are drowning and wake up gasping. Just some food for thought.
Hi Joseph,
Things have been going well here. I’m sorry to hear you are having a recurrence. Are you saying the Ambien helped, but now you are off it and things are worse?
I’m coming up on a solid 12 month anniversary of no alcohol (or anything really). I have occasional episodes of waking with a light gasp but they are extremely rare now. The most common I get is a minor occurence if I nap in front of the tv during the day. I think more and more that low melatonin (it is supposed to be low in the day) may be the cause of these. Perhaps on the very rare occasion at night (I can maybe remember 2 or 3 in a year now) it is a melatonin issue? I don’t know.
I still run and cycle a lot (total activity around 6 hours average per week), and about 6 months ago I took up swimming which I was truly terrible at at first (my trainer said it should be easy to make it 25 meters without breathing, and I could barely accomplish this with breaths. Now I can, so I see this as great progress). I think this may have added a new level to the breathing comfort I am now experiencing. Something I learned from James Nestor’s “Breath” book, was that our body panics when certain neuroreceptors sense high CO2 concentrations in the blood, but also that that level is trainable. In other words, when swimming we can’t breathe when we want to, we are forced to train for breath holds. These breath holds train those neuroreceptors not to panic, through brute force of repetition. Swimming (assuming you dip your face each stroke) desensitizes, therefore, those CO2 neuroreceptors and adds a new level of calm. Through all of this training, I actually find myself breathing smaller breaths more slowly, more calmly throughout the day. What I understand about this is that it is all a function of increased red blood cell count, increased VO2 max from cardio training, and a desensitization of those neuroreceptors. I believe that the panic I felt before on waking short of breath, may have been a function of overly sensitive CO2 receptors in my brain. And I believe they have been fairly well trained now to tolerate longer breath holds during the day, and that this carries over into the night. In short, I do believe swimming may be able to help others do this same thing.
There is another way one can train this, on dry land. They are called “CO2 tables”. They are common practice for free divers who have to be able to train those neuroreceptors for a very high blood CO2 concentration. Basically CO2 tables are practiced breath holds. I have been doing them now also about 6 months, and can now hold for 1m45s 8 times in a row with a brief rest to catch the breath between. You can find talk about this on Youtube. I do these more often than Wim Hof breathing exercises these days. Wim Hof is good, but does not train CO2 tolerance quite as well as CO2 tables, I believe (the purpose of the two are not the same). This is simply because the heavy breathing with Wim Hof first empties your blood of CO2, which then cannot cause as much stress to the CO2 neuroreceptors, therefore, as the CO2 tables do. (Breathing for CO2 tables is not supposed to be heavy or rapid like Wim Hof, it should be full but slow and calm. This leaves CO2 in the bloodstream for the breath hold, which trains and desensitizes the neuroreceptors)
I hope that is not too much information. That’s what I’ve been up to lately though and the results have been positive for me. Hope it is of use to others.
Hi Abc123,
To answer your question, I was on Ambien for only six months during my initial onset of TSA (8 years ago). One day I decided not to take it and I've been symptom-free up until the beginning of this past March when everything started to happen again. My theory is that Ambien can be used as a treatment for TSA because it helps you fall asleep quicker and keeps you asleep. This, in some sort of way, trained my brain and lungs to basically get back on schedule. There are also studies that demonstrate how Ambien reduces the number of apnea events in patients. Once these symptoms started again, I decided not to go back on Ambien. For one, I felt as if my doctor wouldn't continue to prescribe it and I didn't want to start depending it (not in the addiction way). I've been pretty good for the past two months and only have had a few rough nights with falling asleep and waking up feeling out of breath. The odd thing is that I've begun tracking my SpO2 for a little over a month now and my overnight levels are pretty incredible. With sleep apnea, patients usually see their numbers drop well below 88, but mine have never dipped below 90. My average level for 29 days was 96.3 and my overall score 9.7/10. Although I felt like I had a few apnea events last night, my O2 ring didn't report any drops in oxygen, my overnight average was 97% (96% on Fitbit), and score was 10/10. I actually started doing Co2 table last week for a couple of nights. What time of day do you do yours?
That’s great news about the O2 levels at night! I tracked mine also but only for a few weeks until like you I never saw any important dips. It’s an amazing technology to have on the wrist.
I do my CO2 tables about 4 nights a week. I like to do it right before bed, laying down, because it is already a sort of sleep inducing activity. By the fifth or sixth round (I typically do 8) I’m almost carried off by dreams and have to remember it’s not time yet hehe. It is funny that just laying there would not bring on the dreams so quickly, but my CO2 tables never fail to.
There’s an interesting phenomenon that I’ve found using the SpO2 meter with these CO2 tables. If you measure SpO2 right after completing the CO2 tables, what do you find? My O2 is almost always above 98%, often 100%. I believe James Nestor mentioned this phenomenon in his book when they were purposefully not breathing enough while running. I find it pretty fascinating. Counterintuitive but fascinating.
HI abc123, i have always been a decent sleeper.
I haven't been able to read your whole post yet and i see it's 2 years old but i need help now. My sister found this for me. I was crying when i started reading it because it was almost exactly what i have been trying to communicate this past week. I need support. I am terrified to go to sleep. I had an episode of sleep paralysis i believe about 3 weeks ago. Scary to the max. I somehow managed to psych myself around it and was able to sleep again but all of a sudden last week as i fall asleep i get woken feeling like I'm not getting air but kind of think i am?? but not sure. Some are more violent then others mostly they are subtle. I try sleeping on my left side cause that's what google tells u to do but it doesn't help. I was able to fall asleep two nights without an episode and then back again during nap time and sleep ( and no I'm not 5 years old haha ) i love to nap later in the afternoon i always have. This is all throwing me off and terrifying me.
Been battling panic disorder for 20+ years and the trigger is always breathing because when i have a massive attack i feel like i can't breath. I've always also been afraid to fall asleep i have thoughts of death and dying in the past few years. This is freaking me out and terrifying me. I'm up all night fighting these feelings which also include this weird subtle falling but super subtle. Some more loud jolts.
I feel all alone and terrified. So i appreciate seeing your post and will read it in it's entirety and see if i can pull anything out to help myself . I haven't been able to find help in drs all week unless i want to shove medicine down my throat which i don't. And do i do a sleep test if i know i am never going to tolerate an cpap? do i even need one?
I read on google that if u have apnea do not take Xanax, but i think i need a little which might help me relax. Does anyone have experience with this? i only take a quarter of a 5mg i believe it is. I read that it relaxes your breathing whatever and u might not wake up to breath. I know i know don't read google- but then we wouldn't have found this forum.
Does it matter what position to sleep in?
ANYTHING that can help me immediately to not be alone and afraid tonight?
One of my replies seems to be missing, probably because it was in the thread of a deleted comment. In that post I believe I mentioned Steve Peters’ book “The Chimp Paradox”. Learning how the mind works was invaluable for me to get through a tough time. For one, it is important to know that our amygdalas are just doing their job to keep us afraid, because fear kept us alive in ages past surrounded by innumerable dangers. For another, there are backup systems in the brain that keep the body running even without our having to try. One of those systems forces the muscles that move the lungs to do their job even when we’re asleep or unconscious. One of the reasons we experience great anxiety is thinking we are in control, that we must control everything — perhaps even our breathing, at all times. The reality is that we can control it (breathing exercises) or let go completely (sleep, or perhaps riding a bike or watching a show), and both are ok. One experiment I tried which led me to positive results was actually just trying to stop breathing, “go with the fear”. The funny thing is that it actually led me to sleep when sleep was hard to come by. I believe this had something to do with the breath holds increasing CO2 in my bloodstream which led to very tranquil feelings. The lungs always started moving again. I still practice a version of this in the middle of the night if ever I can’t sleep. CO2 is tranquilizing. So we slow the breath. It both relaxes and induces sleep. Adding some gentle stretching or yoga poses, as well as some relaxing meditation music or some incense? It did not hurt in my case. If anxiety is part of the cause of TSA, and I am not a doctor so cannot say, then to some extent reducing anxiety may reduce the problem. These were my experiences. I do not fear the TSA anymore because I do not believe it can hurt me. Has this relaxed attitude caused the TSA to go away? I cannot say.
HI, this is the first response from you i am seeing. Thank u for reaching out i appreciate. It's horrible being so afraid to go to sleep. I watched the video on WIM Hoff and it was triggering for me- but i will watch it again. I think some of it I can use perhaps not to the depth he speaks of. I will also grab the book you recommended. May i ask if you went thru a sleep study to know what u have?
I have started walking again to get exercise in which i ate- and i have cut back on sugar which was creeping back up on me. I somehow feel like both of those together didn't help and then a few stresses more than normal? not sure. But i took several of the things u said about breathing thru the attacks i call them and not giving them power- am trying to see if that helps.
This kinda sucks tho.
No I did not have a sleep study performed. I did buy a watch with sleep tracking metrics however. It can track heart rate, movement levels, respiration rate, HRV, and of course sleep cycles. This was instrumental in my discovering that alcohol, for example, was of no help to my sleep, and the metrics were why I quit. The savings from that alone paid for the watch several times, not to mention feeling better.
