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Night time Episodes
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Night time Episodes

My husband has been having night time episodes for the last 4 months.  He is a 25 yoa male.  He wakes up feeling like he  needs to take a deep breath.  He then notices that his heart is pounding out of his chest.  I've seen his pulse range from 90-160 during these episodes.  His blood pressure also increases ranging from 140/80 to as high as 200/100.  He then started having a resting HR and BP that were higher then average.  He only has these episodes at night.  

We went to the doctor and they did EKG's all neg, stress test-neg, halter-neg, echo- neg.  Doctor put him on Bystolic.  The medication lowered his HR and BP he was running 70-80 and BP between 110/60 to 130/40.  He continued having these episodes but they were less intense.  The Bystolic started lowering the HR and BP too much and my husbands arms started going numb and tingling.  Dr. decided to stop this med.

In the middle of this they diagnosed him with sleep apnea.  They started him on the CPAP.  I thought this might be the cause....and would solve the problem.  But is hasn't.  

My husband has now been going through this for 4 months.  He is now having all these symptoms plus the numbness and tingling in his arms.  Everyone keeps trying to treat it like anxiety.  But he doesn't have increased respirations or any type of panic.  Even with Xanax and Ativan it does not bring down his HR or BP.  As a nurse this doesn't seem to be anxiety.  

Please help.
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Is the CPAP helping with the apnea events?  I used CPAP for months and when I sent the card in for a reading found out it really wasn't doing any good, I was still having around 40 apnea events per hour.  Just a thought.
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He is set to a pressure of like 7.  His apnea isn't really bad...he has a tendency to breath shallow.  He barely made the cut off to get the machine.  He is scheduled for a re-check next week.  Good idea though.  Thanks.
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You and your husband might want to inform yourselves about something called "Nocturnal Panic Attacks."  These are not the same thing as the daytime variety, since they are linked specifically to disturbances in transitioning from one stage of sleep to another.   The symptoms can mimic heart problems:

http://nocturnalpanicattacks.com/

The causes are not known (though there are suspects), but there are treatments and strategies for dealing with the problem.  You can learn more just by googling the term "Noctural Panic Attacks.''
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With panic/anxiety attacks...doesn't the person have to have hyperventalation or increased respirations?  He doesn't have this. It is just his HR and BP.  
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As the article I linked to says, nocturnal attacks are different.  However, you do mention that your husband's first reaction on awakening is the sense that he needs to take a deep breath.  That fits.

It would be worthwhile to pursue the nocturnal panic attack angle.  Certainly it could do no harm.  The only drawback is that many people are deathly afraid of diagnoses that point even slightly to anything related to emotional problems.
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995271_tn?1408549100
If his heart is checking out OK it's probably a separate issue and the tachy episodes are a manifestation of it.

Things to rule are rheumatology, endocrine (hormones, adrenaline), infection (lymes, viral, other)

achillea has a great point too.

It's all too common for people to have a misconception of what a panic attack or anxiety attack are.  They are sometimes a cognitive issue, meaning it's a reaction people have learned like from PTSD.  There are also varieties that are related to the autonomic nervous system triggering a panic response or a subset of panic responses such as increased sympathetic tone (increased heart rate)

Another issue I can think of, because you said he feels like he needs a deep breath is that perhaps he's having heart pauses or bradycardia while sleeping.  Has he work a holter monitor to catch these episodes?
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He did have a halter done but did not have an episode while he was wearing it.  I had thought about asking for an event monitor but he needs to push the button when it starts and normally wakes up in the middle of the episode.  They have all happened when asleep except one which was when he went to the ER.  ER caught the thing on tele said the wave looked normal and that everything on the monitor was normal.  But a 25 year old with a resting pulse of 160 is not normal in my book.  That's tachycardia.  When I look at his wave as a newer nurse, it looks like his P wave actually comes directly after the QRS complex instead of before.

His half sister was having 5sec pauses and needed to have a pacer placed at 23....his family has a really bad history of autoimmune disorders so it makes it really hard to try and diagnosis anything with him from his history.  He does have significant cardio family hx though.  It also makes it hard to diagnosis him because he only has half siblings....

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995271_tn?1408549100
The wave after a QRS is called the T wave.  The p wave is really tiny usually.  When tachy it's difficult to even see the p wave.  P starts a cycle, which ends with a T wave.  In some people a U wave also occurs.  Then it starts all over, hopefully!!

If his tachy episodes are deemed to be sinus tachycardia then it gets tough to diagnose and is often considered a benign / nuisance issue.    Sinus tachycardia is a normal function.  When you run and your heart rate goes >100, that's sinus tachycardia.  When you get scared and your heart rate goes above 100, that is sinus tachycardia.

If it's happening when it's not supposed to it's called inappropriate.    If it’s happening too frequently you could end up with the formal diagnosis of Inappropriate Sinus Tachycardia (IST).
This could be from an autonomic nervous system dysfunction, endocrine issues, infections, medications, something called sick sinus syndrome.  
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He ended up getting admitted to the hospital Wed, Thurs, and Friday.  They did tilt table test.  He Brady'd down to 45 and passed out within 7.5 minutes.  While he was at the hospital tele also caught him having PVC's for approx 2 minutes with tachacardia with HR of 130.  EP Dr. is stumped because he now has an issue with bradying down and tachacardia.  They DC'd him home with event monitor.  To be seen in 5 wk by EP doctor again.  Family dr on a weekly basis until then.  The events are getting more and more frequent.  
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I had 2 Afib episodes waking up in the morning with them from sleep apnea, even tho I was supposedly being treated appropriately.  The cardiologist sent me to a cardiology sleep center and they gave me a new machine of a different type (bi-pap).  According to my info 50% of Afib cases are caused by sleep apnea.  Blood pressure and heart rate go up at night.  I also need something called a nasal aire head gear instead of a mask.  It doesn't leak and takes care of the apnea, according to the data they extracted from the card. The nasal pillows they gave me, did not stay in place and I had an episode while on it.  My setting is 14.  Not sure any of this is helpful, but the fact he wakes up with it is why I thought I'd share my experience.
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1423357_tn?1373023915
Has he examined the possibility that he's experiencing Central Apneas?  This is different that Obstructive Sleep Apnea which I happen to have. With Central Sleep Apnea,  the brain's respiratory control centers are imbalanced during sleep.  CO2 levels in the blood, and the neurological feedback mechanism that monitors them, do not react quickly enough to maintain an even respiratory rate.  There is no effort made to breathe during the pause in breathing: there are no chest movements and no struggling. After the episode of apnea, breathing may be faster (hyperpnea) for a period of time, a compensatory mechanism to blow off retained waste gases and absorb more oxygen.

Researcher have found there is an association between atrial fibrillation (AF) and central sleep apnea. A study found that the prevalence of atrial fibrillation among patients with central sleep apnea was significantly higher than the prevalence among patients with obstructive sleep apnea or no sleep apnea (27%, 1.7%, and 3.3%, respectively). There was a total of 180 subjects with 60 people in each of the 3 groups.

With CSA, treatment includes a mechanical respirator, or possibly a diaphragmatic pacemaker.  Incorrect CPAP pressures can actually contribute to central sleep apneas, and this is why it's very important to have a professional titrate you properly at a sleep study to insure that the pressure doesn't initiate a CSA.
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I've used nasal pillows successfully for almost 5 years.  The key to keeping the pillows correctly positioned is to remove the weight of the hose from pulling them off your nose.  I don't know which brand you used.  I wear the ResMed Mirage Swift II.  The headgear comes with an often overlooked key component.  It's a small piece of Velcro which is used to secure the headgear's hose to the side of the headband  This stabilizes the nasal pillows and prevents them from being leveraged off your face when you move about.  I love mine as it allows the headbands to be loosely fastened, so the pillows are just resting on your face.  I also have the advantage of have a very low pressure of 7, so I don't need it tight to prevent leakages.
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You might want to investigate Prinzmetal's angina.  It is coronary artery spasms that occur during sleep, generally at the same time of the night.  I have it and was undiagnosed for years - I would wake up with my arms aching, nausea, vomiting, what I thought was maybe heartburn.  I could set a timer - it always lasted 45 minutes.  I was diagnosed with asthma and reflux (I have neither). I never asked for an EKG and one was never suggested because aching arms was my biggest symptom, followed by the nausea.  I would wonder if it was a heart attack but never mentioned my concern about my heart to my doctor because I thought heart attacks wouldn't happen almost every night at the same time for 45 minutes.
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Have they figured anything out for him yet? I am a 25 yr old female and have been having night heart episodes for 1 month now. I wake up with chest pains, tingling left arm and hand, rapid heart beat, weakness, and hurts to breathe. Ive gotten the run around fron 2er visits, one urgent care visit and 2 regular dr visits. Ive been given ambien, hydrocodone, ambien, xanax. The doctors have told me it could be: panic attack(which ive never had) pleurasy, strained chest, acid reflux. This is ridiculous that i am spending so much money and im not getting any answers. I have constant chest pain, migraines, cold sensation around my heart, and tingling left hand for 24 hrs a day for a month.  I see the cardiologist this Tuesday ....
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