Waking at night unable to breathe

[rockbeer]

Hi all,

I'm 41, m, 1.83m tall and a little overweight. Maybe a dozen times in the last five years I've woken up in the night totally unable to inhale. I react by kneeling upright and gasping until my airway clears and I start breathing again. The episode from waking can last for up to 1.5 minutes, and I often notice a strong acidity/reflux sensation in my throat. Once I also had a strong sensation of almost vomiting as I woke.

After the first episode I was tested twice in a sleep disorders lab for sleep apnea. Both times they could see nothing wrong at all from the results. So I quit smoking and stopped eating late at night (a sure trigger), but the episodes have continued, sometimes more than a year apart, at other times very close together - last week I had two in 8 days. I'm nervous of going to sleep now, as I feel that I could easily have a fatal episode. Also I recently suffered a serious knee injury which makes it difficult to get upright, and I fear it could be impossible to regain my breath lying down.

My doctor seems all out of ideas. Last week I suggested to him that it could be nocturnal asthma: he leapt on this idea as though it was his own, and prescribed a seretide diskus, known as Advair in the USA, even though I've no other indications of asthma. He did't seem to think there are any other tests worth carrying out and said I should try this medicine on a trial and error basis.

I've been taking the medicine, but I'm not really happy with my doctor's advice. However, I've no idea what else to start looking for. Any ideas would be appreciated.

Many thanks.

[National Jewish]

Your symptoms, as described, do not suggest asthma.

Gastroesophageal reflux disease (GERD) is the back flow of stomach contents, including digestive juices, into the esophagus or food tube where it does not belong.  This is most commonly called acid reflux or heartburn.  Your symptoms could be caused by esophageal spasm from heartburn or vocal cord spasm from reflux.  This reflux can come all the way up into the mouth and nose.  When this happens the material can be aspirated, dribbling into the windpipe and lungs.  GERD can cause the following symptoms:
· Heartburn or a sour taste in the mouth;
· Pain occurring in the middle of the chest;
· Coughing and/or choking while lying down;
· Increased trouble breathing while asleep; and
· Even no symptoms at all.  This is called “silent reflux” and it is common.

You will need to check with your doctor to know for sure what is causing your symptoms.  An esophageal pH study is the best test to find out if you truly have GERD.  This test measures the acid in your esophagus to see if digestive juices are coming up from your stomach.  Please read our gastroesophageal reflux disease information at http://www.nationaljewish.org/disease-info/diseases/asthma/about/relate-other/gastro-reflux.aspx to learn more about things to do to lessen GERD.  A gastroenterologist is the type of specialist to let you know if further testing is needed to identify GERD and the best treatment.

[ozark]

did you have an episode during the sleep study? It could be reflux, or cardiac. Maybe a 24 hr holter monitor may help to see if something like an arrythmia is causing this? good luck

[rockbeer]

>>did you have an episode during the sleep study?

No, they don't come to order unfortunately.

>>It could be reflux

Yes, I wondered that although my doctor seems sceptical. I don't really know what to ask him to test me for.

>>or cardiac.

Gulp. That sounds ugly. In what way would a cardiac problem manifest as this breathing stoppage?

>>Maybe a 24 hr holter monitor

Sorry, what's a holter monitor??

>>good luck

Many thanks.

[ozark]

He could check you for reflux with a ph probe study and endoscopy. the probe is more accurate.
a 24 hour monitor, is an ekg worn for 24 hrs to see how your heart ryhthm is for 24 hrs.  they put electrodes on your chest hooked to a small cassette and it records your heart beat.  This may be a reach but it's worth a try.
it sounds more like reflux to me  good luck

[Inanga]

sounds very like reflux to me - the acid in the mouth seems pretty clear. and that eating late at night makes it worse. one common 'treatment' is to raise the head end of the bed so your head is higher than your stomache - basicaly gravity helps the acid stay down below. whether it helps I don't know. other approaches are antacides that neutralise the acid, drugs that reduce the volume of acid being produced (eg omeprazole). wathcing your diet. cut out coffee and alcohol. there's a lot you can do to make things better.

i had similar chilking at night episodes - jolted awake not breathing with incredible headache presumably from oxygen starvation, massive amounts of adrenhalin and redicuous pulse rate. It was simply terrifying and I got afraid of sleeping too. It was horrible. My case turned out to be sensitivty to salicylates in food causing excess respiritory mucous and poist nasal drip - i'd chike on the mucous in my sleep.

PS It's hard to belive your doc won't consider reflux - i'd stop wasting my time with him and get another doc. I wasted years (and tons of cash) on doctors that wouldn't belive my problems were food related. Now got an immunologist whos diagnosed it in 5 mins from what I deescribed. GPs don't know everything.

[rockbeer]

Interesting comments Inanga, thanks. Might try the bed raising thing, although it isn't easy when you sleep on a futon without a base!
I've been thinking the same as you about ditching the doc. Trouble is, no one I know is any more impressed with their own docs - no point in jumping out of the pan into the fire. GPs certainly don't know everything. The question is, do they know anything?

[caregiver222]

The reflux syndrome is often caused by eating while lying down. Don't eat within an hour of lying down. There are a couple of components to your problem, and without beinhg there I can only throw out possibles. If you eat while lying down and the muscle valve above the stomach is weak, you will aspirate hydrochloric acid into the lung. This causes inflammation and an immediate asthmatic attack. You need to have your physician prescribe an emergency albuterol inhaler. Most deaths from asthma are in people who do not have chronic asthmatic problems and don't take the situation seriously enough. You must keep the albuterol handy within arms reach for nuse when you have an attack.

[caregiver222]

Advir is a pretty good medication, however the albuterol works very quickly and the difference in the time to open up the alveoli is significant. There is no reason not to have both available.

[caregiver222]

I should emphasize that you have a life threatening situation, and immediate action is necessary. Any normal person will develop an asthmatic attack after hydrochloric acid is dripped into the lung. The leakage occurs when the acid works its way up the esophagus and down into the trachea and the right mainstem carini. This produces plugs of mucus and air hunger. It is like falling off a cliff. I have thought this over and decided that Albuterol is the medication of choice for emergencies. Avoid the long acting steroids prescribed for asthmatics, including the aerosolized ones. The reason is that when the acid hits your lungs you get raw meat and it is very susceptable to infection. You shut down the immune system with the steroids. You need to get the gastric rewfluc syndrome under control. Your life depends on it. You can get a foan pillow that slopes thirty degrees and sleep on that tpo keep youe head elevated or sleep in a recliner. Dietary habit change will usually solve the problem without surgery.

[tony s]

I am 63 years old ..The first episode of waking up from a deep sleep unable to breath happened when I was 26...The next day I went to a lawyer to make out my Will...It was easily the most freighting expierence of my life....I had to use every ounce of strength to get that one first gasp of air into my lungs...It has happened about 35 to 40 times since the in the last 37  years..I know what causes it now ,,although I still forget and get caught....Its caused for me when I eat too much within 2-3 hours of going to bed..and particulary if I eat acidy foods  such as tomato sauce...
           The head should be elevated as much as possible when sleeping...antacids help prevent the episode...But it is definetly a form of acid reflux ,But not readily diagnosed by most GP'S.....
             I hope this helps

[caregiver222]

You have it right, Tony s. The stomach contains powerful hydrochloric acid. If so much as a drip of that ends up in the trachea and leaks down into the lungs you have a frightening life-threatening situation. Eating in a sitting position and not going to sleep until two hours after eating will solve the problem 99 percent of the time. Elevation of the body also helps. I would venture to suggest a large number of asthmatic fatalities are due to this syndrome. Because the people rarely get the symptoms they don't have that magic inhaler present. And it needs to be within arms reach. The process is like falling off a cliff. You go from 100 percent to zilch in seconds.

[nern]

I had this happen to me for the first (and hopefully last) time last night and it was the most terrifying thing I have ever experienced.  I could not get ANY air. My airway felt blocked and I was just gasping for a little while.  I got up and started walking around the bed, don't know why.  Finally I got a breath in, and then another, but I didn't want to go back to sleep for fear of it happening again.

I don't see how an inhaler would help if a person cannot inhale. What am I missing?

[Bass.Man]

First episode for me was last summer.  Had about 4 to 5 incidents
since then.  Just recently found this forum and did some online research.  I now aim for 4 hours with no food before sleeping and have raised the bed 6 in at the end.  I plan on losing 15 pounds (6ft 2in 215 pounds currently) as well.

I'm interested in the emergency inhaler idea but like nern
I'm wondering how the inhaler will work when one can't really
catch one's breath.   I've never used an inhaler.

caregiver222:  can you please comment ?

[PIANOTUNER]

Hello everyone.  I'm new here.  I have woke up, not being able to breath many times since about age 30.  I'm 49 now.  If I could post a picture.....I bet most would guess 35.  It must be the genes I guess, the D.N.A. I don't know.  I'm just blessed.  Here is the crazy flip side.  I have been insulin dependent since age 23.  I smoke, drink, and am in the early stages of c.o.p.d. taking both advair and albuterol.  I do use a treadmill and a weight set, but would not consider myself active.

Each and every time I have woke up not being able to breath, I felt the acid coming up into my throat before springing to my feet from a dead sleep.  You can not breath--- so-- no amount of the fast acting inhaler "albuterol" will help you.  Albuterol only helps those with a lung impairment breath better.  And if you wake up not being able to breath, well then, you will soon learn just how long "you" may need to hold your breath.  For me I know if it happens, I am going to struggle for a breath for anywhere between 15 and 25 seconds.  It feels like forever.  You wonder if you will die this time.  And pissed you had that last piece of Garlic Bread.

Here is what has worked for me.  I take nexium.  Over the counter "Prilosec" will work just as well.  You have to take it every day, but after you get started you will see a difference.  I never want to have that happen to me again.  Occurrences have been rare and few in the last 2 years.  If you fail to treat this, you may damage your vocal cords like I did, could not speak well for 2 months.  Tryed to give up cigarettes, could not.  I am fine now.  The stomach acid coming up into your throat will scar your vocal cords, and you can't breath!!!  You think you may die!!!  Don't pig out at nite....and you already know what foods "you" should avoid, because we are all different.  And instead of a 4,000 thousand dollar visit to the doctor, get some prilosec over the counter and start taking it every day.  This advice is for of course the poor and uninsured.  I am not giving any medical advice as I am not a doctor.  I can only share my experience and what has worked for me.  If you are rich and have plenty of money, please......go spend it.

I'm sorry, but this problem will not just go away.  You will have to take action.  I take the pill.  And most of the time, I can sleep, not having to worrie about waking up not being able to catch a breath.  I shall go on to play another piano tomorow.  God Bless.

[Gobosox]

A related discussion, Waking Up Unable to Breathe was started.