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waking up not breathing
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waking up not breathing

About 2 years ago I started having episodes at night where I would wake up gasping for air.  My throat would feel prickly and as if it was closing off.  It would take me a minute before I could really start breathing again.  Drinking water didn't help.  It was really scary.  It only happened about 4 times a year.  I went to the doctor and they sent me to a sleep clinic.  It was determined that I didn't have sleep apnea, but did have restless limb syndrome.  Most recently, I have been waking up at least 4 times a week not breathing.  Actually I think I am waking up a lot sooner than I used to.  I don't gasp for air now.  My throat feels prickly and tight.  My eyes begin to water as I try to swallow.  The weird thing now is, it happens during the day.  I will be working and it hits me.  I have been taking acid reflux prescribed medicine for about 5 years now.  I have also had 2 endoscopies done that didn't reveal anything unusual.  Since then, the doctor prescribed me Dexilant.  It has done wonders for my nausea and heartburn.  Any idea on what it could be?
242587_tn?1355427710
Obviously, I can’t offer a diagnosis via this post but can state that what you describe as happening during the night is consistent with the description of Sleep-related laryngospasm  from Neurology Medlink    http://www.medlink.com/medlinkcontent.asp

I have appended part of the report at the end of my comments. Note this section of the report:  By contrast, patients with a history of laryngospasm that is not necessarily sleep-related experience sudden attacks at any time during the day or night (Maceri and Zim 2001).

I suggest that you contact, Antonio Culebras MD, editor. Dr. Culebras of SUNY Upstate Medical University and the Sleep Center at Upstate University Hospital at Community General in Syracuse, New York, either for his assessment or his recommendation of a medical center near you where such studies are offered.

Good luck,

Sleep-related laryngospasm

Contributors
Federica Provini MD, author. Dr. Provini of the University of Bologna in Bologna, Italy, has no relevant financial relationships to disclose.

Antonio Culebras MD, editor. Dr. Culebras of SUNY Upstate Medical University and the Sleep Center at Upstate University Hospital at Community General in Syracuse, New York, has no relevant financial relationships to disclose.
  
Publication dates
Originally released March 3, 2008; last updated July 5, 2012; expires July 5, 2015

Key points
  • Sleep-related laryngospasm is a rare condition related to episodic awakenings from sleep, associated with breathing difficulties and a feeling of suffocation.
  • Characteristically, patients describe sudden awakenings from sleep due to feelings of acute suffocation, accompanied by coughing, intense fear, airway obstruction, tachycardia, and stridor. This, in turn, resolves within a few minutes, and breathing returns to normal. Such attacks are traumatic experiences, and patients who suffer frequent attacks are afraid to go to sleep.
  • Sleep-related laryngospasm can be primary or secondary. To give a correct diagnosis it is necessary to collect a detailed history and perform a neurologic and otolaryngologic examination eventually including fibroscopy. Video-polysomnographic recording represents the ideal diagnostic tool in most cases.
  
Historical note and nomenclature
  Laryngospasm is defined as a sudden, prolonged, forceful apposition of the vocal cords (Loughlin and Koufman 1996), and it is believed to be the result of a laryngeal reflex response to noxious stimuli. Sleep-related laryngospasm is a clinical condition characterized by episodic, abrupt awakenings from sleep accompanied by a sense of suffocation and followed by stridor that usually evolves to normal breathing. Little has been published on spontaneous laryngospasm during sleep and its devastating effects on sleep quality and patients' overall quality of life. In 1977, Chodosh reported the first case of gastroesophageal-pharyngeal reflux-induced laryngospasm (Chodosh 1977). The first case series was published in 1995, and the term “sleep-related laryngospasm” was designated to describe this condition (Aloe and Thorpy 1995). In 1999, Morrison and colleagues described a distinct clinical entity under the term “the irritable larynx” characterized by dysphonia, episodic laryngospasm, globus and/or cough. The irritable larynx syndrome is hypothesized to arise from repeated exposure to noxious stimuli, such as gastroesophageal reflux, viral illness, or emotional or postural muscle misuse. The authors proposed a hypothesis on neural plastic change to brainstem control networks. According to this theory, the controlling neurons are held in a “spasm-ready” state, and symptoms may be triggered by various stimuli (Morrison et al 1999).
  In the American Academy of Sleep Medicine's Diagnostic and Coding Manual, sleep-related laryngospasm is classified as a sleep disorder associated with conditions classifiable elsewhere (American Academy of Sleep Medicine 2005).
  
Table 1. International Classification of Sleep Disorders (2005):
Diagnostic Criteria for Sleep-Related Laryngospasm

(1) The patient has infrequent (less than 1 per week) abrupt awakenings from sleep, associated with total or near total cessation of airflow for a short time (5 to 45 seconds), followed by choking or stridor for several minutes.

(2) Associated features include at least 2 of the following:
- rapid heart rate
- intense anxiety
- sensation of impending death
- residual temporary hoarseness

(3) The disturbance is not better explained by another sleep disorder, medical or neurologic disorder, medication use, or substance use disorder.

  Source: (American Academy of Sleep Medicine 2005)

Clinical manifestations
  The clinical presentation of sleep-related laryngospasm is highly characteristic in nature (see Table 2). The attacks begin with short coughs and inspiratory stridor while the patient is asleep (Bortolotti 1989; Schiff et al 2003).   Then the patient suddenly wakes up in a panic, unable to breathe either in or out, with a period of complete blockage lasting seconds. The attack is accompanied by acute fear or suffocation (Bohadana et al 2002), which yields intense, desperate respiratory maneuvers that produce little or no airflow. After this short phase of total respiratory blockage, the patient's breathing continues to be labored and is associated with persistent stridor (Thurnheer et al 1997; Bohadana et al 2002). This in turn resolves within a few minutes, and breathing returns to normal (Roland et al 2008). After an attack, some patients return to sleep though most, fearful of recurrence of the stressful event, try to remain awake (Thurnheer et al 1997; Roland et al 2008). Interestingly, patient descriptions of these terrifying episodes share a common theme. Asked where the blockage occurs, the patients point to the larynx, take the thyroid cartilage between the thumb and index finger, state that it feels like a tightening cord around the neck, or make a throat-cutting gesture (Thurnheer et al 1997). The infrequent and almost exclusive nocturnal occurrence of sleep-related laryngospasm and the short duration of the attack make them usually inaccessible to medical observation. By contrast, patients with a history of laryngospasm that is not necessarily sleep-related experience sudden attacks at any time during the day or night (Maceri and Zim 2001).
  Patients with sleep-related laryngospasm secondary to a gastroesophageal reflux disease may also awaken from sleep with a sour metallic taste in the mouth or a burning discomfort in the substernal area.
  
Table 2. Clinical Manifestations in Sleep-Related Laryngospasm

  • Abrupt arousal from sleep
  • Violent cough attacks
  • Sensation of suffocation; complete loss of breath
  • Loud inspiratory stridor
  • Extreme anxiety, sometimes seeking an open window
  • Loss of voice
  • Perspiration
  • Syncope
2 Comments
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Thank You. I finally think I have an explanation to my one time attack.
But I still suffer from that choke hold feeling. even though I was put on an allergy med that helped, that feeling will not go away.
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