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Steven Y Park, MD  
Male, 52
New York, NY

Specialties: Sleep-breathing disorders

Interests: Running, Baking, origami
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212-315-9058
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Anxiety and Sleep Position

Nov 01, 2008 - 29 comments
Tags:

Anxiety

,

Sleep Apnea

,

sleep position



Do you have an anxiety problem which is affecting your life? Do you overreact to everything or have pain attacks for no reason? Do you wake up in the middle of the night in a state of panic, in a cold sweat and with your heart racing out of control? Many people with panic disorders can be treated either conservatively with therapy of stress control and relaxation methods, but many people end up being placed on an anti-anxiety medications.

Any time I see patients in my practice with anxiety disorders, in almost every case, the person prefers not to sleep on his or her back. The reasons for this is that due to certain anatomic factors, if the person lays flat on his or her back, then due to gravity, the tongue falls back partially. If they have smaller than normal jaws, or any degree of dental crowding, the tongue falls back even further. Everything is fine until they go into deep sleep, when all the muscles (including the throat and tongue muscles) relax, and the tongue falls back and obstructs breathing.

At this point, one of three things can happen:

1. You can wake up immediately to light sleep or completely awake, wondering why they are suddenly awake,

2. You can stop breathing for 1-9 seconds and then wake up to light sleep or completely awake, choking, coughing or gasping for air, with your heart pounding, or

3. You can stop breathing for more than 10 to 40 seconds, and then wake up go back to sleep.

Depending on how sensitive your nervous system is, you will either wake up quickly every time you obstruct, or wake up after long breathing pauses. A pause for more than 10 seconds is called an apnea. More than 5-10 apneas every hour means you may have obstructive sleep apnea.

To compensate for breathing problems, most people with anxiety like to sleep on their sides or stomach, but whenever they roll onto their backs, this is when they are most likely to obstruct and wake up. Imagine if you kept waking up from deep to light sleep 5-10 times every hour. Think how you would feel during the day. Your nervous system, emotions and senses will be heightened, and you'll overreact to every little thing. Plus you'll be always tired, no matter how long you sleep.

So the next time you go to sleep, think about your sleep position, and which position you tend to wake up most often. If you developed a habit of sleeping on your back for whatever reason (your grandmother told you it was healthy, or your dermatologist told you to do so to reduce facial wrinkles), go back to sleeping on your stomach or side, or whichever is more comfortable.

If you continue to have anxiety issues and are tired more often than not, you may want to get evaluated for a sleep-breathing problem.

____________________________________________
Steven Y. Park, M.D., author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Endorsed by New York Times best-selling authors Dr. Christiane Northrup, Dr. Dean Ornish, Dr. Mark Liponis, and Mary Shomon.

www.doctorstevenpark.com


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Avatar universal
by LukeL, Nov 02, 2008
I have bad anxiety and also sleep paralysis. Back when I was on valium, I would wake up but still be paralyzed and could feel my tongue and throat muscles collapse and close off my airway for 5-15 seconds. Now that I am on Paxil, my snoring and sleep paralysis have stopped completely however I wake up anywhere from 5-10+ times per night. As a result I nap a lot (of course I nap in a recliner and sleep like a rock) It is also strange how all my sleep paralysis episodes happened when I was sleeping on my back as well.

This was a very interesting post and will discuss it with my doctor at my next visit.

Avatar universal
by angelinamarina, Nov 02, 2008
I have had panic disorder for many years.  when I was pregnant a few years ago I started waking up in the night with major horrific panic attacks.  no doctor could answer why this was  happening.  i was miserable.   a few years later i found out that i have severe sleep apnea...i wake up 81 times per hour.

Apparently, the panic attacks were a way of my body trying to wake up and/or survive!!!


angi

Avatar universal
by joj, Nov 02, 2008
I found this very interesting.  I have sleep apnea and I have been given a CPAP but I can not use it because Everytime I sleep with it I find my stomach bloated in the morning and I burp and pass wind all day.  I have spoken with my doctors about this and they tell me the machine will still work and I will have to put up with the side effect.  I feel exhausted most of the time and have continually put on more and more weight.  I have Diabeties and now they think I have RA or some poly arthritis of unknown type.  I have a hiatis hernia and gastritis and when using the CPAP my stomach pain wakes me.  It seams as though they are great a diagnosising the conditions but not so great at finding a workable solution for the problem.  I wish there was a better way to treat sleep apnea.

Avatar universal
by Danielle718, Nov 02, 2008
Its funny how you mention that. My doctor feels that I have anxiety issues (he's known me for almost 20 years). There are times I fall asleep and then when my body feels like its going into a deep sleep, it feels as though my breathing stops and I wake up in a panic with my heart pounding and breathing hard. I had this problem one night and couldnt fall asleep for 2-3 hours. Everytime I wanted to go to sleep, my body would do the same thing till I guess I passed out from extreme tiredness.  I hate it when that happens!  But no matter what position I was in, I had the same thing!! I tried to lay on my sides, on my back, even on my stomach. I notice I only get like that when I really anxious about something.

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by lonewolf07, Nov 02, 2008
I found this post interesting too.  The term "falling asleep" is one I can relate to.  I suffer from depression and anxiety and have sleep disorders because of it.  Sometimes I can feel myself "falling into sleep" and everything slows down - breathing, pulse, etc.  My brain is still somewhat awake and I wonder if the anxiety isn't causing the feeling that the slowing down that happens when we sleep is somehow making me think that I'm dying, not falling asleep.  The feeling of dying has happened when I've slept or woken up on my side or back.   I can't remember the last time I had a restful sleep, regardless of body position.  





Avatar universal
by Steven Y Park, MDBlank, Nov 02, 2008
Thanks for all your great comments. One thing I have to stress is that everything's a vicious cycle. Poor sleep leads to a low grade stress response where your nervous system is on edge, and so your nerves, including your mind, is heightened. Think how this can prevent you from falling asleep, or even worse, if you're afraid of that feeling of dying or suffocating as you wake up from sleeping, that could prevent you from falling asleep. I've heard other various terms for how people feel when waking up after stopping breathing: dying, falling, choking, gasping, panic, screaming, etc. If someone or something is suddenly preventing you from breathing while in deep sleep, imagine how this can be interpreted by your subconscious in the split second before you wake up. I even had one patient who had this problem proclaim, "I curse the mornings when I wake up."

As for sleep positions, many people sleep better on their sides or stomachs, but for some people, it doesn't matter which position they're in—they obstruct in all positions. It's surprising how almost every patient that I happen to see with either depression or anxiety have the same sleep-breathing issues. Chances are, one or both of your parents will snore and have undiagnosed obstructive sleep apnea.

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by AR-10, Nov 03, 2008
Do you feel the Bi-PAP is superior to the C-PAP?

I do, personally. What I see though is that anyone diagnosed with Apnia is given a C-PAP to use. I struggled for months trying to get used to the machine and find the right mask for me.

A nasal canula solved the mask issue, but I never was able to breath out properly with the C-PAP. Too much pressure to allow me to empty my lungs. I finally went back to the perscribing doctor and as soon as I described my problem, a form was submitted to my insurance stating I needed a Bi-PAP, and I got one. Much easier to use, for me.

I realize a Bi-PAP is more expensive, and thus an insurance issue.
Wouldn't the cost go down if the volumn sold went up? Or if the Bi-PAP was offered without the heated water feature? Or if the medical supply houses didn't drive up the costs by trying to sell me parts and supplies twice as often as I need them just because my insurance allows it every few months?

Should the C-PAP be retired?    

213044 tn?1236531060
by AR-10, Nov 03, 2008
Sorry this is not pertinanat to this discussion.

I've read your other submissions, and this was on my mind.
Didn't mean to ignore the subject or drag the discussion off topic.

213044 tn?1236531060
by AR-10, Nov 03, 2008
I guess my thought on C-PAP/Bi-PAP is; the insurance companies try to cut costs by forcing the doctor to justify a Bi-PAP. It costs them more in the end when patients like myself end up with both machines.

Am I the exception to the rule?
Do many people transition from one machine to the other?

Avatar universal
by Steven Y Park, MDBlank, Nov 03, 2008
AR-10, your question about CPAP/BiPAP is an excellent question that would be more appropriately answered in the expert forum section under sleep-breathing (which I moderate). I have not doubt that for you, BiPAP was definitely the better choice, but for most people, regular CPAP works just fine. All the various xPAPs besides regular CPAP are reserved for people with specific problems and indications. For example, people on very high CPAP pressures (but not all) tend to have trouble exhaling so would benefit from BiPAP. Many people with central sleep apnea benefit from regular CPAP, but some need an adaptive servo ventilation model (ASV). In fact, with the advent of c-flex and other computer algorithm-generated pressure curves, BiPAP is not as popular these days. If cost were a major issue, you may have been given a cheaper BiPAP model rather than the more expensive c-flex model ;)  

I would imagine that in the future, with advancing technology and lowered manufacturing costs, every one of these features may be incorporated into one machine. So, in answer to your question, "different strokes for different folks." Finally, yes cost is an issue, but the biggest barrier to CPAP use and compliance is the quality of follow-up and counseling on the part of the sleep doctor and durable medical goods people. All the new features, gadgets and new technology is useless unless there's a solid relationship that's developed between the patient and all the health care providers involved.

213044 tn?1236531060
by AR-10, Nov 03, 2008
Thank you, and again, I am sorry to drag your entry off topic.

Your submissions have been usefull and thought provoking.
I'll have to check out your forum.
Thanks again.

Avatar universal
by Steven Y Park, MDBlank, Nov 03, 2008
My pleasure.

671280 tn?1225812719
by pudmott, Nov 04, 2008
I'm afraid im one of those who obstruct whereever i sleep. i am generally a side sleeper and now i can be just dozing and feel myself begin to obstruct. i hear myself snore while im awake if i dont have my cpap machine on. I have an AHI of 126. Considered severe. I have been very lucky though and took to my cpap like a duck to water. my body is so trained to it now that i cant fall asleep unless i have it on. I found once i switched to the nasal pillows rather than the mask it was much better. I also have sjogren's so need the humidifier and have the c-flex as well which realy helps.
Also as a side line. a heated tube in winter helps keep away the condensation. Oh yeah and my depression and anxiety. nearly zero. just the odd occurance.
thanks for the thread. very interesting

Avatar universal
by iSteppenwolf, Nov 05, 2008
by Steven Y Park, MD


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Steven Y Park, MD  
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, Nov 02, 2008 10:04PM
"Thanks for all your great comments. One thing I have to stress is that everything's a vicious cycle"

I agree about the vicious cycle. If true does it not beg the question : where and how did it all start? Then before starting treatment with medications a plan should be considered and discussed with the patient. I say this because it has been my experience that with many medications once you start it's almost impossible to be completely off medications EVER AGAIN!

It seems to me that this fact is never discussed as a reality and an issue. Hopefully this does not come off as a conspiracy theory because I would suggest that anyone and everyone who reads this answers their own survey and if you find that you yourself, a loved one, or just someone you may know was started on some medication ( maybe with the exception of antibiotics although I got stuck on that merry-go-round when I was 24yo and went to the VA Hospital for a unrinary infection and after one whole year my infection was worse than ever and the VA told me that they had tried me on every antibiotic available ie gram positive, gram negative and gram positive and negative. Their position was that I at 24 had a antibiotic resistant bug and would probably have to live with it the rest of my life. That didn't happen because I found one doctor outside the VA system who told me that the VA created that monster and had me cold turkey off of antibiotics for a month while drinking a gallon of distilled water a day. That month was horrible but on that last visit he did this old fashion prostate massage and the infection was gone! ) So do you think that the drug makers don't realize that at some point your doctor is going to suggest a drug to balance or counter another drug and that some are designed to be taken " for the rest of your life " If you accept that concept and BUY into it litterally and figuratively, that got you and your doctor where they want you and all in the name of "helping you".
Don't mistake this to mean that many medications are not needed. I just question the long term plan. There is none.

Avatar universal
by iSteppenwolf, Nov 05, 2008
It seems that there is no way to edit or ammend these posts....i realized that in my diggression about the antibiotics I never finished the thought which a suggestion to review the history and see if there isn't a pattern of one medication leading to another.
Maybe one of the side effects of medication is addiction to medication? After all most medications have as one of the side effects death which is easy to understand if a person can die from touching something that was touched by a peanut.

Peanuts will soon come with a warning label like cigarettes: PEANUTS may be addictive and can cause death. And of course there will be a warning to pregnant women or women who are nursing. And lets not forget the choking hazzard.

Avatar universal
by Steven Y Park, MDBlank, Nov 05, 2008
I can understand why you feel that way about medications. I do agree with you that most medications that doctors prescribe are given to cover up signs and symptoms without getting to the root of the problem. Even if you don't know that actually is the root cause, the closer you are to the root, the better the results will be (think about pulling out a weed). So while it may seem that antibiotics or other medications cause other problems (which it does, leading to more medications), the real question you have to ask is, what's the root cause? Peanuts are not bad. It's the allergic person's immune system that's too hypersensitive. But then why is it too hypersensitive? The questions can go on and on.

I'm sure there are exceptions, but in my opinion, most of the chronic medical conditions that people use medications for are directly due to diet, lifestyle and stress issues. So in theory, most medications are not really needed. But what this means is that as a society, we have to make dramatic changes in our diet and lifestyles. It means making big sacrifices, for the better in the long term. But some of you will say, I'm too busy, and I have no time or I'm too tired, or I don't have any money. So in the end, you work hard untill you get sick, get placed on medications, and need to keep working harder to maintain your medical insurance to pay for all the expenses. The medicines only keep  you from getting sicker, without really taking care of the original problem.

Sorry for rambling. In short, I understand your frustrations.

Avatar universal
by iSteppenwolf, Nov 05, 2008
Thanks for replying.

Here's an interesting link that you and the readers may find interesting:

http://www.sciencedaily.com/releases/2008/10/081023195216.htm

Avatar universal
by LovelyBebe, Nov 06, 2008
Maybe this will help someone out there who is suffering from sleep apnea:
I was placed on  a CPAP machine for s.a. and within a very short period of time developed thrush and a yeast infection in the back of my throat.  My tongue developed candida all over it.  BigTime.  Caused me to have to take antibiotics, which I abhor.  
Sleeping under the mask was also so horrible an experience for me that I simply could not tolerate the claustrophobic conditions of such enclosure. I also found it intolerable in not being able to speak or  talk to my husband as we both fell asleep.  Bottom line:  my body and my mind rejected it.
My pulmonary care doctor then recommended that I sleep under oxygen at night.  She ordered for me a quiet-running
machine; the company supplied me with extra-long tubing and a small child-size cannula for my nose, which they replace on a regular basis.   With the machine set at the recommended 2 liters, I sleep like a baby; the long tubing allows me to turn easily in my sleep;
I can, of course, read with it on, drink with it on, and talk until we fall asleep.  A wonderful unexpected bonus is that I no longer have nightmares which had, at times, waked me up because of my screaming out loud.  Perhaps that is due to the deeper sleep I receive.
Ask your physician about this possibility. It is drug-free therapy, not addictive, just pure wonderful oxygen.
Good Luck!
    

Avatar universal
by desiree211, Nov 06, 2008
ok i know im in the wrong area but im haveing bad problem with my rib i cant move i cant eat or do any theing what shoild i do

Avatar universal
by Steven Y Park, MDBlank, Nov 06, 2008
Sounds like you should see your doctor or go to the emergency room.

Avatar universal
by conie0710, Nov 10, 2008
Hi!! i usually feel pain on my jaw which causes me to be rushed to the E.R... i'm scared and thought it was a lock jaw...xray show a normal result... doctor recommended me to take iterax since it was due to anxiety.. i was just wondering is the pain on my jaw related to my scoliosis which thoracic?.. I often feel that pain on my jaw and kept me worried.. ive taken rivotril, iterax, myonal and lots of muscle relaxant... what do yiou think is the best thing to do.. you can send my reply top my email mybaby_mike21***@****....

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by strictlyforpain, Nov 11, 2008
Wow!!!

Dr. Park,

Thanks for posting this I found it interesting. I've had sleep apnea since I was a child. I remember waking up you describe as a kid. As an adult I think I played soccer so much (3 to 4 games a week and practice 3 days a week) that I was just so exhausted my body never woke up even if it wanted. My observant wife was first to cue in on my 97 apnic events per hour and my sleep doctor put me on CPAP. That was in 1999 and boy have I been happy ever since. I won't say my sleep is cured. It's much better though. My biggest problem is facet joint syndrome. I have chronic back pain that just won't let up at all. I think it does more to interfere with my sleep than anything else. I took Oxycodone 10/325 for 2+ years while we attempted shots and other RFA injections to treat the pain. Nothing really took. My pain is over the top. Despite it I exercise 7 days a week for at least 60 minutes with my heart rate at 85% of it's maximum and I've lost 80+ doing this and have my weight down from 264 to 180.

I just wanted to chime in on the medication leading to more medication and the vicious cycles. I do believe there are times in life where medicine might just be the necessary evil. For me I've not been able to find a cure for pain. I've diligently pursued physical therapy to no good end. I've done no impact exercise and prescribed weight lifting to no good end. I've also dropped nearly $8,000 out of pocket for shots and other remedies to no good end. So far the methadone I take for $26 a month out of pocket without insurance has done more for me than anything. Too bad methadone in and of itself carries so many drawbacks but it is what it is and I've been sleeping through the night every night for the last 2 months for the first time in 8+ years.

I love seeing your comments. I love the mature exchange of ideas and information between a medical doctor and an informed patient base. I think this is where medicine (both prescribers and prescribed) can benefit. When we exchange thoughts and ideas in a free medium such as this it benefits everyone.

I for one am still on the hunt to find a cure to my extreme back pain. I believe that exercise at least 3 days a week is mandatory if you are physically able and have a doctors approval. I believe that sometimes medicine can make a major improvement in your quality of life so long as you are open and honest with your doctor and do not attempt to abuse them (your doctor) or the medicine. The rest I think is a journey called life and I've learned there are never easy answers but our hope must carry us.

My hope is certainly buoyed seeing Dr. Park involved like this. Gosh it's just a huge relief to see it. My general practitioner doctor is one talented lady and I respect her a ton. I wish I had this kind of access to her. That'd be fantastic.

Well good luck to everyone. One thing I would suggest is regular exercise and a notebook. I try to write down everything that helps or exacerbates my medical conditions and I make sure that I give my doctor a chance to look through it from time to time. This journaling has been very helpful and someday I hope to be farther along than I am now.

Best Regards,

Rex

Avatar universal
by Steven Y Park, MDBlank, Nov 11, 2008
Rex,

Thanks for your feedback. It sounds like you've come to terms with your chronic medical conditions. I do agree with you that for certain people, medicines can be a necessary evil.

I don't want to add one more thing to the list of things to try for your back, but I read a book about back pain last year by Dr. John Sarno. He has a completely different approach to back pain, and although controversial, I know a number of patients that swear by his methods. Check out his books if you can.

374225 tn?1269902862
by strictlyforpain, Nov 13, 2008
Dr. Park,

I'll do it. Frankly if I could get away from medication it would be nice. John Sarno... off I go!!!

Thank You!!!

- Rex

Avatar universal
by keyran, Dec 02, 2008
I always sleep on my side, it makes the anxiety feeling in my stomach calm down, whereas if I sleep on my back, the feeling is much worse for some reason.

Anxiety likes to play games with me, if I wake up in the middle of the night, I don't even remember about my anxiety/depression, but then 5-10 minutes later, it kicks in like a bullet right in the pit of my stomach, and then it can take me upto an hour to get back to sleep =(

This was a very interesting read, Dr. Thanks for posting it.

Avatar universal
by Sammymudgirl, Jul 30, 2009
I have Bipolar Disorder and Fibromyalgia and Sleep Apnea. I am always very anxious and often aggitated (feeling like I am flying apart and want to scream or break things etc.). I also have been diagnosed with Asthma from frequent visits to the ER when I couldn't breathe for a prolonged period of time like an hour. Then when my Sleep Apnea started occuring about three years ago or prior, I began waking up not breathing and gasping for breathe. I started waking up sitting straight up, since this was the only position I could breathe in. Then I started switching from side to side, getting a very short respite from not breathing until I could fall asleep again in exhaustion. Then I was having chest pains, so my Dr. sent me to a cardiologist. I had a clean bill of health.Then I had chest pains with very stong fear which I thought was because of the chest pains. Now, I often get breathing problems when I first lay down to sleep. So, I tried my inhaler to no avail, and realized I was having panic attacks with labored breathing, and panic and very high anxiety. With the extreme anxiety, I felt the panic to do something quick to stop it, so, I took a bath which helped temporarily, until I tried to sleep again.Then still panicing, I took a Doxepin ( a tricylic antidepressant which induces sleep), which I am prescribed to fall a sleep with. So, I fell asleep in total exhaustion about a half an hour later still full on panicing. This was my second panic attack in this manner in the last month. Now there is another type of panic attack I have been having, and that is whenever I try to use The CPAP I wake up feeling totally claustrophobic and rip it off my face because I am totally panicing. I have never been able to ear it all night long - I always panic. I have tried wearing the CPAP at night before I go to sleep. I have only tried this a few times, should I try it some more? I also have allergies and so am often very congested when it is time to go to sleep which makes matters worse. I talked to my PCP and he said he would precribe something for my congestion, but he forgot to call in my prescription, so I went to the drugstore from a really bad sinus headache. and  I got Afrin nasal spray for extreme congestion, but only to use temporarily, because I heard you can become dependent on it and it stops working. I will be talking to my PCP and my Psychiatrist within the next month, but does anyone have any suggestions? Also, Dr. Park would a BiPAP be good for me? I know this is a little complicated, but any help would be appeciated. I sleep more than I am awake between the Fibromyalgia and the Sleep Apnea.

Thanks,

Sammymudgirl
I'm a potter!



Avatar universal
by Tonton441, Aug 04, 2009
I have a problem similiar to this too.  When I am falling asleep, I feel like I'm hallucinating.  I feel myself falling asleep (not actually falling), but like I'm losing control.  I will be thinking about something and falling asleep at the same time and I will stop breathing..how long I don't know, but I wake up gasping for air.  I have had 2 sleep studies, and naturally, during those 2 nights, I only had minor instances.  My husband has observed these episodes, so I know they are real.  I feel like I've been without air, and am in a "fog" when I wake up.  If I fall asleep in the daytime, I do the same thing.  Not every day, or ever night, but when they start, it will occur several nights in a row.  I always feel tired in the mornings, and have fallen asleep at redlights and at my son's school in the line.  Any suggestions?

I had a stroke in 2007, which nobody can find a reason for, except they think my blood pressure shot up during a panic attack.  I've had every test imaginable.  I take Hydrochlorathiazide and Xanas (as needed), and aspirin daily.  

Thank you!

Avatar universal
by Griffy04, Sep 14, 2009
I am in an incredibly complex & life altering situation with complex central sleep apnea.  CPAP worsened the condition, BIPAP did not help & neither did BIPAP AUTO. After 4 sleep studies in one year I am on Adaptive Servo Vent (ASV).  I was sleeping 12-14 hrs straight & then 3 hour naps.  I have had the ASV for one week & feel no symptom relief. I am very concerned that this may not be working.
Dr Park do you have experience with ASV & do you know how long it takes to see results. I have had a diagnosed sleep apnea for 18 mos. Interestly, I too suffer from depression/anxiety. Anxiety meds can worsen sleep apnea I know.
I would appreciate any help and advice.
Any suggestions as to other medical conditions that may be causing exhaustion other than the apnea. I am on a thyroid med & levels are normal as is iron & B12.
Thank you
As for the previous blogger falling asleep while driving........STOP driving you could kill your child or mine. My doc would have pulled your license by now.

Avatar universal
by dfrkaitt345, Nov 30, 2015
I just tried to fall asleep about 30 minutes ago , my eyes were closed and I was dreaming but still awake .. it's weird I know but suddenly I felt like I was falling through my bed and I couldn't move when I tired and couldn't open my eyes. I also tried to make noise but couldn't. I was breathing heavily. it lasted for about 30 seconds. does this happen to anyone else ?! can someone PLEASE answer and  help me out ! it's really scaring me , thanks !! PLEASE READ AND RESPOND DONT IGNORE

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