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Sleep Disorders

Forgetting to Breathe?

10/01/2009

Question:

Well, first off, I have been experiencing these symptoms for a year almost. Whatever it is, it`s getting worse. Whithin the first hour or two of sleep, I wake up after what seems to be episodes of "forgetting to breathe" My whole body; arms, legs, face, chest...everything is waking up from an uncomfortable, painful numbness. It is getting harder and harder to catch that breath after I realize what is happening. Sometimes my jaw will be completely locked shut. I am bipolar and have experienced respitory failure after 2 attempts of "checking out" Can this have anything to do with it? Because I am so sick of people telling me it`s JUST ANXIETY.

Also, Have you heard of Ondine`s curse? Besides apnea, that`s the only thing that sounds right on?

Answer:

Based on the limited information in your question, it’s hard to know exactly what the cause of your symptoms may be. However, there are several possibilities and you are right to seek help. The symptoms you describe could be related to a primary sleep disorder associated with either breathing in sleep or a possible parasomnia (unusual behaviors or sensations during sleep). It’s also possible that they may be related to a primary lung disorder (you mention you have had respiratory failure twice?), a medication effect or an underlying psychological / psychiatric problem such as anxiety. As you can see there are a number of possibilities and you will need further evaluation to help sort his out. I recommend you seek the help of a sleep specialist. Having said that, I will comment on some of your symptoms and hope this is of some help.

If this is a true breathing problem in sleep, then this could be one of a number of problems, including obstructive sleep apnea (OSA) , where an individuals upper airway collapses during sleep, asthma, post-nasal drip, heartburn (or reflux disease), heart failure, or spasm of the vocal cords. Based on the limited information in your question, it’s possible you could have one of these conditions and obstructive sleep apnea (OSA) is a definite possibility. Individuals with OSA often awaken from sleep with gasping for their breath with fear and a feeling of air hunger. “Ondine’s curse” is a term used these days to describe a form of central sleep apnea in new born children. This form of sleep apnea results from a failure of the brain to send the signal to breathe when the individual falls asleep and is not likely in your case.

There are some dream-related conditions in which individuals experience a sense of not being able to breathe. Probably most common of these would be sleep paralysis, in which the individual describes an inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head. While breathing is actually not affected, the sensation of not being able to breath can accompany the paralysis and can be quite scary. Most individuals will recall the events. The episodes usually only last for seconds up to a few minutes and tend to resolve on their own. Occasionally, the episode will end if the person is touched or spoken to. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy).

Sleep paralysis usually first appears in young adults and tends to disappear with aging. Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

Other possibilities to explain your symptoms include disruption of sleep stage related to your medications. Several medications for bipolar disorder cause changes in the sleep architecture and may promote dream enactment. In some cases a condition called bruxism can cause jaw pain due to teeth grinding during one’s sleep.

It would probably be a good idea to discuss your problems with your primary doctor. Referral to a sleep specialist in your area may be useful. To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University