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Some new SE's from CPAP? Help appreciated.
Some new SE's from CPAP? Help appreciated.
Hi all.  Hope I am in the right place to seek a little assistance.  I can be wordy but tried to put the important stuff up front.  Let me know if I missed anything important.

Current issues:
Palpitations/Panic Attack (I think?), felt primarily in neck, waking me up (only occurs while sleeping and mostly not in first 3-4 hours of sleep (that I can remember)).  Sleep Maintenance Insomnia after 5-6 hours (can sometimes go back to sleep for an hour with YT sleep hypnosis vids).  Possibly a subtle "buzzing" or vibration in right calf.

- 3.5 years ago, diagnosed with OSA-induced panic attack after waking up and hyperventilating as a result of an OSA.  Did sleep study, said I had moderate OSA.
- 1.5 years ago, started having more issues (see "current issues" and "history"), no diagnoses were concluded, though symptoms were changing a bit.
- A month ago, diagnosed by a GP with having OSA-induced panic attacks (note, I would not consider myself an anxious or depressed person, normally).  Doc put me on a week of Klonopin, a benzo diazepine, to test.  1g of Klonopin worked like magic.  Slept 7 hours.  All symptoms disappeared and felt no side effects, other than feeling "normal".
   Felt good about having some new information but then Doc didn't have a long term solution except to see him once a month and get more Klonopin.  Reading up on benzo addiction, I decided that indefinite Klonopin was probably a bad idea.  Also wasn't clear if it was preventing symptoms or just masking the real problem.  Stopped Klonopin with no withdrawal, I think, but previous symptoms came back immediately.  Side note: He wasn't sure about the leg but thought maybe it was Restless Leg Syndrome even though there's no urge to move or kick, just a vibration feeling.  Apparently Klonopin is also good for RLS...but...again, not a good long term solution, from what I have read.
- Started experimenting with different settings on my Resmed Airsense 10.  Tried some higher pressures but didn't seem to help.  Just last night, tried turning on EPR-3 and setting pressure back to 8-12.  AH went from 0.5-1 down to 0.  So I guess that was a good idea.  But didn't seem to affect my symptoms at all.

Related Questions:
1. These palpitations/panic attacks (if that's what they are) didn't show up on Holter Monitor.  Is that normal?
2. Is it damaging my body?  I know a few palpitations aren't an issue, necessarily.  But I am not sure if I am sleeping through long periods of high BP until I finally wake up.

Detailed History/Background (can skip if not important): Using CPAP for 3.5 years, first Resmed 9 and then Resmed 10 Airsense Auto.  CPAP never made me feel 'amazing' again but the mask (Airfit P10) and machine never bothered me too much and it became necessary to not wake up choking, later on.

About 1.5 years ago, I started feeling strange buzzing vibrations in my right calf.  Occurred during the day and night but more noticeable at night.  No other symptoms.  Neurologists said it didn't match any major diagnoses.  Might be unrelated.

But a couple months later, I woke up with strong pulsations in my neck (and only the neck).  Very strong, leapt out of bed.  Within seconds they went away.  Saw cardiologists, neurologists, orthopedists and others.  Ran all kinds of tests, including Holter monitor.  These occur *only* while sleeping and the the overnight Holter monitor showed no results that correlated with my events or anything out of the ordinary.  Nothing out of the norm.  Tried pregabalin and electrolytes.  Continued happening a few times every night.  On the upside, the cardiologists did put me on BP meds and that's probably a good thing.  But the cardiologists all kind of ruled out cardio-related issues for my symptoms.

At first, the pulsations felt cardiological, like an arrythmia.  Later, they became more muted and I started to think it was nerve-related (I had had a couple pinched nerves in my neck before, though they felt nothing like this).  The whole time, though, when I would change body position, they would go away within a few seconds.

A few months ago, they started to feel more like slight palpitations.  If I put my arms in my armpits or along the sides of my neck, I can feel rapid pulsing.  I would say 4-5 times a night I wake up enough to remember but not sure how many times it happens and I just sleep through it.

At around the same time, I started having a bit of Sleep Maintenance Insomnia, waking up and not going back to sleep after 5-6 hours of sleep, where my body prefers 7.

On the upside, I am not sure if I still have the calf vibrations anymore.  They are much more subtle, now, or my brain has learned to ignore them.  In any case, the vibrations were never as bothersome as the other issues.

Charts:  I don't have a lot of history as I didn't have a working SD card previously but I will include Jan 12, 2022, when I was on Klonopin and had no symptoms and Feb 4, 2022 (last night).  The text is a bit weird on my Oscar for some reason, not sure how to fix that.  Will also include the statistics screen since it has a longer history.

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RE: Some new SE's from CPAP? Help appreciated.
Hello SamCertainly.  I have struggled with similar issues that you describe (both before cpap (I am on a vent.) and now using the vent.  But I must say I have noticed the "buzzing" has become much less frequent and intense when using the ventilator at night.  Just my experience.

I had a holter monitor.  It showed that I was in perfect sinus rhythm when the "buzzing, etc." occurred.  I had an MRI on my neck 3 years ago that showed some mild degeneration of C4, C5, and C6, but otherwise normal.  (The very 1st thought I had was that it was a pinched nerve in my neck also, but it was ruled out).  That is my answer to your question #1.

Question #2 - I do not know if it is damaging to the body.  I sure hope not, but I guess it could be.  I have read also that extreme anxiety can manifest itself as a "vibrating, etc." sensation in the body.  When I feel the "buzzing" it is a real sensation.  When I feel my chest and head and neck, it is perfectly still and not moving in any way when it occurs.  Also, one time a kept a small hand - held mirror in my bed and looked at my chest and head and neck when the "vibrating" was occurring.  Nothing was moving.  I was perfectly still.  It has only occurred when I wake up from sleep (and sometimes just as I am falling asleep).

I applaud you in that you found a solution, (but have decided to discontinue it).  I do not personally want to try any melatonin, or psychiatric "calming" medications because I have bradycardia.  It gets down to high 30's during sleep.  I am a former endurance athlete, so my Cardiologist is not worried about it.  Using my vent. raises my nighttime pulse about 5 beats per minutes.  My father's PCP and Cardiologist told him never to let his pulse get into the mid 30's for fear that his heart might stop (go into cardiac arrest because it is beating so low).  

Without the vent, my minute ventilation (both respiratory rate and tidal volume) can decrease significantly during sleep.  Looking at your OSCAR charts, I see the summary data in the left hand side about your minute vent (and breathing rate and tidal volume).  Do you mind posting the large charts of 1.  Minute Ventilation  2.  Respiratory Rate and 3.  Tidal volume that are tracked all night?  Hopefully see a better picture of your entire night.  

I have an S9 Adapt ASV and have several weeks worth of successful naps recorded on OSCAR (and I have really kept an eye on Minute Ventilation (and Breathing Rate and Tidal Volume).
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RE: Some new SE's from CPAP? Help appreciated.
Thank you for your reply and sharing a part of your story with me, Jay51.

The buzzing in the calf isn't too bad, I can ignore that.  It's the palpitation feeling that is making a good night's sleep impossible.

Where you have bradycardia, I have tachycardia, I guess.  I don't have a way to monitor my bp or heart rate while I am sleeping and it disappears almost as soon as I wake up and move.

I would be happy to post any charts or provide any info that might help (me or others).

Attached are Tidal Volume, Resp. Rate and Minute Vent. for both Feb 4, my most recent data (including enabling the EPR-3), and Jan 12, when I was on Klonopin and symptoms disappeared, for reference.

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RE: Some new SE's from CPAP? Help appreciated.
Thank your for sharing that.  You only have a few spikes down in your minute vent. and respiratory rate and tidal volume.  Most of your night is at your median.  The spikes may be times that you woke up, etc.  It looks ok to me.  I am not an expert in interpreting charts, but an expert will clean up my post if they see something important.  

When I used the 24 hour heart monitor, I pushed the button about 49 times.  About 7 times each night.  49 were in perfect rhythm.  Once I was in tachycardia.  I stood up and that caused POTS (Postural Orthostatic Tachycardia Syndrome).  I guess I went into tachycardia because my heart rate is so low (in the 40's resting).  

If OSA is the cause of your panic attacks from hyperventilating, then treating the OSA should stop the hyperventilation.  I hypoventilate 1st which starts the cycle that ends in hyperventilation.  Hypoventilation can be caused by OSA, CSA, a combination of both, neurological, etc.  If treating the OSA does not stop the hyperventilation and waking up in panic, further testing my be needed to figure out why.  

I am like you in that I usually ignore it and just go back to sleep.  It does not cause any pain to me, but it sure would be nice to figure out what is causing it and get rid of it once and for all.
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RE: Some new SE's from CPAP? Help appreciated.
I spoke too soon on the improved numbers with EPR-3, Pressure 8-12 settings. Ended up with an AHI of 1.79, somewhat high, for me.  That said, I slept through more of the palpitations, I think.  Didn't seem worse, at any rate, even with a higher AHI.  Will add the graphs from today.

"If treating the OSA does not stop the hyperventilation and waking up in panic, further testing my be needed to figure out why."

I may have miscommunicated (I know I ramble).  While I was diagnosed with OSA, originally, from a hyperventilating instance, that was only that one time.

Right now, my main issue is that I wake up with palpitations like 4-5 times a night, disrupting sleep a lot, and a GP suggested it was the palpitations were basically a panic attack, resulting from OSA.

Also, while I may be sleeping through some tachycardia/palpitations (which is a cause for concern, in itself), they are waking me up at least 4-5 a night, usually, that I can remember so...it's...really messing with my sleep.  There's no pain or shortness of breath.  Just a rapid heartbeat (always) and I feel hot (sometimes).

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RE: Some new SE's from CPAP? Help appreciated.
Thank you for that SamCertainly.  These OSCAR charts look ok to me also.  It seems like your Pap therapy is doing an adequate job in combatting your OSA.  I appreciate you explaining that the hyperventilation only happened once.   I would cycle between hypoventilation and hyperventilation.  

It seems like the goal is to combat the palpitations.  I also wake up hot sometimes when I wake up at night. Almost sweating.  I hope you find some relief from the palpitation (and panic attacks from OSA).
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RE: Some new SE's from CPAP? Help appreciated.
Thank you, Jay.  Yes, the goal is to combat the palpitations, both for long term health and immediate quality of life improvements.  I would say getting 7 hours sleep is also the goal but I think the palpitations or panic attacks or whatever they are...are behind that, too.

Oh, two other things I forgot to mention:
1. The palpitations mostly occur after 3 hours of sleep...the first few hours are usually ok...or maybe I am just tired enough to sleep through them in the first few hours, not sure.
2. At 6:01 am and 7:14 am, in the first post, for Feb 4, I had palpitations and woke up.  I should have mentioned them to see if they matched up with anything on the chart.  Didn't look like it to me but I don't understand the charts so I should have mentioned it.

I am hoping someone has some insight if there are any adjustments I can make or other ideas on how to investigate.  So far, doctors have not been helpful in this regard, other than finding out that Klonopin works...and is over-prescribed lol

Thanks again, to you, Jay, and anyone else that might have some thoughts.
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RE: Some new SE's from CPAP? Help appreciated.
Great post again SamCertainly.  I got a nighttime oximeter (that checks SPO2 and heart rate) to check my heart rate all night (and see if it correlated with the "buzzing).  It also checked my SPO2 all night to see if during a huge drop, that was what caused the "buzzing."  This might give some clue to you as to what is happening in your current situation at night; and it may not (both may be normal).  

I am kind of guessing that when my heart rate gets very low during this night, this could be contributing to it possibly for me.  It happens to me just like you usually also:  after a few hours of sleep when I wake up during the night I notice it.  

Also, someone who has had success in dealing with palpitations at night might want to post here how they accomplished that.
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RE: Some new SE's from CPAP? Help appreciated.
I have an oximeter that I bought at the start of Covid.  It doesn't track all night but I have used it when I woke up with a palpitation several times.  It's a little hard to say but seems like my normal bedtime HR was is 62-64 and when I checked it after an event, it was like 72. SPO2 is always 95-99.  Might not be accurate, though.  Cheap oximeter and by the time I wake up and I am taking the reading, it might have come down a bit.

They don't sell overnight oximeters in my country, from what I can tell, but they do sell Fitbits that can supposedly do it.  Might not be all that accurate but may be an idea.

"Also, someone who has had success in dealing with palpitations at night might want to post here how they accomplished that."

Would love that.  Or anyone who has any advice on settings or alterations I can experiment with, with my Airsense 10.

Thanks again for the reply.
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RE: Some new SE's from CPAP? Help appreciated.
So I borrowed a friend's Fitbit Charge 5 for a couple days. I know it's no sleep study but I was interested to see the heart rate monitor while I was sleeping.

Fitbit doesn't seem to see any issues there. Sleeping heart rate average of 55 (normal resting heart rate of 58), low SPO2 variation. Looking at the heart rate monitor graph over time, I don't see any pattern of big drops leading to wakefulness (i.e. if my HR dropped too low and my body woke me up).

Starting to wonder if the doc's theory of apnea-inspired panic attacks is true or not.
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