Question: Hello Doctor: I've been facing this issue for about two years now and still have no definite answers. This issue appeared/became more noticeable after a viral? lung infection approximately two years ago (took 1000mg of Biaxin for 7 days). At this time I truly believed that "something changed or made my breathing dysfunctional." I started to question the infection itself and/or the antibiotic. My respiratory drive seems to be compromised most noticeably when in the supine position and particularly before trying to go to sleep. For example last night as i tried to sleep i noticed that my breathing would stop and a big breath would follow. This felt uncomfortable and after several times I decided to sleep in an elevated position which made this more comfortable. Eventually i slept but woke up a few times during the night. Sometimes i will wake up during the the night with a fast heart rate. I'm currently on CPAP for mild OSA/Hypopnea. However with CPAP being used...I can experience episodes of breathlessness followed by a "waking deep breath" while conscious in a "semi sleep". I have seen a cardilologist that assures me that this is not a hear issue. Also a have seen a respirologist/lung specialist with no significant diagnosis at this time. The only thing mentioned was that there seems a bit of dysfunction with exhalation? I was advised to try to lose a bit of weight. I am close to 50 years old, my height is 5'10'' and my weight is been stable around 214lbs. I believe my BMI is around 30.5? My question at this stage is why is my breathing stopping while in the flat position? Also i notice that when I try to exersise (and this is happening more often now) my breathing becomes heavy and sometimes it feels like i may "lose control of it.". I try to do aerobic type (interval training) exercises for about half an hour every other day. This can be challenging. My question at this stage is that is there a possibly of damage to the breathing centre in the brain that becomes more apparent during sleep and/or trying to exercise? Could this issue be a symptom of another underlying issue? Your input will be greatly appreciated. Thank you, XXXX

Dr. Kumar: Thank you for your response. Based on your assessment of my situation I will now push for an investigation of the diaphragm. Could this possibly explain the tension/stiffness around my waist(like a rubber band) that is more apparent when sitting down in a chair or in car seat for example? Also your other point....for additional examination to rule out any neuromuscular disease is a great idea. Thank you very much for your expertise, your time and input. XXXX

Than you Dr. XXXXXXX ..I will let you know what i find out (hopefully I will find out something soon because I am not imagining this stuff). Since i still have one more consultation with you...I would appreciate your input to the following concerns/questions. I'm not trying to "play doctor" but i'be been reading a lot regarding my issue lately...i hope you understand because i know something is going on...and with no diagnosis at this time...its really bothering me! Last night the same thing happened again around 3am while on CPAP....I woke up....a few minutes later I experienced some form of tachycardia?...then i tried to get back to sleep. The same dysfunctional breathing pattern was noticed again...moments of "stopping of breathing" followed by deep breathing. Could this be what is known as Cheyne-Stocks respiration in the early stages of sleep? If yes...what could this mean? Could this be related to things like MS (since you mentioned the possibility of spinal cord issues previously)? I have had some form of exercise intolerance/muscle weakness? first noticed around the age of 26. ..I've been mentioning this to my doctors here but so far...no answers have been given. I was an active football player till around the age of 20 but I tried to get back into it a few years later with no significant success. I also looked into an article that mentioned viral infections could weaken the diaphragm and I've saying to my doctors that my breathing seems to have changed since some type of severe respiratory infection about 2 years ago. As mentioned previously I could only sleep in an elevated position(2-3 pillows) before going to the flat position again months later. Now the apparent need to elevated sleep has returned again...with a noticeable dysfunctional breathing pattern in the early stages of sleep. Yes...one thing that I forgot to mention previously is that my SpO2...while fully awake....can drop significantly when assuming the supine position...it can go as low as 90-91%. I mentioned this to two doctors here...they told me that i probably had using a malfunctioning oximeter to measure this at home. They both asked me to use their own oximeters in their respective offices and he same phenomenon was observed and confirmed (ie. significant Spo2 drops). Then I was tested for something called PMVS (Pulmunary Arterio-Venous Malformations) about a years ago. All tests came back negative. Can you see my frustrations Dr. Kumar? Thank you so much for your time and input! XXXX

Thank you so much Dr. XXXXXXX ..you sound like an amazing...true doctor...and trust me...WE NEED MANY MORE LIKE YOU!!! ESPECIALLY HERE!!! I will keep in touch. Kindest Regards, XXXX