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What causes breathing difficulties interfering with sleep?

Nov 2013
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Answered by

Practicing since : 1994
Answered : 5576 Questions
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
Posted Sun, 23 Feb 2014 in Brain and Spine
Answered by Dr. Sudhir Kumar 7 hours later
Brief Answer: My reply is below. Detailed Answer: Hi Mr XXXXXXX Thank you for posting your query. It is unfortunate that you have breathing difficulties interfering with sleep for two years, moreover, no definite diagnosis or treatment plan has been made. First of all, I would like to reassure you that these symptoms do not suggest any problems with the sleep centre. The sleep is regulated by hypothalamus & related brain structures and you have no other symptoms to suggest any hypothalamic dysfunction. However, if no other cause is found, a brain MRI scan may be done to definitely exclude hypothalamic disease. Your symptoms are more like orthopnea (breathing difficulty occurring in supine/flat position). In addition to heart and lung disease (both of them have been excluded by experts in those fields), a weakness of diaphragm (muscles that help in breathing)could cause orthopnea. Diaphragmatic weakness can be assessed by fluoroscopy. You can discuss this with your physician. In addition, you would also need evaluation to exclude any disease causing neuromuscular weakness (by neurological examination, nerve conduction studies, EMG, etc) I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: My BLOG:
Above answer was peer-reviewed by
Follow-up: What causes breathing difficulties interfering with sleep? 24 hours later
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
Answered by Dr. Sudhir Kumar 34 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Tension or stiffness around the waist may occur with diaphragmatic weakness, but it is more likely to be due to spinal cord disease. If posterior columns (sensory fibre tracts in the spinal cord) are affected, then, one can get these sensations. I would be pleased to know the follow up of your further investigations. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: What causes breathing difficulties interfering with sleep? 13 hours later
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 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. thing that I forgot to mention previously is that my SpO2...while fully awake....can drop significantly when assuming the supine 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
Answered by Dr. Sudhir Kumar 13 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: I can understand your frustrations and I would be glad to be of help now and in future. I agree that you have a "problem" that needs to be identified and treated. It is not Cheyne Stokes breathing, as it occurs in patients with severe brain injury, who are semi-conscious or unconscious. MS is a possibility that needs to be considered/excluded, by doing appropriate tests (MRI of spine, brain, lumbar puncture, etc). Yes, viral infections and antibodies to virus could weaken diaphragmatic muscles (and other muscles). Drop in oxygen saturation can be explained by your breathing difficulty in supine position, and we have to trust that reading of pulse oximeter and try to explain it rather than no believe it! I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: What causes breathing difficulties interfering with sleep? 26 minutes later
Thank you so much Dr. XXXXXXX 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
Answered by Dr. Sudhir Kumar 5 minutes later
Brief Answer: Thank you. Detailed Answer: Thank you for your appreciation! Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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