Life and death struggle to fall asleep

Hi RiverKat

?It does sound like it could be an apnea type of episode especially with the gasping for air. I was experiencing the same symptoms and had to really push my doctors in the UK to send me for a test. I am witing some initial results now.

The test they gave me was to wear an overnight pulseoximetry monitor which measures your pulse and oxygen saturation levels whilst asleep. I think initially they look at if there are any events during the night where your oxygen levels drop and your pulse rate lowers and rises then this is enough to wake/semi wake you. I dont think this test is a definitive answer to diagnose sleep apnea but it is a start point that they seem to use.

?If you are unable to get these tests done your only option may be to purchase one of these monitors yourself. I brought a Contec C50 E pulse oximeter for £56 off amazon. This came with the ability to record yourself over night and some software to check and print your results. These results could then be used to push your case for further tests. Failing that ask about and see if anyone has one you can borrow for a couple of nights.

?I have used one for a couple of nights and even though I experience the same symptoms as you (even with this monitor on) mine has not really shown much up on the oxygen levels but has showed more up on the pulse side. I am not sure how it is all interpreted. You may be luckier/unluckier than me and obtain better results. I will let you know when I have get my results if I have it or not.

Hi RiverKat,

This sounds like a form of sleep paralysis to me. It's relatively common when waking up but can also happen when you're falling asleep. I've always had it in the more normal form - i.e. waking paralysed - but when I was going through a period of great stress in my life it also started to happen before I fell asleep.

Scary though it is, it won't harm you. I'm a former neuro nurse so know a little about the phenomenon from both ends. In normal sleep, we alternate between periods of dreaming and non-dreaming (regardless of whether we actually remember our dreams or not). During dreaming sleep - often referred to as rapid eye movement or REM sleep - the brain secretes a hormone to paralyse our voluntary muscles to stop us jumping up and acting out our dreams. In some individuals, this mechanism gets out of kilter, and the brain starts putting out the paralysing hormone just before we fall asleep or, more commonly, carries on for a few seconds after we wake up.

Normally we go into a long period of non-dreaming sleep at the start of the night, when we're not paralysed. This is is why the sleep paralysis phenomenon is much more common later in the night. However, extreme anxiety can disrupt the REM/non-REM rhythm and send us straight into REM, or dream, sleep as soon as we start to drop off. I know that was what was happening to me during my period of stress, as I have very good dream recall and knew they were starting immediately. Most people don't remember their dreams, but that doesn't mean they're not happening.

During sleep paralysis, we feel as if we can't breathe as the voluntary component of our breathing - the ability to take a deep breath at will - is paralysed. The autonomic part of breathing, which involves the diaphragm, continues to function during the paralysed phase, but because we can't consciously take a deep breath, it can feel as if we're not breathing at all.

It's very difficult to deal with problems like this, that are generated by stress and anxiety. In my case, the stress was down to having to cope single-handed, as an only child, with my mother's dementia, so it was sadly self-limiting. I'm guessing that being a single mother of three is pretty stressful too.

That being said, I still think it might be a good idea to follow David's suggestion and try to get hold of an overnight pulse oximeter if you can. This would reassure you that you weren't actually suffering from lack of oxygen during the night, and help to allay your fears. However, the fact that you eventually overcome the problem and sleep normally after a number of tries suggests in itself that there's no serious problem.

I confess that my own way of coping with it was to take a very small dose of antihistamines an hour or so before going to bed on nights when I was particularly anxious. The older types are better, as they make you sleepier than the more recently developed products. But it has to be the smallest possible dose, and needs to be taken at least an hour before bed, as it's not a knock-out solution and won't work at all if you wait till bedtime. If a small dose doesn't work, you shouldn't try a bigger dose. And antihistamines must not be taken every night, as they quickly lose their effect, just like prescription sleeping meds. They should be used for a couple of consecutive nights, to get a reasonable night's sleep, followed by a break of at least a week.

The other option is to ask whether your doctor will prescribe one of the older tricyclic groups of antidepressants. Amitriptyline and nortriptyline are examples of this group, but there are others. These drugs suppress REM sleep entirely, which would probably solve your problem. However, no medications are without side-effects.

I hope you can find your way out of this ongoing anxiety that is feeding back into itself every time you try and fall asleep. I know just how distressing this is.