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Forum Name: Psychiatric Topics

Question: False Suffocation Alarm


 sleeplessgirl - Sat Mar 31, 2007 2:42 am

I have nocturnal panic and the latest theory suggests that sensitivity to CO2 levels causes a false suffocation alarm. Now that we have a theory, is there any solution? Can anyone think of possible ways to alleviate this horrible problem?
 Dr. K. Eisele - Sat Mar 31, 2007 2:55 pm

User avatar Dear Sleepless:

I think the first step to pursue if you haven't already, would be a sleep study to rule out sleep apnea.

Sleep apnea is a condition in which the person periodically stops breathing while they are sleeping. Consequently, the oxygen saturation of the blood decreases, which can cause the smothered feeling and a panic attack. People with sleep apnea experience a number of daytime symptoms, such as fatigue and depression, among others, some of which are of great long-term significance.

We breathe because our bodies require oxygen to carry out the job of metabolism. Without adequate oxygen, CO2, a byproduct of metabolism, accumulates. Our lungs rid our bodies of CO2 by exchange. For example, when someone breathes rapidly (hyperventilates) the relative amounts of oxygen and CO2 can change rapidly. The concentration of CO2 goes down and oxygen concentration goes up.

In certain health conditions, people do hyperventilate, such as in acidosis--this simply means that they have too much CO2 accumulation. The CO2 comes from metabolism and is in an acid form in the blood--a mild acid called bicarbonate (HCO3). Bicarbonate is converted to CO2 (a gas) and is exhaled.

Anyway, to sum it up, I do believe that sensitivity to CO2 could cause nocturnal panic. A way to reduce this problem would be to make sure that proper oxygenation is taking place during sleep.

There are basically two types of sleep apnea: central sleep apnea (CSA) and obstructive sleep apnea (OSA). The latter is more common, and is the result of obesity, enlarged tonsils or adenoids, fatty tissue in the throat area, or even a deformed uvula (the "hangy down" thing of the roof of your mouth). In OSA, the airway is being blocked, or obstructed by excess weight or tissues. In CSA, the problem is a dysfunction in the brain and can result from polio, brain inflammation, disorders of the cervical spinal cord, stroke, or even some degenerative diseases of the brain.

Start with your family doctor and explain the symptoms you are having, and ask for a referral for a sleep study.

Good luck to you!
 sleeplessgirl - Sat Mar 31, 2007 7:33 pm

Thank you SO much for the information. It is so fascinating to find people who understand the co2 mechanism and how it all works because I don't . I did, however, do a sleep study and they found I had no apnea or even any moments of cessation in my breathing. I did have a panic attack during it too, but nothing showed up on whatever they were measuring. WOuld oxygen help regulate my CO2 levels? Would anything else help regulate it?
 Dr. K. Eisele - Sun Apr 01, 2007 2:38 pm

User avatar Dear Sleepless:

You're welcome!

It's certainly good news that you don't have sleep apnea, but it doesn't answer the question, then, does it?

The treatment for sleep apnea, and possibly for you, is C-PAP. Some people absolutely loathe it, because it makes some noise and because some people don't like having to wear a mask while they sleep. C-PAP stands for Continuous Positive Air Pressure. In OSA, it helps to keep the airway open to stop the periodic cessation of breathing; in CSA it acts to force air into the lungs when the signal to breathe from the brain is temporarily absent. I think that C-PAP may work for you because your oxygen saturation would be regulated, and therefore, so would the CO2.

What I don't know is whether or not C-PAP is ever used for this purpose, or if insurance would even cover the cost of C-PAP for this application.

The next possibility is the standard treatment of Panic Disorder. Do you have any panic attacks/episodes during the day? If so, then you would definitely benefit from a medication such as paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), or even fluoxetine (Prozac). Venlafaxine (Effexor) is also a good medicine for Panic Disorder, but many people are unwilling to take it because of the potential adverse effect of high blood pressure, nausea, increased sweating, and the fact that there can be a very nasty withdrawal syndrome. Paroxetine also has that disadvantage, but is not known to cause high blood pressure.

I recommend that you see your physician for this condition, and mention that panic disorder can be treated easily by one of the above methods.

A side note:

Looking back at my previous response, I notice that somehow something didn't get into the published response. (I have a very sensitive touch pad on my notebook pc). Anyway, the part that is missing simply notes that the symptoms of panic are easily reproducible by hyperventilation. The symptoms are actually caused by decreased cerebral blood flow (low oxygen to the brain). The decreased cerebral blood flow occurs because of the decreased CO2.


Good luck to you. Please let us know how things work out for you.
 sleeplessgirl - Sun Apr 01, 2007 9:33 pm

I am truly so grateful for your advice and that you took the time to answer my specific question. It is so hard to find MDs that will do that, or even understand the issue. Most look at it purely from a psychological point of view. I don't have panic attacks during the day, only after I fall asleep and, I believe, transition from one phase of sleep to the next. I currently take klonopin when needed and it does work, but I wish I didnt have to for all the reasons you speak of.

I will take all of this info to my doc and see if he can keep looking into an alternative. I really think the Cpap or something like it could be the answer. That would be amazing if it was and after 12 years of hell it would really be great.

You are an angel to take the time to help people and may God bless you for your efforts!!

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