Entries in RASO (1)


Sleep Onset Apnoeas / "Throat Closing"

One of the search terms that people find this blog with surprised me by how frequently people search for it, there are several variations but these two sum things up well:

  • Throat closes as I go to sleep
  • Choke as I fall asleep

I hadn't really considered this before but I really should have done because it happens to me, and one of my parents. Normally when I experience those throat-closing moments they are accompanied by the first snore / cluck / snort of the night, a flash of whatever broken dream images were going through my mind and the knowledge that I'll soon be asleep. I guess it's something that a lot of us experience but don't really talk about it because it sounds a little strange.

Polite and usual "sleep chat" is usually along the lines of "Did you sleep well?" and not much deeper than that which is a shame because it's such a fascinating subject that few of us speak about because many (wrongly) consider sleeping to be a waste of 8 hours and some even see it as a weakness ("Sleep is for wimps" etc etc).

I've been using CPAP for a month or so now and have been adjusting my own pressures based on the sleep study data that I record each night. When I reviewed each night's data, one of the things that stood out about breathing as we drop off to sleep was how it changes at sleep onset (the moment that a sleep lab would declare that we are now asleep).

This becomes more pronounced with CPAP (or at least for me as a relative newcomer to using CPAP for myself) because when I first switch the machine on at night I instantly become aware of my breathing and try to control it. Oddly, consciously controlling our breathing is something that we don't do very well and it is best left when our bodies do it for us automatically. Can you imagine the chaos that would result if we had to consciously take every breath or control every heartbeat?

The following is a few minutes of data representing my breathing as I was dropping off to sleep whilst wearing CPAP. It's taken from Resmed's ResScan software (click for a larger version).

The breathing on the left is when I was awake, it is clearly different to the smooth regular breaths on the right side of the graph. Falling asleep is what brought about the change as I "forgot" to consciously breathe and my body took over.

So far so good, but on several nights I noticed that the handover from from awake breathing to asleep breathing wasn't so smooth... 

Notice how there are gaps in my breathing? This is from a night where some apnoeas were still occuring; I remember that as I was falling asleep I experienced at least two of those "throat closing" moments. The apnoea briefly woke me as left me realising that a moment before I was asleep, which also seemed to shift the hypnagogia into my conscious mind and then into my memory because this night was also a night that I remembered a lot of it.

Several different images and phrases came and went as I drifted off to sleep. The Zeo recorded that I briefly entered REM as I fell asleep (possibly causing a loss in muscle tone resulting in apnoeas)...

This is something that I see on many nights when I look at my Zeo data, but in the interest of accuracy, Zeo do point out that if your sleep is generally healthy with 7-9 hours per night and no feelings of tiredness during the day that this brief period of REM could be wake being misinterpreted as REM. It could be that N1 sleep mixed with brief periods of wake (from my respiratory arousals) were interpreted as REM by the Zeo (as wake is so similar to REM). 

The following night my sleep looked very different and I achieved a lot more REM along with no apnoeas or hypopneas recorded at sleep onset, intriguingly the Zeo data doesn't show me passing through REM as I fell asleep. So this could actually be REM, although this could also be because there were no respiratory related arousals during the transition from wake to sleep.

With the Black Shadow Sleep Monitor I've seen that less significant respiratory events are linked with altered REM sleep, in my case a series of hypopneas leading to a Lucid Dream. This raises an interesting issue that may provide some insight into dream formation.

I used to be comfortable with those throat-closures before I knew I had Sleep Apnoea as they had become so familiar to me. I used to use them as a way of knowing that I'd soon be asleep. In a strange way I will be sad if they go because after each "cluck" or snort I'd briefly wake and commit the partial dream or hypnagogic image to memory and would be able to study sleep as I drifted off.

Famously people have used a technique that relies on waking from hypnagogia in order to remember it which involves napping in a chair whilst holding a metal spoon over a metal tray or plate. Once you drop off to sleep you automatically release the spoon, causing a clattering sound which then wakes you allowing you to recall what you saw and heard.

I see my sleep onset apnoeas as such a system, alebit a naturally occuring one. I think that during the times that I want the best of both worlds of having the apnoeas at sleep onset but sleeping safely for the remainder of the night that I will experiment with setting a RAMP on my CPAP which delays the maximum pressure by up to 45 minutes, giving me time to explore the hypnagogic world.

Knowing that I have obstructive sleep apnoea and that the first apnoeas of the night are usually at sleep onset, I would suggest that anyone who experiences these throat-closures at sleep onset should at the very least be aware that they could have Obstructive Sleep Apnoea and look out for other symptoms. The best thing to do it get it checked professionally as it could also be a sign of another condition such as Acid Reflux (GERD) or Laryngospasm.