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Old 03-06-2016, 04:43 AM   #1
Wide-O
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Confused Scary night

First time in this section - I'm normally over in the PN section.

Last night was the most scary occurrence until now, by far: I woke up feeling I was chocking or had stopped breathing, and it took me getting out of bed and walking around for a few seconds until I could start up again. Very disconcerting. I'm amazed I didn't fall, as I was completely disoriented as well. It felt like my muscles needed to breathe were not listening to my brain (or my brain had some malfunction).

Before this episode, it sometimes (once every 2 to 3 months) happened just when I fell asleep and I'm on my back. Normally, I sleep on my sides. However, yesterday I was reading, on my back, dozed off, and jolted awake several times.

I do have problems swallowing during the day.

I'm not overweight, which would go against obstructive apnea - although I read that it can happen to normal weight people too. (I also read I might have had a stroke, heart attack, and Parkinson's onset, but that's what Dr. Google does to you... ) The fact that a mild version happened before when on my back might still indicate physical obstruction?

It might be central sleep apnea, but if I understand correctly this can only be confirmed by a sleep study?

As for medication, I take amitryptiline for my PN, since November 2015. No alcohol or smoking. Aged 53, and normally sleep like a baby unless I'm very stressed out. I do not feel tired in the morning, which probably means it doesn't happen all the time.

I will go to my GP tomorrow, obviously, but I'm just looking for a bit more information I guess.
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Old 03-06-2016, 08:19 AM   #2
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That does seem worth checking out.

My first thoughts are that you may have an enlarged thyroid gland or thymus (in the chest). Also I have read that a prolapsed mitral valve in the heart, makes lying on the back difficult and symptomatic.

I'd ask the doctor to check for long QT syndrome(heart). Amitriptyline is a drug which can make this worse, and it is potentially serious. (and sometimes deadly)

Amitriptyline also causes dry mouth and throat. You might try a drug free period, to test this out as well.

Drugs always have a dark side, and should be evaluated always when problems occur like this.
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Old 03-06-2016, 12:40 PM   #3
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Quote:
Originally Posted by mrsD View Post
I'd ask the doctor to check for long QT syndrome(heart). Amitriptyline is a drug which can make this worse, and it is potentially serious. (and sometimes deadly)
This rings a bell... you may think I'm a bit nutty, but over the last few years I sometimes had the feeling - always in bed just before falling asleep - that my heart started a beat and then "waited" a while before continuing. I could literally feel that in my chest/throat, very unnerving. I'm almost sure it is related to this.

I read that the LQTS 3 version mostly happens when you are at rest or sleeping. This means it was probably not initially caused by amitriptyline, but surely can make be made worse by it.

I will ask the doc for an ECG, and I would not be surprised at all if you "called it". I will also propose to gradually go off the amitriptyline.

Thanks, as always.
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Old 03-07-2016, 10:08 AM   #4
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Update: GP has ruled out QT prolongation. She said it's a perfectly valid condition to test for given the symptoms, but the quick ECG she did found QT times that are in the normal range. (a relief...)

She does however see some arhythmia, nothing really dangerous, result was inconclusive, and prefers to have a second opinion from a heart specialist.

Whom I will see tomorrow morning (it doesn't always go this fast, but it's great that I don't have to wait). She also prefers me to ask his opinion on whatever may be wrong and the link with amitriptyline, but if I want to get off it I am free to start tapering.

She also did a blood panel which will be ready tomorrow morning to take to the cardiologist.
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Old 03-07-2016, 10:17 AM   #5
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I think your next step will be a 24 hr Holter monitor. You wear this day and night and it records your heart during that time.

I had this done years ago... and mine came up clean, after I had an episode of chest pain at work during a very stressful day. I also had an echo cardiogram then as well. (it as all written off as a panic attack--which I had never had until that day).

Are you still not smoking? A chest X-ray may be helpful too. Some lung conditions give very odd symptoms when they first start up. Also hiatal hernia may move the stomach up into the chest when you are lying down, and this squeezes the heart and large vessels, and can give alarming feelings.
Do not eat large evening meals,and try to elevate your bed head area, to minimize this if you have a hiatal problem.
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Old 03-09-2016, 03:13 AM   #6
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Quick update: both the routine test and the stress test (6 minutes on a bike with gradually heavier load) gave perfectly normal results for my age. I felt no discomfort during the test. The cardiologist is 99% sure it's not related to my heart, but ordered a CT scan with contrast material anyway to rule it out 100%. Blood pressure in rest is 112/79, only thing that puzzles me is a slightly higher RR (75 where I used to see 50) - but that could be stress/panic related.

As I'm lucky (in a way) I can have the CT scan in a few hours. After that, it's probably a sleep study, but both docs agreed with tapering down the Elavil (well, it's Redomex in our neck of the woods), and the cardiologist suspected it might be involved, or have an effect on whatever is wrong with me. As did the GP.

Blood panel was absolutely fine, and I was surprised to see B12 at >1000, even though I only take a 5mg methylcobalamin tablet every 2 to 4 days. More proof those tablets work perfectly fine, are safe, no injections needed etc. Some values (like hematocrit that was way up there 2 years ago still) have dropped spectacularly since I stopped smoking 2 years ago (and yes Mrs. D., still stopped.)
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Old 03-16-2016, 03:43 AM   #7
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Update: CT scan reveals heart is 100% clear, no QT delay etc. Next step is planning a sleep study. Note that I had the same symptoms (but not as scary) last night falling asleep, two times. So it's not just "in the head".

Elavil dose down 50% now without too many problems. I might still consider continuing a low dose (10-20 mg/night) given the possible link to nerve regeneration.
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