What causes violent diaphragm convulsion during sleep?

Question

Hi doctor,

Last night during sleep, I was awoken by a violent diaphragm convulsion. I felt a sensation of being drawn down into a cold dark blackness. It was very disturbing and I felt like I was going to die. I had benign arrhythmias with a follow-up Holter monitor and a stress test revealed no signs of heart disease. It occurred thrice in the last 18 months. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand that you have been investigated for arrhythmia-paroxysmal (attachment removed to protect patient identity), but my main concern here would be obstructive sleep apnea (OSA).

There is a scoring system that we use to stratify your risk for OSA. Please provide me with the following information so that I can plug in your numbers. Please answer either yes or no.

1. Do you snore loudly?

2. Do you often feel tired, fatigued, or sleepy during the daytime?

3. Has anyone observed that you stop breathing during your sleep?

4. Do you have or being treated for high blood pressure?

5. Is your neck circumference more than 16 inches?

If it is not OSA, my other consideration would be nocturnal hypoglycemia. Also, it would be helpful to know if you have any past medical history of ENT-related issues, seizures, or respiratory problems. Also, let me know if you are a smoker. All the information above will be obtained in an attempt to generate a better plan of care and to rule out certain conditions including but not limited to OSA, nocturnal hypoxia during sleep due to chronic respiratory failure, hypoglycemia during sleep, and also arrhythmia.

Yes, in arrhythmia you have to remember that the Holter monitor only checks you for 48 hours or so. You may need a loop recorder that stays with you longer and catches events that are more spaced out. Revert back with the answers to a cardiologist.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.