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Fatigue and AnemiaFatigue and Anemia
           
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Anemic Maybe?
Feb 10, 2001

Dear Doctor, I woke up several times last night gasping for air. It took me minutes to catch my breath. The problem is, I am a little confused as to what the cause might be, and more so, what I can do. At first, I think anemia. A recent blood test indicates that my red blood cells are slightly low but hemoglobin in normal. My doctor was not concerned. If anemia is not the cause, then I believe there may be two other possibilities--lipodystropy and sleep apnea. I have the protease paunch. It is at the point where exhaling all the oxygen out of my lungs is difficult and as difficult, really taking a full breath. Can a person die from the protease paunch in terms of breathing? Could the area the fat is accumulating be causing me to stop breathing at night or is it apnea? What should be my course of action in determining what is happening?

Response from Dr. Frascino

Hello, Waking up gasping for air can be very disconcerting! There are several possible causes. The most common cause being a nightmare! It is possible you were having a bad dream and awoke in a panic, gasping for air. This happened to me last month when I dreamed "Dubya" was going to be sworn in as President. Unfortunately that dream turned out to be true -- let's hope it doesn't become a nightmare. So, bad dreams are one possibility -- what else? Yes, sleep apnea is also a possibility. There are a variety of signs and symptoms often associated with sleep apnea and you should review these with your doctor. The final diagnosis is made by performing a sleep study. This involves spending the night with monitors that record your breathing cycles attached, while you sleep. Protease paunch? Well, this can be disfiguring and at times somewhat uncomfortable (like when we are trying to button our pants!) but I haven't seen it significantly compromise breathing function or induce sleep apnea. Obesity is associated with sleep apnea, so if your paunch is very severe, I suppose the possibility is there, but I think it's highly unlikely. Anemia? Yes, anemia can cause shortness of breath -- but this is usually gradual in onset. Anemic folks usually first note exercise intolerance. Waking up gasping for air would not be sign of developing anemia. You mentioned that your red cell count was only slightly low and your hemoglobin still in the normal range so I can assure you that anemia is not the cause of your current symptom.

Your next course of action? If these episodes are continuing to occur you should see your doctor for an evaluation. Many different conditions can be associated with difficulty breathing -- asthma, congestive heart failure, panic attacks, etc. If your physical exam and detailed history are suggestive of sleep apnea -- the sleep study would be the next step. Hope this helps! Good luck... I hope it was just an isolated event, perhaps a bad dream. But then again, George W is president so I guess anything is possible.

RJF


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