Breathe Easy: Sleep Better By Not Inhaling

Sleep apnea is a sleep disorder that causes your breathing to stop and start while you're asleep. It can cause you to stop breathing for 20 to 30 seconds at a time, numerous times throughout the night. The most common cause of apnea is obstructive sleep apnea (OSA), which occurs when the tissues of the upper airway collapse into the throat and block the normal airflow. Central sleep apnea is another form, caused by the brain momentarily forgetting to tell the muscles to breathe. Sleep apnea can lead to serious health conditions, including high blood pressure, heart disease, and diabetes, so it is important to seek treatment.

Sleep apnea

There are two main types of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when the airway becomes blocked, often due to obesity, large tonsils, or changes in hormone levels. Central sleep apnea, on the other hand, is caused by the brain failing to send the necessary signals to breathe. This type of sleep apnea is often associated with certain health conditions, such as heart conditions, or the use of opioid pain medications.

The symptoms of sleep apnea include snoring, fatigue, mood changes, memory loss, trouble concentrating, and frequent waking during the night. It can also lead to more serious health complications, such as heart damage, arrhythmias, and sudden cardiac death. Therefore, it is important to seek medical advice if you suspect you may have sleep apnea.

Treatments for sleep apnea include the use of continuous positive airway pressure (CPAP) machines, lifestyle changes, such as weight loss, and in some cases, surgery. In 2024, the FDA approved the weight-loss drug Zepbound for the treatment of moderate to severe obstructive sleep apnea in adults with obesity. This medication works by reducing body weight, which can help improve the condition.

Obstructive sleep apnea

When you have OSA, you stop breathing for 10 to 30 seconds at a time, numerous times throughout the night. This prevents your body from getting enough oxygen and disrupts your sleep cycle. Your brain tries to protect you by waking you up just enough to breathe, but this prevents you from getting restful, healthy sleep. Over time, OSA can cause serious complications, including an increased risk of high blood pressure, heart disease, stroke, diabetes, and some headache syndromes.

The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine, which pipes humidified air through the nose to create air pressure and keep the throat open while you sleep. Other treatments include oral appliances (mouthpieces), nerve stimulation, and surgery.

Central sleep apnea

There are several forms of CSA, including high-altitude-induced periodic breathing, idiopathic CSA, narcotic-induced central apnea, obesity hypoventilation syndrome, and Cheyne-Stokes breathing. The prevalence of CSA varies depending on the specific form, with idiopathic CSA being relatively uncommon and obesity hypoventilation syndrome becoming more prevalent due to rising obesity rates.

CSA can be caused by various factors, such as opioid-based medications, brainstem lesions, and high altitudes. Treatment options for CSA include weight loss, surgical weight loss, oxygen therapy, respiratory stimulants, and devices to aid breathing during sleep, such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP).

CSA can lead to significant comorbidities and an increased risk of adverse cardiovascular outcomes. It is often associated with frequent nighttime awakenings, excessive daytime sleepiness, and other symptoms depending on the underlying cause.

Complex sleep apnea syndrome

The central apnea index (CAI) must be greater than five events per hour, and central apneas must comprise more than half of the residual sleep-disordered breathing events or lead to a periodic breathing pattern. The prevalence of CompSAS is estimated to range from 0.56% to 18%, with a higher prevalence among males.

The pathophysiology of CompSAS is thought to involve the interaction of upper airway obstruction and unstable central ventilatory control factors, as well as individual characteristics. The condition is more common in males, those with coronary artery disease, and individuals with congestive heart failure.

Treatment options for CompSAS include bilevel positive airway pressure ventilation in spontaneous mode, adaptive servoventilation, permissive flow limitation, and certain drugs such as theophylline or acetazolamide.

Shortness of breath

Sleep Apnea

Obstructive sleep apnea (OSA) is a common cause of shortness of breath while lying down. It occurs when the tongue and soft palate block the airway during sleep, causing pauses in breathing. This activates a survival reflex, waking the person up just enough to resume breathing. OSA can lead to excessive daytime sleepiness due to fragmented sleep. It is often confused with snoring, but it is a more serious condition that can have potentially deadly consequences if left untreated.

Heart Failure

Congestive heart failure is a condition where the heart is unable to pump blood efficiently, often due to other health issues such as high blood pressure, heart attack, or defects. This can lead to shortness of breath, fatigue, fluid build-up, coughing, and loss of appetite. Heart failure is a serious condition that can become fatal, but effective treatments and surgeries can help prolong life and resolve underlying causes.

Obesity

Excess weight or obesity can cause difficulty breathing when lying down due to the increased pressure on the respiratory system and chest wall structures. This can affect the movement of the diaphragm and the body's ability to breathe properly. Obesity is also linked to other health conditions such as hypertension, high blood pressure, and certain cancers. Losing weight through a healthy diet and exercise can help relieve these symptoms.

Panic Disorder

Panic disorder, a type of anxiety disorder, can cause sudden panic attacks lasting several minutes, during which a person may feel short of breath or unable to breathe normally. Other symptoms include sweating, trembling, choking, and lightheadedness. Counseling, cognitive behavioral therapy, and psychotherapy are recommended treatments for panic disorder.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a serious lung condition that damages the air sacs in the lungs and narrows the breathing tubes, making it difficult to breathe. It is often caused by smoking, genetic factors, pollution, or passive smoking. While lung damage from COPD cannot be reversed, quitting smoking, inhalers, surgery, and rehabilitation can help improve symptoms.

Pregnancy

During pregnancy, the growing uterus presses down on the diaphragm and lungs, reducing lung capacity. Additionally, hormonal changes and increased blood volume further contribute to shortness of breath. This is typically a temporary condition that resolves after birth.

Respiratory Infections

Respiratory infections, such as the common cold, mild flu, or sinus infections, can also lead to shortness of breath. These infections usually last between 3 to 14 days, and the difficulty in breathing should subside once the infection clears.

It is important to consult a healthcare professional if you experience regular or severe shortness of breath while lying down. They can conduct a thorough evaluation and recommend appropriate treatments based on the underlying cause.

Frequently asked questions