Ashwin Lewis
When we sleep, our breathing patterns change, and these changes can provide insight into our overall health. Typically, our breathing slows down during sleep, and this rate of breathing is determined by our metabolic rate. However, during the REM sleep stage, breathing becomes faster and more erratic. Sleep disorders such as sleep apnea can significantly impact breathing during sleep, causing repeated cessations in breathing and resulting in reduced sleep quality and various health complications. Obstructive sleep apnea (OSA) occurs due to a blockage in the airway, while central sleep apnea (CSA) arises when the brain fails to send signals to breathing-related muscles.
| Characteristics | Values |
|---|---|
| Respiratory rate | Slows down |
| Oxygen levels | Lower |
| Carbon dioxide levels | Higher |
| Cough reflex | Suppressed |
| Heart rate | Decreases during non-REM sleep and increases during REM sleep |
| Blood pressure | Decreases during non-REM sleep and increases during REM sleep |
| Blood flow | Increases to the brain during REM sleep |
| Body temperature | Decreases by 1°C-2°C |
| Sleep apnea | Obstructive sleep apnea (OSA) occurs when the airway is blocked; central sleep apnea (CSA) occurs when the brain doesn't send signals to keep breathing-related muscles working |
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What You'll Learn
Obstructive sleep apnea (OSA)
OSA affects a person's breathing during sleep, preventing them from getting restful sleep. This can impact a person's physical and mental health. People with OSA often experience daytime sleepiness, fatigue, and insomnia due to repeated awakenings throughout their sleep. These awakenings occur because the brain tries to protect the body by waking it up enough to breathe, but this interrupts healthy sleep. As a result, OSA can cause problems with memory, concentration, and mood changes.
The condition can also lead to physiological changes that affect the heart and blood vessels. During episodes of OSA, the heart is stressed, which increases blood pressure and heart rate. OSA is often associated with being overweight, and weight loss may cause the condition to go away. Alcohol consumption can also worsen OSA as it suppresses breathing. Sleeping on one's back can further aggravate OSA, and it is recommended to use pillows or other strategies to sleep on the side.
OSA can be diagnosed through in-laboratory polysomnography (PSG), which involves monitoring using electroencephalogram (EEG) leads, pulse oximetry, temperature and pressure sensors, respiratory belts, and electromyogram sensors. Treatment options include continuous positive airway pressure (CPAP) machines, oral appliances, and surgery. CPAP machines act like compressors to blow air into a mask worn over the nose and/or mouth, preventing the upper airway from collapsing. Oral appliances are custom-made devices fitted by a specialized dentist or oral surgeon, while surgery may involve removing tonsils or adenoids, clearing tissue from the throat, or repositioning the tongue.
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Central sleep apnea (CSA)
During sleep, the respiratory system typically slows down, and breathing becomes more even and regular. However, for those with central sleep apnea (CSA), the respiratory system is disrupted, causing a range of symptoms and potential health complications.
CSA is a sleep disorder characterised by interruptions in normal breathing patterns during sleep. Unlike obstructive sleep apnea (OSA), where the airway is physically blocked, CSA occurs when the brain fails to signal the muscles to breathe, resulting in repeated cessations of breathing. This condition can lead to unusual breathing patterns, such as fast breathing that gradually becomes shallower until breathing stops and then starts again.
The primary symptom of CSA is pauses in breathing, which can last from 10 to 30 seconds, occurring intermittently or in cycles. These interruptions in breathing can cause fragmented sleep, leading to excessive daytime sleepiness, restless sleep, and abnormal blood oxygen levels. While some people with CSA may not exhibit noticeable symptoms, bed partners might observe abnormal breathing patterns or pauses in breathing during sleep.
CSA is often associated with underlying health conditions, particularly those affecting the lower brainstem, which controls breathing. Neurological diseases such as Parkinson's, Alzheimer's, and amyotrophic lateral sclerosis (ALS) have been linked to CSA. Additionally, certain medications, such as opioids, can induce CSA by affecting breathing patterns.
Treatment for CSA depends on the underlying cause. In cases where CSA is medication-induced, reducing the dosage or discontinuing the medication may improve the condition. For those with CSA caused by heart failure, continuous positive airway pressure (CPAP) therapy can be beneficial. A recently approved treatment option is the remedē System, an implantable device that stimulates the phrenic nerve in the chest, aiding the diaphragm's breathing function.
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Respiratory rate and sleep
A person's respiratory rate is the number of breaths they take per minute. It is a vital sign that can offer a window into a person's overall health. During sleep, the respiratory rate tends to slow down, and breathing evens out and becomes less variable with each successive stage of sleep. However, during the rapid eye movement (REM) sleep stage, breathing becomes faster and more erratic.
The rate of breathing during sleep is determined by an individual's metabolic rate. During non-REM sleep, which constitutes about 80% of an adult's sleeping time, breathing is slow and regular. However, during REM sleep, the breathing rate increases, and it becomes more shallow and irregular. This is also the time when dreaming typically occurs.
Breathing patterns during sleep can be influenced by various factors, including sleep position and underlying health conditions. For example, sleeping on the back can cause the airway to become blocked or narrowed, leading to obstructive sleep apnea (OSA). OSA occurs when the muscles in the throat relax, causing surrounding tissue to press on the windpipe and block air movement. Central sleep apnea (CSA), on the other hand, is caused when the brain fails to send signals to keep breathing-related muscles functioning during sleep.
Abnormal respiratory rates during sleep, whether too high or too low, can indicate underlying health issues. For instance, a low respiratory rate can be caused by sleep apnea, heartburn, or other health conditions, while a high respiratory rate can be indicative of anxiety, infection, or lung conditions. If you or your partner notice abnormal respiratory rates during sleep, it is recommended to consult a healthcare provider for further evaluation and guidance.
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Sleep's impact on the body
Sleep has a profound impact on the body, affecting multiple systems and functions. One of the most notable effects is on the respiratory system, where breathing patterns change throughout the various stages of sleep.
During non-rapid eye movement (non-REM) sleep, which accounts for about 80% of an adult's sleeping time, breathing slows and becomes more regular and even. This is because the metabolic rate decreases during this stage, resulting in a slower respiratory rate. The respiratory rate, or breathing pace, is a vital sign that provides insight into overall health, and typically decreases slightly during sleep. However, during REM sleep, breathing becomes faster, more erratic, and less regular, resembling wakeful breathing patterns. This is associated with dreaming activity and increased brain and eye movement.
Obstructive sleep apnea (OSA) is a condition that affects breathing during sleep. It occurs when the airway becomes blocked or narrowed due to muscle relaxation in the throat, causing the surrounding tissue to press against the windpipe and obstruct airflow. This results in breathing cessation or hypopnea (decreased airflow), leading to frequent awakenings and disrupted sleep. OSA can cause serious complications over time, impacting both physical and mental health. Central sleep apnea (CSA) is another disorder where breathing stops during sleep due to the brain temporarily ceasing to send signals to the muscles that regulate breathing.
Sleep also influences other aspects of the body, including temperature regulation, the autonomic nervous system, the cardiovascular system, the immune system, digestion, and the endocrine system. Body temperature decreases by 1°C-2°C during sleep, contributing to a good night's rest. The autonomic nervous system exhibits increased parasympathetic activity during non-REM sleep, promoting electrical stability and reducing the risk of arrhythmia. Heart rate, blood pressure, and other cardiovascular parameters decrease during non-REM sleep but increase during REM sleep, resembling daytime patterns. The immune system becomes more active during sleep, while the kidneys produce less urine. Additionally, growth hormone production surges, and the body repairs cells and completes digestion.
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REM sleep and breathing
When we sleep, our breathing changes due to biological processes that affect our respiratory and muscular systems. During non-REM sleep, which accounts for about 80% of an adult's sleeping time, breathing is slow and regular. However, during REM sleep, the breathing rate increases, and breathing becomes more shallow and irregular. This irregular breathing during REM sleep corresponds to bursts of eye movement and is not controlled by chemoreceptors but by the activation of the behavioural respiratory control system.
During sleep, the pace of breathing, or respiratory rate, tends to slow down due to a decrease in metabolism. This decrease in respiratory rate is more pronounced as sleep progresses through the three stages of NREM sleep. However, during REM sleep, the breathing rate increases, and breathing becomes more erratic. This faster breathing during REM sleep is thought to be related to increased brain activity during this stage.
The respiratory rate during sleep can provide insights into a person's overall health. While it is normal for the respiratory rate to vary during sleep, consistently low or high respiratory rates can indicate an underlying health condition. For example, a very low respiratory rate during sleep can be caused by sleep apnea, a condition where the airway becomes blocked or the brain fails to control breathing muscles, resulting in breathing cessation. Sleep apnea disrupts sleep and can lead to serious complications over time. On the other hand, a persistently high respiratory rate during sleep may be caused by anxiety, infection, or lung conditions.
In summary, while breathing generally slows down during sleep, it speeds up and becomes more irregular during the REM sleep stage. This change in breathing pattern is a normal part of the sleep cycle and is associated with increased brain activity during REM sleep. However, significant deviations from a healthy respiratory rate during sleep can indicate underlying health issues.
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Frequently asked questions
Sleep apnea is a condition that affects your breathing while you sleep. It can either be caused by a blockage of your airway (obstructive sleep apnea) or because your brain doesn't control your breathing as expected (central sleep apnea).
When you sleep, your breathing rate tends to slow down and even out. However, during the REM sleep stage, your breathing becomes faster, more erratic, and shallower.
People with sleep apnea often experience daytime sleepiness, fatigue, and insomnia due to the repeated awakenings throughout the night. Sleep apnea can also cause problems with memory, concentration, and mood changes.
Treatment for sleep apnea aims to keep the airway open during sleep. This can be achieved through lifestyle changes, such as avoiding sleeping on your back, or using devices like continuous positive airway pressure (CPAP) machines or oral appliances.
