Breathing Problems During Sleep: What's Happening And Why?

There are many reasons why someone might experience difficulty breathing during sleep. One common cause is sleep apnea, a sleep disorder characterised by pauses in breathing while asleep, often due to narrowed or blocked airways. This can lead to loud snoring, gasping for air, and feeling tired during the day. Other potential causes include asthma, allergies, anxiety, and heart conditions. Experiencing shortness of breath at night can be a symptom of a serious health problem, so it is important to consult a doctor or sleep specialist to determine the underlying cause.

Sleep apnea

Obstructive sleep apnea (OSA) is the most common form, occurring when the tongue and other tissues in the mouth fall back and block the airway when you lie down. This can cause you to stop breathing for up to a minute or longer, and it can happen hundreds of times a night. Risk factors for OSA include obesity, large tonsils, and changes in hormone levels.

Central sleep apnea (CSA) is less common and is caused by the brain failing to send signals to the breathing muscles during sleep. CSA can be brought on by certain medical conditions, drugs, or sleeping at high altitudes.

The symptoms of sleep apnea include loud snoring, extreme sleepiness during the day, and gasping for air during sleep. If you experience these symptoms, it is important to see a sleep specialist or a doctor, as sleep apnea can be a serious health problem. They may recommend a sleep study, which can be done at home or in a hospital sleep clinic, to diagnose the condition.

Treatments for sleep apnea include continuous positive airway pressure (CPAP) machines, which use a mask-like device to create pressure in the airways and prevent them from collapsing during sleep. Lifestyle changes, such as weight loss and quitting smoking, can also help treat sleep apnea. In some cases, surgery may be recommended to widen the airway.

Asthma

Nocturnal asthma, or nighttime asthma, is a common occurrence, with up to 60% of asthma patients experiencing symptoms while sleeping. The exact reasons for this are not fully understood, but several factors can contribute to the increased severity of asthma during sleep. One possible explanation is the cooling of the airways at night, which can cause the airways to narrow and trigger coughing and further tightening of the airways. Another factor is the body's natural circadian rhythm, which regulates the fluctuation of hormones such as adrenaline, cortisol, and melatonin over a 24-hour period. Adrenaline, which helps to keep the airways open, is lower during the night, while cortisol, which can affect airway narrowing, also decreases. Additionally, melatonin, which is associated with decreased lung function, is higher at night. These hormonal changes can trigger nighttime asthma symptoms.

Other factors that can trigger nocturnal asthma attacks include exposure to allergens such as dust mites, pet dander, and mould, as well as cold air from air conditioning or open windows. Obstructive sleep apnea, acid reflux, and obesity are also common comorbid conditions that can worsen asthma symptoms at night.

The impact of nocturnal asthma can be significant, disrupting sleep quality and making it challenging to manage asthma during the day. It is recommended that individuals with asthma take steps to improve their sleep hygiene, such as maintaining a consistent sleep schedule, avoiding electronic devices before bed, and keeping the bedroom dark and quiet. Additionally, it is crucial to take prescribed controller medications daily and keep quick-relief inhalers nearby to manage nighttime asthma symptoms.

If you experience asthma symptoms at night more than twice a month, it is important to consult a doctor or an asthma specialist, such as an allergist or pulmonologist, to discuss treatment options and develop an Asthma Action Plan tailored to your specific needs.

Anxiety

If you are experiencing anxiety, you may benefit from breathing exercises, such as inhaling and exhaling slowly through your nose, holding your breath for a few seconds, and relaxing your jaw, face, stomach, and shoulders. These exercises can help calm your nervous system and reduce feelings of anxiety.

In addition to anxiety, sleep apnea could be another reason why you don't breathe properly during sleep. Sleep apnea is a common disorder where your airways collapse or become blocked while you sleep, causing you to stop breathing for 20-30 seconds at a time, numerous times throughout the night. This can result in snoring, snorting, or gasping for air. If you suspect you have sleep apnea, consult a doctor for a proper diagnosis and treatment options.

Allergies

There are several common allergens that can trigger sleep breathing issues, including:

• Dust mites: These are tiny bugs that live in bedding, mattresses, carpets, and furniture.
• Pet dander: Pet hair and dander are common allergens that can impact sleep.
• Mold and mildew: This can grow anywhere moisture breeds, including bathrooms.
• Pollen: Pollen from plants such as trees, grass, and ragweed can be a big allergy problem for many people.

If you're experiencing sleep breathing issues due to allergies, there are several things you can do to find relief:

• Use an air purifier to help clear your bedroom air of allergens.
• Close your doors and windows to keep allergens out.
• Keep your furniture and bedding as dust-free as possible.
• Keep pets out of your bedroom.
• Change your clothes and take a shower after spending time outside to remove pollen from your skin and hair.
• Take allergy medication at night to ensure you're still getting a strong dose when you go to bed.
• Talk to your doctor about treatment options, including over-the-counter medications, prescription medications, and lifestyle changes.

Heart conditions

Sleep-disordered breathing (SDB) is the most common comorbidity in patients with heart failure, affecting 50-80% of patients. SDB can accelerate the progression of heart failure and worsen morbidity and mortality. However, it often goes undiagnosed and untreated.

There are two types of SDB: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is caused by repeated episodes of partial or complete upper airway obstruction during sleep, affecting 20% of the general population and 35% of patients with heart failure. Risk factors include being overweight, older age, male sex, and a history of snoring.

CSA is characterised by the temporary withdrawal of central respiratory drive, resulting in the cessation of respiratory muscle activity and airflow. CSA occurs in 30-50% of patients with heart failure and a reduced left ventricular ejection fraction, and 18-30% of patients with preserved left ventricular ejection fraction. Risk factors include male gender, higher New York Heart Association class, lower left ventricular ejection fraction, waking hypocapnia, higher prevalence of atrial fibrillation, higher brain natriuretic peptide levels, and frequent nocturnal ventricular arrhythmias.

The presence of SDB in patients with heart failure can lead to several negative consequences, including increased sympathetic nervous system activation, increased renal medulla activation, and activation of the renin-angiotensin system. These responses can contribute to myocardial ischemia, arrhythmias, hypertension, and worsening ventricular dysfunction in patients with heart failure.

The gold standard test for diagnosing SDB is polysomnography (PSG), or an overnight sleep study performed in a sleep laboratory. Treatment options for SDB in patients with heart failure include optimising medical therapy for heart failure, behavioural and lifestyle modifications, continuous positive airway pressure (CPAP) therapy, and adaptive pressure support servoventilation (ASV).

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