Human beings breathe continuously, semi-automatically, throughout their lives. Breathing allows us to get the oxygen our cells need to survive, and not having this process for long enough causes us to die (in fact, for a long time, we considered the time to breathe as die). It is such an essential thing that it is necessary even when our level of consciousness is altered, and even when we are asleep.
But sometimes during sleep there are alterations that prevent us from performing this vital process, even for a few seconds. like that, we may encounter different breathing disorders during sleep. We will talk about this type of health disorder in this article.
Breathing problems during sleep
By sleep respiratory disorders is meant all the alterations occurring during the period of sleep during which insufficient ventilation or breathing occurs or a change in respiratory rate. Most of these are disorders in which apneas appear, or short periods in which the patient stops breathing for at least ten seconds and usually generates a partial awakening of the subject to be able to inhale and receive oxygen. There is also another related concept, hypoapnea, in which although the subject does not stop breathing at any time, the amount of air entering the body is drastically reduced by returning it to shallower breathing.
These disorders tend to generate frequent nocturnal awakenings (Mostly unconsciously perceived), and are often linked to the onset of snoring. They usually have consequences, the difficulty in maintaining continuous, restful sleep is perhaps more noticeable, which can lead to the onset of daytime sleepiness, fatigue and difficulty concentrating. It can also lead to relationship issues, such as discomfort and conflict with bed mates.
Respiratory disorder during sleep is considered by the majority of the population to be something benign that does not cause complications, and in some cases it is, but in reality the presence of a respiratory disorder during sleep it can have a number of serious health consequences if not treated properly.
And this can have very harmful effects on our cardiovascular system: in fact, this type of disorder is a risk factor for heart disease. And it is that the obstruction of the air passage generates pulmonary hypertension and an overload in the right ventricle of the heart (which is the part of the heart responsible for sending blood to the lungs for re-oxygenation) which can lead to a greater likelihood of arrhythmias, angina and even heart attacks.
It can also have cognitive effects, because it hinders the maintenance and rhythmicity of sleep cycles and, in addition, the presence of repeated micro-anoxias. this can lead to the death of groups of neurons. In children, it can also lead to growth and development delays, as well as increased insulin resistance or other metabolic-type problems. They have also been observed to be detrimental to diabetic patients and those with neuromuscular disorders.
There are many different phenomena which could be considered as respiratory sleep disturbances and which have different levels of impact on the subject who suffers from them. Here are some of the most common.
1. Obstructive sleep apnea
Perhaps the most well-known respiratory sleep disorder, obstructive sleep apnea is a disorder in which the sleep sufferer suffers while asleep. obstruction of the upper airways, while continuing to perform the action of breathing. This causes the respiratory rate to increase in an attempt to receive air that has not just arrived.
Unconscious awakenings and micro-awakenings are common during sleep although the subject will eventually wake up to the contraction of the muscles related to breathing, in search of oxygen. This can happen cyclically several times during the night.
One of the most common symptoms is the presence of irregular and intense snoring, in addition to the awakenings caused by our body seeking air. It is not uncommon for vivid dreams and high levels of night sweats to appear. During the day, they often suffer from fatigue, lack of strength, memory problems and less sexual desire. Arrhythmias are common and can lead to serious heart problems.
2. Central sleep apnea
Central sleep apneas are those types of apneas that occur when a person’s airways are not obstructed but allow good passage of air, but there is nonetheless a decrease in respiratory flow. The problem itself is that the body does not make the effort to breathe normally. In other words, there is an interruption in the air flow due to reduced or no respiratory effort.
This is a problem caused by a heart or brain disorder, and there can be many possible causes. Unlike other apneas and sleep disorders, snoring is not common and may not even be detected directly. What is perceived is the presence of daytime fatigue, nocturnal awakenings caused by the feeling of suffocation and sometimes afraid to sleep because of the aforementioned sensations.
3. Mixed sleep apnea
It is a respiratory disorder during sleep which corresponds to the characteristics of the previous two: the respiratory problem begins with a central apnea in which the effort to breathe is greatly reduced, but when it returns to normal rhythms, a real obstruction of the airways which usually generate the arousal of the subject.
4. Upper airway resistance syndrome
Syndrome less serious than others in which no decrease in oxygen levels received is generated. This disorder is characterized by the presence of awakenings during sleep, without an episode of apnea. The problem in this case seems to be related to an increase in inspiration effort. An intense snoring resulting from this exertion usually appears. It also tends to cause daytime sleepiness.
5. Hypoventilation syndromes
These syndromes are characterized because, unlike with apneas, there is no period during which a complete cessation of breathing occurs. These are syndromes in which the subject who suffers from them exhibits some type of deficit in the respiratory system that prevents a sufficient level of air from reaching the body, usually shallow breathing. Less oxygen reaches the brain and there is an increase in the levels of carbon dioxide in the blood.
Snoring is not uncommon, And like the previous ones usually cause fatigue, memory problems and nocturnal awakenings. We talk about syndromes because there are several that could be included in this category, such as Ondina syndrome (caused by a congenital impairment of respiratory control).
Causes of the appearance of these disorders
There can be many reasons for the onset of a certain type of respiratory disorder during sleep, both genetic and environmental.
Alterations of a biological and genetic nature are found in the presence of head deformities or enlarged organs such as the tongue or tonsils, Or in different syndromes and diseases both genetic and acquired.
One of the most relevant controllable risk factors is obesity: increased fatty tissue, especially around the neck it can put weight and pressure on the airways that make it difficult for air to pass through. The obstruction and deterioration of these pathways can also contribute to the generation or maintenance of a disorder. breathing during sleep, such as smoking. Allergies are also a possible reason for their occurrence.
They can also be related (as in the case of central apneas) or derived from the presence of heart disease or brain damage which may result from infections, cardiovascular or cerebrovascular accidents, tumors, respiratory diseases or cranioencephalic trauma.
The treatment of respiratory disorders during sleep can be carried out in a number of ways depending on the needs and abilities of the patient, as well as his personal characteristics.
One of the options available is to implement a weight loss plan for obstructive sleep apnea while avoiding respiratory irritants.
They can use different drugs in the treatment, although they are usually not too effective. The exception can arise if we deal with a patient the obstruction is allergic or derived from different diseases expressed in time. In such cases disease or condition that causes or facilitates impaired breathing during sleep should be treated.
A common treatment mechanism is the use of continuous positive airway pressure or CPAP equipment. It is a mechanism that provides continuous pressure through a mask placed in the nose and / or mouth, allowing continuous pulmonary functionality while keeping the airways open. It is applied in patients in whom nocturnal breathing problems are very common and do not respond to sleep hygiene and other treatments, and aims to achieve cessation of apnea and limitation of respiratory flow.
In some cases, surgery is necessary, For example when hypertrophies occur in the tonsils or even in the tongue. Alternatives such as the use of dentures or mandibular advancement devices can also be used.
- Nazar, G. (2013). Respiratory sleep disorders in pediatric age. Clinical medical journal Les Comtes, 24: 403-411. Elsevier.