Breathing disorders during sleep: symptoms, causes and treatment
This type of disturbance can have very harmful effects on health.
Human beings breathe continuously, in a semi-automatic manner, throughout their lives. Breathing allows us to obtain the oxygen that our cells need to survive, and the absence of this process for long enough causes us to die (in fact, for a long time, the moment when we stop breathing was considered the moment of death). It is so essential that it is necessary even when our level of consciousness is altered, and even when we sleep.
But sometimes during sleep some alterations occur that make it difficult for us to carry out this vital process, even if only for a few seconds. Thus, we can find ourselves with different respiratory disorders during sleep. We will talk about these types of health disorders in this article.
Breathing disorders during sleep
They are understood as respiratory disorders of the sleep to that set of alterations occurred during the period of sleep in which ventilation or insufficient breathing occurs or a change in the respiratory rhythm. In most cases, these are disorders in which apneas appear, or brief periods in which the patient stops breathing for at least ten seconds and which usually generate a partial awakening of the subject in order to be able to inhale and receive oxygen. There is also another associated concept, hypoapnea, in which although the subject does not stop breathing at any time, the amount of air entering the body is greatly reduced as breathing becomes more shallow.
These disorders tend to generate frequent nocturnal awakenings (mostly not consciously perceived) and are often (mostly not consciously perceived), and are often linked to the occurrence of snoring. They often have consequences, perhaps the most visible of which is the difficulty in maintaining a continuous and restful sleep, which can result in the appearance of daytime sleepiness, fatigue and concentration difficulties. It can also lead to relational problems, such as discomfort and conflicts with bed partners.
Breathing disorders during sleep are seen by the majority of the population as mild and uncomplicated, and in some cases this is true, but in reality the presence of a breathing disorder during sleep can have a number of serious consequences for a person's health. can have a number of serious health consequences if not treated correctly. if not treated correctly.
They can have very harmful effects on our cardiovascular system: in fact, this type of disorder is a risk factor for heart disease. 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 reoxygenation) that can lead to a greater likelihood of arrhythmias, angina pectoris and even heart attacks.
It can also have cognitive effects, as it hinders the maintenance and rhythmicity of sleep cycles and, in addition, the presence of repeated micro-anoxia can lead to the death of groups of people who are not able to sleep. can lead to the death of groups of neurons.. In children, it can also cause growth and developmental delays, as well as increased insulin resistance or other metabolic problems. It has also been observed that they are detrimental to diabetic patients and those with neuromuscular disorders.
Types
There are many different phenomena that could be considered as sleep-disordered breathing and have different levels of impact on the subject who suffers from them. The following are some of the most common ones.
Obstructive sleep apnea
Perhaps the best known sleep breathing disorder, obstructive sleep apnea is a disorder in which the sufferer experiences during sleep obstruction of the upper airway, despite continuing to perform the action of breathing.. This causes the respiratory rhythm to increase in an attempt to receive the air that does not arrive.
Non-conscious awakenings and micro-awakenings are frequent. during sleep, although the subject is eventually awakened by the contraction of the muscles involved in breathing, in search of oxygen. This can occur cyclically several times during the night.
One of the most frequent symptoms is the presence of irregular and high intensity snoring, in addition to the awakenings caused by the search for air by our organism. Vivid dreams and high levels of night sweats are not uncommon. During the day they usually suffer from fatigue, lack of strength, memory problems and reduced sexual appetite. Arrhythmias are common and can facilitate the onset of severe cardiac problems.
2. Central sleep apnea
Central sleep apneas are those types of apneas that occur when the person's airway is not obstructed but allows the correct passage of air, but nevertheless there is 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 of airflow due to a reduction or absence of respiratory effort.
It is a problem derived from a cardiac or cerebral alteration, and there may be numerous possible causes behind it. Unlike other apneas and sleep disorders, snoring is not common and may not even be detected directly. What is noticeable is the presence of daytime fatigue, nocturnal awakenings caused by the sensation of suffocation and sometimes fear to sleep due to these sensations.
3. Mixed sleep apnea
This is a breathing disorder during sleep that combines the characteristics of the two previous ones: the respiratory problem begins with a central apnea in which the effort to breathe is greatly diminished, but when it will return to normal rhythms appears a real obstruction of the airways that usually generates the awakening of the subject.
4. Syndrome of Resistance of the Upper Airway
Syndrome of lesser severity than the others in which does not generate a decrease in the oxygen levels received by the subject.. This disorder is characterized by the presence of awakenings during sleep, without the appearance of an episode of apnea. The problem in this case seems to be linked to an increase in the effort made to breathe in. Intense snoring usually appears as a result of this effort. It also tends to generate daytime sleepiness.
5. Hypoventilation syndromes
These syndromes are characterized by the fact that, unlike apneas, there is no period of time in which there is a complete cessation of breathing. They are syndromes in which the sufferer has some type of deficiency in the respiratory system that causes a sufficient level of air to not reach the organism, generally with shallow breathing. Less oxygen reaches the brain and there is an increase in the levels of carbon dioxide in the blood.
It is not infrequent that snoring appears.and, like the previous ones, it usually causes fatigue, memory problems and some nocturnal awakenings. We speak of syndromes because there are several that could be included in this category, such as Ondina syndrome (caused by congenital alteration of respiratory control).
Causes of the appearance of these disorders
The reasons for the appearance of some type of breathing disorder during sleep can be multiple, both genetic and environmental.
Alterations of a biological and genetic nature can be found in the presence of cranial malformations or in hypertrophies of organs such as the tongue or amygdalae. the presence of cranial malformations or in hypertrophies of organs such as the tongue or tonsils, or in different syndromes and syndromes of the brain.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 throat, can exert weight and pressure on the throat. can exert weight and pressure on the airways, making it difficult for air to pass through. Obstruction and deterioration of these airways can also contribute to generate or maintain a respiratory disorder during sleep, such as smoking. Allergies are also a possible reason for its appearance.
They can also be linked (as in the case of central apneas) or derive from the presence of heart disease or brain injury. the presence of a heart disease or brain injury which may result from infections, cardiovascular or cerebrovascular accidents, tumors, respiratory diseases or head injuries.
Treatment
The treatment of sleep-disordered breathing can be carried out in multiple ways depending on the patient's needs and capabilities, as well as his or her personal characteristics.
One of the options available is the implementation of a weight loss plan in the case of obstructive apnea, along with the avoidance of airway irritants.
Different drugs can be used in the treatment, although they are usually not very effective. The exception may occur if we are dealing with a patient whose obstruction is allergic or derived from different diseases expressed punctually. In these cases the disease or disorder that causes or facilitates sleep disordered breathing must be treated..
A common mechanism for treatment is the use of continuous positive airway pressure equipment or CPAP. This is a mechanism that provides continuous pressure through a mask placed in the nose and/or mouth, allowing continued pulmonary function by keeping the airways open. It is applied in those patients in whom nocturnal breathing problems are very frequent and do not respond to sleep hygiene and other treatments, and aims to achieve the cessation of apneas and respiratory flow limitation.
In some cases surgical intervention is required.The use of dentures, for example when there are hypertrophies in the tonsils or even in the tongue. Alternatives such as the use of dental prostheses or mandibular advancement devices can also be employed.
Bibliographic references
- Nazar, G. (2013). Sleep-disordered breathing disorders in the pediatric age. Las Condes Clinic Medical Journal, 24: 403-411. Elsevier.
(Updated at Apr 14 / 2024)