Sleep Related Breathing Disorders
Sleep related breathing disorders are a group of disorders that affect someone’s breathing while he or she is asleep. These disorders are characterized by disruptions of normal breathing patterns that only occur during sleep. Therefore, the person with the disorder may be the last to know he or she has a problem. The most common sleep related breathing disorder is sleep apnea.
The following is a brief description of the more common sleep related breathing disorders:
Obstructive Sleep Apnea (OSA) is a common, serious sleep disorder that causes you to stop breathing during sleep. OSA happens when the throat and upper airway collapse while asleep. It is often a familial disorder with excess tissue and the muscles inside the throat relaxing as you sleep. This blocks the airway, keeping air from getting into the lungs. Oxygen levels in the body drop, and sleep is disrupted. This can happen dozens or even hundreds of times a night! Everyone who snores has OSA, but one in four cases may not snore at all. The snoring sound is made as the flow of air causes tissue in the back of the throat to vibrate. Snoring and OSA can happen when you breathe through the nose or the mouth, or both.
Common OSA Symptoms:
- Daytime sleepiness
- Poor memory
- Loss of concentration
- Muscle aches
- Night sweats
OSA is a very serious sleep disorder. Patients with OSA suffer from fragmented sleep and may develop
cardiovascular abnormalities because of repetitive cycles of blocked breathing and arousals (short waking which
helps the breathing resume).
OSA is known to worsen the following and more:
- Mood disorders
- Cardiac arrhythmias
- Heart attacks
- Motor vehicle accidents
Obstructive Sleep Apnea in Children
Children can also suffer from OSA. Most children with OSA have a history of snoring and sometimes, obvious pauses in breathing and gasps for breath. The child’s body may move in response to the pauses in breathing. The breathing problems can produce unusual movements of a child’s chest and abdomen. The rib cage may appear to move inward as the child inhales, which is called “paradoxical movement.” For healthy children over three years of age, this type of breathing is not normal. In extreme cases a child with untreated OSA may develop a “funnel chest” over time. The ongoing breathing problems cause the sternum, or “breastbone,” to sink in. This produces a depression in the chest wall. Children with OSA may experience the following symptoms:
- Sleep in unusual positions such as sitting up or with the neck overextended.
- May sweat a lot during sleep and may have headaches in the morning.
- Bedwetting or sleep terrors may occur.
- Tend to breathe normally when they are awake. But it is common for them to breathe through the mouth.
- Frequent infections of the upper respiratory tract.
- Large tonsils make it hard to swallow. This is called “dysphagia.”
- Learning and behavioral problems. These problems may include aggressive behavior, attention-deficit/hyperactivity disorder, delays in development and/or poor school performance.
- High blood pressure
- Slow growth rate
Symptoms of OSA tend to appear in the first few years of life. But OSA often remains undiagnosed until many years later.
Central sleep apnea (CSA) is a breathing disorder that causes the body to decrease or stop the effort of breathing during sleep. Central sleep apnea is also strongly associated with congestive heart failure. Other diseases that can cause central sleep apnea include:
- Pain treatment and medications
- Reaction to CPAP (complex central sleep apnea)
- An illness or damage to the brain stem (encephalitis, polio, or a tumor)
- Conditions that affect the nervous system (stroke)
- Diseases that affect the muscles involved with breathing (Lou Gehrig’s disease, myotonic dystrophy)
CSA syndromes in adults are divided into five categories:
Primary Central Sleep Apnea is when the breathing pattern consists of the repetitive absence of breathing effort and air flow.
Cheyne-Stokes Breathing Pattern is caused by heart failure, stroke, and possibly kidney failure. The breathing pattern consists of a rhythmic increase and decrease of the breathing effort and the amount of air flow.
Medical Condition Not Cheyne-Stokes is when CSA is caused by medical conditions, but without the typical Cheyne-Stokes breathing pattern. It is caused by heart and kidney problems. It may also result from a problem in the base of the brain where breathing is controlled.
High-Altitude Periodic Breathing is caused by sleeping at altitudes higher than about 15,000 feet. The breathing pattern is similar to the Cheyne-Stokes Breathing Pattern. The difference is that there is no history of heart failure, stroke, or kidney failure. Also, the cycle time is shorter.
Due to Drug or Substance is caused by the use of drugs, mainly pain medicines in the opioid category. Breathing may stop completely or increase and decrease in a regular pattern. Breathing can also be quite irregular. It can even have elements of obstruction such as the breathing that is seen in OSA.
Almost all people with CSA have disrupted sleep with frequent awakenings, difficulty falling asleep and daytime sleepiness. Other problems often seen are snoring, pauses in breathing and waking up with shortness of breath. Central sleep apnea is a serious medical condition and complications include:
Cardiovascular problems. Sudden drops in blood-oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. These changes raise the risk of heart failure and stroke. If there’s underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) worsen prognosis and increase the risk of abnormal heart rhythms.
Daytime fatigue. In addition, the repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. You may have difficulty concentrating and find yourself falling asleep at work, while watching TV or even when driving.