Breathing disorders during sleep: symptoms and causes

The human being breathes continuously, in a semi-automatic way, throughout his life. Breathing allows us to get the oxygen our cells need to survive, and the absence of this process during enough time causes death (in fact, for a long time the moment when you stop breathing was considered as the moment of die). It is something 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 for a few seconds. So, we can find different respiratory disorders during sleep. We will talk about this type of health alterations in this article.

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Breathing disorders during sleep

Respiratory sleep disorders are understood to be the set of alterations that occur during the period of sleep in which insufficient ventilation or breathing occurs or a change in breathing rate. Mostly, these are disorders in which apneas appear, or brief periods in which the patient stops breathing for at least ten seconds and that usually generates a partial awakening of the subject to be able to inhale and receive oxygen. There is also another associated concept, hypopnea, in which although the subject does not stop breathing at any moment the amount of air entering the body is greatly reduced as breathing becomes more superficial.

These disorders tend to cause frequent nocturnal awakenings. (mostly not consciously perceived), and are usually linked to the appearance of snoring. They usually have consequences, being perhaps more visible is the difficulty to maintain a continuous dream and restorative, which can result in daytime sleepiness, fatigue, and difficulty concentration. It can also lead to relational problems, such as annoyances and conflicts with bed partners.

Breathing disorders during sleep are seen by the majority of the population as something mild that does not generate complications, and in some cases this is so, but in reality the presence of a respiratory disorder during the dream can have a number of serious health consequences if it is not treated correctly.

And it is that they can have very harmful effects on our cardiovascular system: in fact, this type of disorder is a risk factor for suffering from heart disease. And it is that the obstruction of the passage of air 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 probability of arrhythmias, angina pectoris and even heart attacks

Likewise, it can have cognitive effects, since it hinders the maintenance and rhythmicity of sleep cycles and, in addition, the presence of repeated micro-anoxias can cause the death of groups of neurons. In children, it can also cause growth and development delays, as well as increased insulin resistance or other metabolic problems. It has also been observed that they are detrimental to diabetic patients and patients with neuromuscular disorders.

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Guys

There are very diverse phenomena that could be considered sleep-disordered breathing and that have different levels of repercussion on the subject who suffers from them. Below are some of the most common.

1. Obstructive sleep apnea

Perhaps the best-known respiratory sleep disorder, obstructive apnea is a disorder in which the subject who suffers from it suffers during sleep. the obstruction of the upper airways, despite continuing to perform the action of breathing. This causes the respiratory rate to increase as an attempt to receive the air that does not finish arriving.

Unconscious arousals and microarousals are frequent during sleep, although the subject ends up waking up due to the contraction of the muscles related to 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 awakenings caused by our body's search for air. It is not uncommon for vivid dreams and elevated levels of night sweats to occur. During the day they often suffer from fatigue, lack of strength, memory problems and decreased sexual appetite. Arrhythmias appear frequently and can facilitate the appearance of severe heart problems.

2. central sleep apnea

Central sleep apneas are those types of apneas that occur when the person's airways are 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 reduced or absent respiratory effort.

It is a problem derived from a cardiac or cerebral alteration, and there may be numerous possible causes behind it. Contrary to other apnea and sleep disorders, it is not common for snoring to occur, and it may even go undetected directly. What is perceived is the presence of daytime fatigue, nocturnal awakenings caused by the sensation of suffocation and sometimes fear of sleeping due to these sensations.

3. mixed sleep apnea

It is a respiratory disorder during sleep that combines the characteristics of the two previous ones: the respiratory problem begins with a central apnea in which the The effort to breathe is greatly diminished, but when it returns to normal rhythms, a real obstruction of the airways appears, which usually causes the awakening of the subject.

4. Upper Airway Resistance Syndrome

Less serious syndrome than the others in which there is no decrease in the oxygen levels received. This disorder is characterized by the presence of awakenings during sleep, without an episode of apnea appearing. The problem in this case seems to be linked to an increase in the effort made to inspire. Intense snoring usually appears as a result of this effort. It also tends to cause daytime sleepiness.

5. Hypoventilation syndromes

These syndromes are characterized because, contrary to what happens with apneas, there is no period of time in which there is a complete cessation of breathing. These are syndromes in which the subject who suffers from them has some type of deficiency in the respiratory that does not reach a sufficient level of air to the body, generally being the breath superficial. Less oxygen reaches the brain and there is an increase in carbon dioxide levels in the blood.

It is not uncommon for snoring to appear, and like the previous ones, it usually causes fatigue, memory problems and some nocturnal awakenings. We are talking about syndromes because there are several that could be included in this category, such as Ondine syndrome (caused by a 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 are found in the presence of cranial malformations or hypertrophies of 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 throat it can exert weight and pressure on the airways that make it difficult for air to pass through. Likewise, the obstruction and deterioration of these pathways can contribute to generating or maintaining a respiratory disorder during sleep, such as tobacco use. Allergies are also a possible reason for its appearance.

They may also be related (as in the case of central apneas) or derived from the presence of heart disease or brain injury which can come from infections, cardiovascular or cerebrovascular accidents, tumors, respiratory diseases or head injuries.

Treatment

The treatment of breathing disorders during sleep can be carried out in multiple ways. ways depending on the needs and capacities of the patient, as well as their characteristics personal.

One of the available options involves carrying out a plan to lose weight in the case of obstructive apnea, together with the avoidance of irritating substances for the airways.

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 on time. In these cases the disease or condition that causes or facilitates sleep-disordered breathing should be treated.

A common mechanism for treatment is the use of continuous positive airway pressure equipment or CPAP. It is a mechanism that provides continuous pressure through a mask placed in the nose and/or mouth, allowing continued lung functionality by keeping the airways open aerial. 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 flow limitation respiratory.

In some cases surgical intervention is required, 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 used.

Bibliographic references

• Nazar, G. (2013). Respiratory sleep disorders in the pediatric age. Las Condes Clinic Medical Journal, 24: 403-411. Elsevier.