Breathing pauses – causes, treatment and prevention

Breathing pauses are among the sleep-related breathing disorders . We speak of breathing pauses or sleep apnea syndrome when a sleeping person stops breathing at least five times, but often more than ten times an hour, and this pause lasts at least ten seconds, but often longer than a minute.

Due to the respiratory arrest, there is a reduced oxygen supply and arousal reactions, which usually do not actually lead to waking up, but rather to an accelerated pulse , increasing heart rate , violent gasping and breathing or snoring that starts again .

The repeated course of such phases during sleep, in severe cases several times within an hour, means that those affected can suffer from severe daytime tiredness or the compulsion to fall asleep. Most of these patients are also heavy snorers due to the relaxation of the upper respiratory tract. However, that doesn’t mean that all snorers suffer from breathing pauses.

Causes

Breathing pauses have different causes. They can be caused by a respiratory disorder or a neurological disease. They may occur as a result of a medical condition such as a heart attack or pneumonia.If the symptom of the breathing pause is an obstructive, i.e. narrowing apnea, this is due to a particularly high degree of relaxation of the muscles in the pharynx during sleep, which leads to a blockage of the airways in the pharynx and during which snoring also stops. This results in forced diaphragmatic and thoracic breathing until the arousal response occurs, which protects the sleeper from suffocation and causes breathing to resume.

Central apnea is brain-related and is due to impaired breathing regulation in the respiratory center of the brain. These symptoms also lead to respiratory arrest, but without muscular relaxation of the pharynx. The airways are therefore not blocked here. However, all breathing muscles, including the diaphragm, suddenly stop, during which the oxygen level in the blood falls and the carbon dioxide level increases. This in turn triggers a wake-up reaction and strong breathing in the sleeping person. Central sleep apnea occurs particularly after a stroke and in many patients with cardiac insufficiency.

Diseases

• stroke

• lung infection

• cardiovascular diseases

• myocardial insufficiency

• arteriosclerosis

When to the doctor?

If you stop breathing, see a doctor as soon as possible. If they occur during the night’s sleep, there can be interruptions lasting several minutes and thus a lack of oxygen. The pauses in breathing lead to severe strain on the organism and are considered to be worrying. The patient suffers from sleep apnea that needs to be treated.

The stress on the body caused by regular breathing pauses can lead to other serious and life-threatening conditions. The lack of oxygen in the organism leads to an increase in cardiac activity. Since this permanently increases the risk of a heart attack or stroke, a doctor should be consulted as soon as the breathing pauses last for several weeks.

If the breathing pauses occur after heavy physical activity or through sporting training sessions, in most cases there is no reason to worry. It is a normal condition that regulates itself within a few minutes. However, if the breathing pauses worsen or last longer, a doctor should be consulted.

Breathing pauses caused by colds are often associated with other symptoms such as swelling of the mucous membranes in the nose or throat. In this case, a doctor should be consulted to take measures that initiate relief. With the healing of the underlying disease, the breathing pauses also disappear permanently.

Diagnosis and course

In order to find out the trigger and type of breathing pauses, a patient can be examined by specialists at a sleep center either on an outpatient basis or in a sleep laboratory. During the outpatient examination, the breathing, the oxygen content of the blood and the breathing movements of the person sleeping at home are measured using a device connected to him. These values ​​are then read out in the supervising sleep center.

In a sleep laboratory, the diagnostic methods mentioned above and a number of additional ones are applied to the patients who spend the night there. During one or two nights, the sleeping person is checked through. It starts with the brain waves, which are measured to determine the depth and continuity of sleep. A long-term ECG is used to examine whether the cardiac activity shows the fluctuations that are typical of breathing pauses.

A sensor placed over the upper lip examines breathing activity, and sensors on the chest and abdomen monitor breathing movements in these areas of the body. With the help of electrodes attached next to the eyes, the revealing eye movements, eg in the REM sleep phase (rapid eye movement during dream phases), can be checked. Muscle tension, snoring noises, blood oxygen levels, leg movements and body position are also examined.

Complications

Breathing pauses, which usually occur at night in connection with snoring, should not be taken lightly with regard to possible complications. After all, during this time the entire organism is not sufficiently supplied with oxygen (hypoxic state). The less oxygen gets into the blood, the more stress hormones the body releases. Blood clotting can increase and the walls of the veins become compromised, which is diagnosed as atherosclerosis. This results in an increased risk of thrombosis . The risk of high blood pressure (hypertension) also increases significantly. The risk of sugar and fat levels increasing should not be underestimated,

Because the night’s sleep does not allow for the necessary relaxation, many of those affected experience a loss of concentration , which can have a negative effect on the psyche because productive behavior at work is damaged over time. There is also an increased risk of a heart attack or stroke. If obstructive sleep apnea (OSAS) is the cause of the breathing pauses, the patency of the airways can be further damaged over time if treatment is not given. Increasing nerve damage is to be feared if breathing pauses based on central sleep apnea (CSAS) are not treated. If these symptoms are not treated, they can become life-threatening.

Treatment and therapy

Untreated breathing pauses not only reduce everyday quality of life, but also life expectancy considerably. They cause insufficient oxygen supply and thus increase the risk of a heart attack or stroke.

Slight pauses in breathing can often be corrected with the help of a prosthesis. This is specially made for the patient, moves the lower jaw slightly forward and is placed in the mouth before sleeping. In the ideal case, the upper airways are no longer closed and this can improve breathing.

Treatment of more severe obstructive apnea consists primarily of respiratory therapy, with positive airway pressure treatment being the most effective. Overpressure is created during sleep with a breathing apparatus in the pharynx or through a nose mask, which in turn ensures that the airways are kept open. The device must be individually adjusted to the patient in a sleep laboratory.This therapy significantly improves the quality of life and performance of the patients. It ensures balanced breathing and healthy sleep as well as a disappearance of snoring. Those affected wake up fresh and rested. However, this treatment only treats the symptoms of the breathing pauses, not their causes. This means that the patient has to use the device for the rest of their life while they sleep. If bottlenecks are identified in the upper respiratory tract, a surgical procedure can remove them. A snoring splint can also help, with the help of which the airways remain open.

If it is proven that the breathing pauses occur predominantly or exclusively in the supine position, a lateral sleeping position can be forced. A special sleeping vest was developed for this purpose, with Styrofoam balls in the back, making it impossible to sleep on your back.

Outlook and prognosis

Breathing pauses lead to a reduction in quality of life. The misfires interrupt the quality of sleep, which can be seen as the basis for the regeneration of the entire organism. Memory functions are disrupted and recovery is minimized. As soon as breathing pauses persist over a longer period of time, further illnesses can be expected. The cessation of breathing leads to a permanent strain on the body. There is a regular undersupply of the brain. The oxygen is not made available to him in the necessary form and must be compensated. This causes the heartbeat to increase. The heart muscle is subjected to variable and irregular exertion by this process. This can eventually lead to cardiac arrhythmias .

This significantly increases the risk of a heart attack. Disorders of blood flow to the heart muscle increase noticeably. Diseases caused by a defect in the heart muscle increase blood pressure. This increases the overall pressure on the individual blood vessels in the body. This puts additional strain on the heart and other vital organs. This condition can lead to failure, dizziness, or difficulty breathing. Shortness of breath sets in and patients show increased nervousness. In addition, prolonged sleep apnea increases the risk of stroke. In addition to lifelong symptoms of paralysis or various functional failures, this can also be fatal.

Prevention

In order to prevent breathing pauses, a distinction must be made between behavioral and disease-related risk factors. For example, drinking alcohol in the evening should be severely restricted. It can also help you lose weight , since fatty tissue encourages breathing pauses.

Those affected should try to sleep mostly on their side. Disease-related factors must be treated either medically or surgically. These include a severe cold , high blood pressure , narrowing of the larynx or a curvature of the nasal septum. Sleeping pills that reduce muscle tone (e.g. diazepam) should be avoided if breathing stops.