Sleep and breathing

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When we sleep, our breathing changes due to normal biological processes that affect both our respiratory and muscular systems.

Physiology

Sleep Onset

Breathing changes as we transition from wakefulness to sleep. These changes arise due to biological changes in the processes that regulate our breathing. When we fall asleep, minute ventilation (the amount of air that we breathe per minute) reduces due to decreased metabolism.

Non-REM (NREM) Sleep

During NREM sleep, we move through three

Periodic oscillations of the pulmonary arterial pressure occur with respiration. Pulmonary arterial systolic and diastolic pressure and PAD increase by 4-5mm in NREM sleep

Effects Of Arousals

Induced transient arousal from NREM sleep cause the following: Increase EMG activity of the diaphragm 150%, increased activity of upper airway dilating muscles 250%, increased airflow and tidal volume 160% and decreased upper airway resistance.

Steady REM Sleep

Ventilation

Irregular breathing with sudden changes in both amplitude and frequency at times interrupted by central

Hypoxemia due to hypoventilation is noted in REM sleep but this is less well studied than NREM sleep. These changes are equal to or greater than NREM sleep

Pulmonary Arterial Pressure

Pulmonary arterial pressure fluctuates with respiration and rises during REM sleep.

Effect of Arousals

Arousals cause return of airway resistance and airflow to near awake values. Refer arousals in NREM sleep.

Sleep and Breathing in High Altitudes

At a lower altitude, the link between breathing and sleep has been established. At a higher altitude, disruptions in sleep are often linked to changes in the respiratory (breathing ) rhythm. Changes in altitude cause variations in sleep time (reduced to 0% up to 93%), as shown in a study that examined people at sea level and Pikes Peak (4300 meters).^[2] These subjects also experienced more frequent arousals and diminished stage 3 and stage 4 sleep. A poorer quality of sleep was indicated, but not due to less sleep time, but more frequent awakenings during the night.

Sleep-disordered breathing (abnormal sleep and breathing or sleep-related breathing disorders)

Primary snoring

Snoring is a condition characterized by noisy breathing during sleep. Usually, any medical condition where the airway is blocked during sleeping, like obstructive sleep apnea, may give rise to snoring. Snoring, when not associated with an obstructive phenomenon is known as primary snoring.^[3] Apart from the specific condition of obstructive sleep apnea, other causes of snoring include alcohol intake prior to sleeping, stuffy nose, sinusitis, obesity, long tongue or uvula, large tonsil or adenoid, smaller lower jaw, deviated nasal septum, asthma, smoking and sleeping on one's back. Primary snoring is also known as "simple" or "benign" snoring, and is not associated with sleep apnea.

Upper airway resistance syndrome

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Obstructive sleep apnea (including hypopnea) syndrome

Obstructive sleep apnea is apnea either as the result of obstruction of the air passages or inadequate respiratory muscle activity.

Central sleep apnea syndrome

Sleep apnea (or sleep apnoea in British English; /æpˈniːə/) is a sleep disorder characterized by pauses in breathing or instances of shallow or infrequent breathing during sleep. Each pause in breathing, called an apnea, can last for several seconds to several minutes, and may occur 5 to 30 times or more in an hour.^[4]

Complex sleep disordered syndrome

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Sleep related hypoventilation syndromes

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References