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Can You Breathe and Sleep at the Same Time?

A silly question? You probably answered “yes”.
You may be interested to know that many people experience difficulty sleeping and breathing simultaneously. Sleep related breathing disorder, commonly known as Obstructive Sleep Apnea (OSA), affects over 12 million Americans.

Do any of these signs and symptoms apply to you or someone you know: Difficulty falling asleep? Loud snoring? Choking or gasping? Kicking legs during sleep? Waking up with a headache? Feeling sleepy during the day? Memory or learning problems? Feeling irritable or lacking energy?

If you observe a person who is lying down with his eyes closed, he looks about the same whether he is sleeping or quietly awake, resting, with his eyes closed. But, if you pay particular attention to the person’s breathing pattern and facial muscle tone, you will notice subtle differences. The face of a person who is sleeping will be relaxed while the person who is awake with his eyes closed exhibits subtle facial muscle tension. Also, a careful observer will notice that the breathing pattern and sound is also slightly different as a person falls asleep.

The most easily discernible sign of transition to sleep is muscle relaxation. When we get tired and sleepy, we often notice our eyelids getting heavy. This is because our facial muscles are starting to relax. When someone is “nodding off,” his neck muscles begin to lose their tone, and it becomes apparent that the person is falling asleep.

Human airway begins with the nose and ends deep within the lungs. Constructed of cartilage and facial bones, the nose is semi-rigid. The windpipe, or trachea, is lined by rings of cartilage which give it shape and hold it open. Our throat, or pharynx, located just above the vocal cords is different. This part of the airway is unusual as it lacks any rigid structures. It is simply a group of thin, floppy muscles that require tension to maintain shape. Another characteristic of this area is that it is under a high level of control by the brain and it takes up an enormous amount of brain function. The reason is because we use this part of our airway for oral communication. This particular function separates us from animals. A thin and floppy airway is needed not only for communication but also for eating, swallowing, and of course for breathing. Unfortunately, when we fall asleep we lose muscle tension and this area may become partially narrowed and obstructed. As a result we are the only “mammals” that snore and have sleep related breathing disorders.

When we fall asleep and our muscles relax, there is a collapse of this part of the airway. For the majority of people, this is not a problem because the airway remains open enough to adequately facilitate breathing during sleep. However, for millions of others, collapse of this part of the airway is beyond normal and there is very little open space in the pharynx for breathing during sleep. This causes increased turbulence which we call snoring. Further relaxation and the resulting collapse of the airway lead to apneas.

While our brain is in the sleep mode, normal breathing occurs without much effort. But severe snoring, or sleep apnea, results in an increased effort to breathe as the body struggles to get more air though the narrowed airway. This causes an amplified level of stress to the body and sometimes a drop in oxygen level. There is surge in the stress hormones called catecholamines. Soon, the brain wakes up to respond to the “breathing emergency” that it detects and our sleep is interrupted. The awakening by the brain causes a sudden increase in the upper airway tone. The airway opens as the body continues to hunger for oxygen. This leads to sudden inhalation of air which sleep mates sometimes describe as a “snort” or “gasping for air”.

The result of untreated sleep apnea is that labored breathing constantly interferes with sleep and the sleep pattern becomes fragmented. We now understand that fragmented sleep is non-restorative. Most people experiencing sleep apnea wake up without feeling refreshed and feel less awake throughout the day.

A profound cardiovascular effect often accompanies obstructive sleep apnea syndrome. With increased efforts to breathe through the narrowed upper airway, the body produces tremendous variations in chest pressure. At the same time, there is a rise in stress hormones being released into the body. There may be “heart pounding” and the development of anxiety (the “fight or flight” response) as the body and lungs continue their struggle for air. Normally, during sleep hours, our blood pressure drops to compensate for less expenditure of energy. Sleep apnea syndrome causes wide swings in blood pressure that can result in hypertension and heart disease.

Inchel C. Yeam, MD, FCCP Diplomate, American Board of Sleep Medicine,
Pulmonary & Critical Care Medicine,
American Board of Internal Medicine