Breathing interruptions - causes and therapy

Breathing interruptions - causes and therapy

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Breathing interruptions during sleep

If breathing interruptions occur again and again in the night, medicine is usually referred to as "sleep apnea" or "sleep apnea syndrome". This is a so-called “breathing regulation disorder”, in which breathing is repeatedly interrupted for a few seconds during sleep, making healthy, deep sleep impossible. As a result, sufferers suffer, among other things, from chronic daytime fatigue and difficulty concentrating. In addition, the risk of heart attack, high blood pressure and other serious diseases increases. Accordingly, with typical signs such as heavy snoring with irregular breaks and chronic daytime tiredness, a doctor should be consulted. It often already helps those affected to forego nicotine or to lose excess weight. In addition to this, there are a number of other treatment options such as special masks with which breathing problems can usually be treated well.

Suspended breathing / sleep apnea: definition and symptoms

The term “breathing interruptions” is usually used to describe the relatively common “sleep apnea” (or “sleep apnea syndrome”). Characteristic of this breathing disorder are loud and irregular snoring and breathing interruptions during sleep, which last more than five times an hour and each longer than ten seconds. As a result, the body sounds the alarm by triggering a wake-up reaction so that those affected can breathe. Although they do not wake up from this, the so-called "hyperventilation phases" lead to a disturbed sleep rhythm with far-reaching consequences, which include extreme daytime sleepiness with a tendency to fall asleep ("falling asleep"), difficulty concentrating and reduced performance.

In some cases, patients with sleep apnea also suffer from anxiety, upset or depression, as well as morning headaches, dizziness, reduced sexual desire and problems with potency. In not a few cases, sleep apnea also leads to very serious or even life-threatening complaints, because the lack of oxygen increases the risk of high blood pressure and cardiovascular diseases, which can lead to a stroke or heart attack in an emergency.

The dangerous breathing interruptions at night are not a rare phenomenon. Rather, the syndrome, which affects around two to four percent of the adult population in this country, is one of the most common sleep disorders.

Causes of breathing disorders during sleep

Breathing interruptions are in most cases caused by a so-called "obstructive sleep apnea syndrome". This causes the pharynx muscles to relax during sleep, which partially or even completely blocks the upper airways. As a result, the body is no longer adequately supplied with oxygen and there is a sudden drop in pulse and blood pressure. The brain raises the alarm and triggers a wake-up reaction (“arousal”), causing the person concerned to wake up briefly to take a breath. While waking up is usually not perceived consciously, the sleep rhythm is interrupted each time and the heart rate and blood pressure are increased. Sleep apnea sufferers are “awakened” up to several hundred times a night, making healthy, deep sleep impossible.

The causes of nighttime narrowing or blockage of the upper respiratory tract are varied and complex. In addition to a genetic disposition, e.g. Peculiarities in the mouth and throat area such as enlarged tonsils, crooked nasal septum, polyps, too large a soft palate or too small a lower jaw may be the reason. Severe forms of sleep apnea often also occur in connection with Down syndrome (trisomy 21) or other congenital malformations such as the so-called "Pierre Robin sequence". In these cases, anomalies such as an enlarged or throaty tongue or an oversized suppository (uvula hyperplasia) often constrict the airways and thus lead to nocturnal breathing interruptions.

A key risk factor is (excessive) overweight, and smoking and the consumption of alcohol, sleeping pills and tranquilizers can cause the muscles to relax and the breathing to be disturbed. Age also seems to play a role, because women in particular often develop the respiratory disorder only after the menopause, which can probably be attributed to the tissue that becomes increasingly flaccid in old age. Sleeping on your back can increase snoring and disturbed breathing, but is usually not solely responsible for the problem.

In very rare cases, the breathing interruptions can also be caused by a so-called "central sleep apnea". This is triggered by a malfunction in the central nervous system and mostly occurs in people with pre-existing conditions such as heart failure or poor circulation in the brain (e.g. after a stroke). In contrast to obstructive sleep apnea syndrome, the upper airways are not blocked in this form, but the respiratory muscles of the chest and diaphragm only work to a limited extent, which means that the body cannot be adequately supplied with oxygen. As a result, wake-up reactions occur again and again during sleep, which among other things leads to permanent daytime sleepiness, difficulty concentrating and poor performance.

What does the doctor do about breathing interruptions?

If there is suspicion of an obstructive sleep apnea syndrome, the doctor can often make a relatively clear diagnosis based on the symptoms described and the description of lifestyle habits. Accordingly, the patient is usually first asked to report as detailed as possible on his personal medical history (anamnesis). Important questions include, for example: "Are medications being taken?", "Are previous illnesses known?", "What are your own sleeping habits?". In addition, a general physical examination is usually carried out, and a portable measuring device can also be used to examine sleep.

If abnormalities are found when checking breathing, heart rate, oxygen saturation in the blood, etc., referral to a so-called “sleep laboratory” brings ultimate clarity. Here, the patient spends one or more nights in a specially equipped room, where, among other things, the respiratory rate, pulse, brain waves, eye and leg movements are recorded during sleep. The results can then be used to calculate how severe sleep apnea is. The so-called “Apnea Hypopnea Index” (AHI) is used as a measure, which indicates the average number of breath stops and times with reduced breathing flow (hypopnea) per hour of sleep. In milder cases, this index is less than 5 (breathing pauses) per hour, and “severe” is an obstructive sleep apnea syndrome with a value of over 30.

Treatment for obstructive sleep apnea syndrome

If breathing interruptions occur repeatedly during sleep, this can have life-threatening consequences in the long run. Accordingly, sleep apnea must be treated in any case in order to support breathing and normalize it again. The specific therapeutic measures depend on the individual impairment of those affected and the possible benefit of the procedure. With light breathing interruptions, weight loss often helps in overweight patients, and a change in lifestyle and sleeping habits can also work a little miracle. Above all, this means avoiding alcohol and nicotine, and it can also be beneficial if you sleep on your side instead of on your back.

In most cases, the therapy of choice is the so-called “CPAP mask” (“Continous Positive Airway Pressure”, translated: “continuous airway pressure”), which the affected person wears during sleep. This "respiratory mask" is connected by a hose to a type of compressor, which creates an overpressure and thus ensures that the airways can no longer close. In principle, this procedure can achieve very good treatment success - but many patients find the device uncomfortable and annoying, and the mask does not always work properly.

An effective alternative in these cases could be a so-called “tongue pacemaker” in the future, which is currently still being tested in clinical studies. Like a cardiac pacemaker, this is placed under the clavicle of the person concerned and has two functions: On the one hand, the respiratory movement is measured via a cable that leads to the costal arch. At the same time, the neurostimulator ensures that when the current impulses are too weak, the tongue muscle is tense and the airways remain clear when inhaled. To what extent the therapy will prevail remains to be seen. Because it has been very successful so far, it is also comparatively complex and expensive. In addition, it is not considered for all those affected, because an operation is e.g. if you are overweight or have heart disease.

In addition to the CPAP mask, a number of other measures such as nasal plasters or bite splints can be used to treat obstructive sleep apnea, depending on the severity of the symptoms. In more severe cases, surgery may also be appropriate to correct the cause of the breathing disorder. Possible here are e.g. the tightening of the soft palate or the removal of enlarged tonsils (tonsil hyperplasia). Medicines, on the other hand, are currently irrelevant in the treatment because the potential benefits of the funds available so far have not been scientifically proven.

Self-help for snoring and breathing interruptions

Adhering to proper sleep hygiene can often significantly alleviate or even eliminate the breathing interruptions. This means all measures that have a positive effect on sleep quality, because the body can only really regenerate under certain circumstances. It can be helpful e.g. be nice when those affected sleep on their side. The supine position favors snoring and breathing disorders, since the heavier rear part of the tongue slides towards the throat due to gravity and narrows the airways. In order to maintain the lateral position during sleep, it can be useful, e.g. to place a small pillow in the back, which gives an uncomfortable feeling when rolling back. Alternatively, an elevated position of the upper body (e.g. with the help of a thick pillow) can improve breathing.

It is also important to get the body used to a regular sleep-wake cycle and to go to bed at the same time every day. The bedroom should be designed to be as unattractive as possible, well ventilated and under no circumstances be overheated. Rather, experts recommend an ideal sleeping temperature of a maximum of 18 degrees Celsius.

Since alcohol has a relaxing effect on the muscles and can thus increase the relaxation of the respiratory muscles, especially in the hours before bedtime, no beer, wine or the like should be used. to be drunk more. Sedatives and sleeping pills should also be avoided, as they can slow down breathing considerably. At dinner it is advisable to choose a rather light diet and not to take it too late in order not to strain the body even more.

Breathing interruptions in children and babies

Children can also be affected by snoring and respiratory arrests. In this case, enlarged tonsils or polyps are usually the cause, but are possible, for example also overweight or frequent inflammation in the throat area. Sleep apnea manifests itself here as in adults: in response to the breathing pause, the child takes a particularly deep breath, which is noticeable as a loud snoring sound. The little patients cannot remember the wake-up reactions the next morning, but the consequences of constantly interrupted sleep and the limited oxygen supply are profound. Typical here too are weakness in concentration, daytime sleepiness and listlessness. In addition, many young people suffer from hyperactivity, aggressiveness, delayed sleep, failure to thrive and an increased susceptibility to infection. In addition to snoring and a generally restless sleep, other signs that should definitely be taken seriously are e.g. an unusual sleeping position, profuse sweating at night and a dry mouth in the morning.

It is particularly problematic that symptoms such as pronounced fidgeting, restlessness of movement and impulsiveness are often incorrectly associated with an attention deficit hyperactivity disorder (ADHD). Accordingly, parents who are suspected of having obstructive sleep apnea should see a pediatrician promptly and have the child examined in a children's sleep laboratory. It is important not to waste any time, because while the respiratory disorder is usually easy to treat, possible developmental disorders due to disturbed sleep cannot simply be "erased". (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


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ICD codes for this disease: G47.3ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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