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Sleep Disorders

Sleep Apnea Sounding Like Respiratory Failure

04/02/2007

Question:

Is it normal to sound like you`re in respiratory failure when waking up from an apnea event instead of gasping? If not, what would cause that? Breathing decreases in my sleep w) hypoxemia, oxygen level drops down to 84%.

Answer:

The term “respiratory failure” may represent different symptoms for different people. The range of symptoms often associated with this term include: shortness of breath, difficulty breathing, anxiety, fatigue, chest pain, chest tightness, heaviness, wheezing, and gasping. It is not unusual for people with sleep apnea to experience many of these symptoms related to waking up at night. However, sleep apnea is not the only reason for these night-time symptoms. There are many conditions that cause such sensations and these include: lung diseases (like asthma and emphysema), heart disease (like congestive heart failure), and other problems (like gastroesophageal reflux disease and panic attacks). This is only a short list.

There are two types of sleep apnea: obstructive and central. Both can result in the symptoms you describe and low oxygen levels during sleep. Obstructive sleep apnea is the most common type and it occurs when the back of the throat relaxes with sleep leading to airway collapse and apnea. Causes of worsening of collapse are being overweight, having large tonsils, a large tongue, and abnormal jaw anatomy or nasal anatomy. When the airway collapses in obstructive sleep apnea, the brain and body protect themselves by making the individual briefly awaken in order to resume normal breathing. Loud snoring often accompanies this type of sleep apnea.

Central sleep apnea is much less common. In central sleep apnea, there is generally a lack of effort to breath during sleep. The brain fails to send the signal to breath and individuals will stop breathing for several seconds at a time before resuming normal respirations. This condition may be seen in individuals who have had a stroke or who have advanced heart failure, although in some individuals no cause is identified. A number of treatment options are available for obstructive and for central sleep apnea, and will depend upon associated conditions and other clinical factors.

Based on the information you provided, your problem should be further evaluated. A thorough medical interview, a physical exam and simple breathing tests can determine if there are reasons other than sleep apnea for the symptoms and hypoxia you are experiencing at night. I recommend you discuss your problems with your doctor. Evaluation by a Sleep Specialist may be necessary to determine how best to evaluate and treat your problem.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it Good luck, and sleep well.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University