Sleep apnea shortness of breath

Why do I wake up gasping for air?

An individual may wake up gasping for air for a variety of reasons, including:

Obstructive sleep apnea

Share on PinterestSleep apnea may be treated using a CPAP machine.

Sleep apnea refers to involuntary pauses in breathing during sleep. The two main types are:

  • Central sleep apnea, which is caused by signaling problems in the brain.
  • Obstructive sleep apnea, which occurs when a blockage in the airway stops airflow.

According to the National Sleep Foundation, around 18 million adults in the United States have obstructive sleep apnea.

A person may be unaware that they have the condition until someone informs them that they snore and gasp for air while asleep. When the person gasping catches their breath, they may not fully awaken.

Additional symptoms of sleep apnea include:

  • morning headaches
  • daytime tiredness
  • memory problems
  • fatigue
  • irritability

Anxiety

Anxiety can lead to panic attacks, and when they occur at night, a person may wake up gasping for air. According to the Anxiety and Depression Association of America, around 70 percent of people with anxiety disorders report difficulty sleeping.

Other symptoms of anxiety include:

  • restlessness
  • feelings of dread or worry
  • a fast heart rate
  • panic
  • difficulty concentrating

Asthma

Asthma is a chronic condition that causes inflammation in the airways. Nocturnal asthma is the medical term for having symptoms while sleeping. When the condition is poorly controlled, nocturnal asthma is common.

Additional symptoms of asthma include:

  • coughing
  • wheezing
  • feeling unable to catch a breath
  • tightness in the chest

Chronic obstructive pulmonary disease (COPD)

COPD occurs when small air sacs in the lungs are damaged. These sacs, called alveoli, become floppy, making it difficult to push air out of the lungs.

Symptoms can occur while a person is sleeping. They may wake up gasping or feel as if they are suffocating.

Other symptoms of COPD include:

  • wheezing
  • excess mucus
  • coughing
  • fatigue
  • tightness in the chest

Heart failure

Share on PinterestThough waking up gasping for air is often due to respiratory problems, heart failure may also be a cause.

When the heart is not pumping blood as efficiently as it should, this is called heart failure.

Abnormal heart valves, a history of a heart attack, and coronary artery disease can all lead to heart failure.

Shortness of breath is one of the most common symptoms. At first, a person may only notice it during physical activity. As the condition progresses, a person may develop shortness of breath while resting or sleeping.

A person with heart failure may also experience:

  • fatigue
  • swelling of the feet and legs
  • chest pain
  • abdominal swelling

Post-nasal drip

Mucus and saliva produced throughout the day typically flow to the back of the nose and throat and are swallowed. A person may be unaware of this process.

Post-nasal drip occurs when this mucus accumulates and trickles down the back of the throat.

As the mucus builds up, a person may feel like they cannot breathe. If they are asleep, they may wake up gasping for air.

Gastric reflux disease, sinus infections, and allergies are all common causes of post-nasal drip.

Additional symptoms include:

  • bad breath
  • a sore throat
  • a bad taste in the mouth
  • coughing

Central Sleep Apnea During the Day

Central Sleep Apnea (CSA) is a condition characterized by interruptions in breathing during sleeping and resting hours. This sleep disorder can either be present from birth, which is known as Congenital Central Hypoventilation Syndrome (CCHS), or be acquired later in life. Central Sleep Apnea functions very differently than Obstructive Sleep Apnea. Central Sleep Apnea stems from the brain not sending the appropriate signals to breathe, whereas Obstructive Sleep Apnea is caused by physical obstruction to the airway. Central Sleep Apnea is much rarer than Obstructive Sleep Apnea and some patients experience symptoms during periods of rest as well as while asleep.

What is CCHS?

Researchers have found that Congenital Central Hypoventilation Syndrome is a congenital condition caused by a mutation in the PHOX2B gene. This gene’s job is to encourage the growth of nerve cells and ensure that the nerves are assigned a specific function. In the autonomic nervous system, the nerves affected by this mutation include those responsible for regulating breathing.

According to the National Institutes of Health, this disorder is very rare, with only 1,000 patients identified worldwide. It is believed that some children who die from Sudden Infant Death Syndrome (SIDS) may have had undiagnosed CCHS. Children can either develop this from a parent, which has become more common as CCHS patients are more frequently living into adulthood, or have a mutated gene. The latter reason accounts for 90% of cases.

Characteristics of CCHS

CCHS is characterized by breathing difficulties. Those who have the condition hypoventilate, or take very shallow breaths, which is worsened during sleep. Though most people view the condition as more severe at night, patients may also have breathing difficulties while awake. The result of these shallow breaths is that there is an increase in carbon dioxide in the blood and a decrease in critically needed oxygen. Normally, the autonomic nervous system regulates consistent involuntary breathing. In patients with CCHS, this involuntary function is not working. The brain “forgets” to tell the patient to breathe. For these patients, an Avery diaphragm pacemaker may be a lifesaving device.

Central Sleep Apnea

With CSA, like CCHS, the brain lacks the ability to send signals to the diaphragm to breathe. Unlike CCHS, which is acquired, CSA develops during a person’s lifetime. It is typically caused by another health condition that impacts the brainstem. Because the brainstem is in control of sending signals to breathe, if there is any damage to this area, it is likely that breathing will be impaired.

Some of the ways patients develop CSA include:

  • Stroke
  • Brain tumor

Characteristics of Central Sleep Apnea

While the patient is sleeping, his or her breathing stops cycling normally. The periods where the brain does not signal the body to breathe, called apneas, last for one to two minutes. After the periods of not breathing, the body then tries to overcompensate for the lack of oxygen by breathing faster for a period of time, known as a hyper-apnea. Depending on how long the apneas are, the damage CSA can cause may vary from person to person. When breathing is stopped for extended periods of time, brain damage may occur. Other risks caused by lack of oxygen to the brain include seizures, strokes or heart attacks.

CSA patients have an excess of carbon dioxide in the blood, presenting lingering side effects like difficulty breathing throughout the day. A malfunctioning brainstem is the root of the cause, in addition to the lower carbon dioxide levels. Though difficulty breathing during the day is possible, the most severe symptoms of Central Sleep Apnea happen during the night, as the autonomic nervous system operates differently during wakefulness than during sleep.

Patients with Central Sleep Apnea may experience daytime sleepiness and headaches as a result of their interrupted sleep cycles. They may also have difficulty concentrating and feel weak throughout the day. Being overly tired during the day can be how patients discover they are periodically not breathing during the night.

Treatment for CCHS/Central Sleep Apnea

Because Central Sleep Apnea is often the result of another medical condition, the primary condition is typically treated first, in the hope that it will correct the breathing difficulties. When this is not possible, an Avery Breathing pacemaker may be an alternative to other forms of ventilation.

The Avery Biomedical Diaphragm Pacing System is a helpful option for patients with Central Sleep Apnea. The diaphragm pacing system is implanted surgically and stimulates the phrenic nerve which signals the diaphragm to contract at a normal rate. Because patients with Central Sleep Apnea never know when the apneas will occur, the pacemaker is consistently helpful, removing the risk of a lack of oxygen.

Symptoms That Mean You May Have Sleep Apnea and Should Get Screened

Ignoring Sleep Apnea Symptoms May Put More Than Your Own Health at Risk

Sleep apnea symptoms can be similar to symptoms of lots of other medical conditions, or may be ignored and chalked up to things like work stress, having a busy schedule, or having a lot going on with the family. But doctors urge people not to overlook or disregard symptoms.

If it’s not sleep apnea, your doctor may be able to help correctly diagnose another medical problem if there is one — or help you find ways to deal with stressors in your life that cause you to feel the way you do.

And if it is sleep apnea, your doctor can help diagnose the problem and help you get the treatment you need before the condition starts causing complications — and before the sleepiness and fatigue associated with sleep apnea leads to an accident that could harm you or others.

RELATED: Sleep Apnea Correlates With Injury on the Job

“When sleep apnea is untreated, an individual has a two-and-a-half-times increased risk of having a motor vehicle accident,” says James Rowley, MD, a professor of medicine at Wayne State University School of Medicine in Detroit and a member of the board of directors of the American Academy of Sleep Medicine (AASM). That’s according to data published in the March 2015 issue of the journal Sleep. (9) “It’s the equivalent of driving drunk,” Dr. Rowley says.

Truck drivers are known to be at a particularly high risk for sleep apnea. In part that’s because certain factors that characterize a high number of truck drivers, such as being middle-aged, male, and obese, are also risk factors for sleep apnea. (10)

Research published in the May 1, 2016, issue of the journal Sleep specifically looked at truck drivers’ accident risk. Those with sleep apnea who didn’t follow their recommended treatments were five times more likely to crash than drivers without sleep apnea. (11)

It’s a serious problem, many sleep medicine experts, public health officials, and others have said, because commercial automobile accidents tend more often to be fatal or serious than noncommercial automobile accidents. (12)

“Truck drivers with untreated obstructive sleep apnea are at dramatically greater risk of serious, preventable truck crashes, consistent with the greatly increased risk of motor vehicle crashes among automobile drivers with untreated obstructive sleep apnea,” said one of the study’s co-authors, Charles A. Czeisler, PhD, MD, the chief of the division of sleep and circadian disorders at Brigham and Women’s Hospital and the Baldino Professor of Sleep Medicine at Harvard Medical School in Boston, in a press release when the study was published. (13)

Despite these risks, the current guidelines for screening truck drivers and other commercial vehicle operators are lax. In a November 2017 letter to the Federal Motor Carrier Safety Administration (FMCSA) and the Federal Railroad Administration (FRA), AASM urged the two agencies to improve current guidelines and sleep-apnea screening procedures for drivers and other personnel who hold positions that can affect public safety in highway and rail transportation. The Federal Aviation Administration has in recent years implemented requirements to screen their pilots for sleep apnea. (14)

Yet, in January 2017, the U.S. Preventive Services Task Force (USPSTF) released a recommendation against screening for obstructive sleep apnea (OSA) in asymptomatic adults (even when those asymptomatic individuals were at high-risk for sleep apnea), citing insufficient evidence to do so. (15)

In response, the AASM, which recommends screening patients who have a high risk for OSA even if they don’t report any sleep-related symptoms, said that primary care providers should identify patients who have a high risk for OSA (such as people who have type 2 diabetes, obesity, or hypertension) and should screen them for OSA, not only to improve the quality of life and health outcomes for those individuals, but also to benefit the public. (16) AASM noted that diagnosing and treating every patient in the United States who has OSA would save an estimated $100 billion a year.

CPAP machine. This device includes a mask that you wear over your nose, mouth, or both. An air blower forces constant air through your nose or mouth. The air pressure is just enough to keep your upper airway tissues from relaxing too much while you sleep. A similar device is the BPAP, which has two levels of air flow that change when you breathe in and out.

Oral devices. If you have mild sleep apnea, you might get dental appliances or oral “mandibular advancement” devices that keep your tongue from blocking your throat or bring your lower jaw forward. That may help keep your airway open while you sleep. A trained dental expert can decide which type of device may be best for you.

Surgery. This is for people who have extra or uneven tissue that blocks airflow through the nose or throat. For example, if you have a deviated nasal septum, swollen tonsils, and adenoids, or a small lower jaw that causes your throat to be too narrow, surgery might help you. Doctors usually try other treatments first.

Types of surgery for obstructive sleep apnea include:

Upper airway stimulator. This device, called Inspire, has a small pulse generator that your surgeon puts under the skin in your upper chest. A wire leading to your lung tracks your natural breathing pattern. Another wire, leading up to your neck, delivers mild signals to nerves that control your airway muscles, keeping them open. You can use a remote to turn it on before bed and turn it off in the morning.

Somnoplasty. Your doctors uses radiofrequency energy to tighten the tissue at the back of your throat.

UPPP, or UP3. This procedure takes out soft tissue in the back of your throat and palate, making your airway wider at your throat opening. (UPPP stands for uvulopalatopharyngoplasty.)

Nasal surgery. These operations correct obstructions in your nose, such as a deviated septum (when the wall between your nostrils is off-center).

Mandibular/maxillary advancement surgery. Your doctor moves your jawbone and face bones forward to make more room in the back of your throat. It’s a complex procedure used only for people who have severe sleep apnea and problems with their head or face.

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