Breathing and Sleep Disorders Explained

Disordered breathing during sleep is common, under-diagnosed, and often treated as a snoring problem when it is a nasal airway problem. This sets out the distinct conditions involved, how they are diagnosed and what the treatment options are.

What these disorders are

Breathing and sleep disorders cover a range of conditions from snoring and insomnia to obstructive sleep apnoea and low blood oxygen. They disrupt normal breathing patterns during sleep, leading to poor sleep quality and a range of related health problems.

Obstructive sleep apnoea

The most common breathing-related sleep disorder. It occurs when the muscles at the back of the throat relax excessively during sleep, blocking airflow and causing pauses in breathing. These pauses can last from a few seconds to a minute or more, and often occur many times through the night. In more severe cases they cause significant drops in blood oxygen.

Central sleep apnoea

Unlike obstructive apnoea, central sleep apnoea results from a failure in the brain’s signals to the muscles that control breathing. It is less common but can be equally problematic, causing fatigue and cardiac complications.

Insomnia

Insomnia is difficulty falling asleep or staying asleep, often related to anxiety, stress or other underlying conditions. Chronic insomnia leads to daytime sleepiness, cognitive impairment and long-term health risks.

Causes

Weight

Excess weight, particularly around the neck, increases the likelihood of airway obstruction during sleep because of tissue that narrows the throat.

Age

The muscles of the throat and mouth tend to weaken with age, increasing the risk of airway obstruction.

Nasal congestion and allergy

Chronic nasal congestion or conditions such as sinusitis make breathing through the nose difficult, leading to mouth breathing during sleep. This worsens snoring and contributes to the development of sleep apnoea.

Alcohol and sedatives

Alcohol and sedative medication relax the muscles of the throat, increasing the likelihood of airway collapse during sleep.

Smoking

Smoking irritates the airways, causing inflammation and increasing the likelihood of sleep apnoea. It also worsens breathing difficulty in existing respiratory conditions.

Family history

A family history of sleep disorders increases individual risk. Genetics play a significant role in the development of conditions such as sleep apnoea.

Chronic conditions

Heart disease, diabetes and high blood pressure are frequently associated with breathing and sleep disorders.

Symptoms

Loud snoring

One of the most common signs of sleep apnoea. Snoring occurs when air passages become partially blocked, causing the throat tissues to vibrate.

Daytime sleepiness

Excessive tiredness during the day despite adequate hours in bed. Persistent fatigue leads to poor concentration, memory problems and mood disturbance.

Breathing pauses or gasping

Interruption of normal breathing during sleep is the hallmark of sleep apnoea. Episodes of choking, gasping or waking abruptly unable to breathe are significant findings.

Dry mouth or sore throat

Waking with a dry mouth or sore throat often results from mouth breathing during sleep, particularly with nasal congestion or apnoea.

Restlessness and frequent waking

Insomnia and other sleep disorders lead to restless sleep and frequent waking during the night.

Diagnosis

Sleep studies

Polysomnography is the comprehensive test used to diagnose sleep apnoea and other sleep disorders. Sensors monitor brain activity, heart rate, breathing patterns, oxygen levels and muscle movement during sleep. This data establishes the type and severity of the disorder.

Home sleep tests

For less severe cases, home sleep testing monitors airflow, oxygen levels and other factors related to sleep apnoea and can be done at home.

Pulmonary function tests

These assess the overall health of the lungs and airways and may be relevant where sleep problems relate to underlying respiratory disease.

Imaging

X-ray or CT may be used to assess the structure of the airway and identify obstruction or anatomical problems contributing to breathing problems during sleep.

Treatment

CPAP

Continuous positive airway pressure is the most common treatment for obstructive sleep apnoea. A machine delivers a continuous stream of air through a mask, keeping the airway open during sleep. It is effective for most people with moderate to severe apnoea.

BiPAP

For patients who cannot tolerate CPAP or who have more complex forms of apnoea, bi-level positive airway pressure adjusts the pressure separately for inhalation and exhalation.

Oxygen therapy

Where low blood oxygen results from sleep apnoea, supplemental oxygen may be prescribed to maintain adequate levels during sleep, sometimes alongside CPAP or BiPAP.

Medication

For insomnia, medication may help with falling and staying asleep. These are typically short-term and are used under medical supervision.

Behavioural therapy

Cognitive behavioural therapy for insomnia is a non-pharmacological treatment that addresses the thoughts and behaviours affecting sleep. It is particularly effective for chronic insomnia.

Oral appliances

Mandibular advancement devices are worn during sleep and hold the airway open by repositioning the lower jaw. They are used in milder sleep apnoea.

Surgery

Where structural problems contribute to obstruction, surgery may be indicated — correcting a deviated septum, or addressing nasal obstruction that is forcing mouth breathing. Surgical options are typically considered after other treatments have been tried.

Lifestyle measures

• Weight management — losing excess weight can reduce the severity of sleep apnoea.
• Sleep position — sleeping on the back can worsen snoring and apnoea; side-sleeping reduces airway obstruction.
• Alcohol and sedatives — reducing or eliminating alcohol intake improves sleep quality.
• Stopping smoking — reduces airway irritation and improves lung health.
• Managing stress — relaxation techniques help where anxiety contributes to insomnia.

Conclusion

Breathing and sleep disorders are treatable, but treatment depends on correct diagnosis of which condition is present. A sleep study is the starting point. Where a structural nasal problem is contributing, surgical correction may form part of the plan alongside the medical treatments above.