When Your Breathing Stops in Your Sleep

If you happen to be a firsthand witness, it can be a little scary to realize someone has stopped breathing during sleep. While several things can make your breathing stop while you're asleep, a common cause is sleep apnea. People often ask, "Can sleep apnea kill you?" The answer is that it can have numerous short-term and long-term health consequences and yes, some of them can be life-threatening.

Causes of Breathing Stopping During Sleep

Sleep-related breathing disturbances are fairly common. The most familiar one to most people is snoring. The characteristic sound is caused by vibration in the tissues of your upper airway while you breathe.

It is also possible for you to completely stop breathing for a while. These breathing pauses are called sleep apnea, from the Greek for “no breath.” By definition, apnea events last at least 10 seconds, but they can stretch on for several minutes.

The most common cause of apnea is the sleep disorder known as obstructive sleep apnea (OSA). OSA occurs when the tissues of the upper airway—the tongue, soft palate, and uvula—collapse into the throat and block the normal airflow.

Your body may still make an effort to breathe, with the chest and abdomen moving, but the air can't get past the obstruction. As a result, airflow through your nose and mouth is reduced or cut off during these periods.

Other potential causes of disturbed breathing during sleep are less common. They include:

• Central sleep apnea: Pauses in breathing are caused by the brain temporarily failing to tell the respiratory muscles to work. This can be caused by a problem with the brainstem, severe obesity, and medications including opioid painkillers.
• Cheyne-Stokes respiration: Alternating heavy and shallow breathing and pauses in breathing are associated with severe heart failure and neurological disorders including dementia.
• Congenital central hypoventilation syndrome (Ondine's curse): Shallow breathing, especially during sleep, leads to an oxygen shortage and excess carbon dioxide in the blood. The condition is usually due to nervous system impairment.

How Breathing Resumes

With improper breathing, the blood’s oxygen levels drop. The brain senses that inadequate breathing is occurring, with increased carbon dioxide levels, and stimulates an awakening.

These awakenings are associated with episodes of increased heart rate and blood pressure and can lead to other problems over the long term. When you experience it, you may wake up gasping or choking, and your partner may witness a loud snort and movement as you come out of deep sleep

When Does Sleep Apnea Become Serious?

The severity of sleep apnea varies. It's thought to be normal for pauses in breathing to occur up to five times per hour in adults and once per hour in children. These events may even occur as part of normal sleep-stage transitions.

If breathing disruptions occur more frequently, a sleep study may diagnose OSA. The following categories are used to classify sleep apnea based on the apnea-hypopnea index (AHI):

• Mild: 5-14 events per hour
• Moderate: 15-30 events per hour
• Severe: More than 30 events per hour

It is also important to recognize the degree of oxygen deprivation that occurs with these events. When oxygen levels fall below 90%, this is called hypoxemia.

In the setting of heart or lung disease, the oxygen levels may drop drastically with each apnea event. As a result, there can be greater stress placed on the body overnight. Chronic oxygen deprivation may lead to both short-term and long-term effects.

Can Sleep Apnea Kill You?

It's extremely unlikely that the breathing pauses of sleep apnea itself could cause death. In other words, you won't just stop breathing permanently. OSA can, however, increase your risk of potentially fatal short-term and chronic health conditions, some of which may cause sudden death.

Short-Term Risks

Breathing stoppages may provoke a cardiac arrhythmia that leads to cardiac arrest. It can also lead to atrial fibrillation, heart attack (myocardial infarction), and even stroke.

These events seem to increase toward morning, which is coincidentally when REM sleep occurs more commonly and when more sleep apnea is apt to occur. Studies suggest the relative risk of sudden death during sleep between midnight and 6 a.m. is about 2.5 times higher for people with OSA.

The good news is that treatment with CPAP (a continuous positive airway pressure machine) appears to lower the risk of most serious complications and the chances that OSA will lead to long-term cardiac problems.

Chronic Risks

Evidence shows that long-term sleep-disordered breathing can have important health consequences. It may increase the incidence of high blood pressure (hypertension), diabetes, and heart problems.

It's also associated with depression and memory problems like Alzheimer’s disease. It increases daytime sleepiness and may contribute to accidents.

So while OSA isn't fatal on its own, many of the problems it can lead to can threaten your life. That makes treating sleep apnea important for protecting your health.

When to See a Healthcare Provider

If you or someone you love experiences recurrent pauses in breathing, you should seek medical evaluation. Don’t dismiss breathing disturbances in sleep as inconsequential; over time, serious problems can develop.

Other symptoms or signs may point to the diagnosis, but a sleep study will give you a definitive answer as to the cause. Fortunately, effective treatment options are available, including the use of CPAP or an oral appliance.

Speak with your healthcare provider and get the treatment you need to breathe and sleep better. You’ll be glad that you did.