Breath failure - causes and therapy

Breathing interruptions in sleep

If breath breaks occur again and again in the night, medicine usually speaks of "sleep apnea" or "sleep apnea syndrome". This is a so-called "respiratory regulation disorder" in which breathing is continually interrupted for a few seconds during sleep, making healthy, deep sleep impossible. As a result, sufferers suffer from, among other things, chronic daytime tiredness and difficulty concentrating. In addition, the risk of heart attack, hypertension and other serious diseases increases. Accordingly, a doctor should be consulted for typical signs such as heavy snoring with irregular breaks and chronic daytime fatigue. Often it already helps those affected to abstain from nicotine or to reduce excess weight. In addition, there are a number of other treatment options, such as special masks that usually treat the breathing problems well.

contents

• Breathing interruptions in sleep
• Exposing respiration / sleep apnea: definition and symptomatology
• Causes of breathing disorders during sleep
• What does the doctor do when breathing??
• Treatment for obstructive sleep apnea syndrome
• Breathing interruptions in children and babies

Exposing respiration / sleep apnea: definition and symptomatology

The term "respiratory misfire" usually describes the relatively common so-called "sleep apnea" (or "sleep apnea syndrome"). Characteristic of this breathing disorder are loud and irregular snoring and sleep pauses, which last more than five times an hour and more than ten seconds each. As a result, the body raises "alarm" by inducing a wake-up response for those affected to catch their breath. Although these do not wake up, the so-called "hyperventilation phases" lead to a disturbed sleep rhythm with far-reaching consequences, which include above all an extreme daytime sleepiness ("microsleep"), impaired concentration and reduced performance.

Snoring and breathing are often not only a burden for those affected, the partners also suffer. (Image: Andrey Popov / fotolia.com)

Some patients with sleep apnea also suffer from anxiety, mood or depression, as well as morning headaches, dizziness, decreased sexual desire and potency problems. In quite a few cases, sleep apnea also leads to very serious or even life-threatening symptoms, as the lack of oxygen increases the risk of hypertension and cardiovascular diseases, which can lead to a stroke or heart attack in an emergency.

The dangerous breathing misfires at night are not a rare phenomenon dar. Rather, the syndrome, according to the German Society of Sleep Medicine in this country about two to four percent of the adult population are affected, is one of the most common sleep disorders.

Causes of breathing disorders during sleep

In the vast majority of cases, respiratory murmurs are caused by a so-called "obstructive sleep apnea syndrome". In this occurs during sleep, a relaxation of the pharyngeal muscles, whereby the upper respiratory tract partially or even completely blocked. As a result, the body is no longer supplied with sufficient oxygen and there is a sudden drop in heart rate and blood pressure. The brain sounds the alarm and triggers a wake-up reaction ("arousal"), causing those affected to wake up for a moment. Although waking up is not usually consciously perceived, sleep is interrupted again each time, increasing heart rate and blood pressure. Sleep apnea people are woken up in this way up to several hundred times a night, making healthy, deep sleep impossible.

The causes of nocturnal constriction or blockage of the upper respiratory tract are manifold and complex. In addition to a genetic disposition, e.g. Special features in the mouth and throat such as enlarged tonsils, crooked nasal septums, polyps, too large a soft palate or too small a lower jaw, the reason his. Severe forms of sleep apnea often occur in connection with Down syndrome (trisomy 21) or other congenital malformations such as the so-called "Pierre-Robin sequence" on. In these cases, abnormalities such as an enlarged tongue or an oversized suppository (uvula hyperplasia) often restrict the airways and cause nocturnal breathing interruptions.

A major risk factor is (overweight) obesity, and smoking, as well as the consumption of alcohol, sleep aids and sedatives, can cause the muscles to relax and their breathing to be disturbed. Age also seems to play a role, because women in particular often develop the respiratory disorder only after menopause, which is probably due to the increasingly drowsy tissues of older people. Sleeping supine may increase snoring and disturbed breathing, but is not usually responsible for the problem.

In very rare cases, the respiratory murmur may also be caused by a so-called "central sleep apnea". This is triggered by a malfunction in the central nervous system and usually occurs in people with pre-existing conditions such as heart failure or circulatory disorders of the brain (for example after a stroke). Unlike obstructive sleep apnea syndrome, although the upper airways are not obstructed in this form, the respiratory muscles of the chest and diaphragm are limited in their ability to provide adequate oxygenation to the body. As a result, it also comes here during sleep again and again to wake-up reactions, which among other things leads to permanent daytime sleepiness, difficulty concentrating and poor performance.

What does the doctor do when breathing??

If there is a suspicion of obstructive sleep apnea syndrome, the doctor can often make a relatively clear diagnosis based on the described symptoms and the description of the habits of life. Accordingly, the patient is normally first asked to provide as much detail as possible about his personal medical history (anamnesis). Important questions include: "Are medications taken?", "Are pre-existing diseases known?", "What is your own sleeping habits?". In addition, a general physical examination is usually carried out, and a portable measuring device can be used to examine sleep.

If abnormalities occur in the examination of respiration, heart rate, oxygen saturation in the blood, etc., a referral to a so-called "sleep laboratory" brings definitive clarity. Here, the patient spends one or more nights in a specially equipped room, where, among other things, the respiratory rate, heart rate, brain movements, eye and leg movements are registered during sleep. Finally, the results can be used to calculate how severe the sleep apnea is. The measure used is the so-called "apnea-hypopnea index" (AHI), which indicates the average number of respiratory misfires and times with reduced respiratory flow (hypopnea) per hour of sleep. In mild cases, this index is less than 5 (breathing pauses) per hour; obstructive sleep apnea syndrome is considered to be "severe" above 30.

Treatment for obstructive sleep apnea syndrome

If breath breaks occur again and again 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 and restore normal breathing. The specific therapeutic measures depend on the individual impairment of the affected persons and the possible benefits of the procedure. In light respiratory distress often helps in overweight patients already a weight reduction, as well as a change in the living and sleeping habits can cause a small miracle. This includes, above all, the renunciation of alcohol and nicotine, in addition it can be beneficial if, instead of sleeping on the back in a lateral position.

In most cases, the treatment of choice is the so-called "CPAP mask" ("Continuous Positive Airway Pressure"), which patients wear during their sleep. This "breathing mask" is connected via a hose with a type of compressor, which creates an overpressure and thus ensures that the respiratory tract can no longer close. In principle, a very good treatment success can be achieved by this method - but many patients feel the device as unpleasant and disturbing, moreover, the mask does not always work properly.

With a special breathing mask, the nocturnal breathing mishaps and their health consequences can usually be avoided. (Image: BVDC / fotolia.com)

An effective alternative could be a "tongue pacemaker" in these cases, which is currently being tested in clinical trials. This is - like a pacemaker - placed under the collarbone of those affected and has two functions: First, a cable, which leads to the costal arch, measured the breathing movement. At the same time, the neurostimulator ensures that if the current pulses are too weak, the tongue muscle becomes tense and the respiratory tract remains free to breathe. To what extent the therapy will prevail remains to be seen. Because it shows so far very good results, but is also relatively complex and expensive. Moreover, it does not come into consideration for all those affected because an operative procedure is e.g. excluded if you are overweight or have heart disease.

In addition to the CPAP mask, the treatment of obstructive sleep apnea may involve a number of other measures, such as nasal plasters or bite splints, depending on the symptoms. In more severe cases, surgical intervention may be indicated to correct the cause of the respiratory disorder. Possible here are e.g. the tightening of the soft palate or the removal of enlarged palatine tonsils (tonsillar hyperplasia). On the other hand, medications do not currently play a role in treatment, as it has not yet been scientifically proven that any of the available resources could be used.

The reduction of existing overweight can in many cases already cause a significant reduction in nocturnal breathing mishaps. (Picture: JPC-PROD / fotolia.com)

Self-help with snoring and breathing interruptions
Often, maintaining proper sleep hygiene can greatly alleviate or even eliminate respiratory failure. This means all measures that have a positive effect on the quality of sleep, because the body can only really regenerate under certain circumstances. It may be helpful, e.g. even be if sufferers sleep on the page. Because the supine position favors snoring and respiratory disorders, as the posterior heavier part of the tongue slips towards the throat due to gravity and narrows the airways. In order to maintain the lateral position during sleep, it may be useful, e.g. To place a small pillow in the back, which makes for an unpleasant feeling when rolling back. Alternatively, elevation of the upper body (e.g., with the aid of a thick pad) can provide improved breathing.

It is also important to get the body used to a well-regulated sleep-wake cycle and, accordingly, to go to bed at the same time every day. The bedroom should be as charm as possible designed, well ventilated and not too heated. Rather, experts recommend an ideal sleep temperature of up to 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 oää. be drunk more. Calming and sleeping pills should also be avoided, as they can slow down breathing. At dinner, it is advisable to choose a light diet and not take it too late, so as not to burden the body even more.

Breathing interruptions in children and babies

Even children can be affected by snoring and respiratory arrest. In this case, mostly enlarged tonsils or polyps are the cause, but are possible, for example. also overweight or frequent inflammations in the area of ​​the throat. The sleep apnea manifests itself as in adults: In response to the breath interruption, the child takes a particularly deep breath, which is noticeable as a loud snoring sound. The little patients will not be able to remember the wake-up reactions the next morning, but the consequences of the sleep being interrupted and the limited supply of oxygen are profound. Among other things, concentration weakness, daytime sleepiness and listlessness are typical. In addition, many young people suffer from hyperactivity, aggression, delayed sleep development, failure to thrive and an increased susceptibility to infection. Other signs that should definitely be taken seriously include snoring and generally restless sleep, e.g. an unusual sleeping position, heavy night sweats and a dry mouth in the morning.

Particularly problematic is that especially symptoms such as pronounced Zappeligkeit, Bewegungsunruhe and impulsivity are often falsely associated with an attention deficit / hyperactivity disorder (ADHD). Accordingly, if a suspected obstructive sleep apnea is suspected, parents should consult a pediatrician promptly and have the child examined in a childrens sleep laboratory. Here, there is no time to lose, because while the respiratory disorder is usually easy to treat, possible developmental disorders due to disturbed sleep can not be "erased". (No)