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Sleep Disorders

Having Dreams That I Can`t Breathe

03/03/2009

Question:

Sometimes at night I have dreams that I cant breathe. Sometimes I wake up gasping for air. Normally I sleep with my mouth open. I have sinusitis.

Answer:

This is an interesting question that raises the issues as to whether you are experiencing a dream disorder or an actual problem with breathing in your sleep. Based on the information you have provided and the fact that breathing problems in sleep are generally more common than dream disorders, I would be suspicious that you may have a sleep-related breathing problem. However, you will need a complete history and physical examination, coupled with possible objective testing, to determine the underlying cause of your problems. Once a diagnosis is made, then effective treatment should be available for you.

Breathing problems in sleep range from sleep apnea, where an individuals upper airway collapses during sleep, to problems related to asthma, post-nasal drip, heartburn (or reflux disease), heart failure, or spasm of the vocal cords. Based on the limited information in your question, it’s possible you could have one of these conditions and obstructive sleep apnea (OSA) is a definite consideration.

OSA is defined as repetitive episodes of airway narrowing or collapse during sleep. During sleep, the muscles supporting the upper airway in the back of the throat tend to relax. When individuals with a narrowed airway to start with fall asleep, this muscle relaxation may be enough to cause significant narrowing or collapse of the tissue in the back of the throat. A narrowed airway is most commonly the result of being overweight as fatty tissue tends to deposit in the tissues of the airway. Other causes of a narrowed airway may include large tonsils (a very common cause of sleep apnea in children), a large tongue, and abnormal jaw anatomy or nasal anatomy. If your nose is recurrently blocked or congested, this may place you at risk for OSA.

When the airway collapses in OSA , the brain and body protect themselves by making the individual briefly awaken (most people who do this are not aware of this happening) and opening their airway to allow for normal breathing. Unfortunately, as they fall back asleep, the process of airway closure tends to repeat over and over. These recurrent awakenings fragment or break up sleep, resulting in poor sleep, a lack of feeling refreshed after sleep and daytime sleepiness. Other symptoms of OSA may include a sense of choking or gagging at night, morning headaches and restless sleep. Loud snoring often accompanies the sleep disordered breathing.

If you are experiencing these symptoms, it is best to have a full sleep evaluation. Not only does the poor sleep affect quality of life, but OSA has now been linked to numerous other problems if it goes unrecognized and untreated for a prolonged time period. Most concerning of these conditions are high blood pressure and cardiovascular disease (for example stroke and heart disease). OSA is treatable by a number of methods and the type of treatment best suited for each individual depends on a number of factors.

There are some dream-related conditions in which individuals experience a sense of not being able to breathe, though these are generally not associated with nasal issues or oral breathing. Probably most common of these would be sleep paralysis, in which the individual describes an inability to perform voluntary movements either at sleep onset or upon awakening. Individuals often report an inability to speak or move the limbs, trunk or head. While breathing is actually not affected, the sensation of not being able to breath can accompany the paralysis and can be quite scary. Most individuals will recall the events. The episodes usually only last for seconds up to a few minutes and tend to resolve on their own. Occasionally, the episode will end if the person is touched or spoken to. While most of the time sleep paralysis is not associated with other medical conditions, it can be one of the signs of narcolepsy (individuals with this condition are also very sleepy).

Sleep paralysis usually first appears in young adults and tends to disappear with aging. Surprisingly, up to 15-40% of young adults experience this at least once in their lifetime and as many as 5-6% have this occur recurrently. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

It would probably be a good idea to discuss your problems with your primary doctor. Referral to a Sleep Specialist in your area may be useful. To learn more about sleep apnea or other sleep disorders, please visit the American Academy of Sleep Medicine's website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you.

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University