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Sleep Disorders

I Can`t Breathe the Moment I`m About to Sleep

06/21/2010

Question:

Over the past couple of weeks I`ve had 3 nights when I`m trying to go to sleep and my breathing slows right down to the point when I either stop breathing or am not breathing in enough air. It always happens the moment I am about to get to sleep and then I jolt back into alertness so that I can breath normally again. I have asthma, but I don`t think this has anything to do with it. It`s not difficult to breathe. I don`t feel constricted in my breathing. It`s just as if my body doesn`t want to breathe anymore.

I looked this up online and it seems that this is a lot like sleep apnea, however I am lost as to what might cause it so I am wondering if it could be something else. I am not overweight, I am 19 years old, I don`t snore (I am pretty sure) and I have no other sleep disorders (at least no symptoms that suggest anything I`m aware of). The only incident that I`ve had in the past which I`d only had for 2 nights and then went away was being very dizzy before getting to sleep.

Thank you for any help.

Answer:

This is an interesting question and there are a number of possible explanations for your symptoms. However, based on the limited information in your question, it’s hard to know exactly what the cause of your symptoms may be. The possible explanations for the symptoms you describe could be related to a primary sleep disorder associated with either breathing in sleep or a possible parasomnia (unusual behaviors or sensations associated with sleep or with falling asleep). It’s also possible that your symptoms may be related to your underlying asthma or that you have an underlying psychological / psychiatric problem such as anxiety. You will need further evaluation to help sort his out and I recommend you seek the help of a sleep specialist. Having said that, I will comment on some of your symptoms and hope this is of some help.

If this is a true breathing problem associated with sleep, then this could be one of a number of problems, including obstructive sleep apnea (OSA, where an individuals upper airway collapses during sleep), central sleep apnea (CSA, where an individual does not make the effort to breathe), 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 be having central apneas with sleep onset. This form of sleep apnea results from a failure of the brain to send the signal to breathe when the individual is asleep and is commonly seen with sleep onset. This can be a normal occurrence and may not represent a significant disease. OSA and asthma may also be considerations for you, but based on the information in your question, these seem less likely.

There are some dream-related conditions in which individuals experience a sense of not being able to breathe. 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 breathe 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 breathing disorders or other sleep disorders, please visit the American Academy of Sleep Medicine 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