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Sleep Disorders

I Can`t Breathe in Sleep

11/29/2011

Question:

In the last few weeks, I woke up with difficulty breathing a few times. It`s usually occer early in the morning although I breastfeed my baby around 1am so it`s probably 2 to 3 hours after I fell asleep. The first time it occered, I woke up with fear that I couldn`t breathe in, but by the time I woke up I was breathing. I didnt remember whether I was dreaming or not. My heart was racing for short time, but I was able to go back to sleep soon after. I thought I had a panic attack. The second time was different. I was dreaming, I was looking for someone and I went in the steaming bathroom and locked the door. All the sudden I felt I was going to have difficulty breathing and then I couldn`t breathe in, but soon after I could manage to breathe in. I wokeup then and my heart was pounding. I had my heart checked and it was normal. I don`t snore or breathe through mouth. I have 3 children, one with severely disable, one with speech delay and 6 months baby. Disable son is sick often and my stress level can be very high sometimes, but i remember these episode occered the night after I felt relieved from some pressure. Am I having nightmeres or panic attacks or sleep disorder? Please help.

Answer:

You are reporting episodes of awakening from sleep with a racing heart beat (also known as palpitations), and shortness of breath. One of the episodes was associated with dreaming but also included palpitations. You are now possibly a couple of months after the delivery of your third baby and you also state that your heart was checked and it was fine. I assume you had an echocardiogram?

Sleep disruption obviously is a major part of the post delivery period. Often caring for the baby is the only reason. But sleep, medical or mood disorders may also occur and contribute to the sleep disruption. The sleep disruption you describe may be a sign of one of these disorders. More information would be needed to address these possibilities. Here is an overview of what I would be concerned about.

First, what you're experiencing could be entirely caused by the sleep disruption of this post delivery period. In normal circumstances, our sleep involves transitioning through several cycles. A typical night's sleep includes 3-4 sleep cycles, each of 90-12 minute duration. A typical sleep cycle includes transition from lighter sleep to deeper sleep with lighter sleep termed Stage 1 and the deepest stage is Stage 3. Normal sleep involves transitioning from stage 1 through stage 2 and then into stage 3. This is typically followed by dream, or Rapid Eye Movement (REM), sleep. It is widely accepted that dreaming occurs during REM sleep. This stage of sleep recurs with every sleep cycle and increases towards the early morning hours. If our sleep is disrupted, such as in the case of caring for a baby, then the transition of sleep cycles is disrupted.

Usually, in sleep disruption and sleep deprivation states, our systems try to make up first for the lost REM sleep and we may end up dreaming more, regardless whether we remember that or not. The state of REM sleep is also associated normally with decreased muscle tone and some patients report awakening feeling "paralyzed" if awakened while still in a dream. REM sleep is also associated with rapid changes in the heart rate and it is possible that if someone awoken in this stage they would be aware of the heart beating fast. Thus, awakening from REM sleep could potentially contribute to some of your symptoms.

Another concern could be breathing problems in sleep. Obstructive sleep apnea (OSA), during which the airway repetitively collapses during sleep, is more common during REM sleep. 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. Increased weight and hormonal changes such as in pregnancy and shortly after delivery can increase the risk of sleep apnea.

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 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. It is often associated with stress and sleep deprivation. Other than reassurance and avoiding situations that may bring on the episodes, no treatment is needed in most cases.

An existing panic disorder could present itself primarily in sleep as you are describing. Depression is common in the post-partum stage and it can affect the sleep architecture by causing increased arousals and increased REM sleep.

At this stage, you are certainly dealing with great deal of stressors and it is unlikely that you will be able to do anything to change your circumstances or affect the type of sleep you’re getting. However, you can go over your sleep habits and follow the recommendations listed in the Common Sense Tips for Good Sleep, attempting to change what you are able to change.

I suggest that you go over these episodes in more details with your general physician. Additional testing or referral to a Sleep Specialist may be needed. Good luck!

For more information:

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University