Sleep Effects and Respiratory Diseases - Exploring the Connection

Introduction

Sleep is important for the normal functioning of the human body, like food and water. Besides, its impact on respiratory health is complex, involving changes in normal patterns and respiratory disorders. Most of these disorders negatively affect sleep. When sleep is disturbed or altered, it also affects overall health, including respiration. This intensifies the underlying disease and burden of the disease.

What Is Normal Sleep and How to Assess It?

It is a complex phenomenon involving a reduced level of consciousness. Different individuals have different sleep patterns and habits. There are two stages of sleep:

1. Rapid Eye Movements (REM): Resembles wakefulness, but less muscle activity is noticed. Rapid eye movements are seen, and it is like dreaming. In this stage, insatiable cardiac and respiratory activity is seen,

2. Non-rapid Eye Movements (NREM): There is a decrease in respiratory rate and breathing. Complete muscle relaxation is seen, which impacts the airways, too.

A common assessment method is overnight recording. The individual is asked to sleep in the laboratory, and an overnight polygraph, usually with an eight-hour recording, is noted. Other methods include multiple sleep latency tests for patients who are sleepy during the day. The patient has to stay in the clinic for four to five daytime naps, and graphs are noted. Wakefulness maintenance is also noted. Portable home recorders are also available but only recommended for some of the population.

What Are the Physiological Changes Seen During Sleep?

The true reason for everyone to fall asleep is unknown. However, it has phenomenological significance; it affects various body systems like cardiovascular, respiratory, immune, and wound whaling.

1. There is a decrease in overall temperature when sleeping.

2. Most body hormones and secretions follow a circadian rhythm, peaking between 4 and 8 am.

3. All heart rate and blood pressure decrease during sleep.

What Is the Effect of Sleep on Respiration?

These are cases that affect sleep, causing abnormal and difficult respiration. Patients are noticed as loud snorers, frequently experience daytime tiredness, and complain of a lack of good-quality night sleep. These do have health impacts, from tiredness to severe consequences like severe obstruction or oxygen deprivation, leading to respiratory failure and death.

1. Sleep Apnea:

• Obstructive Sleep Apnea: This is most commonly seen. It is caused by partial or complete obstruction of the upper airways during sleep. This affects breathing while sleeping. This also affects the oxygen levels in the blood. The various causes and risk factors for this condition include obesity, the elderly, enlarged tonsils, and weak airway muscles frequent breathing issues in sleep lead to daytime fatigue, headaches, and other health consequences. During sleep, the individual frequently snores, gasps, or chokes for air waking up. If left untreated, it can cause other complications like stroke and hypertension.

• Central Sleep Apnea: This is a temporary stoppage of breathing as the brain's respiratory centers do not send the signal. This is mainly due to disruption in brain and respiratory muscle pathways. Even when the airways are unobstructed, respiration does not happen. This is commonly seen in individuals with pre-existing neurological conditions. It is also seen in high altitudes and the use of narcotics. These lapses in breathing are because of a lack of effort to breathe. The brain fails to send proper signals.

2. Hypoventilation Disorders: Inadequate ventilation leads to increased concentration of carbon dioxide and, in severe cases, deficient oxygen. This mainly results from a lack of air moving through the lungs. Mechanical restraints are noticed on ventilation, affecting the lungs' dead space. Patients have to put extra effort into breathing. Common risk factors include obesity and neurological abnormalities. Sleep in normal circumstances impairs breathing slightly. There is a slight increase in carbon dioxide levels compared to the wakeful state. The reason for this is the pharyngeal muscle relaxation seen in sleep. Sleep also decreases the body's oxygen stores. In normal individuals, ventilation and lung volume decrease is noted during REM sleep. However, in patients with respiratory diseases, it is mostly exaggerated. In asthmatics, diurnal variation influences the physiological mechanism of sleep.

What Are the Effects of Respiratory Disorders on Sleep?

Many medical disorders are associated with disrupted sleep or sleepless nights. Among respiratory diseases, the common cold also disrupts sleep. This may be related to an increase in chemical mediators during nighttime. Poor quality of sleep with frequent disruptions is seen.

1. Obstructive Pulmonary Diseases

a. Asthma: This is characterized by inflammation of the airways. Various risk factors trigger the attack. It has shown increased symptoms in the early morning hours. Exposure to allergens triggers it. Symptoms generally worsen at night.

• Sleep deprivation is linked to more stress, and stress is one of the major asthma triggers.

• Patients' overall health is hampered due to a lack of proper, good-quality sleep.

• There is less effect of medications seen.

• A less immune response is seen.

b. Chronic Obstructive Pulmonary Disease (COPD): This is characterized by airflow limitation and respiratory worsening. Eighty percent of cases have sleep associated with oxygen desaturation.

• Poor quality of sleep is seen in these patients. Patients frequently wake up from sleep.

• Less oxygen saturation is seen, particularly during REM sleep.

• Cough and breathlessness increase during nighttime.

2. Restrictive Lung Disorders: Diseases that limit the expansion of the lungs. These include pleural diseases, neuromuscular disorders, and extreme obesity. These diseases interrupt sleep continuity and produce sleep-related reduced ventilation and oxygen in the blood. The patients may require ventilation support to support their airways.

What Are the Future Directions in Sleep Medicine and Breathing?

1. Precision Medicine: Using the information on genomics and biomarkers, the sleep world can be unraveled, and personalized sleeping help should be provided.

2. Wearable Technology and Artificial Intelligence: Technological advances have seen real-time sleep monitors that can detect any respiratory event immediately. These devices can be used as smartwatches and are assessed on phones. The data can be used to research new treatment modes and telemedicine, where a doctor can be consulted remotely. Artificial intelligence-based models can be utilized to predict sleep disorders.

3. Neurostimulators: Targeted therapies can program sleep in a regular, good-quality pattern.

4. Integrative Care: Collaboration between different physicians and care teams should be done.

Conclusion

Sleep and overall body health are significantly interrelated, particularly respiratory health. Respiratory disorders negatively impact sleep. A decreased sleeping duration and poor sleep quality lead to impaired quality of life and a sad and depressed overall life.