The other 16 hours

[AfibApnea]

We all (presumably) have sleep apnea. In its simplest state (obstructive) it consists of a posture-induced physical blockage preventing air from getting to the lungs. Central and Complex are a bit more…complex. In order to deal with all these forms of apnea we employ machines to assist us in our overnight breathing.

But…what about those other 16 hours?
- If obstructive sleep apnea is the only (or the major) part of the problem, why can’t a simple change in sleeping posture alleive/relieve the whole problem?
- We breathe 24/7. Is there anything about those 8 nighttime hours that makes them special? (I recall a post where a "nap" was considered qualitatively different from (proper?) sleep time.)

• Why don’t we have to be on the machine 24/7?
  What’s going on with our bodies the other 16 hours—the awake time we don’t classify as sleep apnea time.

[BlackSpinner]

When you are awake - you are conscious of what is happening. Your brain is not on auto pilot. You are using your breathe with every movement.

[AfibApnea]

Yes, you may be conscious of what you are doing, but you are NOT conscious of your breathing. In fact, breathing is one of those classic things they tell us about that the body takes care of by itself--unconsciously.

[Overflow]

The muscles only relax enough during sleep. Also most of the day you're upright anyway and it seems people sleeping in recliners can minimise or eliminate OSA due to lack of gravity pushing down on airpipe from relaxed throat.

[The Latinist]

There are several reasons wakeful breathing is different.

1. Upright posture is less likely to lead to apneic events.

2. Our muscles are not as relaxed as they are in sleep and our airways are therefore less likely to collapse.

3. Our breathing is under conscious as well as subconscious control.

4. We are able to respond to flow restrictions by altering our throat muscles and posture in ways that will prevent apneic events.

The upshot is that we just don't have apnea when we are awake.

In answer to your other question: for some people with mild sleep apnea a change in sleeping position may, in fact, be all that is needed. Some people, for instance, only have apneic events when lying on their back and sleeping with a wedge pillow that will keep them on their side will relieve their symptoms. But for those of us with more serious apneas that's just not adequate.

[The Latinist]

Yes, you may be conscious of what you are doing, but you are NOT conscious of your breathing. In fact, breathing is one of those classic things they tell us about that the body takes care of by itself--unconsciously.

Certainly your brainstem is perfectly capable of regulating your breathing without your conscious control. But your breathing is also under conscious control: you can, for instance, hold your breath. Or you can deliberately hyperventilate. Or you can take three short breaths followed by two long ones. If you experience a flow restriction when you are awake, you are able to respond by increasing your breathing effort or changing your position or posture. You may not even realize you are doing it, but you are. When you are asleep, you just can't do that.

[AfibApnea]

All very good answers to the obstructive sleep apnea dilemma.
What about when the brain gets involved and we're talking central or complex.

Why is it the brain sends out wrong signals when we're sleeping and suddenly doesn't when we're awake?

[BlackSpinner]

All very good answers to the obstructive sleep apnea dilemma.
What about when the brain gets involved and we're talking central or complex.

Why is it the brain sends out wrong signals when we're sleeping and suddenly doesn't when we're awake?

Because even if it does you are also conscious and in control of you muscles. One can totally control ones breathing - it is one of the things you learn in things like Yoga or other exercise programs. The automatic breathing is only used when you are not in conscious control. People who hyperventilate and pass out will immediately start breathing normally. Central sleep apnea occurs when you are asleep and the whole actions of the sleeping brain are different from the awake brain.

[AfibApnea]

So are you suggesting that in the case of central or complex that the difference between us and normal people (that sounds ominous!) is that because of an anomaly adopted by the brain while we were sleeping (I won't say "possibly in response to our CPAP machine") we're (now having to) fighting the brain all day?

[Julie]

Not at all. The point is that when your whole physiological system relaxes while sleeping, breathing is not triggered by our jogging the brain's components (whatever ones might be involved - and we don't know for sure about all of them or would have answers now) by movement - even just the tension of remaining upright - or even conscious thought that leads to micro-tension of parts of your body. Centrals do show up when we're drifting off or awakening, but we are more 'out' than anything by then and don't have control (conscious or otherwise) over them. It's as if by our lying down and closing our eyes we signal to the brain that we've given it total control, and that's when centrals take over, or at least do so by completely ceasing to be 'present' in the process of breathing altogether - a kind of negative control.

But - we may stop breathing without realizing it for short times while awake, but become conscious of not doing it very quickly, so begin breathing as soon as we realize it, whether consciously, or because the rest of our system demands air to continue whatever it is that we're doing... something that's not going on while asleep (the 'doing something' part).

[The Latinist]

I'm not sure why you're having trouble understanding this. People who have sleep apnea (whether the cause is obstructive or a signal originating in their central nervous system) do not suffer its ill effects when awake because they are awake. Being awake means you are in control of your breathing to a greater extent. Thus, if a person feels the need to breath, he will do so whether his brain stem is signaling a breath or not.

[SleepyToo2]

I am not sure of the reason why, before I was diagnosed with OSA I would have "spells" of extra long inspirations/exhalations. I have to believe that there was some loss of central control there, which may have lead to falling asleep at my desk.Since my diagnosis, those events have become fewer and further between. Now I believe my main problem is getting to sleep early enough. Time for the full face mask that doesn't allow me to wear glasses and read until the wee hours of the morning!

[JDS74]

All very good answers to the obstructive sleep apnea dilemma.
What about when the brain gets involved and we're talking central or complex.
Why is it the brain sends out wrong signals when we're sleeping and suddenly doesn't when we're awake?

In my case, I have central apnea events when awake when I am relaxed but not asleep.
I wiil be just sitting there and suddenly it comes to my that I haven't been breathing for a while. Then its catchup time.
But when you are up and about, the extra muscle use probably results in more regular breathing and that kind of bypasses whatever is causing the central apneas to occur - just my speculation and observations about me.

[robysue]

Yes, you may be conscious of what you are doing, but you are NOT conscious of your breathing. In fact, breathing is one of those classic things they tell us about that the body takes care of by itself--unconsciously.

Wake breathing is controlled by the voluntary part of the nervous system. We are not particularly aware of our breathing when we are awake anymore than we are aware of the exact muscles we use when we're walking around not thinking about walking, our conscious brain still controls the breathing through the voluntary nervous system. And we also control the muscles around the airway through the voluntary nervous system if I recall correctly.

Sleep breathing, on the other hand is controlled by the autonomous (involuntary) nervous system. And those muscles that keep the airway open relax far too much when control for our breathing is handed off to the autonomous nervous system when we fall asleep---if the problem is OSA. For folks with CSA problems, the problem lies in the autonomous nervous system and the brain's response to the CO2 levels in our blood. Once the control for breathing is handed over to the autonomous system once we fall asleep, the misinterpretation and imbalance in the CO2 levels starts to occur. When we are awake, the voluntary nervous system and the conscious part of the brain have a much better sense of the CO2 levels and are much less likely to get caught in a long CO2 overshoot/undershoot cycle simply because we'll start to realize that we're hyperventilating at some point in the overshoot part of the cycle and bring our breathing under control because we are awake and conscious.