Sleep Heavy Breathing Effect: Highest Mortality Rates
Sleep
Heavy Breathing Effects explains decades of medical research and clinical
observations that sleep and especially early morning hours (4-7 am) are the
times of highest mortality rates for asthma, angina pectoris, stroke, seizures,
and many other conditions. (Can he die in his sleep? What are the causes?)
Asthma
American pediatricians from the Washington University School of Medicine in St. Louis in their publication noted, “BACKGROUND: Symptoms from asthma are often prominent at night. In adults significant circadian variation has been shown with reduced peak expiratory flow rates and increased bronchial reactivity to methacholine in the early morning hours” (Porter et al, 1999).
A group of Brasilian medical scientists investigated,
according to their title Morning-to-evening variation in
exercise-induced bronchospasm (Vianna et al, 2002). Their
objective was “to compare morning and evening EIB [exercise-induced
bronchospasm] and minute ventilation during exercise (VE)” (Vianna et
al, 2002). Baseline FEV1 was significantly lower during early
morning hours, while minute ventilation higher.
Over 30 years ago the Thorax published a study Physiological patterns in early morning asthma (Hetzel, et al, 1977). The goal of the study was also to explain “the sudden nature of some asthma deaths as these often occur in the early morning” (Hetzel, et al, 1977).
COPD
Several other publications were devoted to effects of sleep on patients with COPD (chronic obstructive pulmonary disease). American scientists from the Yale Center for Sleep Medicine (Yale University School of Medicine, New Haven) wrote, “Symptoms related to sleep disturbances are common in individuals with moderate to severe COPD, particularly in the elderly, which is commonly manifested as morning fatigue and early awakenings. One major cause of morbidity in this population is abnormalities in gas exchange and resultant hypoxemia as they can lead to elevated pulmonary pressures, dyspnea and in severe cases right ventricular overload and failure. Sleep has profound adverse effects on respiration and gas exchange in patients with COPD…” (Urbano & Mohsenin, 2006).
Moreover, Sheppard and colleagues in the publication from the
Chest magazine noted, “Epidemiologic investigation has revealed that
patients with pulmonary disease are at increased risk of dying during
the early morning hours” (Sheppard et al, 1984). The load on the heart
muscle during the episodes of hypoxemia during sleep can be, according
to their conclusion, “can be transiently as great as during maximal
exercise”.
Coronary spasms and cardiac arrest
If patients with pulmonary conditions can die due to heart problems at night, what about heart patients themselves? “Coronary spasm occurs most often from midnight to early morning when the patient is at rest”, (Yasue & Kugiyama, 1997) says the Japanese study Coronary spasm: clinical features and pathogenesis published in the Internal Medicine magazine. The main and the only cause of these spasms is heavy breathing.
Intensive care professionals from the Department of Anaesthesia and Intensive Care Medicine of the Hadassah Medical Centre in Jerusalem, Israel also decided to investigate, according to their title, In-hospital cardiac arrest: is outcome related to the time of arrest? They wrote,
“BACKGROUND: Whether outcome from in-hospital cardiopulmonary
resuscitation (CPR) is poorer when it occurs during the night remains
controversial. This study examined the relationship between CPR during
the various hospital shifts and survival to discharge…CONCLUSIONS:
Although unwitnessed arrest is more prevalent during night shift,
resuscitation during this shift is associated with poorer outcomes
independently of witnessed status” (Matot et al, 2006)
Trying to explain the cause of deaths, Turkish cardiologists from Ankara published a study with the title "Circadian variations of QTc dispersion: is it a clue to morning increase of sudden cardiac death?" They explained, “BACKGROUND: Several studies related to cardiac events including sudden death have shown a peak incidence in the early morning hours. Our data suggest that QTcD has a circadian variation with an increase in the morning hours, especially in patients with coronary artery disease. This finding was thought to be an explanation for the role played by sympathetic nervous system in the occurrence of acute cardiac events and sudden death during these hours” (Batur et al, 1999).
A group of American cardiologists from the Georgetown University Medical Center in Washington, D.C. was also interested in the most likely time of death, “The time of death was available in… 96 of the 139 patients who died suddenly. There was a circadian variation of all SCDs [sudden cardiac deaths] compared with other deaths with a distinct peak during the morning (p = 0.04)” (Behrens et al, 1997).
Angina pectoris
Swiss medical doctors explained in their abstract, “Prinzmetal's angina is a variant of the classic exertion dependent angina pectoris. Typical is the appearance of the symptoms at rest during early morning hours. It is due to spasms in the coronary arteries. Various provocation tests may be used to trigger spasms, among others hyperventilation which leads to vasoconstriction of coronary arteries” (Jacob et al, 1994).
Stroke
Even healthy people have heavier breathing and lowered
oxygenation of the brain during early morning hours, as Australian
scientists from Latrobe University in Melbourne revealed. After testing
health subjects, these scientists concluded, “These data indicate that
normal diurnal changes in the cerebrovascular response to CO(2)
influence the hypercapnic ventilatory response as well as the level of
cerebral oxygenation during changes in arterial Pco(2); this may be a
contributing factor for diurnal changes in breathing stability and the
high incidence of stroke in the morning” (Cummings et al, 2007).
These effects will cause symptoms of morning sickness fatigue or morning headache fatigue with possible adrenal fatigue and high morning cortisol.
Cerebral ischemia and stroke
It is not a surprise then that British researchers from the National Heart and Lung Institute (Imperial College, London) also noted, “The reduction in hypercapnic cerebral vascular reactivity that occurs in the morning after sleep is associated with an increased risk of cerebral ischemia and stroke” (Meadows et al, 2005).
Similarly, Californian neurologists wrote, “This reduced morning response to hypercapnia suggests diminished vasodilator reserve during this period, and may be related to the increased stroke risk during the morning hours” (Ameriso et al, 1994).
Diabetes
Patients with diabetes also suffer from lower oxygenation in tissues during nights: “Circadian rhythms of tissue oxygen balance and blood rheological properties were investigated in 40 patients with insulin dependent diabetes mellitus... Preserved blood hyperviscosity and increasing tissue hypoxia at night indicated stable disturbance of hemorheological properties and tissue oxygen balance” (Galenok et al, 1988)
Seizures
Japanese doctors from the Department of Pathology for the
Handicapped in Ehime University warn that those who care about people
with epilepsy should know about higher chances of seizures during
nights, “…S-w paroxysms combined with clinical symptoms and continuing
for more than four seconds were fewer during the afternoon than the
morning and, moreover, during sleep. …Therefore, the observation of
typical absence seizures during the morning should be regarded as
important” (Nagao et al, 1990). Since heavy breathing reduces blood
supple and oxygenation of the brain, while also making nerve cells
over-excited, it is sensible that epileptics are most likely to
experience seizures during sleep (early morning hours).
Inflammatory conditions
A marker of inflammation, C-reactive protein, was measured during different parts of the day in obese patients (Punjabi & Beamer, 2007). The conclusion of these medical scientists from the Johns Hopkins University in Baltimore was in the title of the study, C-reactive protein is associated with sleep disordered breathing independent of adiposity. Hence, it is not just obesity, but disordered breathing at night that can lead to inflammation: “…the results of this study suggest that mechanisms other than adiposity per se could contribute to the inflammatory state seen in adults with SDB [sleep disordered breathing]” (Punjabi & Beamer, 2007).
Inflammation in the amnesic patients
Since inflammation can get worse during nights in many patients, is it possible that cortisol production (cortisol is one of the key hormones to fight inflammation) also decreases at nights? German researchers suggested, “Some studies found patterns of enhanced or blunted waking cortisol responses observed under chronic stress, burnout, or post traumatic stress disorder… The morning cortisol increase typically observed in healthy subjects and also observed in the control group was absent in the amnesic patients… Further studies are needed to understand the neurological or psychological mechanisms leading to a missing morning cortisol response in amnesic patients” (Wolf et al, 2005).
Morning sickness
“Approximately two-thirds of women experience nausea or
vomiting during the first trimester of pregnancy. These symptoms are
commonly known as morning sickness” (Flaxman & Sherman, 2000).
It is known that pregnancy of modern women means chronic
hyperventilation. Many of these women have even heavier breathing
during sleep in comparison with their usual daily chronic
hyperventilation. Hence, they often experience adrenal fatigue and high
morning cortisol and morning headache fatigue.
Conclusions. Most diseases appear and progress due to heavy breathing during early morning hours. Severely sick people are most likely to die during the same time of the day (about 4-7 am). The real health of the person can be only as good, as their morning CP measured immediately after waking up. All previous tables and graphs do not reflect the full story about health state of the sick people since all those measurements (minute ventilation, CP, etc.) were done during daytime.
Google-video clip "How we breathe in the morning" or Youtube video Sleep heavy breathing effect (Buteyko technique). This video clip has information and quotes from medical studies, which are described below.
Causes of Sleep Heavy Breathing Effect and Highest Sleep Mortality- Mouth
breathing during sleep |
Resources*
Sleep Positions Research |
To solve the problem with morning hyperventilation is one of the main goals of the Buteyko breathing method.
Note. These results (about heavy breathing and critically low body oxygenation in the sick) also suggest that all our previous considerations (Graphs and Tables about prevalence of hyperventilation in the sick, their oxygenation, etc.) underestimate the real picture. The real respiratory parameters in the sick patients are worse than those which have been measured by doctors, scientists, and researchers during daytime studies and investigations.
Two main causes of morning heavy breathing effect and millions of deaths worldwide every year are: 1) sleeping on one's back and 2) mouth breathing at night. There are simple and specific methods or techniques to address these and other problems. They can be found in Learn Section of this website. You have much less chances to die in your sleep if you apply some simple techniques.
Quoted references (click for medical articles quoted here).
Additional resources:
-
Internet
Deception About Ideal Sleep Positions
- Good Sleep Hygiene provides detailed
analysis of lifestyle risk factors and practical actions to prevent Sleep
Heavy Breathing Effect.
Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and
Body Oxygen in Healthy, Normal and Sick People
Breathing
norms Parameters, graph, and description of the normal
breathing pattern
6 breathing myths 6
myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of
hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the
Sick. Table
1. Western scientific evidence about prevalence of CHV
(chronic hyperventilation) in patients with various chronic conditions
(34 medical studies)
Normal Minute Ventilation in
Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of
Normal People (24 medical publications)
HV and hypoxia
How and why deep breathing reduces oxygenation of cells and tissues of
all vital organs
Body oxygen test
How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy
Table 4. CP (body oxygen level) in healthy people (27 medical
studies)
Body oxygen in sick Table 5.
CP (body oxygen level) in sick people (14 medical studies)
Buteyko
Table of Health Zones with clinical description of most common zones
Morning HV Morning
hyperventilation effect or how and why critically ill people are most
likely to die during early morning hours
References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion
(or blood
supply) to all vital organs
The Bohr effect
How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by
alveolar CO2 and breathing
Oxygen Transport depends on
breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr
effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2
content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes
place due to anaerobic cell respiration caused by cell hypoxia. Hence,
antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by
breathing since hypoxia leads to or intensifies chronic inflammation through over-expression
of the hypoxia-inducible factor 1, while normal
breathing reduces these processes
Nerve stabilization takes place due to calmative or
sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells
is normal at high CO2, while hypocapnia causes muscular tension, poor posture
and, sometimes, aggression and violence
Brochodilation - dilation of
airways (bronchi and bronchioles) by carbon dioxide, and their constriction due
to hypocapnia
CO2: Best Natural Cough Suppressant
and "home remedy" since it calms urge-to-cough nerve receptors located in the
tracheobronchial tree and larynx
Blood
pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon
dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine
in the Brain, CO2 fixation, and other chemical reactions
CO2 myth
"CO2 is a toxic waste gas" myth
Breathing control
How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic?
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