Heavy Breathing at Night: Highest Mortality Rates
Here is the YouTube video "Heavy breathing at sleep". This video clip has information and quotes from medical studies, which are described above.
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.
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 Brazilian 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).
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, 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).
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).
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).
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)
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).
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).
“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.
Causes of Heavy Breathing at Night
breathing during sleep
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 that have been measured by doctors, scientists, and researchers during daytime studies and investigations.
Two main causes of heavy breathing at night 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. Any sick person has much less a chance of dying in his sleep if he or caretaker apply some simple techniques, such as mouth taping and prevention of supine sleep (see links below).
- 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
- Mouth-Breathing Treatment - Methods and techniques to help mouth breathers.
Reference pages: Breathing norms and medical facts:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- 6 breathing myths: Myths and superstitions about breathing and body oxygenation (prevalence: over 90%)
- Hyperventilation: Definitions of hyperventilation: their advantages and weak points
- Hyperventilation syndrome: Western scientific evidence about prevalence of chronic hyperventilation in patients with chronic conditions (37 medical studies)
- Normal minute ventilation: Small and slow breathing at rest is enjoyed by healthy subjects (14 studies)
- Hyperventilation prevalence: Present in over 90% of normal people (24 medical studies)
- HV and hypoxia: How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test
- Body oxygen in healthy: Results for the body-oxygen test for healthy people (27 medical studies)
- Body oxygen in sick : Results for the body-oxygen test for sick people (14 medical studies)
- Buteyko Table of Health Zones: Clinical description and ranges for breathing zones: from the critically ill (severely sick) up to super healthy people with maximum possible body oxygenation
- Morning hyperventilation: Why people feel worse and critically ill people are most likely to die during early morning hours
References: pages about CO2 effect:
- 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: How alveolar CO2 influences oxygen transport
- Oxygen transport: O2 transport is controlled by vasoconstriction-vasodilation and the Bohr effects, both of which rely on CO2
- Free radical generation: Reactive oxygen species are produced within cells due to anaerobic cell respiration caused by cell hypoxia
- Inflammatory response: Chronic inflammation in fueled by the hypoxia-inducible factor 1, while normal breathing reduces and eliminates inflammation
- Nerve stabilization: People remain calm due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
- Muscle relaxation: Relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
- Bronchodilation: Dilation of airways (bronchi and bronchioles) is caused by carbon dioxide, and their constriction by hypocapnia (low CO2)
- Blood pH: Regulation of blood pH due to breathing and regulation of other bodily fluids
- CO2: lung damage: Elevated carbon dioxide prevents lung injury and promotes healing of lung tissues
- CO2: Topical carbon dioxide can heal skin and tissues
- Synthesis of glutamine in the brain, CO2 fixation, and other chemical reactions
- Deep breathing myth: Ignorant and naive people promote the idea that deep breathing and breathing more air at rest is beneficial for health
- Breathing control: How is our breathing regulated? Why hypocapnia makes breathing uneven, irregular and erratic.
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