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Sleep-Related Hypoventilation
- Sleep-related hypoventilation is a sleep-related breathing disorder in which breathing becomes too slow or too shallow during sleep, causing carbon dioxide to build up in the blood.
- Common symptoms include excessive daytime sleepiness, morning headaches, poor-quality sleep, fatigue, and difficulty concentrating, though some people may not notice symptoms until the condition becomes more severe.
- Diagnosis often involves a sleep study and measurements of oxygen and carbon dioxide levels. Treatment focuses on addressing the underlying cause and may include positive airway pressure (PAP) therapy or other respiratory support.
- Treatment may include PAP therapy, medications or therapies to address the underlying cause, and other respiratory support to help maintain healthy oxygen and carbon dioxide levels during sleep.
Normal, healthy breathing is essential to keep your body functioning, whether you’re awake or asleep. When your breathing is too slow or too shallow, it’s called hypoventilation. When you hypoventilate, carbon dioxide levels rise in your body, while blood oxygen levels lower. An imbalance in these levels can be a sign of lung or kidney dysfunction. Hypoventilation also disrupts the quality of your sleep, leading to feelings of tiredness during the day.
What Is Sleep-Related Hypoventilation?
Sleep-related hypoventilation describes breathing that’s too slow or shallow during sleep. The first signs of hypoventilation typically occur during sleep because when we’re awake, our brain can play a more active role in regulating our breathing. When we sleep, however, our brains and muscles relax. Hypoventilation is most severe during REM sleep.
Problematically, sleep-related hypoventilation reduces sleep quality, which leads to sleep deprivation. When we’re sleep-deprived, our brain’s ability to control breathing also becomes impaired, creating a vicious cycle. Sleep-related hypoventilation can also increase your risk for pulmonary artery hypertension, right-sided heart failure (cor pulmonale), and neurocognitive disorders.
Symptoms of Sleep-Related Hypoventilation
People with sleep-related hypoventilation may report symptoms like:
- Daytime fatigue
- Difficulty exercising
- Excessive daytime sleepiness
- Morning headaches
- Poor sleep quality
- Shortness of breath
Causes of Sleep-Related Hypoventilation
Chronic hypoventilation can appear with a number of lung and respiratory disorders. While some people exhibit hypoventilation as early as childhood, it’s more common to develop due to obesity, an underlying medical disorder, or drug use.
People with chronic obstructive pulmonary disease (COPD) are significantly more likely to have sleep-related hypoventilation. Other underlying medical conditions that have been linked to sleep-related hypoventilation include obesity, lung and respiratory diseases, and neurological and musculoskeletal disorders.
Chronic use of certain medications or drugs may also lead to sleep-related hypoventilation. Long-term use of narcotics, anesthetics, sedatives, opioids, muscle relaxants, and alcohol may all increase your risk for sleep-related hypoventilation. One study of individuals with chronic pain found that up to 50% of those on long-term opioid therapy also had hypoventilation.
Diagnosing Sleep-Related Hypoventilation
When diagnosing sleep-related hypoventilation, doctors will ask you to describe your breathing and sleep quality. Some people with sleep-related hypoventilation may not report any sleep-related symptoms, so doctors may ask about daytime symptoms, such as headaches, fatigue, or trouble exercising.
Sleep-related hypoventilation is officially diagnosed when a person’s blood oxygen levels decrease below 90% for five minutes or longer during sleep, and their carbon dioxide levels stay elevated for ten minutes or longer.
Treatment for Sleep-Related Hypoventilation
When recommending treatment for hypoventilation, doctors start by focusing on the underlying condition first. If drugs contribute to your hypoventilation, your doctor may recommend alternative medications, lower doses, or ceasing the drug use altogether. Never stop taking medication without speaking to your doctor first.
Treatment for hypoventilation, whether sleep-related or obesity-related, usually involves special ventilation machines that help the person breathe better. This may include oxygen therapy or ventilation support via a tracheostomy tube. Non-invasive ventilation techniques (NIV) like these have been shown to improve a person’s quality of sleep and rebalance their blood gas levels. There’s also some evidence that NIV improves survival rate. In patients with COPD and hypoventilation, NIV reduced the patients’ chance of death from 33% to 12%.
Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapies may be prescribed to help with sleep apnea symptoms. Intended to be used at night, these machines deliver pressurized air to a person as they sleep via a face mask that sits over the nose or mouth and is connected to the machine by a hose. The constant delivery of air helps keep the person’s airways open, enabling them to breathe better during sleep, improving their blood gas levels and sleep quality. Certain BiPAP therapies can be configured to simultaneously treat Obstructive Sleep Apnea along with OHS. Along with positive airway pressure, these devices can deliver a target volume as well effectively helping ventilate patients.
In the case of OHS, diet or weight loss plans may be recommended to help reverse the condition.
If you believe you may have OHS or sleep-related hypoventilation, consult your doctor. They can help you determine the cause behind your sleep and breathing problems, and recommend treatments to help you feel better.
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Jay Vera Summer is a writer, editor, and wellness coach. She holds a Bachelor's of Science in psychology and Master's degrees in both writing and public policy.
Dr. Abhinav Singh, board certified in Sleep Medicine and Internal Medicine, is the Medical Director of the Indiana Sleep Center, which is accredited by the American Academy of Sleep Medicine. He is also a Clinical Assistant Professor at Marian University College of Medicine in Indianapolis, where he developed and teaches a Sleep Medicine rotation.
Learn more about our medical advisory boardReferences2 Sources
Schäfer T. (2006). Respiratory pathophysiology: sleep-related breathing disorders. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 5, Doc01.
https://pubmed.ncbi.nlm.nih.gov/22073070/Beuther D. A. (2009). Hypoventilation in asthma and chronic obstructive pulmonary disease. Seminars in Respiratory and Critical Care Medicine, 30(3), 321–329.
https://pubmed.ncbi.nlm.nih.gov/19452392/
