Sleep Paralysis and Breathing Difficulties During Sleep

Feeling of suffocation during sleep?

Hello, doctor.
I have previously experienced a sensation of being pressed all over my body during sleep, occurring 2 to 4 times a night.
I researched and found that it might be related to sleep paralysis, so I didn't pay much attention to it.
However, recently, not only do I feel pressure on my entire body while sleeping, especially around my throat, but I also experience a sensation of suffocation, as if my throat is being constricted.
Upon waking, although I don't have difficulty breathing, I feel dizzy, my limbs feel weak, and I experience a sense of unreality, as if I am still trapped in a dream and haven't fully awakened.
I would like to ask what these symptoms might indicate.
Should I seek medical attention? If so, which specialty should I consult? Thank you.

Ya, 20~29 year old female. Ask Date: 2019/05/10

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Ya,
The sleep cycle can be divided into rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM), alternating approximately 3 to 5 times each night.
The brain regions that control the sleep-wake cycle (biological clock) include the suprachiasmatic nucleus, which promotes sleep, and the posterior hypothalamus, which inhibits sleep.
REM sleep, also known as paradoxical sleep, is characterized by significant muscle atonia, rapid eye movements, dreaming, increased blood pressure, accelerated heart rate, and irregular breathing patterns, and it may be associated with dreaming.

Non-rapid eye movement sleep (NREM), also referred to as slow-wave sleep, includes physiological responses such as decreased muscle tone, pulsatile secretion of growth hormones and sex hormones, lowered blood pressure, slowed heart rate, and decreased respiratory rate.
NREM can be further divided into four stages:
1.
Stage 1: A relaxed state with closed eyes, characterized by fleeting thoughts, disappearance of alpha waves, and the emergence of theta waves.
2.
Stage 2: More difficult to awaken, with sleep spindles (similar to theta waves) present in the brain waves.
3.
Stage 3: A deeper sleep occurring approximately 20 minutes after sleep onset, with both theta and delta waves appearing.
4.
Stage 4: Decreased respiration, pulse, blood pressure, and body temperature, increased gastrointestinal motility, and relaxation of skeletal muscles, with delta waves present; bedwetting and sleepwalking can occur during this stage.
REM periods are approximately 90 minutes apart, with each successive REM period lengthening until waking in the morning.
In infancy, REM sleep accounts for about 50% of total sleep time, while in adults it accounts for about 20%, and it is even lower in the elderly, indicating that older adults have the lowest neural activity.
This is a basic medical understanding of sleep physiology.
Your symptoms lead you to believe you may be experiencing sleep paralysis; however, I cannot confirm this personally.
You may want to discuss this with your family physician or visit a psychiatric outpatient clinic for further evaluation.
In the meantime, please consider whether you are consuming excessive amounts of coffee or tea, overeating, experiencing high levels of stress, maintaining irregular sleep patterns, frequently staying up late, or feeling overly anxious, as these factors should be ruled out first.

Reply Date: 2019/05/10

More Info

Sleep paralysis and the sensation of breathing difficulties during sleep can be distressing experiences that often lead to confusion and concern about one's health. Based on the symptoms you've described, it seems that you may be experiencing a combination of sleep paralysis and possibly other sleep-related issues, such as obstructive sleep apnea or anxiety-related disturbances.

Understanding Sleep Paralysis:
Sleep paralysis occurs during the transition between wakefulness and sleep, particularly when waking up or falling asleep. During this state, the brain is awake, but the body remains in a state of temporary paralysis, which is a natural mechanism to prevent acting out dreams. This can lead to feelings of pressure on the chest, difficulty breathing, and a sense of being unable to move. Many individuals report vivid hallucinations during these episodes, which can exacerbate feelings of fear and anxiety.

Breathing Difficulties:
The sensation of feeling like your throat is being constricted or that you are unable to breathe can be alarming. This could be related to several factors:
1. Obstructive Sleep Apnea (OSA): This condition occurs when the muscles in the throat relax excessively during sleep, leading to temporary blockages of the airway. Symptoms include loud snoring, gasping for air during sleep, and excessive daytime sleepiness.

2. Anxiety and Panic Disorders: Anxiety can manifest physically, leading to sensations of tightness in the chest and difficulty breathing, especially during sleep when the body is in a more relaxed state.

3. Sleep Disorders: Conditions such as REM sleep behavior disorder or other parasomnias can also contribute to these sensations.

Symptoms You Described:
The feelings of being pressed down, experiencing a choking sensation, and waking up with a sense of confusion or unreality are common in sleep paralysis and can also be associated with anxiety. The fact that you feel disoriented and have physical symptoms like dizziness and weakness upon waking suggests that your sleep quality may be significantly affected.

When to Seek Help:
Given the complexity of your symptoms, it is advisable to consult a healthcare professional. You should consider visiting a sleep specialist or a neurologist, as they can conduct a thorough evaluation of your sleep patterns and symptoms. A sleep study (polysomnography) may be recommended to monitor your sleep cycles and identify any disruptions, such as sleep apnea or other sleep disorders.

Potential Next Steps:
1. Sleep Hygiene: Implementing good sleep hygiene practices can help improve your sleep quality. This includes maintaining a regular sleep schedule, creating a comfortable sleep environment, and avoiding stimulants before bedtime.

2. Stress Management: Techniques such as mindfulness, meditation, or cognitive behavioral therapy (CBT) can help manage anxiety and improve sleep quality.

3. Medical Evaluation: A thorough evaluation by a healthcare provider can help rule out any underlying medical conditions that may be contributing to your symptoms.

In conclusion, while sleep paralysis and breathing difficulties during sleep can be alarming, they are often manageable with the right approach. Seeking professional help is a crucial step in understanding and addressing these issues effectively.

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