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Sleep-Related Breathing Disorders

Sleep-related breathing disorders (SRBD), also known as sleep-disordered breathing, describes a number of conditions in which there are pauses in breathing or a low intake of air. More than half of stroke survivors are affected by SRBD.

The most common SRBD in stroke survivors is obstructive sleep apnea (OSA). With OSA, the airway closes during sleep, causing a person to stop breathing and wake up in order to reopen the airway and begin breathing normally.

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It is important to realize that OSA can be both a risk factor for stroke and an aftereffect. OSA can cause high blood pressure and atrial fibrillation, two major stroke risk factors. OSA is also an independent risk factor for stroke. A sleep-related breathing disorder discovered after a stroke could have been present before the stroke and could have contributed to the cause of the stroke. Post-stroke sleep apnea is more common in stroke survivors who have had multiple strokes.

Other SRBDs:

  • Upper airway resistance syndrome symptoms and treatments are similar to those of sleep apnea. The source of breathing problems with upper airway resistance syndrome is in the upper airway, not deeper in the throat as with sleep apnea. Also, the condition does not result in a lack of oxygen in the blood, which occurs with apnea.
  • Central sleep apnea (CSA) is different from OSA in that both air intake and the effort to breathe stop. Patients with CSA do not take in oxygen and do not attempt to breathe. In contrast, with OSA, attempts to breathe do not stop.
  • Cheyne-Stokes breathing is a specific pattern of breathing associated with central sleep apnea. The average person will not be able to identify and differentiate Cheyne-Stokes breathing compared to other breathing patterns, but it is a term you might hear from a healthcare professional.
  • Hypopnea is breathing in an unusually low amount of air. As with apnea, hypopnea can be obstructive or central. The difference is that while hypopnea results in a reduced amount of air intake, apnea results in breathing stopping completely.


The following are symptoms that identify a sleep-related breathing disorder:

  • Waking up holding the breath, gasping or choking
  • Dozing off and feeling sleepy during the day
  • Failing to feel refreshed after waking up
  • Fatigue
  • Insomnia, or not being able to sleep
  • Loud snoring or breathing interruptions

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In general, treatments for any sleep-related breathing disorder are similar, but it is best to consult with your doctor to determine the most appropriate treatment for your specific sleep-related breathing disorder.

Continuous Positive Airway Pressure

Continuous positive airway pressure, or CPAP, is one of the most common and effective treatments of sleep-related breathing disorders. CPAP uses a machine to deliver short bursts of compressed air that prevent obstruction in the airway. Typically, the settings of the machine will be determined in a lab and the machine can be taken home with the stroke survivor. CPAP can help a stroke survivor get an uninterrupted night of sleep. A CPAP machine is similar in size to a household toaster and requires the stroke survivor to wear a mask with a tube attached. The tube is where the air is delivered from.

While the treatment is effective, some stroke survivors do not tolerate CPAP machines well. Issues with CPAP machines include:

  • Discomfort with the mask or tubing
  • Nasal congestion
  • Leakage of air
  • Skin irritation
  • Claustrophobia
  • The complexity of the machines
  • The noise of the machines
  • The general inconvenience of their use

Other Common Treatments and Therapies

If continuous positive airway pressure proves to be an ineffective treatment or is deemed to be a bad fit for the stroke survivor, there are other ways to control sleep-related breathing disorders. A special mouthpiece can be made to help minimize symptoms. The most common purposes for mouthpieces are to prevent teeth-clenching or to prevent the tongue from interfering with breathing. In some cases, upper airway surgery can result in a wider airway and relieve SRBD symptoms.

A doctor can also prescribe medication that may help control SRBD. Some medications are designed to stimulate and improve breathing. Another type of prescription treatment prevents entering into an REM sleep cycle. This is prescribed if it is determined that SRBD symptoms occur while the patient is in REM sleep.

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Permanent or long-term use of a continuous positive airway pressure machine or a mouthpiece are common when living with a sleep-related breathing disorder. Simple changes to your lifestyle, such as quitting smoking or losing weight, have proven to help SRBDs. Also, sleeping on your back often makes symptoms worse. Sleeping on your side is better, and special backpacks, balls strapped to the back and wedge pillows to elevate the head and shoulders can prevent sleeping on your back.

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Content Updated: August 2012

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