Hypopnea

A hypopnea is a sleep-related breathing event of shallow breathing. Shallow breathing is when you only inhale a small amount of air. It lasts at least 10 seconds. This causes your airflow and blood oxygen levels (the amount of oxygen in your blood) to decrease.

Your breathing doesn’t stop completely, as it does with an apnea. But shallow breathing may wake you up often in the middle of the night, even if you don’t realize it. You might feel tired during the daytime. And it may affect your mood.

If you aren’t breathing enough during sleep, it could affect your overall health. This sleep condition may increase your risk of complications like heart disease.

Treatment options are available to help you breathe easier as you sleep.

Types of hypopneas

There are three types of hypopneas:

• Obstructive hypopnea: This is when an airway blockage (like body tissue) leads to shallow breathing events.
• Central hypopnea: Your brain isn’t telling your muscles to breathe as expected, so you have fewer breathing attempts during sleep.
• Mixed hypopnea: This is a combination of obstructive and central hypopnea causes.

Symptoms of hypopneas

Daytime symptoms of hypopneas may include:

• Daytime fatigue and/or sleepiness
• Headaches
• Mood changes
• Sexual dysfunction

Nighttime symptoms of hypopneas may include:

• Frequent middle-of-the-night wakeups
• Choking or gasping sound while breathing
• Loud snoring

A sleeping partner is usually the first person to notice nighttime symptoms. Your partner may tell you about them in the morning.

Hypopnea causes

A partial airway blockage causes an obstructive hypopnea. If something is blocking the path of air into your lungs, you won’t be able to take in all of the air possible.

Some of the most common causes include:

• Airway narrowing from a condition like hypothyroidism or obesity
• Your jaw shape
• Your tonsil size

Central hypopneas happen due to a miscommunication between your brain and your muscles. Under normal circumstances, your brain sends signals to breathing-related muscles to tell them to move when you sleep. Sometimes, these signals don’t get where they need to go. As a result, you aren’t able to breathe as often or as well as you would if you were awake.

Some structural abnormalities in your brain may cause this (like in your brainstem). Heart problems may also cause this. It could also be a side effect of taking certain medications. The cause may also be unknown.

Risk factors

You may be more at risk of having hypopneas if you:

• Have overweight or obesity
• Smoke
• Take certain medications (like sedatives)
• Have alcohol use disorder
• Have a condition that narrows your airway

Complications of hypopneas

Hypopneas may lead to potentially life-threatening outcomes over time if untreated, like:

• Heart disease
• Heart attack
• Stroke

How doctors diagnose hypopneas

A healthcare provider will diagnose hypopneas after a sleep study. During a physical exam, your provider will learn more about your symptoms and your health history.

A sleep study identifies how many hypopnea events you have during sleep and how frequently they occur. This overnight test happens at a sleep laboratory. Sensors monitor your heart rate, breathing, blood-oxygen levels and more.

Your provider will use the apnea hypopnea index (AHI) to see how many hypopnea events you have per hour of sleep. They’ll use the AHI score to identify the severity.

Some at-home sleep studies may show your apnea hypopnea index as well. But these can miss certain types of hypopneas.

How are hypopneas treated?

Treatment for hypopneas is typically a combination of methods, including:

• CPAP machine: A CPAP machine is a device that increases air pressure in your airway. You’ll wear a mask and turn on the device when you sleep.
• Lifestyle changes: Your provider may suggest reducing your risk factors like managing any underlying conditions, stopping smoking or maintaining a healthy weight.
• Oral appliances (mouthpieces): An oral appliance is a device that you put in your mouth when you sleep. It holds your jaw and tongue forward to keep your airway open.
• Surgery: Certain surgeries can remove airway blockages that cause obstructive hypopnea.

Your provider will help you find the right combination of treatments that work best for you. Treatment for hypopneas varies from person to person.

Do hypopneas require a CPAP?

Not all cases require a CPAP. But your healthcare provider may recommend this machine if you have an apnea hypopnea index score that’s moderate to severe, or if it’s mild but you have certain other health conditions or symptoms. Your provider will let you know if a CPAP is a good option to treat hypopneas.

When should I see a healthcare provider?

Visit a healthcare provider if you feel exhausted when you wake up or have frequent middle-of-the-night wakeups. A sleeping partner may mention that they noticed choking or loud snoring while you were sleeping. A provider can help you figure out what’s causing these symptoms.

If you have hypopneas, let your provider know if you notice new or worsening symptoms. It’s important to follow up with your provider regularly so they can monitor how well your treatment plan is going and make adjustments as needed.

What questions should I ask my healthcare provider?

You may want to ask your provider:

• Do I have apneas, hypopneas or both?
• What type of treatment do you recommend?
• Do I need to use a CPAP machine?
• Are there side effects of treatment?
• Am I a candidate for surgery?
• Can you recommend any lifestyle changes for me?

What can I expect if I have hypopneas?

Hypopneas may make getting a good night’s rest difficult. But this is a manageable condition with a variety of treatment options to fit your lifestyle and needs. Your provider will help you find one or a combination of treatments that work best to improve your nighttime breathing. You may need to do another sleep study to see how well your treatment is working.