breathing that comes and goes

Overview

Breathing that comes and goes means that a person's breathing pattern stops for a short time and then starts again. This can happen during sleep or while awake. It is often a sign of an underlying condition such as sleep apnea (when the airway is blocked during sleep) or other health problems that affect the brain's control of breathing.

Yes, breathing that comes and goes is very common, especially in the form of sleep apnea. Millions of people worldwide have sleep apnea, though many are not diagnosed.

It can affect people of all ages, but it is more common in adults over 40, people who are overweight, and those with a family history of sleep apnea. Children can also have it, often due to large tonsils or other airway issues.

Symptoms

Common symptoms

• Loud snoring that is noticed by a partner
• Witnessed pauses in breathing during sleep
• Gasping, snorting, or choking sounds during sleep
• Waking up with a dry mouth or sore throat
• Excessive daytime sleepiness (feeling very tired during the day)
• Morning headaches
• Trouble concentrating or memory problems
• Irritability or mood changes

Symptoms in children

• Restless sleep or unusual sleeping positions
• Bedwetting (especially after being dry for some time)
• Daytime sleepiness or hyperactivity
• Poor school performance
• Mouth breathing and large tonsils or adenoids

Symptoms in older adults

• More subtle symptoms like confusion, memory loss, or worsening of other health conditions
• Falls or accidents due to daytime sleepiness
• Often misattributed to aging or dementia
• Increased risk of heart failure or atrial fibrillation

Causes

Main causes

• Obstructive sleep apnea (the most common cause) – when the muscles in the throat relax and block the airway during sleep
• Central sleep apnea – when the brain does not send proper signals to the muscles that control breathing
• Cheyne-Stokes respiration – a pattern of breathing that gradually gets deeper and then shallower, often seen in heart failure or after a stroke
• Other conditions that affect the brainstem or the nerves that control breathing, such as certain neurological disorders

Risk factors

• Being overweight or obese
• Having a large neck circumference
• Being over the age of 40
• Having a family history of sleep apnea
• Smoking or using alcohol before bed
• Using sedative medications or opioids
• Having a medical condition such as heart failure, stroke, high blood pressure, or diabetes

When to see a doctor

See a doctor urgently if:

• If you or someone else notices that breathing stops repeatedly during sleep, especially with gasping or choking
• If you have severe daytime sleepiness that affects your daily activities or safety
• If you have symptoms like chest pain, fainting, or blue lips along with breathing pauses

Book a routine appointment if:

• If you snore loudly and frequently
• If you wake up feeling tired even after a full night's sleep
• If a partner has observed your breathing pauses during sleep

Diagnosis

A doctor will start by asking about your symptoms, sleep history, and any medical conditions. They may also ask your partner about your snoring and breathing pauses. If sleep apnea is suspected, the doctor will likely suggest a sleep study.

Tests that may be done

• Polysomnography (a sleep study) – you spend a night at a sleep lab, where sensors measure your brain waves, breathing, heart rate, oxygen levels, and body movements.
• Home sleep apnea test – a simpler device you use at home that measures breathing, oxygen levels, and heart rate while you sleep.

What to expect at your appointment

A sleep study is painless and non-invasive. You will sleep as normally as possible while sensors are attached to your head, face, chest, and fingers. Some people find it a little uncomfortable at first, but the staff are there to help. If you are using a home test, you will be shown how to set it up. Results usually come back in a week or two.

Treatment

Treatment depends on the cause and severity of the breathing pauses. The main goal is to keep your airway open during sleep or to help your brain control breathing properly. Treatment can greatly improve your energy, blood pressure, and overall health.

Self-care at home

• Lose weight if you are overweight – even a 10% reduction can help
• Sleep on your side instead of your back (use a body pillow or special devices)
• Avoid alcohol, sedatives, and heavy meals for at least 2-3 hours before bed
• Treat nasal congestion with saline sprays or allergy medications as recommended by a doctor
• Quit smoking if you smoke

Medical treatments

The most common treatment for obstructive sleep apnea is a continuous positive airway pressure (CPAP) machine, which delivers gentle air pressure through a mask to keep your airway open while you sleep. Other options include oral appliances that reposition your jaw or tongue, and in some cases, medications or devices that stimulate the nerves that control breathing. For central sleep apnea, treatment may focus on managing the underlying condition (such as heart failure) or using adaptive servo-ventilation (a special form of breathing support). Always discuss the best option with your doctor.

When is surgery considered?

Surgery is rarely the first treatment, but it may be considered if other treatments have not worked or if there is a clear anatomical problem. Options include removing tonsils and adenoids (common in children), repairing a deviated septum, or procedures to tighten the soft palate. A procedure called tracheostomy (creating an opening in the windpipe) is reserved for very severe cases.

Living with this condition

Living with breathing that comes and goes can be challenging, especially if it causes daytime sleepiness. With proper treatment, most people notice a big improvement in their energy, mood, and overall health. It is important to stick with your treatment plan and have regular check-ups with your doctor.

Lifestyle tips

• Use your CPAP machine or oral appliance every night, even during naps
• Keep your equipment clean and replace parts as recommended
• Maintain a healthy weight through balanced diet and exercise
• Set a consistent sleep schedule and create a calming bedtime routine
• Avoid driving or operating heavy machinery if you are very sleepy – your doctor can advise

Diet and exercise

Aim for a diet rich in fruits, vegetables, whole grains, and lean proteins to help manage weight. Regular exercise (like walking, swimming, or cycling) can improve sleep quality and reduce sleep apnea severity. Even gentle activities like yoga can help with stress and breathing control. Avoid large meals close to bedtime.

Mental health and emotional wellbeing

Living with a sleep disorder can be frustrating and cause anxiety or depression. You may feel embarrassed by your snoring or worried about your health. It is normal to have these feelings. Talk to your doctor or a counsellor if you are struggling. Treating the breathing problem often improves mood and mental clarity.

Prevention

Not all cases can be prevented, but you can reduce your risk by maintaining a healthy weight, staying physically active, avoiding smoking and heavy alcohol use, and managing chronic conditions like high blood pressure and diabetes. If you snore or have a family history of sleep apnea, talk to your doctor early.

Vaccines

There are no vaccines to prevent breathing pauses, but getting recommended vaccines (such as the flu vaccine) can help prevent respiratory infections that might worsen breathing problems.

Screening programmes

Routine screening for sleep apnea is not recommended for everyone. However, your doctor may suggest a sleep study if you have symptoms like snoring, daytime sleepiness, or if you are at high risk due to obesity or other health conditions.

Complications

If left untreated

• Increased risk of high blood pressure, heart attack, and stroke
• Heart failure or irregular heartbeats (arrhythmia)
• Daytime sleepiness that can lead to car accidents or work-related injuries
• Worsening of diabetes and other chronic conditions
• Memory problems, depression, and reduced quality of life

Long-term outlook

The outlook for people with breathing that comes and goes is generally very good with proper treatment. Most people see significant improvements in their symptoms and overall health. Treatment can reduce the risk of serious complications and help you feel more energetic and alert. With the right support, you can manage this condition and live a full, active life.

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