Sleeping and Breathing (Part 2)

Breathing, the quintessential interaction between the organism and its environment, must continue when all other such interactions have ceased. As might be expected, this is not always successfully accomplished. Despite complex neural machinery automatically controlling the motor act of breathing, many individuals sustain respiratory failure during sleep. The present communication reviews how sleep and interact such that sleep disorders breathing, disordered breathing disturbs sleep, disturbed sleep further disorders breathing, and so on. In particular, the paper examines how “experiments of nature,” eg, a compromised pharyngeal airway or a restricted respiratory pump, set the stage for such sleep-disordered breathing. Much of our current understanding of how states of vigilance and breathing interact, in fact, derives from such “experiments of nature.” Indeed, night lessons from the bedside of patients with sleep-disordered breathing provide insights that color our view of processes controlling breathing, or, closer to the truth, add a whole new perspective to neural control of breathing. For example, investigation of sleep-disordered breathing has revealed the first tangible evidence of the role of the higher nervous system in control of breathing other than the simple fact of voluntary control of breathing.