Breathing pauses happen for several reasons, and the most common by far is sleep apnea, a condition where you repeatedly stop breathing during sleep. But breathing can also pause while you’re awake, triggered by stress, certain medications, or less common neurological conditions. Understanding which type you’re experiencing is the first step toward fixing it.
Sleep Apnea: The Most Common Cause
If someone has told you that you stop breathing at night, or you wake up gasping, the likely culprit is obstructive sleep apnea. During sleep, the muscles in your throat relax. For some people, the soft tissue in and around the airway collapses enough to partially or completely block airflow. Each pause can last 10 seconds or longer, and in severe cases this happens 30 or more times per hour, all night long.
The severity is measured by how many breathing pauses (apneas) and partial blockages (hypopneas) occur per hour of sleep. Mild sleep apnea means 5 to 15 events per hour, moderate means 15 to 30, and severe means 30 or more. Many people with moderate or severe sleep apnea have no idea it’s happening. The clues are indirect: loud snoring, waking up with a dry mouth or headache, feeling exhausted despite a full night’s sleep, or a partner noticing the pauses.
Central Sleep Apnea: When Your Brain Forgets to Breathe
There’s a second, less common type. In central sleep apnea, the airway isn’t blocked at all. Instead, your brain temporarily stops sending the signal to your breathing muscles. The result looks the same from the outside (you stop breathing) but the mechanism is completely different. This type is more closely linked to heart failure and stroke than to body weight or throat anatomy.
One specific pattern, called Cheyne-Stokes breathing, involves cycles where your breathing gradually gets deeper, then shallower, then stops entirely before the cycle repeats. This happens because of unstable feedback between carbon dioxide levels in your blood and the brain’s breathing control center. In people with heart failure, CO2 levels fluctuate above and below the threshold that triggers a breath, creating a rhythmic pattern of breathing and not breathing. Unlike obstructive sleep apnea, which can cause heart failure over time, this periodic breathing pattern is typically a consequence of heart failure that already exists.
Why Your Anatomy Matters
Not everyone who relaxes during sleep has their airway collapse. The difference often comes down to physical structure. People with a larger tongue relative to their throat opening, a thicker neck, enlarged tonsils, a recessed jaw, or a deviated nasal septum are at significantly higher risk. When a doctor looks at the back of your throat and can barely see past your tongue, that crowded airway is roughly five times more likely to be associated with sleep apnea compared to someone with a wide-open view.
Nasal obstruction compounds the problem. When your nose is partially blocked (from a deviated septum, swollen turbinates, or chronic congestion), you rely more on mouth breathing during sleep, which changes the position of your jaw and tongue in ways that further narrow the airway. The combination of a crowded throat and nasal obstruction is a particularly strong predictor of apnea and its severity.
Sleeping Position Makes a Measurable Difference
Gravity plays a direct role. When you sleep on your back, your tongue and soft palate fall backward into the airway. Research comparing sleep positions found that back-sleeping produced an average of about 60 breathing events per hour, while side-sleeping cut that number roughly in half. Even the difference between sleeping on your left side versus your right side was statistically significant, with right-side sleeping producing fewer obstructive events in people with moderate to severe apnea.
This is why positional therapy (using a wedge or wearable device to keep you off your back) can be effective for some people, particularly those whose apnea is mild or moderate and mostly happens in the supine position.
Breathing Pauses While Awake
If you notice yourself stopping breathing during the day, the causes are different. Stress and concentration are common triggers. Many people unconsciously hold their breath while staring at a screen, during tense moments, or when anxious. This shallow, interrupted breathing pattern during focused work has become common enough to earn its own informal name: “screen apnea.” It’s not dangerous in the way sleep apnea is, but chronic shallow breathing can reinforce anxiety and tension over time.
Panic attacks and severe anxiety can also create the sensation that you’ve stopped breathing or can’t get a full breath, even when your oxygen levels are normal. The feeling is real and distressing, but it’s driven by your nervous system’s fight-or-flight response rather than an actual airway problem.
Medications That Suppress Breathing
Certain drugs directly slow the brain’s respiratory drive. Opioid pain medications are the most significant offenders. They depress the central nervous system, and one of their well-known side effects is slowed or difficult breathing. Benzodiazepines (commonly prescribed for anxiety, insomnia, and seizures) do the same thing through a different mechanism. The FDA issued its strongest safety warning about combining these two drug classes, because together they can cause profound sedation, dangerously slow breathing, coma, or death. Alcohol amplifies this risk further when combined with either drug class.
If you take any of these medications and notice that you wake up gasping, feel short of breath, or a partner observes breathing pauses during your sleep, the medication itself may be contributing to or causing the problem.
Neurological Causes
In rare cases, breathing pauses stem from damage to the brainstem, the part of your brain that controls automatic functions like breathing and heart rate. Strokes affecting the lower brainstem can knock out the neural circuits responsible for involuntary breathing. Research from Johns Hopkins documented cases where damage to specific clusters of nerve cells in the brainstem caused a condition sometimes called Ondine’s curse: the loss of automatic breathing. People with this condition breathe normally while awake and consciously thinking about it, but stop breathing when they fall asleep because the unconscious breathing drive is gone.
This is uncommon and usually follows a clear neurological event like a stroke or brain injury. It’s not something that develops gradually without other symptoms.
The Cardiovascular Stakes
Repeated breathing pauses during sleep aren’t just disruptive. They’re genuinely dangerous over time. Each pause drops your blood oxygen level, triggers a surge of stress hormones, and spikes your blood pressure. Night after night, this takes a measurable toll. Untreated obstructive sleep apnea increases the risk of heart failure by 140%, stroke by 60%, and coronary heart disease by 30%. People with 20 or more breathing events per hour have more than four times the odds of stroke compared to people without sleep apnea, even after accounting for other risk factors like smoking, obesity, high blood pressure, and diabetes.
These numbers make sleep apnea one of the most underdiagnosed cardiovascular risk factors. Many people dismiss snoring and daytime fatigue as minor annoyances, not realizing the connection to serious heart and brain disease.
How Breathing Pauses Are Identified
A sleep study is the standard way to diagnose sleep-related breathing pauses. This can be done overnight in a sleep lab or, increasingly, with a home sleep test that monitors your airflow, blood oxygen, and breathing effort while you sleep in your own bed. The test produces an apnea-hypopnea index (AHI) score that tells you exactly how many times per hour your breathing is disrupted.
For daytime breathing pauses related to stress or anxiety, there’s no equivalent diagnostic test. The pattern is usually identified through self-awareness: noticing that you hold your breath during concentration, clench your jaw while working, or feel chest tightness during stressful moments. Practicing regular check-ins with your breathing throughout the day, consciously relaxing your shoulders and taking a full breath, can interrupt the cycle.