Sleep Respiratory Rate

Respiratory rate refers to how many times a person breathes in one minute. Medical professionals routinely record a person’s respiratory rate as a way to recognize potential health problems, as they do with other vital signs like heart rate, body temperature, and blood pressure.

The body continually adjusts the pace of breathing to ensure the body’s cells can produce the right amount of energy. Different factors can cause a person’s respiratory rate to change, such as illness, exercising, becoming anxious, or falling asleep.

We discuss the significance of your respiratory rate during sleep, how your respiratory rate may be influenced by sleep disorders or other medical conditions, and when you should contact a medical professional.

When a person is asleep, their respiratory rate generally slows compared to when they are awake. Also, a person’s sleep respiratory rate naturally changes throughout the night depending on what stage of sleep they are in.

Each night, a sleeper repeatedly cycles through four stages of sleep, which fall into one of two categories: non-rapid eye movement (NREM) or rapid eye movement (REM) sleep. Stage 1, stage 2, and stage 3 occur during NREM sleep. Breathing typically slows during each stage of NREM sleep as a person moves into deeper periods of rest, reaching its slowest rate of the night during stage 3 of sleep.

Respiratory Rate During REM Sleep

In the fourth stage of sleep, called REM sleep, a person’s respiratory rate becomes less stable and increases along with other measurements like blood pressure and heart rate. People tend to experience more vivid dreams during REM sleep, as they rapidly move their eyes behind closed eyelids.

Breathing is controlled by several muscles in the body, including the diaphragm and muscles in the abdomen, neck, and in between the ribs. During REM, the part of the brain that regulates breathing becomes less responsive and many breathing muscles become temporarily inactive. Together, these shifts account for continual changes in respiratory rate during REM sleep.

For most people, normal changes in respiratory rate during REM sleep do not pose a problem. However, changes in breathing during sleep may be problematic for people diagnosed with a health condition that affects breathing, such as asthma or chronic obstructive pulmonary disease (COPD).

Sleep Respiratory Rate and Sleep Disorders

A person’s respiratory rate can also be affected by several sleep-related breathing disorders, a category of sleep disorders in which a person’s respiration becomes abnormal during sleep.

• Obstructive sleep apnea: Obstructive sleep apnea (OSA) describes a sleep disorder in which breathing stops or slows because of an obstruction in their airway. OSA can cause a person to have an abnormally low respiratory rate or stop breathing for more than 10 seconds during sleep. 
• Central sleep apnea: In central sleep apnea (CSA), respiration is slowed or paused due to a disruptions in signals from the brain. In CSA with Cheyne-Stokes breathing, there is a lapse in breathing, followed by an increase and then a decrease in respiratory rate. In CSA due to high altitude, respiratory rate increases or decreases as a result of an increase in elevation.
• Sleep-related hypoventilation disorders: A person with a sleep-related hypoventilation disorder has breathing that is too slow or too shallow. While these disorders can also affect breathing during the day, hypoventilation is typically worse while a person is asleep.

A person’s respiratory rate depends on a number of factors including their age, activity level, and whether they have certain health conditions.

Established values for healthy respiratory rates are based on when a person is awake and at rest.

• Infants and children: Typical respiratory rates in newborns are about 44 breaths per minute, which slows to around 26 breaths per minute by 2 years old.
• Adults: The respiratory rate of an average adult at rest is around 12 breaths per minute. However, some experts suggest that a healthy adult may have a respiratory rate as low as eight breaths per minute or as high as 20 breaths per minute while resting. Older adults may have a slightly higher respiratory rate.

Respiratory rate can be measured in a variety of ways. Each of these methods determine how many breaths are taken per minute.

• Capnography: Capnography is a standard way to measure respiratory rate in a variety of healthcare settings. In capnography, respiratory rate is measured using a tube that is inserted into the nose or mouth.
• Manual detection: A person’s respiratory rate can also be measured using a stethoscope, by placing a hand on the sleeper’s chest, or by watching their abdomen and counting the number of breaths they take over one minute.
• Pulse oximeter: A pulse oximeter measures oxygen in the blood using a device that attaches to the fingertip or another part of the body. Some pulse oximeters can also be used to calculate a person’s respiratory rate.
• Wearable devices: There are a variety of commercially available devices that are worn on the wrist and can measure vital signs like pulse and respiratory rate.

A sleeper’s respiratory rate is a standard measurement taken during polysomnography, also called a sleep study. During a sleep study (which can also be done at home in many cases), special sensors are used to track respiratory rate through the night. 

A low respiratory rate is also called bradypnea or hypoventilation.

While low respiratory rates are not always related to an underlying medical condition, bradypnea may be caused by medications or illicit drugs, sleep disorders, and medical conditions, including:

• Hypothyroidism 
• Injury to the brain stem
• Brain stem tumors

A high respiratory rate is called tachypnea, but may also be referred to as hyperventilation.

An abnormally high respiratory rate can be caused by certain medications, sleep disorders, and medical conditions such as:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Heart failure 
• Pneumonia 
• Anxiety or panic
• Stress

Talk to your doctor if you have concerns about your breathing or find that your respiratory rate is outside of the healthy range for your age group, whether taken during sleep or awake and at rest.

Symptoms that Warrant Immediate Medical Attention

While you should talk to a doctor about any concerns related to breathing patterns, there are certain symptoms that warrant immediate medical attention.

Symptoms that may be an emergency in a person with an abnormal respiratory rate include:

• Sudden changes in breathing
• Difficulty taking a breath 
• Blue or gray coloring of the skin, nails, gums, lips, or eyes 
• Chest pain
• Fever
• Loss of consciousness
• Seizure
• Pain or bleeding

About The Author

Afy Okoye

Staff Writer, Sleep Health

Afy is a writer and creative strategist in San Francisco with a master’s degree in international health policy from the London School of Economics. She has written for VeryWell Health, BlackDoctor.org, and Paste magazine and edited peer-reviewed journal manuscripts for Elsevier. Afy says her work with The Sleep Doctor is anything but “sleepy.” She enjoys the opportunity to learn new information and share knowledge that gives people the power to make better choices. Afy also likes to read non-fiction, do creative writing, and travel solo.

• Position: Side sleeper
• Temperature: Hot Sleeper
• Chronotype: Bear

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