Why am I using NIV?
Some basic understanding of anatomy and how breathing works can help you get the best out of your NIV.
MND affects the muscles of the body (e.g. the arms, legs and neck), making them weaker and less able to do the work they normally do. This weakness can affect your respiratory (breathing) muscles too. It helps to understand how breathing happens and how the respiratory muscles are used.
There are several muscles involved in breathing: the diaphragm (large flat muscle underneath your lungs), the intercostal muscles (between your ribs) and accessory muscles used in deep breathing (in your neck and shoulders).
When you breath in, the intercostal muscle contract and move your rib cage up and out, while the diaphragm contracts and moves downwards. This creates a bigger space inside your rib cage and then air from outside moves in to fill it. When you breathe out, you relax the intercostals and diaphragm and the air is pushed back out. In MND it can become harder to contract the muscles as much as you were able to before. Therefore, it becomes harder to breath in and out as efficiently – so it affects the way you get rid of the waste gas carbon dioxide.
It is during sleep when this usually first becomes an issue – you may not have even noticed that your breathing has been affected. You will have had some diagnostic tests at your specialist centre to find out if this is a problem for you. You may also have experienced some of the following symptoms:
- Poor and broken sleep
- Sleepiness in the day
- Lack of energy/vitality
- Morning headaches
- Reduced concentration and memory
- Reduced appetite
Why am I using NIV?
So what happens during sleep that makes breathing harder?
When standing or sitting up, the diaphragm muscle is helped in its work by gravity. Laying down flat to sleep makes it harder for the diaphragm muscle to work as easily. So, if you have MND, breathing when laying down can become harder.
When you are in your deepest sleep the only muscle you use to breathe is the diaphragm. As your diaphragm is weaker because of MND, you may not breathe as efficiently during sleep. Your brain is sensitive to this problem and either wakes you, or takes you out of the deep stages of sleep. During this lighter sleep, you are able to use the intercostal (between the ribs) and accessory (neck and shoulder) muscles too, so that you breathe more effectively.
These changes in your sleep pattern results in disturbed, fragmented and unrefreshing sleep and you may not even dream when this happens. A lack of deep sleep results in excessive daytime sleepiness, lack of energy/vitality, morning headaches, poor appetite, and other symptoms that affect your quality of life.