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Why do I have shortness of breath at night?
Fact Checked
Intus Healthcare’s writers, customer service team, and sleep experts review and ensure this information is accurate.
Last updated on September 16th, 2024 at 11:17 am
If you are experiencing shortness of breath during the night, we understand how uncomfortable and disruptive it can be.
We have created this article to explain what causes shortness of breath at night, lifestyle changes you can make to help, and treatment methods to improve your sleep.
Table of Contents
Struggling with shortness of breath when lying down? Here’s why and what you can do
Orthopnoea is the medical term for breathlessness while lying down that goes away when standing or sitting up.
Similarly, episodes of shortness of breath during sleep, known as Paroxysmal Nocturnal Dyspnoea (PND), can cause you to wake up, disrupting your sleep (1). PND occurs suddenly and unpredictably, usually a few hours after falling asleep, and is typically triggered by an underlying condition.
Symptoms of breathlessness
If you suffer from orthopnoea, it may occur as soon as you lay down to sleep or gradually develop throughout the night.
Other symptoms you may experience include:
- Chest tightness
- Coughing
- Sudden awakening from sleep
- Difficulty catching your breath
- Feeling like you can’t take a full breath
- Feeling starved of oxygen
- Feeling as if you are suffocating
- Feeling as if you need to breathe more frequently
- Feeling like you need to breathe faster
Importance of recognising and addressing it
It is important to address these symptoms as they can be clinical signs that help diagnose and manage underlying conditions.
PND can be an early sign of serious health conditions such as heart failure, Chronic Obstructive Pulmonary Disease, Asthma, or Sleep Apnoea. Recognising and addressing PND promptly can lead to early diagnosis and treatment, potentially preventing the progression of these diseases.
What causes shortness of breath at night?
There are many reasons for feeling breathless at night, from heart and sleep problems to lung conditions.
Around 85% of cases related to shortness of breath are associated with conditions affecting the heart, lungs or mental health (2).
Lung conditions
Chronic Obstructive Pulmonary Disease (COPD): Patients with COPD may experience worsening symptoms at night due to a natural nighttime increase in airway resistance.
Asthma: Nighttime asthma can cause chest tightening, wheezing, and difficulty breathing. This can be due to cooler night air, allergens in the bedroom, or hormonal cycles affecting airway resistance.
Pneumonia: Lung infections such as pneumonia can inflame the air sacs in one or both lungs, which can fill with fluid or pus. This condition can cause significant breathing difficulties that may be more noticeable when lying down.
Upper Airway Collapse Syndrome: Those with respiratory conditions including Tracheomalacia, Bronchomalacia, and Excessive Dynamic Airway Collapse may experience symptoms of breathlessness.
Heart conditions
Abnormal heart rhythm (arrhythmia): An abnormal heart rhythm known as atrial fibrillation can cause breathlessness at night.
Heart failure: Congestive heart failure can cause fluid to accumulate in the lungs while lying down, leading to difficulty breathing. Shortness of breath is commonly reported in those suffering from heart failure.
How do I know if my shortness of breath is heart-related? (h3)
Other symptoms associated with heart problems include:
- Heart palpitations
- Feeling lightheaded
- Chest pain
- Fatigue
You must discuss this with your healthcare provider to determine if your symptoms are related to a heart condition.
Obstructive Sleep Apnoea
Obstructive Sleep Apnoea (OSA) occurs when the airway becomes partially or completely blocked during sleep, leading to repeated awakenings and significant breathlessness. You may feel like you’re gasping for air or choking during the night when an apnoea episode occurs.
Symptoms of OSA include:
Sleep Apnoea Test
A quick and easy way to confirm if you do or do not have Sleep Apnoea is by taking a sleep test.
The test requires one night of sleep data, and the results are sent to you within two working days.
If Sleep Apnoea is detected, our in-house clinicians can walk you through your treatment options and any questions you may have.
Allergies
Allergies can disturb sleep by inflaming the airways, causing blockages, and cutting off the air supply. Specific allergies can also enlarge adenoids, making it harder to breathe through your nose.
Mental health conditions
Feeling anxious from anxiety can trigger your body to go into a fight or flight response and lead to a panic attack. This can cause you to feel nauseous and struggle to breathe.
Ascites
A buildup of fluid between the abdomen and abdominal area is known as ascites, which can cause shortness of breath.
This can be caused by the following:
- Obesity
- Consuming alcohol before bed
- Type 2 diabetes
Hormones
Pregnancy: During pregnancy, several physiological changes occur that can lead to nighttime breathlessness and snoring. Reasons for this include increased oxygen demand, elevated progesterone levels, and increased blood volume.
Menopause: Menopause can also affect respiratory function through different mechanisms, such as hormonal fluctuations, sleep disturbances and weight gain. Additionally, menopause is often accompanied by anxiety or panic attacks, which can also contribute to shortness of breath.
Low testosterone: Low testosterone levels can indirectly contribute to shortness of breath at night by affecting muscles, cardiovascular health, sleep quality and weight around the throat.
Other causes
Obesity: Excess body weight can put pressure on the lungs and diaphragm, mainly when lying down, making breathing more difficult during sleep.
Gastroesophageal Reflux Disease (GERD): Acid reflux can cause stomach acid to flow back into the oesophagus, especially when lying down, leading to breathing difficulties.
Medication side effects: Some medications can cause fluid retention that can exacerbate breathing problems.
What to do if you feel breathless at night
If you experience shortness of breath during the night, you should seek help from a healthcare professional.
Diagnosis
To understand the root cause, you may undergo a diagnostic test, depending on your symptoms, investigations could include:
- A sleep test
- Pulse oximetry
- Chest radiography
- Electrocardiography
- Spirometry
- Upper endoscopy
- Stress testing
Sleep Apnoea and shortness of breath
Obstructive Sleep Apnoea is one of the most common reasons for waking up with shortness of breath as the airways narrow, causing breathing pauses.
Many people with OSA experience waking up gasping for air as their body tries to regain oxygen.
The repeated airway closures leave sufferers waking up tired with a headache and difficulty concentrating due to fragmented sleep.
If you think you could have Sleep Apnoea, our at-home sleep test is a quick and affordable way to determine whether the condition is present.
The easy-to-use test takes just one night to complete, and the results are with you within two working days. Our NHS-trained sleep clinicians analyse your sleep data and provide you with a detailed report and treatment advice (if OSA is detected).
Treatments
The treatment you require will depend on the condition causing your discomfort; here are the treatment methods for the most common causes:
Sleep Apnoea: Most people with OSA are recommended to use a CPAP machine. The machine provides a continuous flow of pressurised air through a mask to keep the airway open.
CPAP Masks
CPAP Machines
Alternative treatment methods include a Mandibular advancement device (MAD) or Positional Sleep Therapy.
Mandibular Advancement Devices (MADs) are mouthguards designed to prevent breathing obstructions. The device gently pulls the lower jaw forward, creating more space at the back of the throat to stop it from closing.
Positional Sleep Therapy is designed for those with Positional Obstructive Sleep Apnoea (POSA). This means that Sleep Apnoea primarily occurs when lying on the back. The Somnibel creates small vibrations when the user lies on their back, encouraging them to turn back onto their side.
Different lifestyle adjustments can also help to reduce symptoms, such as a healthy diet, quitting smoking and regular exercise.
Asthma and COPD: Treatment typically involves medication or a breathing device such as an inhaler, nebuliser, or oxygen therapy. Long-term oxygen therapy is recommended for more severe cases of COPD.
Nebulisers and inhalers are similar, as both supply prescribed medication through a small inhalation device.
NEB Pro
NEB 800
The NEB 800 is a portable mesh nebuliser for medication on-the-go, the battery-operated device uses ultra sonic frequencies to vibrate the mesh and provide relief.
Lifestyle modifications such as sleeping with a propped-up pillow and quitting smoking can also help these conditions.
Heart conditions: Your doctor may recommend certain lifestyle adjustments or an implanted medical device, such as a pacemaker, cardioverter defibrillator, or stent.
These devices are surgically implanted to help keep your heart functioning correctly.
Allergies: If you have an allergy, your doctor may prescribe you medication, such as nasal steroids, corticosteroids or antihistamines.
The SinuPulse Elite Nasal Irrigator uses a natural saline solution to flush out the sinuses and make breathing easier before bedtime. Any nasal irrigator device can be combined with SinuAir Nasal Salts to cleanse your sinuses, removing blockages so you can breathe through your nose. The salt can be used in any nasal rinse system.
Other ways to treat your symptoms at home include keeping your room dust-free, regularly washing your bedsheets and eliminating scented items.
Hormonal changes: If your hormones are disrupting your sleep, you should speak with your healthcare provider.
For peri-menopausal or menopausal women, they are typically prescribed HRT (hormone replacement therapy) to help manage symptoms such as night sweats and breathlessness at night.
Those with low testosterone usually receive testosterone replacement therapy, which may be in the form of a gel or through injections.
Ways to help balance your hormones at home include eating a healthy diet, regular exercise, and practising good sleeping habits.
Breathlessness is common in pregnancy, especially during the third trimester. Different sleeping, standing and sitting positions can help open the airway during sleep and reduce shortness of breath. If sleeping problems persist, they should contact their GP for further investigation.
Anxiety and panic attacks: Breathing exercises, such as diaphragmatic breathing, can help manage shortness of breath. Mental health therapy and avoiding triggers can also help.
Ascites: Lifestyle changes to reduce the fluid buildup include avoiding alcohol, lowering the salt in your diet (no more than 1,500 mg/day of sodium), and limiting fluid intake.
Although these changes can help, getting to the root cause with your healthcare provider is recommended.
GERD: If you suffer from GERD, your GP may prescribe you proton pump inhibitors (PPIs) or recommend non-prescription medication such as antacids to relieve the discomfort.
You can also take steps at home to ease your symptoms and reduce sleep disturbances. Some things you can try include modifying your diet, elevating your head at bedtime, and identifying triggers for your GERD.
5 Home remedies for shortness of breath at night
You may like to try some home remedies to ease discomfort while determining what condition is causing your breathlessness.
These could include:
1. Breathing Exercises
- Pursed-Lip breathing: Inhale through your nose for two counts, then exhale slowly through pursed lips for four counts. This helps keep the airways open longer and makes breathing easier.
- Diaphragmatic breathing: Also known as belly breathing, this technique involves breathing deeply into your diaphragm.
2. Stay Hydrated
- Drink enough fluids: Keeping yourself hydrated can help thin mucus in your airways, making breathing easier.
3. Essential Oils
- Eucalyptus: Adding a few drops of eucalyptus oil to a diffuser can help clear the airways and reduce inflammation.
- Lavender: The oil is known for its relaxing properties. It can help reduce anxiety and promote better sleep, which can indirectly help with breathing.
4. Stay Calm
- Reduce stress: Stress and anxiety can worsen shortness of breath, so practice relaxation techniques such as meditation or yoga.
5. Herbal Teas
- Peppermint and ginger tea: These teas can help reduce inflammation and open airways, making breathing easier.
Summary
Shortness of breath at night can significantly impact your sleep and day-to-day life. It is often a sign of an underlying condition and should be treated as soon as possible.
For many people, it is a sign of Sleep Apnoea; if you are experiencing any other symptoms such as chronic snoring or choking in sleep, you could have the condition.
Our home sleep test provides unrivalled accuracy and fast results from our in-house sleep clinicians. If you would like any help or advice regarding the sleep test or treatment, please contact us as we are happy to help.
About Our Editorial Team
Written By,
Danielle Myatt, Staff Writer
Danni is a degree-educated content writer who works closely with our clinical and customer services teams to ensure every article is well-researched and accurate. Each article is written to educate, help, and advise on Sleep Apnoea, spread awareness, and encourage treatment.
Medically Reviewed By,
Jay Gadher, Clinical Manager
Jay is an experienced Respiratory and Sleep Clinical Scientist. He completed his BSc in Healthcare Science, which has allowed him to gain expertise in scoring sleep studies. His knowledge and insights about sleep science and human health ensure every article reflects the latest data.
Related articles:
The difference between COPD and asthma
The link between Sleep Apnoea and COPD
Hormones that affect your sleep
References
- Mukerji V. (1990). Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. Available at: https://www.ncbi.nlm.nih.gov/books/NBK213/. Accessed: 26.06.2024
- Pesola GR, Ahsan H. (2016). Dyspnea as an independent predictor of mortality. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309743/. Accessed: 25.06.2024