Colin Snow
Waking up choking or gagging in your sleep can be extremely uncomfortable and frightening. It can be a sign of a serious health problem, such as obstructive sleep apnea (OSA), a common sleep disorder where your upper airway repeatedly closes during sleep, resulting in fragmented and poor-quality sleep. Other possible causes include acid reflux, asthma, or even seizures. If you are experiencing choking in your sleep, it is important to consult a sleep specialist or your doctor for proper diagnosis and treatment.
| Characteristics | Values |
|---|---|
| Possible causes | Obstructive sleep apnea (OSA), acid reflux, asthma, heart failure, seizures |
| Symptoms | Loud snoring, daytime fatigue, frequent gasping for air, choking, fragmented sleep |
| Treatments | Continuous Positive Airway Pressure (CPAP), weight loss, antiepileptic drugs, medication for asthma, urgent medical attention |
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What You'll Learn
Obstructive sleep apnea (OSA)
Choking in your sleep can be a symptom of a serious condition called Obstructive Sleep Apnea (OSA). OSA is a common sleep disorder that affects the normal flow of air during sleep. It occurs when the soft structures at the back of the throat, such as the tongue and throat muscles, collapse and block the airway. This results in repeated pauses in breathing, which can last 10-20 seconds and occur hundreds of times throughout the night. These pauses in breathing can cause a sudden drop in oxygen levels, leading to arousals from sleep or a complete awakening.
The blockage of the airway often results in a loud choking or snorting noise as the body tries to restart breathing. This can be frightening and disruptive to sleep. OSA is commonly associated with snoring, and the snoring may be interrupted by periods of silence. While snoring is a common symptom, not everyone who snores has OSA.
OSA can lead to extremely fragmented and poor-quality sleep, significantly impacting an individual's quality of life. It is linked to various physical and mental health problems, including daytime fatigue and drowsiness, which can increase the risk of motor vehicle accidents and industrial accidents. People with OSA may experience excessive daytime sleepiness, affecting their daily functioning.
OSA is more common in individuals who are overweight or obese, as the risk factors include physical features that narrow the upper airway. Other associated conditions include endocrine conditions such as hypothyroidism, chronic lung diseases like asthma, and neuromuscular conditions interfering with brain signals to the chest muscles and airway. Heart or kidney failure can also cause fluid build-up in the neck, obstructing the upper airway.
The gold standard treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy, which involves using a small bedside device to deliver low-pressure air through a mask worn over the nose or nose and mouth, gently holding the airway open. Weight management, exercise, and medications like Zepbound (tirzepatide) are also recommended for OSA patients with obesity.
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Acid reflux
Waking up choking on stomach acid can be detrimental to the quality of your sleep and general wellness. This is often due to acid reflux, which is a common experience for people with gastroesophageal reflux disease (GERD). GERD is a chronic condition where stomach acid flows back up into the oesophagus (the tube that connects your throat to your stomach). It is estimated that up to 20% of the US population has GERD.
There are several ways to prevent choking on acid reflux while sleeping. It is recommended to give your body at least three hours to digest before going to bed, as this allows more time for food to leave the stomach, reducing the risk of acid reflux. Wearing loose-fitting clothing can also help, as tight-fitting clothes, especially around the waist and abdominal area, can put pressure on the stomach and push its contents back up into the oesophagus.
It is also suggested that sleeping on your left side can reduce reflux episodes and exposure of the oesophagus to stomach acid. Elevating your head with a wedge pillow or an adjustable bed frame can also help to reduce nighttime GERD symptoms, including choking on reflux while sleeping.
If you experience frequent choking in your sleep, it could be a sign of obstructive sleep apnoea (OSA). This is a sleep disorder characterised by brief interruptions in breathing during sleep, often caused by a blocked airway. If you suspect you may have OSA, it is important to seek medical advice.
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Central sleep apnea (CSA)
Choking in your sleep can be a sign of sleep apnea. Sleep apnea occurs when the windpipe collapses, blocking airflow and momentarily restricting breathing. This results in poor-quality sleep, which can significantly impact your quality of life.
CSA is often associated with various medical conditions, particularly cardiovascular conditions. These include atrial fibrillation, heart failure, ischemic stroke, spinal cord injury, renal failure, and chronic opioid use. The prevalence of CSA tends to increase with age, with older adults above 65 years of age being more susceptible. It is also more common in men than in women.
CSA can be diagnosed through polysomnography, which measures respiratory events during sleep. Treatment options for CSA include reducing or withdrawing medication that may be causing the CSA, or in more severe cases, implanting a device that stimulates the nerve that controls breathing.
While choking in your sleep can be a sign of CSA, it is important to consult a medical professional for a proper diagnosis.
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Complex sleep apnea
Choking in your sleep can be a sign of sleep apnea, a common sleep disorder where your upper airway repeatedly closes during sleep. Obstructive sleep apnea (OSA) occurs when the soft tissue in the back of your throat collapses and blocks the airway, often resulting in a choking or snorting noise.
Now, let's delve into the specifics of complex sleep apnea:
In complex sleep apnea, an individual being treated for OSA continues to experience pauses in their breathing, despite their airway remaining unobstructed. This condition is often discovered when a patient is undergoing positive airway pressure (PAP) therapy, specifically continuous positive airway pressure (CPAP) treatment. During CPAP therapy, adjustments to air pressure settings can cause air to leak out of the mask, leading to a sudden drop in carbon dioxide levels and triggering an episode of central apnea. This phenomenon, where central apneas emerge or persist despite successful treatment of OSA, is what defines complex sleep apnea.
The prevalence of complex sleep apnea ranges from 0.56% to 18%, and it is estimated that up to 20% of people undergoing CPAP titration for OSA may develop this condition. However, only about 1.5% to 2% of patients continue to experience symptoms on long-term CPAP therapy. The exact causes of complex sleep apnea are not fully understood, and it is debated whether certain cases, such as those associated with narcotic use or heart failure, should be included in the definition of complex sleep apnea.
While complex sleep apnea often resolves over time, some individuals may require alternative treatments. Doctors may recommend continuing CPAP therapy and monitoring progress, or they may suggest switching to adaptive servo-ventilation (ASV) or bilevel positive airway pressure (BiPAP) with a backup rate.
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Asthma
Waking up choking or gasping for air can be a symptom of several conditions, including obstructive sleep apnea (OSA), acid reflux, asthma, and nocturnal panic attacks.
If you experience frequent choking in your sleep, the most likely cause is OSA. OSA is a common sleep disorder characterised by brief interruptions in breathing during sleep due to a blocked airway. This can cause oxygen levels in the blood to drop, leading to choking or gasping for air as the body responds to the lack of oxygen. Treatment options for OSA include positional sleep therapy devices, weight loss, and continuous positive airway pressure (CPAP) therapy, which uses a mask-like device to gently hold the airway open and prevent it from collapsing.
Another possible cause of choking in your sleep is acid reflux, also known as gastroesophageal reflux disease (GERD). This occurs when stomach acid flows back up into the oesophagus, irritating the throat and sometimes triggering excessive saliva production, which can lead to choking or gagging. Lifestyle changes, such as avoiding large meals before bed, certain trigger foods, alcohol, and smoking, as well as over-the-counter or prescription medications that reduce acid production, can help manage acid reflux.
Nocturnal panic attacks, which typically occur during the first third of the night, can also cause choking or gasping for air during sleep. These attacks are often accompanied by other symptoms such as a pounding heart, sweating, and feelings of unreality. Treatment for panic disorder may include prescription antidepressants or anti-anxiety medications, as well as deep, slow breathing techniques to help relax the body before bed.
If you are experiencing frequent choking in your sleep, it is important to consult a sleep specialist or your healthcare provider to determine the underlying cause and receive appropriate treatment.
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Frequently asked questions
Choking in your sleep can be a sign of a serious health problem. It could be a symptom of sleep apnea, acid reflux, asthma, or even seizures. If you are experiencing choking in your sleep, it is important to consult a doctor or sleep specialist.
Sleep apnea is a common sleep disorder that occurs when the airway becomes blocked, causing pauses in breathing during sleep. These pauses can last 10-20 seconds and may occur hundreds of times a night, disrupting sleep and oxygen flow to the brain. Obstructive sleep apnea (OSA) is the most common form, caused by the tongue and tissues in the mouth blocking the airway.
In addition to choking and gasping for air during sleep, other symptoms of sleep apnea include loud snoring and daytime fatigue. Sleep apnea can also lead to serious physical and mental health problems due to disrupted sleep.
Sleep apnea is typically diagnosed through a sleep study, which can be done at home or in a hospital sleep clinic. Sensors monitor heart rate, breathing, blood oxygen levels, and body movements to help diagnose sleep apnea and determine its severity.
The current gold standard treatment for OSA is Continuous Positive Airway Pressure (CPAP) therapy, which uses a mask-like device to deliver air pressure and keep the airways open during sleep. Weight loss is also recommended for those with OSA, as it can reduce episodes by up to 50%.
