Ashwin Lewis
Waking up in the middle of the night gasping for air can be a frightening experience and a sign of a serious health problem. There are several reasons why someone might experience this, including orthopnea, nocturnal panic attacks, or sleep apnea. Orthopnea is a condition where a person experiences shortness of breath when lying down, usually due to an underlying medical condition affecting the heart or lungs. Nocturnal panic attacks are another potential cause, with choking and shortness of breath being common symptoms. Sleep apnea, a condition that affects breathing during sleep, is also a possible explanation. Obstructive sleep apnea (OSA), the most common form, occurs when the tongue and tissues in the mouth block the airway, causing repeated interruptions in breathing throughout the night. Central sleep apnea (CSA) is another type, where the brain fails to send signals to the muscles involved in breathing. Sleep apnea can have significant impacts on overall health and well-being, affecting sleep quality, oxygen levels, and heart function.
| Characteristics | Values |
|---|---|
| Condition | Sleep apnea, Orthopnea, Nocturnal panic attacks |
| Symptoms | Gasping for air, Choking, Shortness of breath, Unusual breathing patterns, Excessive daytime sleepiness, Arrhythmias, Abnormal heart rhythms, Tightness or pain in chest, Wheezing or coughing, Heart palpitations |
| Causes | Blocked airway, Brain failing to send signals to muscles, Obesity, Enlarged tonsils or adenoids, Thick neck, Nasal congestion, Underlying medical condition affecting heart or lungs |
| Treatment | Continuous positive airway pressure (CPAP), Mouthguard-like devices, Inspire (FDA-approved device implanted in chest), Psychotherapy or medication |
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What You'll Learn
Sleep apnea
There are two main types of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA, the most common form, happens when the tongue and other tissues in the mouth block the airway. This can occur due to factors such as obesity, large tonsils, or hormonal changes. CSA, on the other hand, is caused when the brain fails to send the necessary signals to breathe. There is also a third, less common type called mixed or complex sleep apnea, which is a combination of OSA and CSA.
The most common symptom of sleep apnea is persistent, loud snoring, often accompanied by gasping for air during sleep. Other symptoms include excessive daytime sleepiness, frequent nighttime urination, and positional sleep apnea, where breathing disruptions are worse when sleeping on the back. Sleep apnea can be diagnosed through a sleep study, which can be conducted at home or in a hospital sleep clinic.
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Orthopnea
To diagnose orthopnea, a healthcare professional will take a full medical history and perform a physical examination. They will ask questions about the number of pillows used, the presence of chest pain or coughing, and exercise tolerance. A pulmonary physical exam may reveal wheezing, rales, or dullness to percussion, indicating pulmonary involvement. A cardiovascular exam may show murmurs, abnormal location of maximal impulse, or additional heart sounds. Further medical testing, such as blood tests, may be required to determine the underlying cause.
Treatment for orthopnea focuses on addressing the underlying disease. In the meantime, respiratory support devices such as CPAP or biPAP can be used to alleviate symptoms.
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Nocturnal panic attacks
People who have panic attacks or panic disorder are more likely to experience nocturnal panic attacks. Nocturnal panic attacks can happen for no identifiable reason, but triggers can include stress, traumatic events, or changes in sleep patterns. They sometimes occur right after a bad dream. It is important to distinguish panic attacks from nocturnal panic attacks as this can help narrow down the probable causes and find the right treatment.
The first step in managing nocturnal panic attacks is to consult a healthcare provider, who may order tests to rule out other health problems that can cause similar symptoms, such as heart disease or thyroid disease. If no physical cause is found, a nocturnal panic attack diagnosis may be made based on symptoms and risk factors. Treatment options include therapy, relaxation techniques, medication, and self-care. Cognitive-behavioral therapy (CBT) and antidepressants can be effective in easing panic attacks. Deep, controlled breathing and muscle relaxation exercises may also help reduce the severity of an attack.
It is important to note that nocturnal panic attacks are not the same as night terrors, which are also disruptive sleep disorders. People experiencing night terrors may appear awake and may scream, jump out of bed, or run around, but they are actually still asleep. They are often unaware of their actions and it is difficult and usually not recommended to wake them. Children are more likely to experience night terrors, but they can occur in adults as well.
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Obstructive sleep apnea (OSA)
The condition can affect your overall health, not just your sleep. When breathing stops, the oxygen levels in your blood drop, triggering a brain reflex that wakes you up just enough to start breathing again. These repeated awakenings interrupt your sleep cycle and prevent you from spending enough time in the deep stages of sleep. This can make you feel tired during the day and affect your productivity and mood. It can also put stress on your heart, which may be life-threatening if left untreated.
OSA can be diagnosed through a sleep study, which can be done at home or in a hospital sleep clinic. The "gold standard" treatment for OSA is continuous positive airway pressure (CPAP), which uses a mask-like device that fits over the nose and mouth and blows air to keep the airways open. Other treatments include oral appliances, such as mouthguards, and surgery to remove tissue from the back of the throat or reposition the tongue. Weight loss and avoiding alcohol before bed can also help improve OSA symptoms.
People with certain risk factors are more likely to develop OSA. These include enlarged tonsils or adenoids, a family history of OSA, obesity, and jaw problems such as a small or pulled-back jaw. Males are also more likely to be diagnosed with OSA before the age of 50. If you are experiencing symptoms of OSA, it is important to see a healthcare provider who can create a treatment plan to help manage the condition and prevent complications.
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Central sleep apnea (CSA)
CSA can manifest in various forms, including narcotic-induced CSA, where opioid medications affect breathing patterns, and high-altitude periodic breathing, which occurs at elevations above 2,500 meters (8,000 feet). Treatment-emergent CSA can develop as a result of positive airway pressure treatment for OSA, while medical condition-induced CSA can be caused by health issues such as heart failure, Parkinson's disease, stroke, or kidney failure. Idiopathic CSA occurs when there is no apparent cause.
The primary symptom of CSA is pauses in breathing, which can last from 10 to 30 seconds and occur intermittently or in cycles. CSA is not typically associated with snoring, which is more common in OSA. However, CSA can lead to excessive daytime sleepiness, frequent awakenings, insomnia, and awakening short of breath. These symptoms can fragment sleep and cause abnormal blood oxygen levels, resulting in daytime drowsiness, cognitive difficulties, and an increased risk of errors and accidents.
Diagnosis of CSA is typically made through a sleep study, which may be conducted at home or in a sleep clinic. Treatment options depend on the underlying cause and may include addressing the underlying medical condition, adjusting medication, or using devices like continuous positive airway pressure (CPAP) machines or the implantable remedē System device.
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Frequently asked questions
Sleep apnea is a serious condition that happens when your breathing stops and starts during sleep. It can affect your overall health, not just your sleep.
The symptoms of sleep apnea include unusual breathing patterns (fast breathing that gets deeper, then shallower again until breathing stops before starting again), excessive daytime sleepiness, and arrhythmias.
Obstructive sleep apnea (OSA), the most common form of this nighttime breathing disorder, occurs if your tongue and other tissues in the mouth fall backward and block your airway when you lie down. Central sleep apnea (CSA) occurs when your brain doesn't send signals to keep breathing-related muscles working while you sleep.
