Choking In Sleep: Can You Wake Up?

Waking up in the middle of the night choking or gasping for air can be a frightening experience. There are many reasons why this might happen, from bad dreams or colds to more serious conditions such as Obstructive Sleep Apnea (OSA). OSA is a common condition affecting over 1.5 million adults in the UK, and 85% of people with OSA are undiagnosed. It occurs when the muscles in the throat relax excessively during sleep, causing a temporary blockage of the airway. This can lead to choking, gasping, or snorting as the person wakes up briefly to resume normal breathing. Other causes of choking in sleep include acid reflux, anxiety, nocturnal panic attacks, and certain anatomical issues in the throat or airway. If you are experiencing frequent choking in your sleep, it is important to consult a healthcare professional for a proper evaluation and diagnosis.

Obstructive sleep apnea (OSA)

Choking in your sleep can be a symptom of Obstructive Sleep Apnea (OSA), a sleep disorder characterised by brief interruptions in breathing during sleep. OSA occurs when the airway becomes partially or completely blocked, leading to pauses in breathing. This blockage can cause oxygen levels in the blood to drop, resulting in the body's natural response to wake up choking or gasping for air.

OSA is a common condition, affecting over 1.5 million adults in the UK alone, and it is estimated that 85% of people with OSA are undiagnosed. The condition can lead to poor sleep quality, leaving individuals feeling tired, unable to concentrate, and experiencing low moods during the day. Additionally, if left untreated, OSA has been linked to the development of significant physical and mental health problems, such as high blood pressure, heart disease, stroke, diabetes, and depression.

The most common symptoms of OSA include loud snoring, stopping breathing, and choking or gasping for air during sleep. These symptoms are often reported by a bed partner. Other symptoms may include frequent awakenings, feeling like you have not had enough sleep even after sleeping for many hours, and restless tossing and turning. People who are at higher risk of developing OSA include those with enlarged tonsils and/or adenoids, a family history of OSA, excessive weight or obesity, and jaw problems such as a small or pulled-back jaw.

If you suspect you may have OSA, it is important to seek medical advice and undergo a sleep test for an accurate diagnosis. Home sleep tests are a convenient option, providing detailed information about your sleep patterns and helping to confirm OSA. In-laboratory polysomnography is also an effective method for diagnosing OSA, particularly for those with a high pre-test probability of moderate to severe OSA or significant medical comorbidities.

Treatment options for OSA include Continuous Positive Airway Pressure (CPAP) therapy, oral appliances, weight loss strategies, and surgical interventions. CPAP machines work by blowing air into a mask worn over the nose and/or mouth, acting as a splint to keep the upper airway open and prevent obstructions. Oral appliances, such as a Mandibular Advancement Device, are typically recommended for mild OSA and involve custom-made devices fitted by a specialised dentist or oral surgeon. Weight loss can also help improve OSA symptoms, especially if the condition is related to being overweight. In some cases, surgery may be recommended to remove tonsils or adenoids, clear out tissue from the back of the throat, or implant a nerve stimulator to move the tongue forward during sleep.

GERD and acid reflux

Waking up with a choking sensation due to acid reflux can be scary, but it is not life-threatening. This condition is known as gastroesophageal reflux disease or GERD, which affects up to 20% of the US population. It occurs when stomach acid flows back into the esophagus, the tube connecting the throat to the stomach. While occasional acid reflux is normal, GERD causes persistent acid reflux, heartburn, and nausea, and can lead to more serious complications.

GERD can significantly impact sleep quality, with nighttime acid reflux symptoms disrupting sleep. This happens because gravity, which usually helps keep stomach acid down during the day, no longer has the same effect when lying down. As a result, the backflow of stomach acid can reach the throat and larynx, causing choking and coughing. People with GERD may also experience worsened symptoms at night due to decreased swallowing, which allows more acid to accumulate in the throat.

To reduce the chances of choking on acid reflux while sleeping, several measures can be taken:

• Elevate your head: Use a wedge pillow or stacked pillows to keep your head elevated at an angle. This position helps to keep acid from backing up into your esophagus by utilizing gravity.
• Sleep on your left side: Sleeping on the left side may help alleviate reflux-related sleep problems.
• Avoid eating close to bedtime: Allow at least three hours between your last meal and bedtime to give your food time to digest and reduce the risk of acid reflux.
• Identify and avoid trigger foods: Keep a food journal to identify specific foods and beverages that trigger your GERD symptoms. Common triggers include spicy and acidic foods, salted foods, caffeinated drinks, mint, carbonated beverages, alcohol, and greasy foods.
• Maintain a healthy weight: Obesity is associated with a higher risk of GERD. Losing weight can help decrease the pressure on the lower esophageal sphincter and improve GERD symptoms.
• Quit smoking: Smoking affects the pressure near the lower esophageal sphincter and increases the severity of GERD symptoms.
• Consult a healthcare professional: Discuss your symptoms and concerns with a doctor or dietitian. They can recommend lifestyle changes, identify trigger foods, and suggest suitable treatments or medications to manage your GERD effectively.

Sleep paralysis and panic attacks

Choking in your sleep can be a symptom of a serious condition called Obstructive Sleep Apnea (OSA). OSA is characterised by brief interruptions in breathing during sleep due to a partial or complete blockage of the airway. This can cause oxygen levels in the blood to drop, leading to choking or gasping for air as the body wakes up to restore breathing. OSA affects over 1.5 million adults in the UK, with 85% of cases undiagnosed. It is important to seek medical advice and consider a sleep test if you suspect you may have OSA.

Sleep paralysis is a temporary condition marked by a brief loss of muscle control and the inability to move or speak just after falling asleep or before waking up. It is often associated with hallucinations and a feeling of suffocation or chest pressure. Sleep paralysis is linked to sleep disorders, such as sleep apnea, and certain mental health conditions, including anxiety disorders, panic disorder, and post-traumatic stress disorder (PTSD). It is also connected to high-stress levels and shift work.

While the exact causes of sleep paralysis are unknown, it is believed to be a parasomnia, or abnormal behaviour during sleep, related to the rapid eye movement (REM) stage of the sleep cycle. Individuals remain conscious during episodes, experiencing distressing emotions like panic or helplessness. Sleep paralysis can lead to excessive sleepiness or fatigue the following day.

There is a complex relationship between sleep disturbances and panic or anxiety disorders. Sleep difficulties are correlated with anxiety symptoms, and poor sleep can contribute to the development of anxiety. Similarly, anxiety disorders can negatively impact sleep quality, creating a cycle of sleep deprivation and anxiety. This cycle can have detrimental effects on overall well-being, cognitive abilities, and physical and mental health.

To address sleep issues related to panic or anxiety, it is important to prioritise sleep and practice good sleep hygiene. Dietary supplements like melatonin, magnesium, and ashwagandha can help calm the mind and body. Additionally, living a healthier lifestyle, including weight loss if appropriate, has been shown to positively impact sleep disorders. In severe cases, medical intervention and treatment for underlying mental health conditions may be necessary.

Asthma and other respiratory issues

Asthma is a common condition that can cause people to wake up choking or gasping for air. The bronchioles, which are tiny tubes in the lungs, are most open in the mid-afternoon and most constricted around 4 a.m. This means there is more airway resistance at night, which can exacerbate underlying asthma. Poor sleep can also worsen asthma symptoms, creating a cycle of poor sleep and worsening asthma. People with asthma may wake up wheezing, and factors such as sleep position and allergens in the bedroom can increase mucus and inflammation, triggering asthma symptoms.

GERD (gastroesophageal reflux disease) can also trigger asthma symptoms and cause choking during sleep. It is characterised by symptoms such as heartburn, regurgitation, coughing, or choking. GERD can be managed through medication and lifestyle changes. Obstructive sleep apnea (OSA) is another common cause of choking in sleep, affecting approximately 12% of American adults. It occurs when the tongue and tissues in the mouth block the airway during sleep, causing pauses in breathing. People with OSA may snore loudly, wake up choking or gasping for air, and experience symptoms such as morning headaches and excessive daytime sleepiness. Central sleep apnea (CSA) is less common than OSA and is caused by issues with brain signals regulating breathing during sleep, rather than physical airway blockage.

If you are experiencing choking or gasping during sleep, it is important to seek medical advice to determine the underlying cause and receive appropriate treatment. Home sleep tests and in-lab sleep studies can be conducted to diagnose sleep apnea. Treatment options for sleep apnea include CPAP therapy and lifestyle changes, such as avoiding alcohol and sedative medications before bedtime. For asthma, taking daily medication as recommended by a doctor can help relieve nocturnal asthma symptoms.

Alcohol and drug use

The use of opioids, including heroin, morphine, and methadone, can also alter sleep patterns. Acute intoxication with these substances can enhance arousal during sleep-wake periods, and even a single dose of oral opioids can significantly affect sleep architecture in healthy adults. Chronic opiate users may experience changes in sleep patterns during periods of abstinence, including decreased total sleep time, slow-wave sleep, REM sleep, and increased sleep latency. Similar effects on sleep have been observed with the use of CNS stimulants and depressants, such as cocaine and cannabis.

It is important to note that alcohol and drug use can impair one's ability to wake up during sleep, especially in cases of alcohol or drug dependence. This impairment can increase the risk of choking during sleep, as the body's arousal responses may be hindered. Additionally, alcohol intoxication can lead to vomiting, and if an individual is unable to wake up, they may choke on their vomit, requiring emergency medical attention.

To reduce the risk of sleep disturbances and potential choking hazards, it is recommended to avoid alcohol and drug use, especially close to bedtime. Maintaining a consistent sleep schedule, avoiding screens and caffeinated beverages before bed, and seeking help for any underlying sleep disorders or addictions are crucial steps to promote healthy sleep and reduce the likelihood of choking during sleep.

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