-Extremely common and often frightening events -- in many cases, all the more frightening because whatever provokes them occurred during sleep, such that their cause may be quite unclear.

BEDPARTNER OBSERVATIONS OF WHAT HAPPENS JUST PRIOR TO THESE EPISODES CAN PROVE INVALUABLE IN ARRIVING AT AN ACCURATE DIAGNOSIS.

Possible causes include the following:

-Sleep apnea.   Arousals may be precipitated either by struggling to overcome upper airway collapse, or by simple failure to make any effort to breathe.  Simultaneously, it should be realized that many sleep apnea patients stop breathing hundreds of times per night without ever awakening as a consequence!

            Clues to this diagnosis include:

• The sensation that one must make repeated efforts to breathe before ‘anything happens’.
• Shortness of breath or chest discomfort are immediately relieved after a few deep breaths
• Awareness of a throaty, gasping sound, snort or snore with some of these episodes.
• May happen more often if sleeping flat -- or if lying on your back. 
• In some cases, may occur less frequently when sleeping in a chair.
• Worsening after weight gain.
• Occurs more often after drinking alcoholic beverages.
• Occurs more often when experiencing more nasal congestion.

-Gastroesophageal Reflux Disease (GERD), with backflow of stomach acid up into the esophagus and throat.  Regurgitated acid may spill over the vocal cords and throw them into spasmodic closure, and inhalation of stomach contents into the lungs may provoke arousals with coughing and choking.  Also, even if acid does not back up to levels higher than the mid-esophagus, a nerve reflex can trigger tight wheezing similar to asthma.  Chest pain, virtually identical to that of angina from coronary disease (even to the point of responding to nitroglycerine) can occur, related to esophageal spasm.

       Clues to the diagnosis of GERD include:

• Awareness of bitter, acidic fluid in the throat or nose, or a sour taste on awakening.
• Associated with vomiting or near vomiting.
• High pitched crowing, stridorous sounds unlike the deeper, throaty-sounding gasps of sleep apnea.
• Wheezing or coughing.
• Occurrence more frequent after weight gain.
• Related to eating late, large meals, alcohol, spicy foods, or certain other foods like chocolate.
• May improve if sleeping with elevation.
• Immediate sitting up or jumping to one’s feet, during frantic efforts to breathe.
• In some cases, prolonged distress -- sometimes relieved by drinking water or by taking antacids.

-Sinus drainage during sleep sometimes can precipitate arousals with choking.

-Asthma  frequently worsens in sleep and in some instances is aggravated by GERD-- particularly since some asthma medications can make GERD worse.

-Heart failure often causes attacks of shortness of breath in sleep called “paroxysmal nocturnal dyspnea” especially when sleeping without elevation.  These usually last more than a few minutes and the patient must sit on the side of the bed for a time and try to catch his or her breath.

-Coronary artery disease and other heart problems, including abnormal heart rhythms, can provoke awakenings with shortness of breath, chest pain, palpitations and other distressing symptoms.

-Panic attacks, Sleep-related Seizures and other abnormal events precipitating abrupt arousals also can cause symptoms of breathless and chest discomfort in some individuals.

 

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