There are few things that are more startling than waking up in the middle of the night with the sensation that you can’t breathe. The experience can leave you lying in bed, feeling both worried and scared as you wonder why it’s happening. The good news is you aren’t alone!
There are several reasons why you may be waking up gasping for air, some of which are temporary and benign, while others may indicate more serious health conditions. Fortunately, most of these causes can be treated or even prevented with the right tools and information.
Today we’ll go over the potential causes of this phenomenon. Additionally, we will discuss the available treatment options for each issue, along with some prevention tips. Plus, we’ll cover some of the most common questions people have regarding this topic. Our hope is that by understanding the root cause, you can take appropriate action to improve your sleep health and overall well-being!
1. Sleep Apnea
If you have ever searched the question “Why am I waking up with shortness of breath?” on Google, you’ve probably come across numerous articles suggesting that you may have sleep apnea. That’s because waking up while struggling to breathe is one of the most commonly recognized signs of this condition, aside from snoring.
Individuals who have sleep apnea tend to produce very shallow breaths and experience pauses in breathing while asleep. Oftentimes these episodes occur several times throughout the night, and as a result, the body struggles to get the amount of oxygen it needs to promote healthy sleep. Individuals with sleep apnea are likely to struggle with feeling as though they are not well-rested when they wake up in the morning.
There are three types of sleep apnea:
- Obstructive Sleep Apnea: This is the most commonly diagnosed form of sleep apnea. It occurs when the airway becomes blocked due to the muscles in the surrounding area becoming weakened. This blockage may lead to snoring, which is one of the most common signs of OSA.
- Central Sleep Apnea: Central sleep apnea is caused by the brain’s inability to regularly communicate with the muscles in the chest that are responsible for breathing. Because of this, the body fails to regulate the respiratory process without additional support.
- Complex Sleep Apnea: This condition occurs when a person who is being treated for obstructive sleep apnea suddenly develops central sleep apnea as well.
Treating Sleep Apnea
The main treatments for sleep apnea fall under a type of therapy called Positive Airway Pressure (PAP). There are multiple kinds of PAP devices, but each works by delivering air that is under positive pressure into the airway of a person with sleep apnea. If you have sleep apnea, your doctor will select a treatment and prevention plan that is right for you. Their suggestions may include the following:
- Obstructive Sleep Apnea Treatment: The most common treatment for sleep apnea is a device called Continuous Positive Airway Pressure (CPAP). This device provides a continuous flow of pressurized air, which helps to keep the airway open as you sleep. If you have other conditions that impact your breathing or have a very severe case of OSA, your doctor may prescribe other PAP devices, such as an Automatic Positive Airway Pressure (APAP) or Bi-Level Positive Airway Pressure (BiPAP).
- Central Sleep Apnea Treatment: This form of sleep apnea can be treated using CPAP or similar PAP devices. However, doctors often prescribe a much more advanced positive airway pressure device called Adaptive Servo-Ventilation (ASV). This device monitors breathing patterns and uses an algorithm to provide the exact amount of pressure needed for each stage of breathing throughout the night.
- Complex Sleep Apnea Treatment: Your doctor will likely choose to either continue with your CPAP device but with a change to the amount of pressure being used, or they may suggest moving to an APAP or BiPAP device if additional support is appropriate. Additionally, Adaptive Servo-Ventilation is a great option for more severe or complicated cases of complex sleep apnea.
Preventing Sleep Apnea
Although certain cases of sleep apnea cannot always be prevented, it is often triggered by certain health changes or lifestyle choices. Your doctor may suggest making the following changes based on the type of sleep apnea you have:
- Obstructive Sleep Apnea Prevention: Weight loss, quitting smoking, avoiding alcohol, avoiding sedative substances, sleeping on your side, and treating underlying conditions such as allergies or nasal congestion.
- Central Sleep Apnea Prevention: Avoiding alcohol, avoiding sedative substances, losing weight, and treating underlying conditions such as congestive heart failure or neurological conditions.
- Complex Sleep Apnea Prevention: Avoiding alcohol, avoiding sedative substances, losing weight, and treating underlying conditions.
Think You May Have Sleep Apnea? Take Our FREE Sleep Apnea Quiz!
2. Post-Nasal Drip
Post-nasal drip is one of the easiest to identify reasons for waking up gasping for air. It occurs when your body produces an excess amount of mucus in your sinuses. This can lead to drainage into your throat and upper airway, which is more likely to accumulate as you sleep. As a result, you may begin coughing or even choking, which leads to the sensation that you are struggling to breathe or having to gasp for air.
If you have a combination of the following symptoms, you may be experiencing post-nasal drip as you sleep.
- Throat irritation and/or redness
- Sore throat
- Bad breath
Treating Post-Nasal Drip
Treatment options typically involve drinking more water along with using saline nasal sprays or over-the-counter medications, such as Sudafed or Benadryl. It may also be helpful to inhale steam to ease the irritation in your sinuses and airways. If your post-nasal drip is accompanied by congestion, you can add diluted essential oils such as eucalyptus or peppermint. Also, some people use throat sprays or cough drops to reduce throat irritation.
Preventing Post-Nasal Drip
The best way to prevent post-nasal drip is to stay hydrated, so be sure to drink lots of water! Many providers also suggest using a sinus wash before going to bed. This can clear out the mucus in your sinuses, which may make it easier to fall asleep and prevent you from waking up.
Because post-nasal drip is caused by other ailments, it is important to target the primary cause. It can be triggered by a wide range of conditions, but the most common are allergies, infections in the sinuses or upper airway, or environmental irritants. Additionally, it may be helpful to sleep at a significant incline.
3. Hypnagogic Jerk
Sometimes referred to as a sleep twitch, a hypnagogic jerk is a sudden muscle spasm that occurs right as you drift into that phase between being awake and asleep. It is also possible to experience a similar effect during particularly vivid dreams. The sudden movement startles you awake and therefore may cause you to feel as though you’ve awoken while unable to breathe for a moment. While they are unpleasant, medical experts fully believe them to be harmless.
Hypnagogic jerks are often accompanied by the following:
- Increased heart rate
- Fast breathing
It should be noted that these symptoms should resolve themselves quickly. If you find yourself with the above symptoms for an extended period of time, you may be experiencing something else.
Treating Hypnagogic Jerk
Because these sleep twitches are harmless and quickly resolve themselves, they typically do not require treatment unless they are related to anxiety. Some people struggle to “calm” themselves after being jolted awake. If you find yourself in this position, you may find it helpful to take a sip of water followed by some slow deep breaths until your heart rate and breathing return to normal.
Preventing Hypnagogic Jerk
If you find yourself being awoken regularly by these twitches, it may be helpful to make some changes to address the underlying cause. You may be more likely to be awakened by hypnagogic jerks if you:
- Have poor or irregular sleep
- Use stimulating substances such as caffeine or nicotine
- Feel stressed or anxious
You may find it helpful to utilize some relaxation techniques to reduce the chances of experiencing excessive sleep twitching. Some of our favorite suggestions include reading before bed, using aromatherapy, or practicing guided meditation.
If you begin to regularly experience hypnogogic jerking multiple times a night, it may be worth looking into ways to improve your sleep health. Suggestions include making changes to your bedtime routine, adjusting your evening diet, or even adding a relaxation and sleep-supporting supplement such as magnesium.
4. Pulmonary Edema
If you regularly find yourself waking up gasping for air, you may have pulmonary edema, which is a condition in which fluid accumulates in the lungs. This excess fluid makes it difficult to breathe and reduces your body’s ability to take in oxygen and remove carbon dioxide.
These effects are often said to be worse at night, as lying down has been proven to worsen the condition. This experience may leave you wondering, “Why do I feel like I’m suffocating in my sleep?” The reason is likely that your pulmonary edema is triggering something called paroxysmal nocturnal dyspnea (PND), which causes your body to suddenly feel severely short of breath while sleeping.
Other symptoms of pulmonary edema include:
- Severe shortness of breath
- Rapid breathing
- Wheezing or gurgling
- Coughing up blood
- Difficulty speaking
Treating Pulmonary Edema
Because this condition can become dangerous if not resolved, pulmonary edema is typically treated using a multitude of methods at once. Solutions include the following:
- Oxygen therapy
- Positive Airway Pressure machines
- Medications to reduce excess fluids
- Medications to reduce blood pressure
- Medications that reduce anxiety from struggling to breathe
- Mechanical ventilation in severe cases
Preventing Pulmonary Edema
Pulmonary edema is most often caused by underlying conditions. Therefore it is important to address those issues in order to prevent PE from occurring or even worsening. Heart failure is commonly associated with pulmonary edema. However, it can also be caused by other complications that are known to cause an increase in the blood pressure within the lungs.
While pulmonary edema may not be prevented entirely, depending on the underlying cause, your risk of developing PE can be reduced by:
- Maintaining a healthy weight
- Reducing salt in your diet
- Lowering LDL cholesterol
- Avoiding smoking
- Limiting fluid intake
- Lying at an incline
5. Anxiety Induced Hyperventilation
If you are someone who struggles with anxiety or has ever experienced a panic attack, you are likely familiar with the sudden feeling of being short of breath during particularly rough bouts. When you become severely triggered, your body responds by alerting your stress pathways, triggering your flight or fight response.
One side effect of this is an increased breathing rate, which can lead to [hyperventilation](https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hypvn#:~:text=Hyperventilation is breathing that is,and be short of breath.). During this process, your breathing becomes fast and shallow, meaning you end up putting out a lot more carbon dioxide than usual. This can trigger the blood vessels in your lungs to constrict. Occasionally this process may occur while you are sleeping, leaving you suddenly waking up gasping for air and heart racing.
Aside from rapid breathing, signs of anxiety-induced hyperventilation include the following:
- Feeling starved of air
- Feeling tingling or numbness
- Increased heart rate
- Chest tightness
Treating Anxiety-Induced Hyperventilation
Thankfully, there are several treatment options for anxiety. Most experts suggest starting with relaxation techniques and therapy, and if those are not enough, there are also many medications that can help take the edge off. If you find yourself being woken up while hyperventilating, you can try a number of steps to calm your breathing back down to normal, such as:
- Breathing into a paper bag
- Intentionally taking slow, deep breaths
- Utilizing relaxation techniques
- Identifying and mentally processing what triggered you
Preventing Anxiety-Induced Hyperventilation
The best way to reduce your likelihood of experiencing a bout of anxiety-related hyperventilation at night is to find healthy ways to manage your anxiety. Some of the following suggestions can be included as part of your bedtime routine in order to give you the best chance of getting a good night’s rest.
- Practice relaxation techniques before bed
- Try out some tips from cognitive behavioral therapists
- Establish a solid bedtime routine
- Avoid stimulants
- Avoid alcohol
- Exercise each day
6. Acid Reflux
Similar to post-nasal drip, acid reflux is another easy-to-identify cause of waking up gasping for air. This condition occurs when the acid in your stomach flows back into your esophagus, causing the feeling of heartburn. Reflux is more likely to occur at night because it is easier for acid to travel up into the esophagus when you are lying down rather than sitting up.
As the acid begins to irritate the throat, it can also trigger spasms in the airway. And if your condition is severe enough, the acid may even make its way into your lungs, which results in symptoms that may be similar to asthma. When this process occurs at night, it can startle you awake due to the sensation of being temporarily unable to catch your breath.
The first sign that you have reflux is obviously heartburn, but there are several ways to know if you are experiencing acid reflux at night:
- Waking up with a sour or bitter taste
- Coughing or clearing the throat
- Hoarseness in the morning
- Difficulty swallowing
- Feeling a lump in your throat
- Sore throat
- Shortness of breath
- Temporary wheezing
Treating Acid Reflux
Acid reflux is often an easy fix. If you often struggle with this condition, it may be a good idea to keep some Tums nearby your bed. Just be sure to avoid taking too much, as it can have negative effects. Other treatments for acid reflux include:
- Over-the-counter antacids
- H2 blockers
- Proton pump inhibitors
- Surgery in severe cases
Interestingly, there is also some evidence that melatonin may improve acid reflux. In 2019 scientists set out to review the potential effect that melatonin has on the effects of GERD. They found that melatonin likely reduces the amount of acid that the esophagus is exposed to, therefore reducing the severity of reflux symptoms.
Preventing Acid Reflux
You can largely prevent acid reflux by making certain changes to your lifestyle. Doctors typically suggest the following tips:
- Avoid triggering foods
- Eat smaller meals
- Elevate the head of the bed
- Reduce alcohol intake
- Avoid smoking
- Maintain a healthy weight
7. Heart Failure
[Heart failure](https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-failure-symptoms#:~:text=If the chamber can’t,which causes shortness of breath.) is one of the more serious reasons why someone may find themselves waking up gasping for air. This condition occurs when the heart muscles are weakened, for one reason or another, and eventually become unable to keep the heart pumping at the level that the body requires.
By the time the heart reaches the point that its pump is that weak, it can cause the blood in the lungs to become backed up. This increases the blood pressure in the lungs, which ultimately leads to the fluid being pushed out of the blood vessels and into the air sacs that fill the lungs.
This process results in another condition that we discussed earlier, pulmonary edema. As we mentioned earlier, PE often triggers sudden and severe breathing issues, which get much worse upon lying down. Additionally, heart failure also causes the body to become low on oxygen. This results in the cells of the body sending out signals that more air is needed, which causes the sensation of being extremely short of breath.
If you have heart failure, you may experience the following signs:
- Shortness of breath
- Swelling in extremities
- Increased heart rate
- Irregular heartbeat
- Chronic cough/wheezing
- Cognitive changes
- Cool and clammy skin
Treating Heart Failure
The treatment for heart failure usually depends on the severity of the condition. Providers typically begin treatment by prescribing certain medications but may end up needing to implant a pacemaker or similar device. Treatment options for heart failure include the following:
- Diuretics to reduce excess fluid
- Other high blood pressure medications
- Lifestyle changes
- Implantable devices
- Oxygen support
- Positive Airway Pressure machines
Preventing Heart Failure
The tips for preventing heart failure mirror the tips for several of the other conditions on this list. That’s because heart failure is typically caused by underlying conditions that are often related to lifestyle choices, such as coronary artery disease and type II diabetes. If you wish to prevent heart failure, try implementing these tips:
- Healthy diet changes
- Limited sodium intake
- Regular exercise
- Avoiding smoking
- Maintain a healthy weight
- Manage stress levels
- Address underlying conditions
Frequently Asked Questions
Why Do I Wake Up Gasping for Air and My Heart Racing?
There are several reasons why you may find yourself waking up gasping for air with a racing heart. Some of the most common causes are nighttime anxiety, sleep apnea, and hypnagogic jerks. If you have any concerns regarding this issue, it’s important to speak with your healthcare provider for an accurate diagnosis and treatment suggestions.
Can Acid Reflux Cause Waking Up Gasping for Air?
Yes! There are a couple of reasons for this. Acid reflux occurs when stomach acid flows back into the esophagus. This can irritate your throat and occasionally may even cause the airway to spasm. Additionally, stomach acid can sometimes make its way into the lungs, which can temporarily trigger asthma-like symptoms.
Is It Normal to Wake Up Gasping for Air Occasionally?
Most of us have experienced the feeling of waking up suddenly, feeling as though we can’t catch our breath. As long as it is an occasional occurrence, there is no reason to become alarmed, as they may simply be caused by something harmless, like a hypnagogic jerk. But if they become regular events or you have concerns, take note of the additional symptoms that you may be experiencing and discuss the situation with your doctor.
If you ever find yourself waking up gasping for air, it’s normal to be a bit concerned as to why this is happening to you. It turns out that there are several causes for this phenomenon.
Thankfully many of these conditions are easy to identify with simple solutions, for example— post-nasal drip, acid reflux, or hypnagogic jerks. However, other causes may require a bit more intervention to resolve, such as sleep apnea, and some may even be life-threatening if left untreated, like pulmonary edema or heart failure.
If you experience these disturbances on a regular basis, it is important to identify the underlying cause so that proper treatment can be determined. Of course, as the saying goes, the best treatment is prevention! It’s best to make diet and lifestyle choices that promote both better general health and better sleep health.
And as always, if you have any concerns regarding this issue, please consult your healthcare provider for a proper evaluation and treatment planning!
Eric graduated from Texas State University in 2016 with a Bachelor’s Degree in Journalism. He has worked as a freelance photographer, editor, and writer. Eric is committed to providing the most value possible to CPAP.com readers by creating a highly approachable user experience, with an emphasis on actionable information and thorough research.