Shortness of breath at night: symptoms, causes and treatments

Shortness of breath can occur during the day or during the night, when it occurs the night it can occur during sleep or wakefulness. In general, if breathlessness occurs only when you are asleep this gives rise to a different set of considerations to breathlessness while you are awake. Shortness of breath could be a symptom of several conditions. Below we explore them in more detail.

What is shortness of breath?

“Shortness of breath – also called dyspnoea – is the sensation of not being able to get enough air into your lungs. It can feel like you are gasping for oxygen, as if your chest is tightening, or that you have difficulty breathing. Shortness of breath can be acute and only last for a few minutes, hours, or days. It can also be chronic, lasting a few months or longer,” explains consultant respiratory physician Professor Michael Polkey.

Shortness of breath symptoms

Shortness of breath symptoms vary and can include:

• feeling as if you need to breathe more frequently, or faster
• a tight feeling or pressure in the chest
• feeling like it’s hard to catch your breath
• feeling like you can’t take a full breath
• a sense of being starved of oxygen
• feeling as if you are suffocating

In some cases, shortness of breath could be an indication of a serious condition. You should seek immediate medical help or call an ambulance if your shortness of breath gets suddenly worse or won’t go away with simple measures.

Shortness of breath causes

There are many causes of shortness of breath but considering why people it is good to consider how breathlessness arises. In general, the function of the lungs is to get oxygen (the ‘good’ gas) into the body and carbon dioxide (the ‘bad’ gas) out. The oxygen must travel from the outside air through the lungs where it crosses into the blood and is pumped around the body by the heart; understanding this helps us to look at each type of cause.

Lung conditions

A variety of lung-related conditions can cause shortness of breath; these may come on suddenly or be more chronic; many of these are treatable, such as:

• lung infection causing mucus build-up
• asthma
• vocal cord problems
• chronic obstructive pulmonary disease (COPD)
• lung fibrosis
• difficulty moving the chest wall due to fluid around the lung (pleural effusion) or where there is substantial obesity

Heart and vascular conditions

You might experience shortness of breath due to your heart not pumping blood sufficiently.

Heart conditions such as coronary artery disease can lead to a heart attack; if enough of the heart muscle is damaged heart failure can occur but it can arise for other reasons such as valvular heart disease or toxins such as alcohol or cocaine. If you are having a heart attack, you are likely to feel shortness of breath along with other symptoms such as chest pain, nausea and fatigue. Other heart conditions that can cause shortness of breath are:

• abnormal heart rhythm (arrhythmia)
• congenital heart disease (heart disease present from birth)
• heart valve disease

Breathlessness can also occur if the blood cannot move freely from the right side of the heart to the lungs. This can occur if there are blood clots on the lung (pulmonary embolus) or where there is a high blood pressure in the pulmonary artery (pulmonary hypertension).

Breathlessness can also occur if you don’t have enough blood (anemia).

Why do I have shortness of breath at night?

Most of the causes of breathlessness above tend to be worse during exercise when the metabolic demands of the body are higher. If you specifically experience shortness of breath when lying flat this may suggest heart failure or, rarely, weakness of the breathing muscles.

Sleep conditions

When you have shortness of breath during sleep, several sleep conditions could be behind it. These include:

• sleep apnoea: a condition that involves the narrowing of the airways as you sleep, leading to decreased oxygen levels and the need to take deeper breaths, which can disrupt your sleep. This is more common in overweight individuals and is usually associated with snoring. Check your risk with the Stop-BANG questionnaire
• paroxysmal nocturnal dyspnea (PND): a condition characterised by waking up suddenly and gasping for air. PND usually resolves quickly by sitting upright or getting out of bed; this is usually indicative of heart failure
• laryngospasm: sometimes reflux of acidic stomach contents can cause either chest pain and breathlessness or closure of the vocal cords

When should I be concerned about shortness of breath?

“If you suffer from frequent shortness of breath, especially when you aren’t doing strenuous exercise, or if it’s accompanied by other symptoms – such as chest pain, a tight chest, sweating or nausea – then you should contact a medical professional, either your GP or a specialist to get a diagnosis, as it could represent a serious underlying condition,” explains Professor Polkey.

We offer a range diagnostic tests and treatments for a range of respiratory and cardiac conditions. If you are suffering from shortness of breath, please get in touch today.

How to reduce shortness of breath at night

General lifestyle changes are not a substitute for a proper medical assessment, but we recommend:

• quitting smoking
• exercising more regularly
• avoiding alcohol, especially late at night
• staying healthy through diet and exercise
• managing body weight aiming for a body mass index of 25 kg/m2
• avoiding allergens and pollutants

Shortness of breath treatment

If you suffer from shortness of breath, you should contact a medical professional for a diagnosis. A cardiologist or a respiratory specialist can help by running cardiac and lung diagnostic tests (such as an electrocardiogram, blood test, chest X-ray, and lung function tests).

Treatment for shortness of breath will vary according to the identified cause of the condition and can include the lifestyle changes outlined in the section above, as well as:

• medication for cardiac-related conditions, including ACE inhibitors and beta-blockers
• surgical options, including implantable devices and heart surgery for heart failure
• respiratory-related treatments, including inhalers for COPD, and antibiotics for pneumonia

Sleep-related shortness of breath

If your shortness of breath occurs only when you are asleep, we recommend that you see a sleep specialist; they will be able to take a history and determine what type of sleep study is likely to be most useful for you.

For more information or to book an appointment, please contact our customer care team.