February 19th, 2009
09:00 AM ET

Why do I awaken with shortness of breath?

As a new feature of CNNhealth.com, our team of expert doctors will answer readers’ questions. Here’s a question for Dr. Gupta.

Asked by Lucinda, Manhattan, Kansas

"I wake up several times a night with shortness of breath. This happens almost every hour during the night. I don't sleep on my back. What could this be?"


First of all, without knowing your full health history, I can’t make a diagnosis. But, Lucinda, let me say right off the bat that you should probably make an appointment with your doctor right away. And, let me tell you why.  From what you’ve described, it appears you may be experiencing something known as paroxysmal nocturnal dyspnea, or PND for short.

When a person suffers PND, he or she begins to experience shortness of breath several hours after going to bed. It then strikes suddenly and frequently during sleep, causing a person to wake up. Others experience shortness of breath only when they lie down on their back. This is known as orthopnea.

Paroxysmal nocturnal dyspnea is an abnormal condition that warrants some investigation. It can be a frequent symptom of a serious cardiovascular and respiratory problem. Again, you should make an appointment with your health-care provider as soon as possible to be evaluated, and if anybody is reading this with similar symptoms here are a few things to look for.

Before your appointment, begin writing down how often your are waking up experiencing shortness of breath, how long the attacks last, whether you have associated swelling in your feet and legs and the positions you are sleeping when it occurs. Also track what provides relief, if anything, for example, sleeping slightly propped up with pillows.

Bottom line, Lucinda, is these symptoms are your body’s way of alerting you something may be wrong. Being evaluated by your doctor is your best bet.

soundoff (868 Responses)
  1. Con.E.

    I, too, awoke in the middle of the night with shortness of breath. The third doctor asked if I had experienced heartburn lately and I had, but very infrequently. It turns out that I had acid reflux; the acids from my stomach were coming up and going into my lungs, giving me a sudden shortness of breath. Adding 2" lifts to the feet under the head of my bed has helped alleviate this problem. I hope this helps. I was 35 at the time.

    February 19, 2009 at 15:59 | Report abuse | Reply
  2. Daniel

    I had this problem and the result of my tests was that I had sleep apnea due to a neurological condition, not obstructive.

    February 26, 2009 at 18:14 | Report abuse | Reply
  3. Barbara

    I have both central and obstructive sleep apnea. Luckily, my stress test showed that my heart is still healthy. But I didn't get diagnosed until my mid-forties, Since then I have used a CPAP. Even so, I sometimes wake up out of breath.

    March 3, 2009 at 16:48 | Report abuse | Reply
  4. Nora

    Not sure if it would help, but after having tests done to check for physical problems with the shortness of breath, it might be helpful for sufferers to get a fan to put in the rooms where they are sleeping. Just getting the air moving slightly can possibly circulate oxygen into their system. It doesn't have to be turned directly on them either. Be sure that you or others are covered warmly enough to avoid the minor draft from slow to low speeds. High speeds can possibly move the air too quickly unless the fan is a good distance away from the sleeping area.

    March 6, 2009 at 10:05 | Report abuse | Reply
  5. Mick DeLeon

    Nora, thanks for the tip!

    March 18, 2009 at 15:54 | Report abuse | Reply
  6. Ima

    I suffered from these symtoms too, several years ago. I was diagnosed with asthma.

    March 19, 2009 at 10:33 | Report abuse | Reply
  7. Lola

    I thought I was having panic attacks, maybe just as i was falling asleep. I would wake and run to the window gasping to breathe in air, but not able to exhale – it seems as if I was only taking short inhalings.
    I was so frightened.
    my MD says it sounded more like sleep apnea- because I felt a CHOKING sensation. I am a good thirty pounds overweight and I
    researched. It seem fat can accumulate in your throat also, and when you relax and fall asleep- it can close up. I also suffer from all sorts of torture dolled out by a malfunctioning thyroid. ( hypo)
    All in all I found that by not eating or drinking anything near bedtime, I had less and less trouble ( maybe the post about acid reflux was correct) But I agree – write down as much aspossible about the type of symptoms you feel when you has this- and talk withyour doctor !!

    April 21, 2009 at 02:32 | Report abuse | Reply
  8. gem

    I'm experiencing short of breathe when i stay home and also in work place. I thought it was because of staying in closed area but i think it is something else that is causing the problem. If anyone suggests Which doctor i have to consult for my initial treatment that would be really helpful. Thanks!!

    June 14, 2009 at 20:37 | Report abuse | Reply
  9. Glenna

    I am a female, 58 years of age. I am experiencing the same symptoms of being awaken in the night, not being able to breathe. Sometimes I even dream I am in close spaces, trying to open windows to breathe, and then I wake up trying to get my breath. Sitting up and opening windows helps somewhat but I still have tightness in my chest. I am also having trouble taking deep breaths at any time and having episodes of dizziness as well, sometimes with nausea. As well, at times I have an aching in my left upper chest that comes and goes but does not seem to intensify. I have Stage 3 CKD and my father had cardiovascular disease at my age.

    I am an American living in the UK and the medical system is quite different than the care I had in the States. Although I see doctors on a regular basis, I haven't had a physical exam in a year. I am given tests and meds but no hands on. My last C-reactive protein test was 6.9 and I have another test scheduled in two weeks. My next appointment with my nephrologist isn't until November, but I am seeing a GP at my local medical practice.

    Any suggestions?

    August 12, 2009 at 12:31 | Report abuse | Reply
  10. C. Carol

    Shortness of breath, air hunger, and sleep apnea can be caused by hypothyroidism, which causes myopathy. The cure is thyroid hormones, T3 and T4, or T3 alone (but not T4 alone).

    Find a checklist for hypothyroidism and don't let your doctor treat you based on tests alone; signs and symptoms are far more important in hypothyroidism than blood tests.

    April 19, 2010 at 18:47 | Report abuse | Reply
  11. Christina Moore

    Waking up in the middle of the night gasping for air was one of the scariest things I've ever had to deal with. After running a variety of sleeping disorder tests, I was diagnosed with sleep apnea. My doctor immediately put me on a CPAP machine for when I sleep. I'm starting to sleep more comfortably and I am hoping for the best!

    August 25, 2010 at 17:35 | Report abuse | Reply
  12. james

    i woke up last night, and was breathing fine,but it was like it was doing me no good, i would take deep breaths,but it seemed like it wasn't doing any good. i was trying to remain calm, but it was a hard thing to do. i noticed when i got up and walked, i felt better. but when my breathing got better, i kind of felt sick to the stomach. i finished the night sleeping sitting on the couch. i had no chest pains, and felt fine this morning. this is the second time in two weeks. first time woke up and could not breath good.

    October 1, 2010 at 16:56 | Report abuse | Reply
  13. Heidi

    Hi. I'm an 18 year old female and I just experienced this shortness of breath when I took a nap this afternoon. I have woken up with shortness of breath before, but I was gasping for air this time for a good 10-15 seconds that seemed eternal. I tried to talk myself out of getting scared by it, but now that I'm trying to fall asleep, I can't stop thinking about it. Is this "normal" for a teen?

    February 22, 2011 at 22:22 | Report abuse | Reply
    • Vanessa

      hello Heidi, I'm only 19 myself and have just started to experience shortness of breath also. I do have acid reflux and sometimes feel like something is stuck in my throat which may be the cause but it's hard to not think of the worst possible scenario when you wake up in the middle of the night cos of it.. By now I hope you've seen a doctor so you could get properly evaluated. Please email me if you'd like I hope you're doing well. vnssalsst@yahoo.com

      July 12, 2011 at 08:01 | Report abuse |
  14. Leah

    paroxysmal nocturnal dyspnea? I would expect a better answer from a CNN doctor. PND is something that usually occurs in people with a serious (life threatening) lung or heart disorder. I do not think that is an appropriate response to such a common ailment. MANY people wake up feeling short of breath for MANY reasons. People should know that anytime this happens it MUST be checked out, but why on earth would you give someone PND (also referred to as cardiac asthma) as something to google after reading this. Unless you are suffering from left sided heart failure, this is probably NOT what you have. Look into the more common conditions such as Sleep Apnea, Anxiety, regular old Snoring, or the position in which you sleep BEFORE listening to this insensitive CNN doctor.

    Nurse Leah

    April 9, 2011 at 01:24 | Report abuse | Reply
    • Summer

      Thank you so much, Leah. My dad just had a blood test for this same problem today, as a first look into what is causing his shortness of breath in the middle of the night. Reading this article scared me. Thank you for providing information that it can actually be something like anxiety and such. His doctor believes it is related to stress (he's been under a lot lately), so we're hoping that's all it is. He said the blood test will tell him if it's something that needs further tests. I don't usually respond to comments for articles, but I just had to say thank you for your comment, 'cause you helped ease my fears a bit. Take care!

      January 14, 2013 at 20:32 | Report abuse |
    • Leek

      Because CNN is a fear based publication. The medical profession these days sells fear. They get you to race to the doc thinking you ar dying and get a ton of tests as well as meds, only to find out 2 months and 50,000 dollars later that you simply have asthma or had a bad sinus infection.

      January 3, 2018 at 12:37 | Report abuse |
  15. gmac

    I am a 59 year old male who wakes up in the middle of the night with air hunger and breathless. It is VERY scary. My doctor said my oxygen level was 98 (like hers) in her office and said I had anxiety and gave me xanax. But I also have breathless episodes during the day when I am not exerting myself. A psychotherapist by occupation for over 30 years, I do not see myself as anxious and I feel I have been misdiagnosed. The xanax will work, although it takes about 20 minutes to kick in. Back in feb 2011, I did go to the emergency room via ambulance because I was so scared but again, I was dx with anxiety.

    Is there another problem here that is being overlooked and is masked as anxiety? It feels like xanax is treating the symptom and not the problem as it feels like anxiety is diagnosing the symptoms and not the problem.

    December 31, 2011 at 11:08 | Report abuse | Reply
    • mremm

      I was wondering if you ever figured anything else out. I am a 50 yr old male, still jog a10 min mile and have no problems breathing while upright, but do wake once every 3 days with shortness of breath. My doctors says acid reflux, although I am on the medication already. He wants to double the dose. I don't want that, as the side effects of the drug are less than beneficial. Any ideas?

      July 19, 2016 at 19:14 | Report abuse |
  16. judah

    hi im 22 years old and recently ive been experiencing shortness of breath when i wake up in the morning, it is randomly of how long it lasts, i feel like something is caught in my lungs so i burb when i do i feel better but i do it constantly, is this acid reflux?? , if somebody knows the answer 2 this i would greatly appreciate it.

    October 18, 2012 at 19:04 | Report abuse | Reply
  17. judah

    and oh yeah i forgot 2 mention i get dizzy spells as well, whenever im sitting down for a long period of time and I get up, that is when I get dizzy.

    October 18, 2012 at 19:07 | Report abuse | Reply
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  21. Catherine

    All these times I thought I just have had bad dream when I experienced the shortness of breath during sleep. And didn't pay much attention to it. But lately it happened twice that scared me. My situation is different when it happened to me. It happened during my sleep at night, and I was conscious in my mind that I need air or I might die.But my body was too tired to breath. I then tried to wake up my tired body by trying to make some sounds but it was hard because I was so tired and couldn't move my body. Knowing I might die, I just had to keep making sound or trying to shake my body in order to wake me up to breath. But it was hard to wake myself (or my body) up to breath in the beginning. Like what Heidi said on her comment, it took me good 10-15 seconds (may be longer than that) that seemed eternal. And once I was awake, I feel the fresh & cool air entering my lung after taking a good deep breath. It was very scary because I live alone. By the way, thank you for all your comments, that help me a lot.

    January 8, 2014 at 22:53 | Report abuse | Reply
    • Le

      I experienced the same thing twice with a gap of 4 days.now I have developed a small amount of fear to sleep after getting twice. Did you visit a doctor? What was the diagnosis if you checked?

      September 9, 2017 at 14:17 | Report abuse |
  22. Greg

    This happens to me every couple of weeks. I wake up short of breath feeling like I'm about to die. I have noticed that my body temperature is normal during the attacks, which means my oxygen level is probably normal, too. Acid reflux seems like a possibility to me, as I usually eat before going to bed. It's just strange because it doesn't happen every night and some nights it's more severe and scary than others. The thought that it's PND is even scarier, but I don't seem to have any other symptoms of PND (ankle swelling in particular), and I feel like I've been getting in better physical shape lately (able to tolerate more exercise and my weight is in healthy range for my height: 5 10, 165). It really makes sense to me that it would be related to indigestion caused by eating before bed, but it's just weird because most nights I eat before bed and don't have symptoms. Plus eating before bed helps me calm my nerves to get to sleep. In addition, I've had heart and lung test over the past few years, none of which showed anything wrong with anything. I've never had a sleep study to test for sleep apnea, but I feel like my episodes only happen within an hour of falling asleep and sleep apnea interrupts sleep all night. Acid redux really makes the most sense, I just don't want to give up eating before bed because my body has grown accustomed to it. But these breathless episodes suck! They are infrequent but very scary. It is a relief to know it's probably not serious, but there's always that nagging what if. anyway, I hope everyone finds relief.

    August 2, 2014 at 01:09 | Report abuse | Reply
  23. Name*

    I get short of breath when im sleeping i suffer from high blood pressure and lupus and sizzers and i can be awake watching tv and i fall asleep

    March 2, 2015 at 05:36 | Report abuse | Reply
  24. Ranjani

    Hai doc..
    I'm ranjani and 18yrs old.
    I have shortness of breath during sleep.
    I awaken with insufficiency of breath and shaking of hands and legs.
    This is just from the day before yesterday.
    May I know the reasons for this symptoms????

    May 3, 2015 at 16:34 | Report abuse | Reply
  25. vicky

    i feel shortness of breath as i was about sleep. some i sleep normally. i have started exercise after that i didnt feel like that. two days i didnt do any exercise then today i was about sleep i feel breathlessness it was severe today. i cant sleep. because when i try to sleep this i feel breathlessness and get up. i m heavy smoker. i started smoking three years ago.

    July 28, 2015 at 17:16 | Report abuse | Reply
  26. Sleepless in Chicago

    Hi folks, yea I have had several scares over the past month, most of which shouldn't be surprising as I do smoke, I do have Acid Reflux, and probably much more. I am a 50 yr old man. My smoking has led me to have shortness of breath throughout the day. Even walking a block makes me breath harder. I also take 60mg of Prilosec each day (as suggested by my Dr) for Acid Reflux. Now, to add insult to injury, Ive been waking up a few times per night (maybe and hour after going to bed) and around 5am with a shortness of breath. Im not gasping, but it just feels strange. I tried one of those Oxygen Saturation Censors that are to be placed on the finger, and my readings have been as low as 94% when I check it immediately upon being woken up. Not sure whats happening, but it"s scary!

    December 12, 2015 at 00:37 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.