Paroxysmal Nocturnal Dyspnea: Symptoms, Causes & Treatment

Paroxysmal nocturnal dyspnea is shortness of breath that starts during sleep. It can cause a sudden feeling of choking or suffocation.

This may make the person need to sit up or get out of bed to breathe more comfortably. Symptoms often improve after a few minutes of sitting or standing.

This type of shortness of breath is most often linked to heart failure, especially when it is not being treated properly. To help prevent it, it is important to take the medicines prescribed by a doctor to improve heart function and relieve symptoms.

Main symptoms

The main symptoms of paroxysmal nocturnal dyspnea are:

• A sudden feeling of shortness of breath

• Waking up several times during the night feeling short of breath

• Waking up gasping or coughing after 1 or 2 hours of sleep

• Excessive sweating

• Wheezing

According to the American Heart Association, sudden shortness of breath at night, waking up breathless, or needing several pillows to raise the upper body can be signs of heart failure.

Confirming a diagnosis

Paroxysmal nocturnal dyspnea is diagnosed based on the person’s signs and symptoms and a physical exam, which includes listening to the lungs and heart.

Additional tests may be ordered to identify the underlying cause and evaluate heart and lung function. These may include an echocardiogram, electrocardiogram (ECG), chest X-ray, MRI, and/or CT scan. A stress test may also be recommended to assess how the heart functions during physical activity.

Possible causes

Paroxysmal nocturnal dyspnea may be caused by:

• Congestive heart failure

• Asthma

• Chronic obstructive pulmonary disease (COPD)

• Sleep apnea

• Pneumonia

• Pulmonary edema

In addition, people with high blood pressure, diabetes, those who smoke, frequently consume alcohol, or have arterial disease may be at higher risk of developing this type of dyspnea.

Treatment options

Treatment for paroxysmal nocturnal dyspnea can vary depending on the cause and may include:

• Continuous positive airway pressure (CPAP) therapy: according to the American Academy of Sleep Medicine, CPAP therapy helps keep the airway open by gently providing air through a mask during sleep. It may be indicated for people with sleep apnea, as it helps maintain a steady flow of oxygen while the person sleeps.

• a type of noninvasive mechanical ventilation that applies continuous pressure during breathing. It may be indicated for people with sleep apnea, as it helps keep the airways open and maintains a steady flow of oxygen while the person sleeps.

• Oxygen therapy: the administration of oxygen at a higher concentration than what is found in normal air, helping ensure adequate oxygen levels. It is mainly indicated in cases of COPD, asthma, or pneumonia.

• Lifestyle changes, such as losing weight, exercising regularly, making dietary changes, and avoiding smoking and alcohol.

To treat heart failure and reduce fluid buildup in the lungs, the doctor may prescribe diuretics, such as furosemide or spironolactone; blood pressure medicines, such as enalapril, captopril, or carvedilol; antiarrhythmics, such as amiodarone; or cardiac glycosides, such as digoxin.