Waking up choking is a phenomenon that occurs while we’re asleep and wake up gasping for breath, choking or coughing.
Waking up choking can occur as an isolated incident, but can also be associated with a number of health conditions including postnasal drip, heart failure, pulmonary edema, anxiety and panic attacks.
Depending on the cause, there are many ways to manage episodes of waking up choking, and things you can do to make it less likely to occur.
It Can Affect Anyone
Waking up choking can be a very scary experience. Some people report gasping for air as they wake. Throughout history there are examples of cultures who blamed the phenomenon on some kind of supernatural being squeezing the chest.
Fortunately, we now have some slightly more scientific explanations about why people wake up choking. It’s happened to me a few times, especially early in the hay fever season when I haven’t got into the swing of taking my antihistamines regularly.
Although not the most common experience, waking up choking can happen to anyone, and can be very distressing, especially if it happens regularly.
So what are the causes of waking up choking, and is there anything we can do to prevent it?
What Is Waking up Choking?
Waking up choking occurs when we’re asleep and something disrupts our respiratory system. The sufferer usually becomes aware of the event by being woken up by choking symptoms, often due to an excessive amount of fluid in the back of the throat.
Waking up choking can also be caused by other obstructions in the airways, such as soft tissue, which can result in the airways becoming blocked, reducing the oxygen supply.
These symptoms can be produced for many other reasons or due to a number of underlying health conditions. To treat episodes of waking up choking most effectively, it’s important to identify the root cause of the symptoms.
What Causes Us to Wake up Choking?
While choking can occur as a one-off incident, there can be several different medical causes for waking up choking:
Obstructive Sleep Apnea
Waking up choking can be a symptom of conditions such as obstructive sleep apnea. It’s a common sleeping disorder that causes a person to pause during breathing, or take very shallow breaths during sleep.
In many cases, people may not be aware they have sleep apnea, but it causes significant disruption to sleep; pauses in breathing can range from seconds to more than a minute, and can occur many times per night.
Though there are different types of sleep apnea, obstructive sleep apnea involves a mechanical partial or full airway blockage, and can lead to waking up choking as we gasp for breath to restore oxygen levels.
This happens when excess fluid is present in the air spaces in the lungs. Pulmonary edema can make it more difficult to breathe, and sufferers may feel like they’re drowning or suffocating, especially when lying down. This can lead to gasping and waking up choking for breath.
Congestive Heart Disease
Another condition that can be responsible for waking up choking is congestive heart disease. This can cause swelling in the legs, fatigue, lethargy and gastrointestinal problems.
Congestive heart disease can also be a cause of pulmonary edema, and can lead to difficulty breathing during exertion and when lying down, resulting in gasping and choking.
A condition known as postnasal drip can also be a factor in waking up choking. This is when secretion from the upper respiratory system, including the nasal passages and sinus can drip down to the back of the throat.
Occasionally, the fluids can become trapped there and cause a blockage of the airways, especially when sleeping on your back. This stimulates our gasping and cough reflexes. Postnasal drip can also be associated with a sore throat, sinus pain and an unpleasant taste in the mouth.
This is an involuntary movement of muscles while we’re asleep. It can happen just as we’re dropping off to sleep; when we suddenly jerk to wakefulness.
A hypnagogic response can be associated with the tightening of the respiratory muscles, rapid heart rate, fasting breathing and perspiration. It can make people gasp and wake up choking for air.
Periods of anxiety and panic attacks can happen at any time, including when we’re asleep. Both conditions are associated with muscle tension, and can cause light, shallow breathing and low oxygen levels. The body responds by waking up choking to help restore the oxygen supply.
Acid reflux and associated conditions such as gastroesophageal reflux disease (GERD) are a frequently overlooked cause of coughing in general. Acid reflux is a backflow of stomach acid.
When we’re asleep, the acid can travel far enough up the esophagus to cause irritation of structures in the throat. This can lead to waking up choking as we attempt to clear the stomach acid and relieve the symptoms.
Is It Serious?
Well, any condition that leads to any kind of choking is potentially serious. Choking is a sign that there’s a blockage in the airways or the esophagus, and is part of our natural reaction to clear it. Waking up choking can be a very frightening event both for the sufferer and for sleeping partners, but it’s rarely life threatening.
During sleep we have a very good mechanism that wakes us up if the body is in distress. In the event of a threat to survival during sleep, such as low levels of oxygen, the brain sends out signals to various parts of the body to reposition themselves and address the problem.
This is essentially what’s happening when we wake up choking—it’s just an extreme reaction which can be disturbing.
What Can Be Done About Waking up Choking?
Whether or not it’s possible to treat the symptoms and prevent further episodes of waking up choking depends on what’s causing the symptoms.
Conditions such as postnasal drip can be treated with nasal sprays to help the airways become clear and healthy. Elevating your head slightly in relation to your body can help to promote proper fluid drainage. Some antihistamine medications can reduce the amount of nasal fluid produced.
In the case of hypnagogic reactions and anxiety and panic attacks, reducing stress can help to dissipate symptoms. Activities like regular meditation and some exercise can help with reducing stress.
Reducing caffeine can also help to decrease the occurrence of hypnagogic responses, and anxiety and panic attacks, although some people may need to seek professional help to treat anxiety and panic attacks. A registered therapist can help to identify and deal with the root causes of these.
Being overweight is a major risk factor for obstructive sleep apnea, as the increased bulk of soft tissues reduces the size of your airway. Losing weight is one way to reduce the incidence of sleep apnea.
Alternatively, sleep apnea can be treated by wearing a breathing device called a CPAP (Continuous Positive Airway Pressure) machine to splint open the airways during sleep. Doctors now also sometimes recommend a mouthpiece or headpiece designed to keep the airways open during sleep.
Pulmonary edema is often treated with medication to reduce the pressure of fluid in the lungs, dilate the blood vessels and reduce blood pressure. Once symptoms are better managed, the frequency of episodes of waking up choking can reduce.
Heart failure or congestive heart disease is a long-term condition which needs to be carefully managed with assistance from your medical practitioner.
People with heart failure generally need medications such as beta blockers, inotropes, ACE inhibitors and diuretics to help improve heart function. Some of these medications, such as diuretics may help to reduce the number of times you experience waking up choking.
There a few different things you can do to control acid reflux too. Research has linked spicy, greasy and heavy foods with increased acid reflux, so cutting down on or avoiding these kinds of foods can help. Alcohol has also been observed to increase the incidence of acid reflux, so keep your intake to a minimum, or avoid it.
At the very least, don’t drink alcohol, or eat spicy or fatty food for two to three hours before you go to bed. This can help to significantly improve symptoms.
When to See the Doctor
Depending on the cause of waking up choking, it’s often possible to do some things at home to help reduce the risk of waking up choking. Unless you’re finding your symptoms very distressing, there’s usually no need to see the doctor.
If you have heart failure, GERD, or any of the other health conditions mentioned, it’s important to tell your doctor that you’re having episodes of waking up choking.
If however, your symptoms are causing you a lot of distress, or if it’s happening several times a night on a regular basis, then it’s worth seeking medical advice.
Similarly, if you have severe chest pain when you wake up choking, lose consciousness or can’t resolve the choking symptoms easily, then it’s time to see the doctor. Your doctor will be able to investigate thoroughly, and identify whether or not there’s an underlying cause to your symptoms.
What to Do If You’re Waking up Choking
If waking up choking is a recurrent event for you, it helps to have a plan in place to manage your symptoms. This can enable people to remain calm, and avoid panic, during an episode.
Before You Go to Bed
Put a small bottle or glass of water next to your bed before you go to sleep. Always put it in the same place to help you locate it when you’re disorientated.
Put a small bin or plastic bucket and some tissues near your bedside. This means if you have any mucus to clear when you wake up choking, you can do so immediately.
If you use any kind of inhaler to help you breathe, an asthma inhaler for example, keep this next to your bed.
Taking these steps helps to reassure many people that they’re prepared in the event of waking up choking.
If You Wake up Choking
Although you may feel anxious and disoriented, try to regain your composure.
Clear any mucus or sputum as you need to.
If you’re gasping for breath, try to take control of your breathing. Focus on gradually returning your breathing to steady breaths in and out as you’re able to.
If you feel you need to cough, try to take one or two really good coughs to clear your chest, rather than lapsing into a coughing fit.
When you’ve got your breathing back under control, take small sips of water to lubricate the throat and reduce irritation.
If appropriate, take a dose of your inhaler. This will help to open the airways and avoid a recurrence of waking up choking.
Waking up choking can be a troublesome condition which may or may not be a symptom of other health problems. Whether you’re waking up choking due to acid reflux, pulmonary edema, anxiety, a hypnagogic reaction or postnasal drip, it can be an extremely disconcerting experience.
Depending on the cause, there are some things that can be done to reduce the risk of waking up choking. The main thing is to do everything you can to remain calm, and have a system in place to help you manage the problem and regain control over your breathing.
If you’re waking up choking very frequently, you’re having difficulty managing your symptoms or if you suspect an underlying cause, it’s best to take a trip to the doc to let them check things out.
Although waking up choking can be frightening when it occurs, it’s not necessarily a serious threat; our body has some great defense mechanisms when it comes to maintaining our breathing and heart rate while we’re sleeping.