In a perfect world, you’d drift off to sleep peacefully each night and wake up in the morning feeling refreshed. While that’s the reality for some people, if you have the less pleasant experience of waking up gasping for air, a good night’s sleep might just be a pipe dream. Plenty of factors could be behind these breathless wake-ups, ranging from normal sleep patterns to more serious health conditions. Here are seven possible reasons you might wake up gasping for air.
1. Hypnic jerks
A hypnic jerk is a harmless muscle twitches that may happen when you fall asleep. “It’s often accompanied with a bit of a gasp, and you can feel like your heart is racing,” board-certified sleep medicine doctor and neurologist W. Christopher Winter, M.D., of Charlottesville Neurology and Sleep Medicine, and author of the book, The Sleep Solution: Why Your Sleep is Broken and How to Fix It, tells.
These little “sleep starts,” as they’re sometimes called, are a type of quick, involuntary muscle spasm known as myoclonus, according to the Mayo Clinic. (Hiccups and seizures are also considered forms of myoclonus.)
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Sleep medicine experts aren’t entirely sure why hypnic jerks occur, but there are a few theories. One is that your nerves simply misfire as part of the natural process your body goes through as it transitions into sleeping. Another is that these hypnic jerks happen when you speed through the first stage of sleep too quickly because you’re exhausted. During this stage, your heartbeat, breathing, and eye movements decelerate, your muscles relax, and your brain waves begin to slow down, the National Institute of Neurological Disorders and Stroke says. If your body fast-forwards to the next stage, which is when your heart rate slows even more, it could think that your health is in trouble and jolt you into consciousness, Dr. Winter says.
As you may have experienced during hypnic jerks, your dreams might compensate for what’s going on in your brain and body. “You might dream you’re going down some steps, miss one, and then jerk awake,” Dr. Winter says. This may be because your brain interprets that sleep-induced muscle relaxation as falling.
While factors like having too much caffeine or being under a ton of stress may bring about hypnic jerks, they also just happen sometimes for no real reason, Dr. Winter says.
2. Postnasal drip
You’ve probably dealt with postnasal drip at some point. If not, it’s when delightful extra mucus accumulates in the back of your throat. This can happen due to allergies, a cold, or any other health condition that makes your nose runny, Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, California, tells.
While postnasal drip is generally not serious—it’s just uncomfortable and irritating—it can actually cause you to wake up gasping for air. “Postnasal drip can block your airway because it’s a glob of stuff sitting in there,” Dr. Casciari explains. Lying down flat while you sleep is particularly bad for this since gravity doesn’t work with you to get rid of the phlegm. Clearing your throat when you wake up can help, Dr. Casciari says, along with propping your head up a little while you sleep so the mucus can drain a bit.
3. Gastroesophageal reflux
Gastroesophageal reflux (also known as acid reflux) is when the contents of your stomach reverse course into your esophagus, the tube that connects your throat to your gut. This can happen if your lower esophageal sphincter (which is supposed to close off your esophagus from your stomach) becomes weak or relaxes when it shouldn’t, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Gastroesophageal reflux can cause the uncomfortable sensation known as heartburn, along with issues like a sour taste in your mouth. And some people experience this reflux at night when they’re lying down, which can lead to irritation and narrowing of your airways that may leave you gasping for air, Dr. Casciari explains.
If you experience intense gastroesophageal reflux at least once a week, you might have gastroesophageal reflux disease (GERD), the more serious form of the condition, according to the Mayo Clinic. This can cause additional symptoms such as chest pain, a persistent cough, laryngitis, and (obviously) disrupted sleep, the Mayo Clinic says. Weirdly enough, it can also lead to new or worsening asthma, which is another reason you might wake up gasping for air that we’ll get to in just a sec.
If you know you have gastroesophageal reflux and you’re often waking up at night with difficulty breathing, talk to your doctor. They may recommend dietary changes, like avoiding certain acidic foods or waiting at least three hours after eating to lie down, or medications such as antacids to neutralize stomach acid, the Mayo Clinic says. If your reflux is bad enough, they may recommend prescription medication or even surgery to fix the issue.
When you have asthma, certain triggers like pollen or pet dander can cause your airways to become inflamed and full of mucus, making it hard to breathe, according to the National Heart, Lung, and Blood Institute. This can leave you gasping for air any time you’re exposed to a trigger, and unfortunately, this and other asthma symptoms (like wheezing and chest pain) also tend to get worse at night.
One potential reason behind this is increased exposure to triggers like dust mites or pet dander that may be lurking in your bedroom, Dr. Casciari says. Also, at night, your body can release higher levels of the stress hormone cortisol, and that can boost inflammation in your airways, Dr. Casciari says. “Just like you would gasp when you have an asthma attack in the middle of the day, you could wake up gasping in the middle of the night,” he says.
If this happens to you, you might feel better once you sit up, since it puts your respiratory system in a better mechanical position to get air in and out, Dr. Casciari explains. If you have an inhaler with medication that opens up your airways, you’ll probably also need to use that, but the specifics depend on your asthma action plan.
If you only wake up every so often due to your asthma, mention it to your doctor during your next appointment. But if you’re regularly waking up gasping for air, you need to make an appointment ASAP. It’s likely that your asthma treatment plan needs tweaking to get your condition under better control, Dr. Casciari says.
5. Panic attacks
A panic attack is a sudden episode of extreme fear that causes intense physical reactions seemingly out of nowhere, according to the National Institute of Mental Health. It’s a really awful situation that can present differently for different people, but in general, having a panic attack might cause a sense of impending doom, a rapidly pounding heart, sweating, shaking, shortness of breath, chills, hot flashes, nausea, stomach cramping, chest pain, a headache, dizziness, and feeling detached from reality. You might worry you’re having a heart attack or even dying.
Unfortunately, you can actually get panic attacks that wake you up from sleep, which are called nocturnal panic attacks. People who have these nocturnal panic attacks are also likely to have them during the day, according to the Mayo Clinic.
If you’re getting panic attacks at any point in the day or at night, talk to your doctor. They may recommend a treatment plan that combines therapy and medications to help manage your symptoms. For example, cognitive behavioral therapy can help you retrain your thought patterns to cut down on anxiety, and selective serotonin reuptake inhibitors that make more of the mood-affecting neurotransmitter serotonin available in your brain.
6. Sleep apnea
Sleep apnea is a potentially serious disorder that causes your breathing to stop and start at night. The most common form of this is obstructive sleep apnea, which happens when your throat muscles relax when you sleep, the Mayo Clinic says.
If your throat muscles become too lax, your airways can constrict, leading oxygen levels in your body to drop. Your brain then senses that you can’t breathe and sounds the alarm by forcing you to wake up so that you can reopen your airways, the Mayo Clinic explains. This might cause you to choke, snort, gasp, or exhibit some other form of breathing weirdness. Even though this can happen multiple times every hour, these awakenings are usually so short that people don’t always recall waking up, Dr. Winter says.
If you have central sleep apnea, which is a less common form of the condition that happens when your brain fails to send signals to your breathing muscles, you’re also likely to wake up gasping for air, Dr. Winter says. There’s also a form of sleep apnea called complex sleep apnea syndrome, which is basically a mix of the obstructive and central versions of the condition.
Beyond waking up gasping for air, symptoms of sleep apnea generally include loud snoring, waking up with dry mouth, having a morning headache, feeling sleepy during the day, and being irritable, the Mayo Clinic says.
If you’re regularly waking up gasping for air and you also snore or your partner says they’ve noticed you’re showing these or other signs of sleep apnea, it’s a good idea to talk to your doctor. They may recommend treatment with a continuous positive airway pressure (CPAP) machine to make sure you continue to breathe while sleeping, oral devices made to keep your throat open, or more intensive options like surgery to shrink tissue that’s collapsing into your airways at night, according to the Mayo Clinic.
7. A heart condition
If you’re waking up gasping for air, it’s much more likely due to one of the factors we mentioned above than to something like a heart problem. But issues like heart failure (which happens when your heart muscle doesn’t pump blood as well as it should), or pulmonary edema (excess fluid in your lungs, which can occur due to heart problems and other things such as a pulmonary embolism) can also cause this issue.
Other symptoms of heart failure include a rapid or irregular heartbeat, fatigue and weakness, swelling in your legs, hands, and feet, a persistent cough or wheezing, abdominal swelling, coughing up bloody mucus, and possibly chest pain if your heart failure is happening due to a heart attack, the Mayo Clinic says.
Pulmonary edema presents in a few forms: acute (which comes on suddenly), chronic (which persists over time), and high altitude (which happens if you travel to or work out in extreme heights), according to the Mayo Clinic. These different types of pulmonary edema can cause slightly different symptoms, but all of them involve severe, abnormal shortness of breath that can happen when you’re lying down. You may also experience symptoms like wheezing, clammy skin, a bloody cough, heart palpitations, fever, and fatigue.
Heart failure and pulmonary edema are medical emergencies and shouldn’t be ignored, so call 911 if you’re waking up gasping for air and having other symptoms of either condition. You can also seek immediate medical help if you’re having real trouble breathing out of nowhere and your body is telling you it’s an emergency, even if you don’t have these specific symptoms. No one can blame you for taking your breathing seriously.