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Sleep Disorders

Wake up choking at night

02/26/2008

Question:

I have had thyroid cancer. If I eat late at night and go to bed, I wake up and cannot get my breath. Gasping to get my breath.

Answer:

Without further information, it's difficult to say for sure what is causing your symptoms, though a number of possibilities need to be considered. Obstructive sleep apnea (OSA), gastroesophageal reflux, post-nasal drip, asthma and heart failure could also present with the symptoms of waking short of breath from sleep. As OSA is a frequent cause of this symptom, I'll address it first.

OSA is a common condition, affecting roughly 5% of middle aged adults in America. Most individuals with this condition are still not diagnosed and, of those that are diagnosed, many have had it for many years prior to undergoing appropriate testing. OSA is a condition where the airway partially or completely collapses during sleep. This results in fragmentation of sleep and, in some individuals, low oxygen level during sleep. Symptoms may include waking up choking or gasping at night, very loud snoring, poor and unrefreshing sleep, morning headaches and daytime sleepiness. The consequences of this condition can be serious and range from a poor quality of life (morning headaches, disabling sleepiness, poor concentration, irritability, etc) to increasing problems with blood pressure control, heart disease and strokes. Increased weight and having a family history predispose individuals to this disorder. For some individuals, certain features of their airway anatomy, such as large tonsils or blocked nasal passages (which could be related to allergies), may increase their risk of developing OSA. It's possible that your past history of thyroid cancer could be playing a role if have an enlarged thyroid or if you had received specific therapy on your neck (surgery or radiation treatment). The diagnosis of sleep apnea usually depends on an overnight sleep study performed in a sleep laboratory, where your breathing during sleep can be monitored. The primary treatment for OSA is the use of CPAP, which is very effective at keeping the airway open during sleep. It does this by "pressurizing" the airway to prevent it from collapsing. In some cases, surgery or oral appliances can be effective treatment for OSA, though this is in the minority of patients

Aside from OSA, waking up short of breath could be related to other problems, mostly commonly post-nasal drainage and gastroesophageal reflux disease (GERD). Post-nasal drainage frequently occurs in the setting of ongoing nasal congestion, which can be related to a number of factors, and is worsened by lying down on your back. Typically, nasal sprays or other medications can effectively control this symptom. GERD is due to gastric contents coming up into the esophagus and irritating the esophagus and/or the upper airway. This condition is often aggravated by lying supine, especially if one eats near bedtime as you mentioned you do. Treatment of GERD includes lifestyle changes, diet changes and medications.

Asthma can sometimes present with shortness of breath at night. This is often accompanied by daytime symptoms that include wheezing, coughing and a sensation of chest tightness. Likewise, individuals with heart failure may wake up feeling short of breath. Heart failure also causes daytime shortness of breath, fatigue and frequently swelling the ankles and legs. Heart failure patients may also find it difficult to lie flat while awake due to trouble breathing.

I recommend you discuss your problems with your doctor. Additional history and examination will help to determine if you may suffer from one of the problems mentioned above. Evaluation by a Sleep Specialist may be necessary to determine how best to evaluate and treat your problem. In the meantime, avoiding meals near bedtime would be a good idea. If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University