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Sleep Disorders

Waking Up Choking, But Only in Certain Beds

09/08/2009

Question:

In the past couple months, I`ve been regularly waking up half an hour to an hour after sleeping believing that I`m choking on something, when I`m not. I sometimes dream that I`m choking on an object such as a CD. I wake up startled and afraid, and I gasp for air. I often feel lightheaded and shaky. It`s been happening more than 3 times a week now. What`s curious is that this never happens when I sleep at my boyfriend`s place. I have been trying to think of the differences, but can`t seem to find any possible causes. I tried sleeping with more pillows to elevate my head, but I had a difficult time sleeping that way. I don`t snore, and don`t feel tired all the time. I`m at a loss as to what I can do.

Thanks so much!

Answer:

It sounds as though this is really troublesome to you and it’s a good idea to look into it. Waking up with a sensation of choking or gasping in sleep can be frightening, but is usually not life threatening. The key is to figure out what is causing the problem so it can be properly treated. With the limited information in your question, I don’t think I can tell you exactly why you are having this problem, but can provide you with some information that might be helpful. You will need to discuss your symptoms with your doctor to get this accurately diagnosed and effectively treated.

The sensation of choking or gasping at night can be caused by a number of conditions, including obstructive sleep apnea (OSA), night-time asthma, gastroesophageal reflux (GERD or heartburn), congestive heart failure, an upper airway anatomic abnormality, vocal cord spasms (laryngospasm) and anxiety. Probably the most common causes to consider are OSA and GERD, so I will discuss these briefly.

OSA is a common condition, affecting roughly 5% of middle aged adults in America. 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. 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. To diagnose OSA, a sleep study is usually required.

The primary treatment for OSA is the use of continuous positive airway pressure, or 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 a large number of well-done studies, CPAP therapy has been shown to be very effective at improving a number of measures of quality of life, including daytime alertness, improved concentration and improved mood. Individuals with OSA who can successfully use CPAP generally feel better! In addition, growing data suggest that CPAP may reduce some of the medical consequences associated with sleep apnea. The main problem with CPAP is that many individuals, have trouble sleeping with this type of device and, as such, alternative therapies must be considered. These alternative therapies generally include surgery or an oral appliance.

Heartburn or GERD is also quite common and frequently recognized by the individual due to the typical heartburn symptoms associated with certain foods or overeating. However, GERD can be difficult to detect as it may be “silent” during the daytime and only manifest itself at night during sleep. In some cases this may present with symptoms of laryngospasm and treating individuals with laryngospasm for GERD often improves their symptoms.

So, why do you not have these symptoms when at your boyfriends? It’s hard to know for sure, but changes in body position, diet or stress levels may all be factors to consider.

To know how best to evaluate and treat you, additional information will be needed. You should discuss your case with your doctor and perhaps see a Sleep Specialist to help sort out the issues.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University