Shortness of breath during sleep

Nighttime breathlessness can occur with asthma, chronic obstructive pulmonary disease, acute bronchitis or bronchiectasis, particularly when cough, wheeze or mucus is present. Anaemia may cause breathlessness with tiredness and a racing heartbeat. Angina can cause chest pressure with exertion, while atrial fibrillation may bring an irregular heartbeat and reduced exercise tolerance.

Breathlessness that appears after lying down, wakes you suddenly or is accompanied by ankle swelling needs a clinician’s assessment. Anaphylaxis is an emergency when breathing trouble begins suddenly with swelling, hives or throat tightness.

Sit upright, loosen tight clothing and use a prescribed reliever inhaler exactly as directed. Avoid smoke and note whether the episode followed exercise, an allergen, a cold or lying flat. Record wheeze, cough, snoring, palpitations, chest discomfort and how quickly you recover.

Arrange a medical review for recurrent episodes. A clinician may examine your lungs, heart and blood count, review inhaler technique and decide whether further testing is needed. Read about [Asthma](/conditions/asthma/) or [Anaemia](/conditions/anaemia/) if their accompanying features match.

Call emergency services for severe or rapidly worsening breathlessness, blue or grey lips, inability to speak normally, fainting, new confusion, severe chest pain, or breathing trouble with facial or throat swelling. Do not drive yourself if symptoms are severe. Sudden symptoms after a trigger may indicate [Anaphylaxis](/conditions/anaphylaxis/).

Could asthma, airway disease, anaemia, a heart rhythm problem or angina explain this pattern? Do I need lung function tests, a blood count or heart assessment? What should I do if it happens again at night?