Reasons for shortness of breath during sleep

Breathlessness that wakes you may be linked with asthma, whose symptoms can worsen at night, or with COPD and bronchiectasis when cough and mucus disturb sleep. Lying flat can make some heart-related breathing problems more noticeable; angina may cause chest discomfort, while atrial fibrillation can bring an irregular or rapid heartbeat. Acute bronchitis can add cough and airway irritation. Anaemia may cause breathlessness during ordinary activity and poorer sleep comfort. Sudden nighttime wheeze, rash or swelling of the lips and tongue can be anaphylaxis. The pattern, duration and accompanying symptoms help distinguish these possibilities.

Sit upright rather than lying flat, keep prescribed rescue medication nearby, and note what woke you and how quickly breathing settled. Record wheeze, cough, mucus, fever, chest discomfort, palpitations, snoring or daytime sleepiness. Avoid smoke and known allergens. Do not use another person’s inhaler. Recurrent episodes need a clinical review; assessment may include heart and lung examination, oxygen measurement, blood tests or breathing tests depending on the history.

Call emergency services for severe or rapidly worsening breathlessness, blue or grey lips, confusion, fainting, severe chest pain, inability to speak normally, or sudden tongue, throat or facial swelling. Seek urgent assessment for breathlessness at rest, coughing blood, a new irregular heartbeat or an episode after an allergic exposure. Arrange a prompt appointment when sleep is repeatedly interrupted or symptoms are worsening.

Could my symptoms fit asthma, heart disease, infection, anaemia or another lung problem? Does lying flat change the urgency? Which tests and nighttime treatment would be appropriate?