What should you know about sleeping with shortness of breath?

Breathlessness at night may reflect asthma, COPD, bronchiectasis or acute bronchitis. Heart-related problems can also make breathing harder when lying flat; angina and atrial fibrillation may cause chest symptoms or an awareness of an irregular heartbeat. Anaemia can reduce oxygen delivery and contribute to tiredness and breathlessness. A severe allergic reaction, called anaphylaxis, can cause rapid swelling and airway difficulty. These possibilities cannot be separated safely from the symptom alone.

Sit upright or lean slightly forward, loosen tight clothing and stay calm while arranging medical advice. Keep prescribed inhalers available and follow the personal action plan you were given. Note whether symptoms occur only when lying down, wake you from sleep, follow exertion, or come with wheeze, fever, cough, ankle swelling or palpitations. Avoid using someone else’s inhaler or delaying assessment to test home remedies.

Call emergency services for severe or rapidly worsening breathlessness, blue or grey lips, inability to speak full sentences, faintness, new confusion, chest pressure, coughing blood, or swelling of the face, tongue or throat. Arrange prompt assessment for new night-time breathlessness, repeated waking, or symptoms that are getting worse.

Ask whether you need lung-function testing, heart assessment, blood tests or a review of your inhaler technique, and what symptoms should trigger emergency action.