There are several reasons why you may find yourself short of breath at night. Shortness of breath, called dyspnea, can be a symptom of many conditions. Some affect your heart and lungs, but not all.

You may also have conditions like sleep apnea, allergies, or anxiety. You need to understand the cause of your nighttime shortness of breath to treat it.

Sudden and severe shortness of breath at night can be a sign of a serious condition. Seek prompt care if you:

  • can’t catch your breath when lying flat
  • experience worsening or prolonged shortness of breath that doesn’t go away or gets worse

You should also seek immediate medical attention if your shortness of breath occurs with:

  • blue lips or fingers
  • swelling near your feet
  • flu-like symptoms
  • wheezing
  • a high-pitched sound when breathing

Many conditions cause shortness of breath at night. Chronic shortness of breath occurs when you experience the symptom for more than a month. According to an article in American Family Physician, 85 percent of conditions that trigger chronic shortness of breath relate to your lungs, heart, or mental health.

Shortness of breath can occur if your body can’t adequately pump oxygen into your blood. Your lungs may be unable to process the intake of oxygen or your heart may not able to pump blood effectively.

Shortness of breath when you lie down is called orthopnea. When the symptom occurs after a few hours of sleep, it is called paroxysmal nocturnal dyspnea.

Different lung conditions can cause shortness of breath. Some are chronic or life-threatening and others can be treated.

Asthma

Asthma occurs because of inflammation in your lungs. This leads to breathing difficulties. You may experience nighttime shortness of breath related to your asthma because:

  • your sleeping position puts pressure on your diaphragm
  • mucus builds up in your throat causing you to cough and struggle for breath
  • your hormones change at night
  • your sleeping environment triggers your asthma

Asthma can also be triggered by conditions like gastroesophageal reflux disease (GERD).

Pulmonary embolism

A pulmonary embolism occurs if a blood clot forms in your lungs. You may also experience chest pain, coughing, and swelling. You may develop this condition if you have been confined to bed for a period of time. This can restrict your blood flow.

If you think you have a pulmonary embolism, seek emergency medical care.

Chronic obstructive pulmonary disease (COPD)

COPD causes blocked or narrowed airways that make breathing more difficult. You may also have symptoms like wheezing, coughing, mucus production, and tightness in the chest. Smoking or exposure to harmful chemicals can cause COPD.

Pneumonia

Pneumonia can develop because of a virus, bacteria, or fungi. The condition inflames your lungs. You may also experience flu-like symptoms, chest pain, coughing, and tiredness.

You should seek medical treatment for pneumonia if you have a high fever along with shortness of breath and coughing.

Conditions that affect your heart can interfere with its ability to pump blood. This may lead to shortness of breath when you lie down or after sleeping for a few hours.

Heart failure and related conditions

You may experience shortness of breath because your heart can’t pump blood at a sustainable level. This is known as heart failure. You may develop this condition for many reasons. Risk factors include poor diet, diabetes, certain medications, smoking, and obesity.

One condition that can lead to a heart attack is coronary artery disease. You may experience shortness of breath from a heart attack as well as chest pain and tightness, sweating, nausea, and fatigue. You should seek medical care right away if you suspect you’re having a heart attack.

Other conditions associated with heart failure include high blood pressure or if your heart experiences trauma, inflammation, or irregular heart rate.

Allergies can get worse at night and lead to shortness of breath. Your sleeping environment may contain allergens like dust, mold, and pet dander that trigger your allergy symptoms. Open windows may cause allergens like pollen to enter your room as well.

Sleep apnea is a condition that occurs during sleep and causes narrowing airways and a low oxygen level. You awaken throughout the night to take deeper breaths, preventing you from getting adequate sleep.

You may feel like you’re gasping for air during the night or wake up in the morning feeling tired. You may also have headaches or feel irritable.

Your mental well-being can correlate with nighttime shortness of breath. Feeling anxious can trigger a fight-or-flight response in your body and cause a panic attack. You may struggle to take breaths, feel faint, and become nauseous during a panic attack.

Your doctor will perform a physical exam and ask you about your health and family history when determining the cause of your shortness of breath. Often, your doctor will be able to diagnose the condition just based on this initial exam. American Family Physician states that doctors can diagnose 66 percent of cases of shortness of breath just on clinical presentation.

You may need to undergo more testing to diagnose the cause. Your doctor may order the following tests:

  • pulse oximetry
  • chest radiography
  • electrocardiography
  • spirometry
  • stress testing
  • sleep study

Treatment for shortness of breath at night will vary depending on the condition causing it:

  • Asthma. Adhere to a treatment plan, avoid triggers, and sleep propped up by pillows to keep the airways more open.
  • COPD. Quit smoking and avoid exposure to other harmful chemicals. Treatment plans may include an inhaler, other medications, and oxygen therapy.
  • Pneumonia. Treat with antibiotics, cough medicines, pain relievers, fever reducers, and rest.
  • Heart failure. Follow your doctor’s treatment plan, which can vary based on your condition. Your doctor may recommend certain medications, lifestyle adjustments, and devices and other equipment to keep your heart working properly.
  • Sleep apnea. Modifying your lifestyle by losing weight and quitting smoking may help. You may need an assistive device when sleeping to ensure your airways stay open.
  • Allergies. Keep your bedroom free of allergens and clean regularly. Carpeting, window treatments, bedding, and ceiling fans can collect dust and trigger allergy symptoms. You may want to try hypoallergenic bedding or an air purifier in your bedroom.
  • Anxiety and panic attacks. Breathing exercises, avoidance of triggers, and talking to a mental health professional may help you relieve feelings of anxiety and avoid panic attacks.

Experiencing shortness of breath at night can occur for a number of reasons. You should talk to your doctor about the symptom to diagnose the underlying cause.

Get quick emergency medical treatment if you suspect the shortness of breath is a signal of a life-threatening condition.