Make your own free website on Tripod.com

Choking, shortness of breath and chest pains
occurring during sleep.

Sleep paralysis.


THE SLEEP SITE

BRINGING SECRETS OF THE NIGHT TO THE LIGHT OF DAY...

Understanding the symptoms of sleep disorders.

ABNORMAL BEHAVIORS IN SLEEP.
Click on the topic of interest:
Introduction.
Analyzing the problem.
-Sleepwalking, screaming, arousals with panic & frantic, agitated behaviors.
-Abnormal body movements during sleep.
-Eating during sleep.
-Inappropriate sexual activity during sleep ("sleep sex") .
-Biting of the tongue or inside of the cheek during sleep.
-Bruxism (toothgrinding; toothclenching).
-Night sweats (sleep-related hyperhidrosis).
-Headaches related to sleep.
-Enuresis (bed wetting) and frequent urination at night (nocturia).
-Abnormal heart rhythms during sleep.
-Choking, shortness of breath and chest pains occurring during sleep.
-Sleep paralysis.

ABNORMAL BEHAVIORS IN SLEEP - 5.


XI. CHOKING, SHORTNESS OF BREATH AND CHEST PAINS OCCURRING IN SLEEP.

Extremely common and often frightening events -- in many cases, all the more frightening because whatever provokes them occurred during sleep, such that their cause may be quite unclear.

BEDPARTNER OBSERVATIONS OF WHAT HAPPENS JUST PRIOR TO THESE
EPISODES CAN PROVE INVALUABLE IN ARRIVING AT AN ACCURATE DIAGNOSIS.

Possible causes include the following:

-Sleep apnea.   Arousals may be precipitated either by struggling to overcome upper airway collapse, or by simple failure to make any effort to breathe.  Simultaneously, it should be realized that many sleep apnea patients stop breathing hundreds of times per night without ever awakening as a consequence!

            Clues to this diagnosis include:

--The sensation that one must make repeated efforts to breathe before ‘anything happens’.
--Shortness of breath or chest discomfort are immediately relieved after a few deep breaths
--Awareness of a throaty, gasping sound, snort or snore with some of these episodes.
--May happen more often if sleeping flat -- or if lying on your back. 
-- In some cases, may occur less frequently when sleeping in a chair.
--Worsening after weight gain.
--Occurs more often after drinking alcoholic beverages.
--Occurs more often when experiencing more nasal congestion.

-Gastroesophageal Reflux Disease (GERD), with backflow of stomach acid up into the esophagus and throat.  Regurgitated acid may spill over the vocal cords and throw them into spasmodic closure, and inhalation of stomach contents into the lungs may provoke arousals with coughing and choking.  Also, even if acid does not back up to levels higher than the mid-esophagus, a nerve reflex can trigger tight wheezing similar to asthma.  Chest pain, virtually identical to that of angina from coronary disease (even to the point of responding to nitroglycerine) can occur, related to esophageal spasm.

            Clues to the diagnosis of GERD include:

--Awareness of bitter, acidic fluid in the throat or nose, or a sour taste on awakening.
--Associated with vomiting or near vomiting.
--High pitched crowing, stridorous sounds unlike the deeper, throaty-sounding gasps of sleep apnea.
--Wheezing or coughing.
--Occurrence more frequent after weight gain.
--Related to eating late, large meals, alcohol, spicy foods, or certain other foods like chocolate.
--May improve if sleeping with elevation.
--Immediate sitting up or jumping to one’s feet, during frantic efforts to breathe.
--In some cases, prolonged distress -- sometimes relieved by drinking water or by taking antacids.


-Sinus drainage during sleep sometimes can precipitate arousals with choking.

-Asthma  frequently worsens in sleep and in some instances is aggravated by GERD-- particularly since some asthma medications can make GERD worse.

-Heart failure often causes attacks of shortness of breath in sleep called “paroxysmal nocturnal dyspnea” especially when sleeping without elevation.  These usually last more than a few minutes and the patient must sit on the side of the bed for a time and try to catch his or her breath.

-Coronary artery disease and other heart problems, including abnormal heart rhythms, can provoke awakenings with shortness of breath, chest pain, palpitations and other distressing symptoms.

-Panic attacks, seizures and other abnormal events precipitating abrupt arousals also can cause symptoms of breathless and chest discomfort in some individuals.


XII. SLEEP PARALYSIS. 

We normally become paralyzed and unable to move anything but our eyes when in rapid eye movement (REM) sleep -- which prevents us from ‘acting out’ our dreams.  Most people are quite unaware that this happens, since they are asleep at the time!  (See page one of this handout for a description of REM sleep).

However, that same paralysis, which normally should occur only in REM sleep, sometimes intrudes into wakefulness.  Such may occur at times of awakenings (as a brief persistence of paralysis when we awaken from REM sleep).  It also may happen as we are just dozing off but not fully asleep.  It can be thought of as an awake brain in a body that transiently ‘got stuck’ in REM sleep.

It is not the same as still being asleep but dreaming that one is struggling to wake up.  Instead, the person is wide awake during sleep paralysis and if unfamiliar with its benign nature, terrified by his or her sudden helplessness and complete inability to move.  It feels like being ‘buried alive’.   Nonetheless, sleep paralysis is harmless.  It usually lasts less than a minute (although it can feel like much longer!).  Touching the person who is experiencing sleep paralysis ‘breaks it’ instantly -- but such seldom happens, since the person cannot call out for help.

Many people who have no other sleep disorders experience sleep paralysis on a rare basis. It can be worsened by sleep deprivation.  Sleep paralysis occurs more frequently in some people with narcolepsy -- a relatively common disorder causing sleepiness and in some cases, such other symptoms as attacks of muscle weakness triggered by strong emotions (cataplexy). 

Also, some patients with sleep apnea may awaken with sleep paralysis, particularly if sleeping on their back.  Both that position and REM sleep can make breathing worse-- resulting in sleep fragmentation with repeated arousals.  Look for other signs of sleep apnea especially if you experience sleep apnea when sleeping on your back and if you have any of its other symptoms.


 

THE SLEEP SITE NAVIGATOR MENU

Columbus, Ohio, Central Ohio, hospitalssleep, wake, insomnia, sleepiness 

COLUMBUS COMMUNITY HEALTH
REGIONAL SLEEP DISORDERS CENTER
Accredited by the American Academy of Sleep Medicine.

Robert W. Clark, M.D., Medical Director
1430 South High Street, Columbus OH 43207

Tel: [614] 443-7800
Fax: [614] 443-6960

e-mail: flamenco@netexp.net 

 © Copyright 2006 Robert W. Clark M.D. Inc.