Paroxysmal Nocturnal Dyspnea: Symptoms, Causes, and Treatment

Paroxysmal nocturnal dyspnea (PND) is shortness of breath that occurs suddenly during sleep, waking you up. It is usually associated with a health problem that requires medical attention. Here, we explain this strange feeling and how to prevent it from reducing your sleep.

What is paroxysmal nocturnal dyspnea?

There are various respiration patterns. While eupnea is what we call normal breathing, dyspnea is described as difficulty breathing or shortness of breath.

It’s okay to feel short of breath occasionally, such as after intense exercise. However, when it occurs regularly or happens suddenly during sleep, it could be a sign of a health problem.

Paroxysmal nocturnal dyspnea is a shortness of breath that suddenly occurs during sleep. When this happens, the person wakes up gasping. Episodes typically occur one to two hours after falling asleep and usually improve when standing.

PND vs. orthopnea

Dyspnea occurs as the result of various factors or conditions, two of which are PND and orthopnea. It's easy to confuse the two as they both describe shortness of breath.

Learning to tell them apart is vital to communicate properly to a doctor what's happening. The main difference between them is that while PND occurs a few hours after a person falls asleep, orthopnea can occur whenever a person is lying down, even while awake.

Like PND, shortness of breath associated with orthopnea usually improves when a person stands up or sits down. Both are seen in patients with heart failure, but PND can also occur in other conditions.

Symptoms of PND

People with PND may experience:

• Waking up short of breath after falling asleep
• Cough upon waking
• Sleep disruption
• Feeling anxious or terrified

During a PND episode, some people can only catch their breath when they sit or stand up. That’s why many like to sleep with their head and upper body propped up.

Causes of PND

In about 90% of cases, dyspnea is linked to cardiac or respiratory problems. Other possible causes of PND include the following:

• Heart failure. Someone with heart failure may experience PND at night. This happens because when they lie down, blood flows to their lungs. A healthy heart can pump this blood back to the rest of the body as needed, but in heart failure, it can’t do this job effectively. This leads to fluid in the lungs and difficulty breathing.
• Asthma. A lung disease that causes breathing difficulties. Symptoms of asthma typically worsen at night and may trigger PND episodes.
• Pneumonia. Shortness of breath is a primary symptom of pneumonia. So, people with pneumonia may experience PND as well.
• Pulmonary edema. Paroxysmal nocturnal dyspnea is a common symptom of pulmonary edema, a condition in which fluid builds up in the lungs.
• Chronic obstructive pulmonary disease (COPD). A lung disease causing breathing difficulties that can trigger PND.
• Sleep apnea. Patients with heart failure commonly experience sleep apnea. In sleep apnea, breathing is interrupted multiple times during the night. It can also sometimes cause PND.
• Pregnancy. Some pregnant people experience shortness of breath and PND. This could be due to pregnancy alone or a heart issue that developed during pregnancy.
• Obesity. While being obese doesn’t make you more likely to experience PND, it can worsen PND or the conditions that cause it.
• Drug and alcohol abuse. Recreational drugs like cocaine and consuming excessive amounts of alcohol can lead to heart problems and, consequently, PND.
• Psychological issues. Mental health conditions like anxiety and panic attacks are also linked with PND.

Risk factors for PND

Paroxysmal nocturnal dyspnea is primarily caused by heart and lung conditions, so those at higher risk of developing these diseases are also more likely to experience the condition. Common risk factors for heart and lung diseases include the following:

• Coronary artery disease. Coronary artery disease is the most common cause of heart failure.
• Diabetes. Type 2 diabetes increases the chances of developing heart failure.
• High blood pressure. High blood pressure raises the risk of experiencing heart failure.
• Smoking and drinking alcohol. Smoking, drinking too much alcohol, and using certain recreational drugs may increase the risk of heart and lung problems.
• Age. Adults over 65 are more likely to experience heart failure than younger adults.
• Obesity. Obese individuals are more likely to experience heart failure than those who are not obese.

Treating PND

Consult a doctor if you wake up during the night short of breath. Your provider will assess what is causing your shortness of breath and recommend the most appropriate treatment.

For example, if the cause of PND is COPD or fluid buildup in the lungs, the doctor may recommend oxygen therapy. However, if sleep apnea is causing PND, using continuous positive airway pressure (CPAP) therapy may be indicated.

Another common cause of PND is heart failure. If that’s the case, the doctor might prescribe medications like beta-blockers, enzyme inhibitors, and diuretics. The provider may also suggest lifestyle changes like exercising, quitting smoking, and limiting alcohol intake.

Sometimes, the doctor may prescribe painkillers or antidepressants to reduce the discomfort caused by dyspnea.

How to sleep better with PND

Identifying and treating the causes of PND will help prevent it from disrupting sleep. Sleep hygiene can be helpful for people with conditions like heart failure and sleep apnea, which are linked to PND.

Tips for improving sleep hygiene include the following:

• Adhere to a regular sleep schedule.
• Participate in physical activity daily.
• Avoid heavy meals, alcohol, and caffeine before going to bed.
• Make sure your bedroom is cool and quiet, and stay away from electronic devices before bedtime.

Some people with breathing problems may feel more comfortable sleeping with their chest elevated. You can use pillows to help you with this or buy an adjustable mattress.

Experiencing PND can be uncomfortable, but it doesn't always indicate a serious condition. In any case, be sure to talk to your doctor if you wake up feeling breathless. Treating the underlying cause of PND and improving your sleep hygiene are steps you can take to overcome this issue.