woman gasping for air in bed

Have you ever woken up gasping for air or has someone heard you do it in your sleep and you didn't even know it? It can be an extraordinarily unsettling experience for you or your bedpartner. Board-certified sleep doctor Joseph Krainin, M.D. discusses what can cause this phenomenon and what you can do about it. 

There are numerous possible explanations for waking up gasping in your sleep. The causes can be divided into primary sleep disorders and other medical problems. 

Primary Sleep Disorders

Obstructive Sleep Apnea

Do you snore regularly? If you do then the most likely explanation is that your episodes of gasping are due to this common sleep breathing problem. Obstructive sleep apnea, or OSA, is due to repetitive collapse of your upper airway while sleeping. Typically people with OSA infrequently experience episodes of waking up gasping for air. 

OSA not only robs those you of a decent nights' sleep and feeling awake during the day but it has the potential to be dangerous. Moderate and severe degrees of sleep apnea have been associated with an increased risk of car accidents, high blood pressure, type 2 diabetes, stroke, and heart disease, including sudden cardiac death. The only way to find out if you have sleep apnea is to have a sleep apnea test

Central Sleep Apnea

Central sleep apnea, or CSA, is caused by your brain forgetting to breathe sufficiently during sleep. This can result in central apneas which are essentially "breath holding spells." CSA is much less common than OSA but patients with CSA typically report a higher frequency of gasping episodes than those with OSA. CSA is usually caused by one of five underlying medical problems:

  • dysfunction of the cardiac pump
  • neurological problems that affect the brain or cervical spinal cord
  • opiate pain medications
  • kidney failure
  • living at high altitude

Like OSA, the only way to determine if you have CSA is to have a sleep study

Medical Disorders

Congestive Heart Failure

Congestive heart failure or CHF is due impairment of the heart's pump capacity leading to fluid backing up into the lungs. People with CHF often have difficulty breathing comfortably when lying down flat, called orthopnea, and may wake up gasping from sleep. Other common symptoms include swelling in the feet or ankles and shortness of breath with minimal physical exertion. Echocardiography,  which is ultrasound of the heart, is helpful in the diagnosis of CHF. There is a blood test called B-type natriuretic peptid that can indicate if you're having a CHF exacerbation. 

Nocturnal Asthma

Asthma, or chronic inflammation of the upper airway, may get worse at night. Some people may be predisposed to having an exacerbation of their asthma symptoms in the early morning hours and waking up gasping for air from sleep. Wheezing and chest tightness are the most common accompanying symptoms. Bronchodilators and inhaled corticosteroids are the mainstays of treatment. 

Neuromuscular Disorders

Neuromuscular disorders like myasthenia gravis and ALS can impair your ability to take full breaths while sleeping, leading to gasp arousals. In these conditions, the breathing muscles are weak and lying down increases the strain on the muscles because they have to work against gravity. Insufficient breathing can lead to carbon dioxide going up in your system and oxygen levels going down and trigger gasping. 

Nocturnal Panic Attacks

This is another potential cause of gasping in your sleep. Most people that have nocturnal panic attacks have also had daytime panic attacks and identifying the similarity between the attacks if often the key to making the diagnosis. People with nocturnal panic attacks frequently report high baseline levels of anxiety. People usually describe a feeling of doom or terror associated with these episodes. SSRIs and SNRIs such as Zoloft and Effexor are usually the go-to treatments for panic disorder. 

Sleep Related Gastroesophageal Reflux

This is due to dysfunction of the lower esophageal sphincter or LES. When working properly, the LES prevents stomach contents from moving the wrong way up the esophagus. Associated symptoms include a bitter taste in the mouth, regurgitation, and heartburn. If this disorder is suspected, a trial of an H2 blocker or proton pump inhibitor is often performed as a "diagnostic challenge" - a trial of  a treatment to confirm the diagnosis based on whether the patient responds. Esophageal pH monitoring is rarely used to confirm the diagnosis. 

Sleep Related Laryngospasm 

This is when the vocal cords of your larynx, the voicebox area, spasm and close off your airway. Sleep related laryngospasm is a very rare cause of waking up gasping. It is usually accompanied by stridor, a high-pitched musical sound. Episodes are very distressing, associated with panic and fear, and it typically takes several minutes to get back to normal breathing. This is essentially a "diagnosis of exclusion" - in other words it is considered if everything else has been ruled out. 

sleep apnea test home sleep study Joseph Krainin

Joseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center.  He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep medicine and neurology. He has been practicing medicine for over 10 years. 


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