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Are you waking up suddenly in the middle of the night and feeling short of breath? Shortness of breath at night has different medical causes, but the surprising truth is that your environment may be playing a part, especially if you have asthma that is triggered by common allergens in your home. If you have difficulty breathing when lying down, you should see your doctor. Please note that this article is only about recurring symptoms*, and if you have breathing difficulty that comes on suddenly or seriously interferes with your breathing, then you should seriously consider going to the emergency room or calling 911.

In this article, read more about why you may have shortness of breath at night and learn possible solutions to try on your own after talking with your physician.

Common Airborne Irritants that Can Cause Shortness of Breath at Night

Shortness of breath at night can be made worse by common irritants in the air like pollen, mold, dust mites, pet dander and secondhand smoke.

What can cause shortness of breath?

You may have shortness of breath for a variety of reasons, such as heart disease if your heart cannot pump enough blood to supply oxygen to your body. Other causes might be problems with the lungs, the airways leading to the lungs, and the heart, according to the U.S. National Library of Medicine (NLM). The official medical term for the sensation of difficult or uncomfortable breathing is dyspnea.

You may feel breathless even though there is no medical problem, such as after mild exercise. If you are hearing a high-pitched sound when you breathe out, that is called wheezing. Ultimately, if you are experiencing shortness of breath, you should see your physician.

Here are some more details (not a substitute for medical advice nor an exhaustive list) from the NLM about medical reasons for why you may experience shortness of breath in general.

1) Shortness of breath because of problems with the lungs, such as:

  • Blood clot
  • Swelling and mucus buildup
  • Chronic obstructive pulmonary disease (COPD)
  • Pneumonia
  • High blood pressure
  • Other lung disease

2) Problems with the airways that lead to the lungs, which may cause shortness of breath:

  • Air passages in your nose, mouth, or throat are blocked
  • Choking because of something that is stuck in the airways
  • Swelling around the vocal cords
  • Asthma

3) Shortness of breath because of problems with the heart that may include:

  • Chest pain because of poor blood flow through the heart’s blood vessels
  • Heart attack
  • Heart defects from birth
  • Heart failure
  • Heart rhythm disturbance

4) Other causes for shortness of breath may include:

  • Allergies
  • High altitudes where there is less oxygen in the air
  • Dust in the environment
  • Emotional distress, like anxiety
  • Panic attacks

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What can cause shortness of breath at night?

If you are waking up with shortness of breath at night, this is not normal. One potential cause is a condition called paroxysmal nocturnal dyspnea (PND), according to the NLM. This condition will cause you to wake up suddenly during the night and feel short of breath. You might even awaken and find yourself coughing or wheezing. PND could be caused by congestive heart failure or COPD.

General breathing difficulty while lying down (called orthopnea) is when you have trouble breathing normally while lying flat. To breathe comfortably, you would need to raise your head (e.g., with many pillows). This general problem is common for people with some types of heart or lung problems.

Causes for shortness of breath while lying down may include:

  • COPD
  • Cor pulmonale (when the right side of the heart fails)
  • Heart failure
  • Panic disorder
  • Sleep apnea
  • Snoring

The above reasons relate to why you could be experience difficulty breathing when lying down in general. These reasons may also be why you may be waking up suddenly in the middle of the night feeling short of breath (as mentioned above, this is called PND). PND often happens after one or two hours of sleep, and is usually relieved by coming to an upright position.

However, one common reason for these symptoms—asthma—has not been discussed yet in this article.

How is asthma related to shortness of breath?

The truth is that recurring episodes of sudden shortness of breath at night or in the early morning hours is an important sign of asthma (Ukena, Fishman & Niebling, 2008). Other symptoms include cough and wheezing. Research has found that if you have frequent nighttime asthma symptoms, the more severe your asthma might be (Lanier & Nayak, 2015). This may also mean your asthma is poorly controlled.

Asthma is a disease that causes the air passages of the lung to swell, making the airway more narrow. This can lead to wheezing, shortness of breath, chest tightness, and coughing. When an asthma attack happens, the lining of the airways swell and the muscles that surround the airways become tight, which reduces the amount of air that can pass through.

If you have sensitive airways, your asthma symptoms could be triggered by breathing in substances called allergens. And when you are home at night, certain indoor air pollutants that are also allergens might trigger asthma symptoms in some people.

Common asthma triggers (which are also indoor air pollutants) could include:

  • Pet hair or dander
  • Dust mites
  • Mold
  • Pollen
  • Tobacco smoke

The common allergens above could be floating in the air inside your home, and breathing them in may aggravate your symptoms if you have asthma.

Isometric drawing of a bedroom with pollen, mold, tobacco smoke, dust mites, and pet hair or dander labeled

Can outdoor air pollution cause shortness of breath?

You may live in an area with a high level of air pollution, such as near a busy street. If so, you may want to monitor when air pollution levels are high through AirNow. Research has shown that levels of pollutants (particulate matter and nitrogen dioxide) may be linked to people’s symptoms of wheezing and shortness of breath (Doiron et al., 2017). It has also been found that older adults, as well as people with asthma, are at an increased risk for the adverse health effects of air pollution.

This idea that outdoor air pollution can worsen asthma and shortness of breath has been known for decades. According to the EPA, air pollution can make it harder to breathe and can cause symptoms like coughing, wheezing, chest discomfort, and a burning feeling in the lungs. The main air pollutants that may affect asthma are ozone and particulate matter. When there are high levels of both, those with asthma are more likely to have symptoms, especially older adults and children.

What are some environmental measures to try for shortness of breath at night?

If you do have shortness of breath at night, you should first talk to your doctor about the problem. If you or a family member has asthma, a physician may suggest changes in the environment to reduce allergens in the air. Common asthma triggers in your bedroom could be dust mite allergens, airborne mold/mildew spores, or dust. Another allergen could be pet dander if pets are allowed in the bedroom.

An important way to reduce levels of common allergens in the bedroom is to prevent the buildup of contaminants like dust and mold as much as possible. For dust mite allergens, you can try using allergen-friendly covers for mattresses and pillows. If you have a child, you can try special steps to improve your child’s bedroom if they have asthma. Another way to reduce levels of allergens in your bedroom is to provide adequate ventilation, if possible.

Can an air purifier help with shortness of breath at night?

If your shortness of breath at night is related to levels of allergens in the air, using an air purifier while sleeping may help. This is true for adults as well as children who suffer from asthma. Research (Sublett, 2011) has shown that using an air purifier placed right by the bed in the “sleep breathing zone” can be beneficial.

Most air purifiers trap allergens on filters, but a newer technology is able to destroy them from the air. This technology, called Photo Electrochemical Oxidation, can break down pollutants to clean the air. This can be important when you want clean air in the bedroom, as recirculation of dust or mold from a saturated filter would not be beneficial.

After discussing with your doctor, taking these environmental measures may help with shortness of breath at night and help improve indoor air quality. Uninterrupted sleep can help you wake up feeling more refreshed and at ease, and in general reduce anxiety about any difficulties with breathing.

*The information contained in this article is for educational purposes only and is not a substitute for medical advice.

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