What does this mean?
When the airway closes during sleep, the brain senses the drop in oxygen and triggers a sudden awakening. In most people this awakening is so short that it is not remembered. In some it is complete: you sit up in bed, take one deep breath after another and feel your heart racing. What you are experiencing is the moment the closed airway opens again.
This symptom is what a witnessed pause looks like in someone who sleeps alone; even with nobody watching you, you live through the event yourself. The telling detail is what you feel at the moment of waking. When the airway closes, a sense of blockage in the throat and of not being able to take air comes first, and it eases after a few deep breaths. If a sour or bitter fluid rises into your mouth, with coughing and a hoarse voice alongside it, the picture shifts towards reflux; stomach contents irritating the voice box can also produce a similar feeling of choking.
The time and the position of the waking carry information. Episodes that cluster while you lie on your back and in the second half of the night go more often with the airway closing; those that appear shortly after going to bed, on a full stomach and while lying flat, go more often with reflux. It is not uncommon for both to be present in the same person, so finding one does not mean the other is automatically ruled out.
Behind waking up gasping there can be both the airway closing during sleep and stomach contents reaching the voice box. The headings below set out these two routes and where they overlap.
Likely causes
What helps at home?
- Note down the moment you wake: the time, your sleeping position, and whether there is a taste in your mouth. These three pieces of information make the distinction easier to draw.
- Finish your last meal at least three hours before bed; lying down on a full stomach can make night-time symptoms worse.
- Instead of stacking pillow on pillow, raise the head of the bed a little; piled-up pillows strain the neck and can fold the airway even further.
- Do not panic and leap to your feet at the moment you wake; sitting up and taking a few calm breaths is usually enough. If it keeps happening, the cause should be looked into.
- If the waking is accompanied by chest pain, or by pain spreading to your arm, back or jaw.
- If breathlessness does not pass even when you sit up, and lasts for minutes.
- If your legs are swollen and waking at night short of breath has become more frequent.
- If what comes up into your mouth after waking is mixed with blood.
- If hoarseness and difficulty swallowing settle in after the waking and last for days.
Frequently asked questions
- Could these awakenings be panic attacks?
- A panic attack can also bring sudden waking, palpitations and a feeling of not being able to breathe. The dividing point is usually the mechanical sense of blockage in the throat: when the airway closes, a few deep breaths bring relief, whereas in a panic attack the unease and fear last for minutes. Because the two can also occur together, telling them apart is a job for a doctor.
- Can it be apnoea even though nobody has seen a pause?
- It can. A witnessed pause is a strong sign, but it is not the only one. In someone who sleeps alone, waking up gasping, a dry mouth in the morning, morning headaches and feeling unrested during the day raise the same suspicion. A sleep study can be done in this situation too.
- If I take reflux medication, will these awakenings stop?
- If a sour fluid rising into your mouth is part of the picture, treatment aimed at reflux may reduce the awakenings. But if the airway is also closing during sleep, reflux medication will not change that; if the awakenings continue while you are on the medication, you need a separate assessment from the sleep side. The choice of medication is for your doctor to make.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.