Waking up gasping for air: causes and when it's urgent

Waking up gasping or choking is most often a sign of obstructive sleep apnea, where the airway narrows or closes in sleep until your brain jolts you awake to breathe. It isn't the only cause. Acid reflux, postnasal drip, panic attacks at night and heart failure can all wake you feeling short of breath. It's rarely an emergency in the moment, but it is always worth getting checked.

Why do I wake up gasping for air?

Waking up gasping for air usually means something interrupted your breathing or made it feel interrupted, and your body woke you to fix it. The cause can sit in the throat, the stomach, the nose, the mind or the heart. Each one tends to leave different clues, which helps a doctor narrow it down.

The sections below go through each one.

Can snoring wake you up?

Snoring can wake you up when it's part of a breathing pause rather than just noise. In obstructive sleep apnea, the airway partly or fully closes, the snoring stops, and the pause ends with a snort, choke or gasp as you rouse enough to breathe again. Many people never fully wake and only know because someone tells them.

The NHS lists the main symptoms of sleep apnoea as breathing that stops and starts, gasping, snorting or choking noises, waking up a lot and loud snoring. During the day you may feel very tired, find it hard to concentrate, have mood swings or wake with a headache. The NHLBI adds that you may not know you have these symptoms until someone tells you.

So if you've ever been woken by your own snort, or a partner says your snoring stops and then restarts with a gasp, that pattern is worth mentioning to a doctor. Our guide to snoring vs sleep apnea explains the difference between ordinary snoring and the kind that needs checking.

Is waking up gasping a sign of sleep apnea?

Waking up gasping is one of the classic signs of sleep apnea. The NHS says to see a GP if your breathing stops and starts while you sleep, you make gasping, snorting or choking noises, or you always feel very tired during the day. It suggests bringing along anyone who has seen your symptoms, since they may have noticed things you haven't.

A GP may refer you for a sleep test, which you can often do at home. The NHS explains that results are graded by how often your breathing stops or becomes shallow each hour, called the AHI: 5 to 14 is mild, 15 to 30 is moderate and over 30 is severe. Our guides to home sleep apnea tests explains how testing works.

The NHS says sleep apnoea needs to be treated because it can lead to more serious problems. Treatment can include lifestyle changes and, for many people, a CPAP machine, which the NHS says can improve breathing and sleep quality and lower the risk of problems such as high blood pressure. Our guide to sleep apnea and the heart covers the wider picture.

Can acid reflux make you wake up choking?

Acid reflux can make you wake up choking, through a reaction called sleep-related laryngospasm. This is a sudden spasm of the vocal cords that briefly blocks airflow. It's dramatic but usually short, and it's often tied to stomach contents reaching the throat during sleep.

A 1997 case series in the European Respiratory Journal described 10 people with the condition. Every one of them reported waking suddenly with a feeling of acute suffocation and intense fear. Breathing stopped for 5 to 45 seconds and was followed by stridor, a high-pitched noisy breath in. Breathing returned to normal within minutes, though people were left exhausted. Nine of the 10 had evidence of gastro-oesophageal reflux, and 6 improved with reflux treatment.

A 2008 report in Sleep Medicine then caught it on a sleep study for the first time. An eight-year-old girl with asthma had acid reach her esophagus several times overnight, and twice an episode of breathing distress with stridor followed. That's one case, but it supports the link.

The NIDDK says reflux can bring food or stomach acid into the throat or mouth, and that GERD may cause a chronic cough or hoarseness. If your choking episodes come with heartburn, a sour taste or a hoarse voice in the morning, tell your doctor. Our guide to mouth tape and acid reflux explains why reflux and tape don't mix.

Can postnasal drip make you choke at night?

Postnasal drip can make you cough and splutter at night, though no study we found has measured how often it wakes people choking. Cleveland Clinic describes it as extra mucus gathering and dripping down the back of the throat. Symptoms include a feeling of mucus draining into the throat, an urge to clear it, and a cough that bothers you more at night.

Cleveland Clinic lists allergies, infections, pregnancy, medications and GERD among the causes. If you wake with a throat full of mucus and a cough rather than a frightening breath-hold, drip is a more likely culprit than apnea. Our guide to postnasal drip at night has practical bedtime tips.

Could waking up gasping be a panic attack?

Waking up gasping can be a nocturnal panic attack, which means waking from sleep already in a state of panic. A 2005 review in Sleep Medicine Reviews found that 44% to 71% of people with panic disorder report at least one. The review describes nocturnal panic as distinct from sleep terrors, sleep apnea, nightmares and dream-related arousals.

The NHS lists a racing heartbeat, sweating, chest pain, shortness of breath and trembling among panic attack symptoms. It also says most of these can be symptoms of other conditions, so a doctor will usually examine you to rule those out first. The 2005 review says assessment focuses on ruling out other explanations, sometimes with a sleep study.

Treatment works for many people. The review found evidence supporting cognitive behavioral therapy, which targets how people read and react to body sensations. The NHS says talking therapies and medicine are the main treatments for panic disorder.

Can heart failure make you wake up breathless?

Heart failure can make you wake up breathless, a symptom doctors call paroxysmal nocturnal dyspnea. Cleveland Clinic explains that when you lie down, blood moves from your legs toward your lungs. If the heart can't move that extra blood on efficiently, fluid puts pressure on the lungs.

Cleveland Clinic says people tend to wake suddenly an hour or two after falling asleep, gasping and coughing, and that sitting up helps within about 10 to 15 minutes. It lists heart failure, sleep apnea, pulmonary hypertension, COPD, asthma and nocturnal panic attacks among the possible causes. Its advice is simple: see a healthcare provider if you're waking at night feeling out of breath.

The NHS lists heart failure symptoms as breathlessness during everyday activity or when lying down, feeling very tired, swelling in the feet, ankles, legs or tummy, sudden weight gain and coughing at night. It says to ask for an urgent GP appointment or contact NHS 111 if you feel breathless when lying down.

When is waking up gasping an emergency?

Waking up gasping is an emergency when the breathing problem doesn't settle or comes with signs that oxygen is low. The NHS says to call 999 if:

• someone has severe difficulty breathing and is gasping, choking or can't get words out
• their lips or skin look pale, blue or grey (on brown or black skin this can be easier to see on the palms, soles or gums)
• someone has passed out and isn't responding normally

In the US, call 911. The NHS also advises not driving yourself to the emergency department.

Short episodes that settle in a minute or two still need a doctor's visit, just not an ambulance. Book one soon if it keeps happening, if a partner notices pauses in your breathing, or if you're breathless lying flat.

What should you tell your doctor?

Your doctor will want details of what happens, how often and what else you notice. A partner's account helps, since the NHS suggests bringing anyone who has seen your symptoms. Before the appointment, jot down:

• how often you wake gasping and roughly what time of night
• whether you snore, and whether anyone has heard your breathing stop
• how long each episode lasts and what makes it pass, such as sitting up
• heartburn, sour taste, hoarseness or a night cough
• swelling in your ankles or breathlessness during the day
• daytime sleepiness, morning headaches or low mood

Our list of questions to ask your doctor about snoring can help you prepare.

Should you use mouth tape if you wake up gasping?

You shouldn't use mouth tape if you wake up gasping until a doctor has found the cause. Choking, gasping and breathing pauses are warning signs of sleep apnea, and mouth tape doesn't treat sleep apnea. Taping over the symptom can delay getting the right help, and reflux that reaches the throat is a reason to skip tape altogether. Our guide to whether mouth taping is safe lists who should avoid it. We don't recommend mouth tape for children.

Once a doctor has ruled out sleep apnea and other causes, mouth tape can be a reasonable option for adults whose main problem is mouth breathing and snoring with a clear nose.

This article is general information, not medical advice. Talk to your doctor about your own symptoms.

Read next

• 10 warning signs of sleep apnea you shouldn't ignore
• Sleep apnea and the heart
• Snoring vs sleep apnea

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.