What Causes Paroxysmal Nocturnal Dyspnea?

Paroxysmal nocturnal dyspnea (PND) causes sudden shortness of breath at night several hours after falling asleep.

Whenever you have an episode of PND, you wake up and gasp for breath. This discomfort is relieved when you sit up and dangle your legs down toward the ground. People with a risk of PND are often advised to sleep with their heads elevated, which facilitates proper breathing.

Some clinicians consider that PND is exclusively caused by congestive heart failure.

Symptoms of paroxysmal nocturnal dyspnea (PND) include:

• Suddenly waking up from sleep with cough or wheezing
• Palpitations
• Need for more air
• Sleep anxiety
• Insomnia (sleeplessness)

Your doctor may observe your breathing to determine the presence of PND, which clinical features may include:

• Shortness of breath
• Unpleasant breathing
• Labored, difficult, or heavy breathing
• Awareness of breathing
• Unable to get enough air
• Choking
• Suffocation

Sometimes dyspnea symptoms may also result in orthopnea, which occurs when a person feels breathless while they are laying down awake.

Your doctor takes into consideration of your medical history, observes your clinical features, and performs a physical exam to make a diagnosis. They may advise some diagnostic tests such as:

• Blood work to check for biomarkers, complete blood count, liver function, and renal function
• Electrocardiogram
• Radiological imaging, such as:
  • Chest X-ray
  • Computed tomography scan of the chest
  • A magnetic resonance imaging scan
  • Echocardiogram

All radiological tests check for structural and functional conditions of the heart and lungs that may predispose paroxysmal nocturnal dyspnea.

The treatment of paroxysmal nocturnal dyspnea (PND) depends on your symptoms and the underlying condition.

Heart failure

• The first step to address heart failure should be a reduction of fluid overload on the heart, for which the doctor may give you diuretics.
• Diuretics eliminate excess water and salt from the body through the kidneys and reduce fluid in the circulatory system.
• Moreover, these reduce high blood pressure levels in the body that lower the heart rate.
• Medications for blood pressure control and digitalis may be prescribed on a case-to-case basis.

Certain surgeries may help reduce the workload on the heart and improve oxygen supply to the heart tissue.

Additionally, the elevation of the neck by placing more pillows under the neck may help with PND.

Respiratory diseases

If an underlying respiratory disease is the cause of PND, treating the disease may relieve the symptoms of your PND.

• The use of long-term asthma control drugs in asthmatic people may prevent shortness of breath at night.
• The use of a continuous positive airway pressure machine, sometimes with extra supplementary oxygen, may assist to improve breathing in situations of sleep apnea.

Stress

Treatments that help reduce stress and increase the general quality of sleep may help with PND. 

• Avoiding coffee and alcohol before bedtime and following a regular sleep schedule may enhance the overall quality of your sleep.
• Other conditions such as acid reflux can be reduced with the use of antacids and lifestyle modifications.

In case of severe breathlessness, seek medical attention immediately because it may be life-threatening.