What Causes Paroxysmal Nocturnal Dyspnea?

Medically Reviewed on 11/5/2021
paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea (PND) is most commonly associated with heart disease; however, it may also result from respiratory diseases as well.

Dyspnea (breathlessness) is a condition mostly associated with respiratory diseases, but paroxysmal nocturnal dyspnea (PND)—a type of dyspnea—is most commonly associated with heart diseases.

Heart diseases

Heart failure:

  • Heart failure or congestive heart failure is a condition in which the heart cannot pump sufficient blood through the body.
  • This may lead to fluid buildup in the lungs (pulmonary edema), making it difficult to breathe, especially while lying down or during physical activity.

Other possible heart conditions that may trigger PND include:

  • Acute decompensated heart failure: Sudden worsening of all the symptoms of heart failure
  • Myocardial ischemia: Reversible heart cell death caused by decreased blood flow to the heart

Respiratory diseases

PND is usually not manifested by lung diseases; however, there are a few respiratory conditions that may lead to it, which include:


Other medical conditions that can trigger PND include:

What is 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.

What are the symptoms of paroxysmal nocturnal dyspnea?

Symptoms of paroxysmal nocturnal dyspnea (PND) include:

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.

How is paroxysmal nocturnal dyspnea diagnosed?

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:

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


In the U.S., 1 in every 4 deaths is caused by heart disease. See Answer

What are the treatment options for 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.


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.

Medically Reviewed on 11/5/2021
Image Source: Frederic Cirou / Getty Images

Chapter 11 Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea: https://www.ncbi.nlm.nih.gov/books/NBK213/

How is paroxysmal nocturnal dyspnea characterized in patients with heart failure?: https://www.medscape.com/answers/163062-86204/how-is-paroxysmal-nocturnal-dyspnea-characterized-in-patients-with-heart-failure

Heart Failure Clinical Presentation: https://emedicine.medscape.com/article/163062-clinical#b1

Paroxysmal Nocturnal Dyspnoea: https://www.sciencedirect.com/topics/medicine-and-dentistry/paroxysmal-nocturnal-dyspnoea