Choking while Sleeping: Causes, Symptoms, Diagnosis, Complications, and Treatment

Nighttime choking can be a terrifying, painful, and disruptive experience that can seemingly arise out of nowhere. In certain cases, it can even be life threatening. However, there are warning signs that can indicate an impending episode of choking while sleeping, as well as symptoms to watch for that can help identify a source of the sudden interruption to breathing, that is causing you to wake up when choking while sleeping.

What are you experiencing?

Going to your doctor with a good understanding of what you may be experiencing is incredibly beneficial to the process of getting an accurate and speedy diagnosis. Therefore, it’s important to try to remember what other symptoms you were experiencing during the choking episode, and to keep as mindful of your body as you can if you experience further episodes.

While nighttime choking is in and of itself a warning sign of a more complicated issue, there are a number of other symptoms that can help narrow down exactly what you might be experiencing. After going through this short list of symptoms that commonly accompany a nighttime choking episode, you will have a good idea of what to bring up to your doctor on your next visit.

Common Symptoms:
1.   Are you experiencing any of the following physical symptoms?

1. Racing heart or severely increased heart rate
2. Difficulty breathing
3. Panic-style coughing or gasping
4. Burning sensation in the chest
5. Horrible taste in throat
6. Feeling of stomach contents “rising” into throat
7. Vomiting
8. Feeling of “volcanic-type” rising burning, acidic, and/or hot pain shooting up through throat
9. Sore throat
10. Phlegmy coughs
11. Severe sweating
12. Fever
13. Swollen areas in back of throat
14. Sharp pain in chest
15. Painful burning when breathing that likely diminishes in the following days
16. Pain in your teeth and gums
17. Burning or Pain in your sinuses

2.  Are you experiencing any of the following psychological symptoms?

1. Feeling of terror, panic, or intense fear
2. Mental exhaustion or fatigue
3. Irritability or mood swings

Taking note of which, if any, of these symptoms you are experiencing can help narrow down the list of possible conditions that might be affecting your sleep. Later in this article, we will explore what common and uncommon illnesses can cause combinations of the symptoms above. While this is not a comprehensive list of symptoms that are often experienced alongside nighttime choking, possessing multiple symptoms from the list can point to a likely cause with some level of accuracy. This information can help guide your decisions and conversations with medical professionals.

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Who experiences nighttime choking?

Nighttime choking can be experienced by anyone of any age or background, though, there are certain groups that are more frequently affected by it than others. The two most prominently affected groups are the elderly and those suffering from obesity. Nighttime choking is more prevalent as a whole in people over the age of 30, with nighttime choking being least common in people between the ages of 10 and 30. Infants have also been reported as having a notably high occurrence of nighttime choking, though still considerably lower of a percentage than people above the age of 30, and generally from very different causes.

From current data available, people belonging to one or more of the groups listed above (for example, an elderly patient who is also categorized as obese) are at heightened risk for experiencing nighttime choking and the illnesses that cause it. As a result, if you or a loved one fall into these risk groups, it’s doubly important to pay attention to the symptoms and possible causes presented here.

How and why is it happening?

The most common causes of severe and recurring nighttime choking in adults can be traced to two conditions: Gastroesophageal Reflux Disorder (GERD) and Sleep Apnea. Both conditions should be treated as serious because, while they are often manageable in their early stages, their complications can be very serious and potentially sudden. There are, of course, other causes of nighttime choking, and based on what symptoms you identified in the first section, a process of elimination can likely lead you to a good idea of what you might be suffering with. We will start with easily identifiable, common, and temporary conditions that may cause choking while sleeping and then continue to more serious conditions.

The most minor causes of nighttime choking are conditions like post-nasal drip from allergies or even common colds. While these are unlikely to cause particularly severe choking during the night, it is possible for enough buildup of phlegm to occur and cause a nighttime choking episode. It is also possible, especially with severe allergies, to experience choking while sleeping as a result of irritated respiratory paths. Sinusitis and pneumonia can both also be causes of nighttime choking. While more severe than the common cold or seasonal allergies, nighttime choking caused by sinusitis or pneumonia is likely to be quite temporary, and usually will not be a recurring issue unless the infection is particularly severe. Also, upper respiratory tract infections, much like pneumonia, can cause nighttime choking by restricting the respiratory tract triggering choking or by causing post-nasal drip similar to a cold.

The aforementioned group of respiratory conditions can certainly cause nighttime choking, however, they are likely to be accompanied by symptoms like fever, coughs, runny nose, sore throat, and body soreness. Additionally, they are likely to be temporary, with choking episodes being less common and usually following particularly bad symptoms of the sickness (for example, a common cold causing post-nasal drip intensifies before the sufferer goes to sleep and causes a choking episode.) Taking over-the counter medication (in the case of common colds or seasonal allergies) or prescribed antibiotics (in the case of bacterial pneumonia and sinusitis) is likely to reduce the occurrence of nighttime choking significantly.

A less common condition that can cause nighttime choking is tonsillitis. Tonsillitis, being a swelling of the tonsils near the back of the throat, can cause irritation in the throat which triggers a choking sensation. Swollen tonsils are the clearest sign of tonsillitis, so checking your throat for swollen tonsils after a choking episode can help rule out this condition right away. Tonsil swelling large enough to cause a choking episode should be visible to the eye in most cases.

The most severe, but also least common conditions that can cause nighttime choking are pulmonary embolisms and heart failure. Heart failure and embolisms both have very similar symptoms characterized by shortness of breath, pain in the chest, coughing, swelling of the legs or feet, and fatigue. Embolisms in particular, being a clot that travels to the lungs, will often most clearly cause pain upon breathing. Both of these conditions should prompt immediate emergency medical treatment as both are very dangerous. Immediate medical care reduces the chance of death or complication majorly. Nighttime choking from these conditions is likely to be restricted to the individual occurrence of heart failure or embolism and is unlikely to be recurring.

If you are experiencing recurring nighttime choking, but your symptoms do not match the conditions above, it is possible you are suffering from acid reflux, GERD, or sleep apnea. All of these conditions are characterized by repeat occurrences of nighttime choking as well as the presence of a number of other very characteristic symptoms. In the sections below, we will explore the key symptoms of acid reflux / GERD and sleep apnea.

GERD is a severe disorder of the stomach that causes excess acid to flow back up into the esophagus from the stomach instead of being neutralized as normal on a frequent basis.

“GERD is the chronic, more severe form of acid reflux”

While acid reflux and GERD are not the exact same disorder, they share many symptoms. Unlike acid reflux, which occurs less frequently and has less severe symptoms, GERD is a chronic issue that is a progression of acid reflux that has become regular. Acid reflux and heartburn more than twice a week may indicate GERD..

The backflow of acid and stomach content associated with Reflux and GERD can trigger a severe choking reflex that can awaken or disrupt the sleep of the sufferer.

While there are varying severities of both acid reflux and GERD, it is common for GERD sufferers to experience “heartburn”. It may feel like a burning, warmth, or pain just behind the breastbone or a feeling of acidic pain shooting up through the throat. In the most severe cases of GERD, sufferers may experience a bad, acrid taste in the back of the mouth, vomiting, or a rise of stomach content through the throat (that may or may not lead to vomiting.)

Additionally, it is common for GERD sufferers to experience coughing and even choking that can lead to a racing heartbeat, hyperventilation, and sometimes accompanied by a sense of terror, panic, or intense fear. This panic will continue while clearing the airway from stomach content and catching one’s breath.

Reflux and GERD sufferers often describe a burning feeling that comes with painful breathing during (and after) episodes of reflux, that likely diminishes in the following days. acid reflux (GERD) can cause pain in the teeth, gums, and even sinuses.

Reflux/GERD symptoms are likely to occur sometime after eating, and are worsened when lying down during a reflux episode.

Nighttime reflux of acid can lead to poor sleep which results in fatigue and sleep deprivation.

It should be noted that while the most common symptom of GERD is heartburn (a burning sensation that may feel like a burning, warmth, or pain just behind the breastbone, often at night or when lying down after eating,) pain behind the breastbone should be closely watched to ensure that it does not match that of heart issues. Heart issues are generally associated with feelings of tight, dull, heaviness, and aching pains or discomfort as opposed to burning pains, and they most commonly occur after you are active.