What is happening when you choke in your sleep
During sleep, the muscles that keep the throat open relax, and the protective reflexes of the larynx stay active. If the airway narrows or something irritates the vocal cords, the body reacts with a sudden awakening, a gasp, a cough or a brief spasm of the vocal cords. The episode usually ends within seconds, but the adrenaline surge leaves the heart racing and makes it hard to fall back to sleep.
Obstructive sleep apnoea: the most important cause
- Loud snoring, often with pauses in breathing followed by snorts or gasps.
- Waking with a choking or gasping feeling, a dry mouth or a headache.
- Feeling unrefreshed and sleepy during the day, poor concentration.
- Getting up to pass urine at night.
- More common with excess weight, a large neck, enlarged tonsils, nasal blockage, alcohol before bed and with age.
Untreated sleep apnoea increases the risk of high blood pressure, heart disease and accidents, so it is worth diagnosing. See can sleep apnea be cured and central sleep apnoea.
Other common causes
- Acid reflux: stomach contents reach the throat when lying down, causing coughing, a burning feeling, a sour taste and sometimes laryngospasm; see laryngospasm.
- Postnasal drip: mucus from allergies, colds or sinusitis drips onto the larynx; see postnasal drip.
- Saliva going the wrong way, especially when sleeping on your back.
- Asthma: night-time cough, wheeze and breathlessness.
- Nocturnal panic attacks: sudden awakening with fear, breathlessness and palpitations, without an airway problem.
- Heart failure: breathlessness when lying flat that improves when sitting up, with swollen ankles: needs medical assessment.
- Swallowing problems in neurological conditions.
Clues to the cause
- A partner notices loud snoring and pauses in breathing: sleep apnoea.
- Heartburn, sour taste or a hoarse voice in the morning: reflux.
- Blocked nose, mucus and throat clearing: postnasal drip.
- Wheeze and cough also during the day or with exercise: asthma.
- Intense fear, tingling and a racing heart without snoring: panic.
What you can do
- Sleep on your side rather than on your back.
- Raise the head of the bed by 15 to 20 cm with blocks or a wedge, which helps reflux and snoring.
- Avoid eating for three hours before bed, and limit alcohol, especially in the evening.
- Treat a blocked nose with saline rinses and, for allergies, a steroid nasal spray.
- Lose weight if you are overweight; even 10 percent helps sleep apnoea.
- Stop smoking.
- During an episode: sit up, breathe slowly in through the nose and out through pursed lips, then sip water.
How it is investigated
An ENT or sleep specialist asks about snoring, daytime sleepiness and reflux, examines the nose, throat and neck, and often looks at the airway with a thin camera. A sleep study, at home or in a sleep unit, measures breathing, oxygen levels and snoring overnight and confirms or rules out sleep apnoea. Reflux and asthma may be assessed with specific tests.
Treatment depends on the cause
- Sleep apnoea: CPAP, mandibular advancement devices, weight loss, positional therapy and, in selected cases, surgery of the nose, palate or tonsils; see CPAP and snoring.
- Reflux: lifestyle changes and medication.
- Postnasal drip and allergies: nasal treatment.
- Asthma: regular preventer inhalers.
- Panic attacks: psychological therapy.
When the fear of choking affects your sleep
After a few episodes, some people become anxious about going to sleep, which makes sleep lighter and more broken. Knowing that most episodes are brief and treatable helps. Relaxation techniques before bed, a regular sleep schedule and treating the underlying cause usually break the cycle. If anxiety persists, cognitive behavioural therapy for insomnia or anxiety can help.
When to see a doctor
- Choking or gasping awakenings that happen regularly.
- Loud snoring with pauses in breathing or excessive daytime sleepiness.
- Breathlessness when lying flat, swollen ankles or chest pain: urgent assessment.
- Difficulty swallowing, weight loss or persistent hoarseness.
- Falling asleep while driving: stop driving and seek help.
Key points to remember
- Choking in sleep is usually caused by sleep apnoea, reflux or postnasal drip.
- Episodes are frightening but usually short.
- Side sleeping, raising the head of the bed and avoiding late meals help.
- Regular episodes or loud snoring with daytime sleepiness need a sleep study.
Questions about choking in your sleep
These answers are general information and do not replace an examination or individual medical advice.
Why do I wake up choking on saliva?
Saliva can pool and fall onto the larynx, especially when sleeping on your back. Reflux and nasal blockage make it more likely.
Is choking in your sleep a sign of sleep apnea?
It can be, especially with loud snoring, pauses in breathing and daytime sleepiness.
Can acid reflux make you choke in your sleep?
Yes. Reflux reaching the throat can trigger coughing and a brief spasm of the vocal cords.
Can anxiety cause choking at night?
Night-time panic attacks can cause sudden awakening with a feeling of choking, but other causes should be ruled out first.
Can you die from choking in your sleep?
Episodes from reflux or saliva are frightening but almost always resolve on their own. Untreated sleep apnoea carries long-term health risks, so it should be treated.
What doctor treats choking in sleep?
An ENT or sleep specialist, often starting with your GP.
Sources
- NHS · Obstructive sleep apnoea
- NHS · Heartburn and acid reflux
- AASM Sleep Education · Obstructive sleep apnea
- NHS · Panic disorder
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.