Sleep-Related Laryngospasm Causes

There are several potential causes of choking, gasping, or coughing in your sleep, known as sleep-related laryngospasm, a spasm of the vocal cords. Most commonly, this occurs as part of obstructive sleep apnea. When the soft tissues of the throat collapse into the airway, it is necessary to wake suddenly to resume normal breathing. This most often occurs when the soft palate, uvula, and tongue block the throat. However, other potential structures can block airflow into the lungs and lead to an awakening.

Illustrated x-ray view of man sleeping with a sleep apnea mask on
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Causes of Choking in Sleep

Sleep-related laryngospasm occurs when the muscles and soft tissues surrounding the larynx (voice box) contract or swell and narrow the passage. This may cause noisy breathing similar to snoring, but it is characterized by a high-pitched and strained inspiratory sound called stridor.

When airflow is sufficiently interrupted—sometimes completely—an awakening is triggered by the brain. This leads to a sudden arousal from sleep. The blockage may last from five to 45 seconds prior to the awakening. However, the noisy stridor may persist for several minutes after waking. Eventually, breathing returns to normal.

There may be a sensation of chest pain or heartburn. It may be associated with a sense of suffocation and this may lead to feelings of panic and fear. In rare cases, the person may appear blue (known as cyanosis). The rate of breathing may be increased to greater than 20 breaths per minute (tachypnea). The discomfort and panic may contribute to a fear of falling asleep and insomnia.

Common Conditions Associated with Sleep-Related Laryngospasm

As noted, obstructive sleep apnea may commonly be mistaken for and associated with sleep-related laryngospasm. There are other associated symptoms. Individuals with typical sleep apnea will not usually wake with persistent difficulty breathing or stridor once awake.

Nocturnal heartburn or gastroesophageal reflux disease (GERD) at night may contribute to the laryngospasm. When acid enters the lower esophagus and trachea, it may cause swelling. Most people will also experience GERD during the daytime.

It may be triggered by the use of sleeping pills called hypnotics or by other medications that affect breathing by suppressing the central nervous system (brainstem) or by relaxing the muscles of the airway. In addition, it seems that viral infections that may occur with chronic allergies may be a trigger in some.

Rare Conditions

Less often it may be a manifestation of sleep terrors. These usually affect children but may persist into adulthood, and are often associated with impaired breathing, choking, a rapid heartbeat, and agitation. Abrupt awakenings, difficulty breathing, and a fear of dying are also seen in panic disorder, though episodes would also occur during the daytime. Asthma at night may cause coughing, wheezing, and shortness of breath in sleep. REM behavior disorder, in which a person wakes acting a dream, can also be a possibility.

Seizures may occur in children and lead to similar symptoms. Tumors within the airway may be a cause and endoscopy can identify any potential dysfunction of the vocal cords or other pathology. In adults, a progressive neurological disease called multiple system atrophy is often associated with stridor.

If you are concerned that you may be suffering from episodes of laryngospasm during sleep, speak with your doctor about your symptoms to determine the most likely cause. It may be necessary to have a diagnostic sleep study called a polysomnogram. Further testing can be arranged and sometimes empiric trials of medications for heartburn can be helpful.

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