Waking up gasping for air is a frightening but common occurrence. Here are the most common causes for this phenomenon.

1. Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a serious medical condition. It occurs when the soft tissues in your throat relax, which can close your airway and cause a temporarily stop to breathing (apneic episode). The result is usually an abrupt disturbance to sleep or an actual awakening, often accompanied by gasping or choking. Other symptoms of OSA include snoring, daytime fatigue, a dry mouth or sore throat, morning headaches, difficulty focusing while awake, low moods, and high blood pressure.

OSA is more common for people with excess weight, smokers, those with diabetes or asthma. It may also occur more frequently for those with naturally narrow airways (certain facial shapes or features), high blood pressure, nasal congestion (often secondary to nasal deformity), those drinking alcohol and in males.

If you suspect you have OSA, talk to your doctor or a sleep specialist right away.

2. Postnasal drip

Postnasal drip occurs when mucus from your nose drips into your throat, which can make you feel congested, and make you want to cough or clear your throat. If enough mucus makes its way to your throat, it can block it completely and cause you to temporarily stop breathing while sleeping, leaving you gasping for air.

This condition has a large number of potential causes, including colds, allergies, inflammation, a deviated septum, changing weather, particular foods, and certain medications.

3. Nocturnal asthma

Asthma inflames the airways, causing them to tighten and make breathing more difficult. If you’ve been diagnosed with asthma, and you find yourself gasping for air during the night, this may be the cause.

4. Anxiety

If you become intensely anxious while sleeping, you may find yourself gasping for air. This is epitomised in popular culture when people wake up from bad dreams.

If anxiety is the reason that you’re waking up gasping for air, you might also be sweating, chilly, have chest pain, a feeling of faintness, and even a sense of impending doom. If you feel you have problems with anxiety, have a chat with your doctor.

5. Acid reflux (gastroesophageal reflux disease)

Acid reflux occurs when stomach acid or bile flows into the food pipe, irritating the lining. When this flows up to the larynx or throat, it can cause the person to wake up gasping for breath.

Acid reflux may also be accompanied by symptoms of heartburn, bad breath, enamel erosion of the teeth, and a chronic sore throat.

6. Hypnic jerk

A hypnic jerk is an involuntary twitching of muscles that happens while falling asleep. They can cause you to jolt and waken abruptly—a potentially frightening experience that can also make you gasp for air.

Hypnic jerks are nothing to worry about, although they might be made worse by anxiety, caffeine, lack of sleep, or an irregular sleep schedule.

7. Pulmonary edema (wet lung)

Pulmonary edema is caused by excess fluid in the lungs, and is usually caused by a heart condition. The accumulation of fluid can make it difficult to breathe, which can cause you to wake up gasping for air.

The condition can also be accompanied by shortness of breath, wheezing, sudden anxiety, chest pain, and a cough that produces a frothy spit. If you suspect you have this condition, consult your doctor immediately.

8. Heart failure

Heart failure occurs when our hearts can’t effectively pump blood, as a result of abnormal heart valves or coronary artery disease. Difficulty breathing is a common symptom of heart failure, which can cause you to gasp for air in the middle of the night. If you’re also experiencing chest pain, extreme fatigue, or swelling in the legs, get medical attention immediately.

When do I need to seek help?

If the gasping for air occurs infrequently, without other symptoms (like chest pain or sustained shortness of breath), and you can get back to sleep quickly, then this may be normal and may not require further investigation.

However, recurrent gasping episodes or occurrence with other symptoms should be reviewed with a doctor.

Any episode chest pain or ongoing shortness of breath deserves immediate medical attention.

If an underlying cause is identified, then treatment is available to allow a return to restful uninterrupted sleep.