What does choking in my sleep mean?

It’s understandably concerning if you wake up choking or gagging in your sleep. It can feel extremely uncomfortable and even frightening, like you’re suffocating. This article explores some of the possible reasons this might be happening.

Obstructive Sleep Apnea

If you wake up choking in your sleep, an important condition to consider is obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common sleep disorder, often associated with snoring, where your upper airway repeatedly closes during sleep.

This results in extremely fragmented and poor-quality sleep. It can significantly impact your quality of life and is linked to a wide range of serious physical and mental health problems. OSA is explained in more detail here.

Why does choking in my sleep happen?

Your upper airway is made up of hard structures, like the roof of your mouth, and soft structures, like the back of your throat and the base of your tongue. Hard structures stay in place by themselves, but soft ones are held in place by muscles.

As you fall asleep, your muscles relax, which causes the airway to narrow slightly. With a narrower airway, the airflow becomes turbulent, causing the soft tissues to vibrate, which we hear as snoring.

If the airway narrows even further, the airflow may stop altogether. This complete closure is called an apnea, or a pause in breathing.

When breathing stops, your oxygen levels drop. After a few seconds, your body becomes alarmed and pulls you into a lighter stage of sleep, or fully wakes you, so your airway muscles can tighten, reopen the airway, and resume breathing. This often restarts with a loud snort or gasp.

Can Acid Reflux Cause Choking or Gasping in Your Sleep?

Another reason you may wake up gasping or choking in your sleep is acid reflux. Acid reflux is a condition where stomach acid, which helps digest food, flows back up into the oesophagus and irritates the throat or mouth. It’s also known as heartburn or gastroesophageal reflux disease (GORD).

This can happen if you produce excessive stomach acid, eat a large meal just before bed, or if the valve at the top of your stomach (which usually prevents acid from washing upward) becomes weaker. This weakening can occur over time or as part of a condition called a hiatus hernia, where a portion of the stomach shifts position.

You might wake up gagging as the stomach acid irritates your throat. Acid in the throat can also trigger excessive saliva production, contributing to choking or gagging in your sleep.

How can I manage acid reflux?

• Avoid large meals before bed.

• Avoid trigger foods like coffee, alcohol, and spicy dishes.

• Use over-the-counter medications such as Rennies, which neutralise stomach acid.

• Ask your GP about prescription medications that reduce acid production.

If your acid reflux persists longer than two weeks or causes significant abdominal pain, speak to your GP, as further investigations may be needed.

Postnasal Drip

If your nose and sinuses are inflamed, this can lead to excessive nasal secretions. When you lie on your back, these secretions can drip down the back of your throat, causing congestion and irritation.

This is more common during a cold or if you have airway inflammation from conditions like hay fever. Over-the-counter remedies that may help include:

• Antihistamines

• Nasal decongestants (short-term use only)

• Nasal steroid sprays

You can also use sinus rinse kits, like NeilMed, to wash out the sinuses. Many people don’t realise that their cheekbones and forehead contain hollow spaces called sinuses. When congested, they can fill with mucus. Using a rinse can help clear them and stop the mucus from dripping down your throat during sleep.

If I wake up with shortness of breath, is it heart failure?

Heart failure is a complex condition where the heart doesn’t beat as effectively as it used to. This can lead to water accumulating in the body. Symptoms may include swollen ankles and breathlessness. The ankles get swollen as they are the lowest point of the body, and the gravity pulls it down.

If you’re carrying extra fluid due to undertreated heart failure, then when you lay flat, your ankles are no longer the lowest point of the body. The water can ‘spill’ into the chest and collect in your lungs.

This might cause you to wake up extremely short of breath, something called paroxysmal nocturnal dyspnoea. If this occurs, you need urgent attention from a doctor, which often means going to A&E.