Paroxysmal Nocturnal Dyspnoea

Paroxysmal nocturnal dyspnoea is a condition that elicits sudden shortness of breath during sleep. This difficulty with breathing can cause a person to wake up gasping for air. This usually occurs after several hours a person has fallen asleep and improves when they sit upright. The experience can be distressing, and the person may feel highly anxious after an episode of paroxysmal nocturnal dyspnoea. For a comprehensive understanding, the name of the condition is best broken down:

• Paroxysmal: This refers to symptoms that come and pass on quickly.
• Nocturnal: This means occurring at night time or during sleep.
• Dyspnoea: This refers to finding it difficult or uncomfortable to breathe.

Cardiologists use this term when a person experiences this issue only at night, and specifically due to heart failure. Dyspnoea is a potential symptom of a number of serious respiratory and circulatory diseases, including:

• Chronic obstructive pulmonary disorder (COPD).
• Pneumonia.
• Heart failure.

Paroxysmal nocturnal dyspnoea diagnosis For paroxysmal nocturnal dyspnoea diagnosis, the following investigations are required:

• Review of medical history and symptoms. 
• Heart and lungs assessment.
• Physical assessment: Such as checking the blood pressure and weight measurements.
• Biopsy.
• Blood tests: To evaluate the levels of sodium, potassium, albumin, creatinine and certain biomarkers in the blood.
• Bronchoscopy.
• Chest CT scan.
• Chest X-ray: To assess the heart for enlargement, or the lungs for congestion.
• Coronary artery angiogram.
• Echocardiogram, or a cardiac ultrasound: To check the heartbeat rhythm, the frequency of the beats, and the electrical activity of the heart.
• 12-lead electrocardiogram.
• Chest MRI scan.
• Pulmonary function test. 
• Cardiac stress test.
• Thoracoscopy.
• Echocardiography: To evaluate the heart’s structure and how healthy it’s pumping.
• Cardiac catheterization.

Paroxysmal nocturnal dyspnoea treatment Paroxysmal nocturnal dyspnoea treatment choice depends on the cause or underlying condition. Heart failure For paroxysmal nocturnal dyspnoea that’s a result of heart failure, certain lifestyle changes may address the issue.

• Quit smoking.
• Maintaining a modest weight.
• Eating a healthy and balanced diet

Alternatively, medications may be used:

• Angiotensin-converting enzyme inhibitors.
• Angiotensin II receptor blockers.
• Angiotensin-receptor neprilysin inhibitors.
• Beta-blockers.

Surgery or specially implanted devices can also be used to treat heart failure. Lung conditions For paroxysmal nocturnal dyspnoea that occurs due to a lung condition, the following may prescribe:

• Asthma medication.
• The use of a continuous positive airway pressure machine to make breathing easier during sleep.
• The use of additional pillows to elevate the chest while sleeping.

Other treatments are focused on reducing stress and improving the overall quality of sleep, such as: 

• Avoiding caffeine before bed 
• Adopting a regular sleep schedule.

Symptoms

Paroxysmal nocturnal dyspnoea symptoms include:

• Suddenly waking up and gasping for air while asleep.
• Coughing upon waking up.
• Insomnia.
• Anxiety.

Causes

Approximately 90% of all dyspnoea cases are as a result of lung or heart condition.

Heart Failure

Paroxysmal nocturnal dyspnoea is said to be a specific symptom of heart failure, which happens when the heart struggles to pump blood throughout the body. Some heart conditions that may lead to paroxysmal nocturnal dyspnoea include:

• Acute decompensated heart failure, a sudden deterioration of heart failure symptoms.
• Myocardial ischemia, a kind of heart disease.

Lung conditions

Some respiratory conditions that may trigger paroxysmal nocturnal dyspnoea include:

• Asthma.
• Chronic obstructive pulmonary disease.
• Pneumonia.
• Postnasal drip.
• Pulmonary oedema.
• Sleep apnoea.
• Pulmonary artery embolism.
• Restrictive lung disease.

Other possible causes of paroxysmal nocturnal dyspnoea may be:

• Psychogenic disorders, such as anxiety and panic disorder.
• Kidney disease.
• Acid reflux.

FAQ

What are the risk factors for paroxysmal nocturnal dyspnoea?

A person may suffer from paroxysmal nocturnal dyspnoea if they are at risk of developing heart or lung conditions.

The risk factors for heart failure are:

• A previous heart condition.
• High blood pressure.
• Coronary heart disease.
• High cholesterol.
• Diabetes.
• Obesity.
• Tobacco and alcohol use.
• Low activity levels.
• Unhealthy diet.

The risk factors for lung disease are:

• Tobacco smoke, as well as second-hand tobacco smoke.
• Air pollutants.
• Allergens.

What is the outlook of paroxysmal nocturnal dyspnoea?

Heart failure is one of the most severe causes of paroxysmal nocturnal dyspnoea. The long term outlook for heart failure depends on the underlying cause, risk factors, lifestyle, and treatments. 

Other conditions that may be responsible for paroxysmal nocturnal dyspnoea, like asthma, stomach acid reflux or sleep apnoea are generally highly treatable.

Also, seek emergency medical attention if you experience severe or continuing shortness of breath or chest pain.

What is the difference between paroxysmal nocturnal dyspnoea and sleep apnoea?

Paroxysmal nocturnal dyspnoea causes difficulty with breathing during sleep, causing people to wake up as a result of shortness of breath.

Orthopnoea occurs when a person feels breathless while lying down, due to congestion in the lungs.

When should I be concerned about paroxysmal nocturnal dyspnoea and see a doctor?

Paroxysmal nocturnal dyspnoea is a severe condition. If a person suspects they have symptoms of paroxysmal nocturnal dyspnoea they should see a doctor as soon as possible for diagnosis and treatment.

If a person notices signs of heart failure, they should seek an emergency medical care, as paroxysmal nocturnal dyspnoea may indicate that a person is living with advanced heart failure.

If a person experiences difficulty breathing and their breathing does not return to normal for a long time, urgent medical help should be sought.