Paroxysmal nocturnal dyspnea can be of great concern and alarm and is a serious symptom of a variety of conditions. When this occurs, people tend to wake up several hours after going to sleep and experience a feeling of shortness of breath or that they cannot breathe (dyspnea). This usually causes people to change positions and more often to sit for a few minutes, causing symptoms to stop. The person may go back to sleep and experience another episode at night or sleep through the night. This symptom can occur every night and requires medical attention.
There are several things that can cause paroxysmal nocturnal dyspnea, and most are related to the heart system. Failure of different parts of the left ventricle to function properly is often the cause, and people with this condition could have damaged mitral or aortic valves. Generally, the symptom is attributed to left heart failure.
More specifically, large amounts of blood in the heart are not adequately pumped to the body. Fluid can start to build up in the lungs, particularly when a person is lying down for several hours. This can create a feeling of suffocation or inability to breathe, which tends to be relieved by shifting the body to an upright position. Not only can the sensation of breathing be affected, but people can also develop congestion or a cough when lying down. Some people have mucus production that can look like blood.
Another indication of paroxysmal nocturnal dyspnea is edema or swelling and swelling in the ankles and feet. This also suggests heart failure. When swollen ankles and episodes of terrifying breathing at night are combined, it tends to confirm the diagnosis of this disorder and suggests that some form of heart failure is occurring.
Since different types of heart failure may be involved, the treatment of paroxysmal nocturnal dyspnea may need to be tailored to the individual. Heart failure, although the term sounds so serious, is a long and progressive process that can often be addressed early with medication. Some medications that might be indicated include those that widen the blood vessels called vasodilators. Diuretics may be given to reduce fluid volume. Other common heart medications may be suggested as needed.
People who have heart failure and symptoms such as paroxysmal nocturnal dyspnea may require more careful monitoring with a cardiologist. If medications fail to adequately address underlying heart problems, surgery may be considered. The type of surgery, again, depends on the problem creating problems: an aortic valve might need to be opened, replaced, or repaired, or a mitral valve might need replacement. Patients should be especially prepared to report ongoing problems with this condition after starting treatments. Those experiencing this symptom for the first time should plan to contact doctors immediately to report it.