Paroxysmal Nocturnal Dyspnea (PND)

What is paroxysmal nocturnal dyspnea (PND)?

Paroxysmal nocturnal dyspnea (PND) is when you’re suddenly awakened feeling short of breath. Unlike orthopnea, it doesn’t happen when you’re awake and lying down or reclining, only when you’re asleep.

PND can feel scary, like you can’t breathe or are working hard to get a deep breath. You may gasp for air and cough. It can be particularly jarring because it wakes you suddenly, after an hour or two of sleep. Sitting up helps you feel better within about 10 to 15 minutes.

Paroxysmal nocturnal dyspnea is pronounced “pair-uh-SIZ-muhl knock-TUR-nuhl DISP-nee-uh.”

What causes paroxysmal nocturnal dyspnea?

Heart, lung and neurological issues are the most common causes of sudden breathlessness when you’re sleeping:

• Heart disease. When you’re lying down, your blood moves from your legs to your lungs. If your heart can’t move the extra blood out efficiently, the extra fluid puts pressure on your lungs.
• Respiratory conditions. Airway and lung conditions that cause breathlessness during the day can get worse at night.
• Neurological issues. Central sleep apnea and other conditions that affect your body’s respiratory drive — the signals from your brain that control your breathing — can cause PND.

Specific conditions that can cause PND include:

• Sleep apnea
• Congestive heart failure
• Pulmonary hypertension
• COPD (chronic obstructive pulmonary disease)
• Asthma
• Pulmonary edema
• Parkinson’s disease
• Sleep disorders
• Nocturnal panic attacks
• Obesity

How is paroxysmal nocturnal dyspnea treated?

Treatment for PND depends on the cause. Treatments for underlying causes include:

• Medications for cardiovascular conditions. These commonly include diuretics, ACE inhibitors and beta-blockers.
• Sleep apnea treatments. CPAP and BiPAP are commonly recommended for treating sleep apnea. Your provider may also recommend weight loss.
• Medications for lung and airway diseases. These usually include inhaled bronchodilators and corticosteroids.
• Oxygen therapy. You might need supplemental oxygen on a temporary or ongoing basis if you have a condition that prevents you from getting enough oxygen.
• Mental health treatments. These might include cognitive behavioral therapy, antidepressants or anti-anxiety medications.

Can paroxysmal nocturnal dyspnea be prevented?

The best way to prevent PND is to treat any underlying causes. If you have an ongoing health condition that might lead to PND, take medications as prescribed. Other ways to keep your heart and lungs healthy include:

• Physical activity. Exercise can strengthen your heart and lungs so they don’t have to work as hard. Talk to your provider about a level of physical activity that’s safe.
• Breathing exercises or relaxation techniques. These can help relieve shortness of breath from underlying breathing conditions and anxiety.
• Don’t smoke (or quit smoking). Smoking damages your lungs and can worsen asthma and lead to COPD and other conditions that make it hard to breathe.

When should I see a healthcare provider?

See a healthcare provider if you’re waking up at night feeling out of breath. It could be a sign of an underlying health condition that needs treatment.

What’s the difference between sleep apnea and paroxysmal nocturnal dyspnea?

Sleep apnea can lead to PND. Sleep apnea is when your airway is blocked or your brain doesn’t tell your body to breathe correctly while you’re sleeping. It can cause you to wake up feeling short of breath (paroxysmal nocturnal dyspnea).