Experiencing pain behind or around the breastbone, known as sternum pain, upon waking can be a confusing symptom. This discomfort, often felt just as one starts the day, can range from a dull ache to a sharp, sudden sensation. While unsettling, it is a relatively common occurrence with various potential origins. Understanding the different reasons this pain might arise is important for identifying appropriate steps. This article explores several factors that can contribute to sternum pain experienced in the morning.
Common Musculoskeletal and Inflammatory Causes
A frequent origin of sternum pain upon waking involves the musculoskeletal system and localized inflammation. Costochondritis, an inflammation of the cartilage connecting the ribs to the sternum, is a common example. This condition typically presents as sharp, aching, or pressure-like pain, often concentrated on the left side of the breastbone. The pain can worsen with deep breaths, coughing, sneezing, or movements of the chest wall, and may also radiate to the arms and shoulders. Lying down can exacerbate the discomfort, making it particularly noticeable upon waking.
Tietze syndrome is a rarer condition similar to costochondritis, characterized by inflammation of the costal cartilage but notably involving swelling at the affected joint. This swelling, often palpable, usually occurs in the higher ribs, typically the second or third, near the sternum. Both costochondritis and Tietze syndrome can cause tenderness when pressure is applied to the affected area, a key diagnostic indicator that helps distinguish them from other types of chest pain. The pain from these conditions can be aggravated by specific sleeping positions that place pressure on the chest.
Muscle strains in the chest wall, such as those affecting the pectoral muscles, can also lead to sternum pain that becomes evident in the morning. These strains might result from unaccustomed exercise, poor posture during sleep, or minor injuries that occur without immediate recognition. The muscles can become stiff and painful overnight, leading to discomfort upon movement or stretching after waking. Any twisting or turning of the upper body during sleep can intensify the pain from such muscle injuries, contributing to the morning onset of symptoms.
Other Potential Causes to Consider
Beyond musculoskeletal issues, other conditions can also manifest as sternum pain upon waking. Gastroesophageal reflux disease (GERD) is a common digestive condition where stomach acid flows back into the esophagus, irritating its lining. This reflux can cause a burning sensation behind the breastbone, often referred to as heartburn, which frequently worsens when lying down and may wake individuals from sleep. The pain from GERD can mimic cardiac chest pain, though it is usually accompanied by a burning sensation and may improve with sitting or standing.
Anxiety and panic attacks can also lead to chest pain or tightness, which some individuals report experiencing upon waking. During these episodes, stress hormones can trigger physical responses, including chest discomfort that may feel sharp, stabbing, or like a persistent ache or tightness. While the pain often subsides as a sense of calm is regained, its sudden onset can be alarming. It is important to consider that physical manifestations of stress can present themselves during periods of rest.
Although less common for pain only upon waking, cardiac conditions like angina, which is chest pain due to reduced blood flow to the heart, or more serious events like a heart attack, can cause chest discomfort. These conditions typically present with additional symptoms such as pain radiating to the arm, neck, or jaw, shortness of breath, or sweating. Similarly, pulmonary conditions such as pleurisy, an inflammation of the lining around the lungs, can cause sharp chest pain that intensifies with deep breathing or coughing. While chest pain should always be taken seriously, distinguishing features often help differentiate these from non-cardiac causes.
When to Seek Medical Attention
While many causes of sternum pain upon waking are not serious, certain symptoms warrant prompt medical evaluation. Seek immediate medical attention if the sternum pain is accompanied by symptoms such as pain radiating to the arm, neck, or jaw, or if you experience shortness of breath, profuse sweating, or dizziness. A severe crushing or squeezing sensation in the chest, or pain that lasts longer than 15 minutes, also indicates a need for urgent care. These symptoms could signal a heart attack or other serious condition.
It is also advisable to consult a healthcare professional if the sternum pain is persistent, worsening over time, or significantly impacting daily life, even without emergency symptoms. Any sudden, unexplained chest pain should be evaluated to rule out serious underlying causes. Do not attempt to self-diagnose potentially serious symptoms.
Managing Sternum Pain at Home
For sternum pain that has been determined not to be a medical emergency, several home management strategies can help alleviate discomfort. Applying a cold pack to the affected area can help reduce inflammation and pain, particularly for musculoskeletal strains or costochondritis. Heat therapy may also provide relief by relaxing tense muscles. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain and reduce inflammation, but their use should be discussed with a doctor, especially if other medications are taken.
Adjusting sleeping posture can significantly reduce morning sternum pain. Sleeping on the back with a supportive pillow under the head and a small pillow under the knees can help maintain spinal alignment and reduce pressure on the chest. For side sleepers, placing a pillow between the knees and ensuring proper head and neck alignment can also provide support. Some individuals find relief by sleeping in a semi-vertical position, using multiple pillows or an adjustable bed to elevate the upper body, which can lessen pressure on the chest and improve breathing.
For sternum pain related to GERD, dietary modifications and lifestyle changes can be beneficial. Avoiding trigger foods such as high-fat meals, caffeine, chocolate, and citrus fruits may reduce acid reflux symptoms. Eating smaller, more frequent meals and avoiding eating close to bedtime can also help prevent reflux. Elevating the head of the bed by six to eight inches can help prevent stomach acid from flowing back into the esophagus during sleep.