The sensation of being unable to breathe when trying to fall asleep can be distressing, especially for those who have had COVID-19. Many report this unsettling symptom, which can significantly impact sleep quality and overall well-being. This article explores how COVID-19 affects breathing, why these sensations intensify during sleep onset, and other contributing factors.
COVID’s Impact on Breathing
COVID-19 primarily targets the respiratory system, causing inflammation and damage to the lungs and airways. The immune system’s response can become overactive, leading to severe inflammation that affects lung tissues. This inflammation may result in conditions like pneumonia, where air sacs fill with fluid, or acute respiratory distress syndrome (ARDS), where fluid hinders oxygen transfer to the bloodstream.
Many individuals experience persistent respiratory symptoms, including shortness of breath, for weeks or months after infection. This is often called Long COVID (Post-Acute Sequelae of SARS-CoV-2 infection or PASC). This lingering breathlessness can occur even at rest and may be accompanied by chest discomfort or tightness. COVID-19 can lead to changes in lung function, such as uneven lung inflation, reduced lung volumes, and increased respiratory dead space, which can persist for a year or more. The severity of the initial infection often correlates with the persistence of respiratory symptoms in Long COVID.
Why It Happens During Sleep Onset
The transition from wakefulness to sleep involves significant changes in the body’s control over breathing. During wakefulness, breathing is both voluntary and involuntary, allowing conscious adjustments. As sleep begins, conscious control diminishes, and breathing becomes solely regulated by automatic systems. If the respiratory system is compromised by post-COVID effects, this automatic control might be less efficient, leading to a sensation of breathlessness.
Anxiety and hyper-awareness can also play a significant role in amplifying these sensations at bedtime. The quiet environment and anticipation of losing conscious control during sleep can heighten a person’s perception of their breathing, making subtle changes feel more pronounced. People experiencing anxiety might become overly focused on their breath, leading to a cycle where the fear of not breathing exacerbates the feeling. Some individuals may also experience subtle shifts in breathing patterns, such as shallower breaths or tendencies towards central sleep apnea, which become more apparent as the body relaxes into sleep. These physiological changes combined with psychological factors can create the distressing experience of feeling unable to breathe during sleep onset.
Other Potential Contributors
Beyond the direct effects of COVID-19, several other conditions can cause similar sensations of breathlessness or choking when falling asleep. These might coexist with or be worsened by post-COVID symptoms. Obstructive sleep apnea (OSA) is a common disorder where throat muscles relax and block the airway during sleep, leading to loud snoring, gasping, choking, and frequent awakenings. Central sleep apnea, a less common form, occurs when the brain temporarily fails to send proper signals to the muscles that control breathing.
Anxiety disorders and nocturnal panic attacks are also significant contributors. Nocturnal panic attacks can jolt a person awake with symptoms such as a racing heart, sweating, and intense shortness of breath, mimicking severe respiratory distress. These attacks can occur without a clear trigger. Gastroesophageal reflux disease (GERD) can cause stomach acid to back up into the esophagus, irritating the airways, especially when lying down. This irritation can lead to coughing, wheezing, and a sensation of breathlessness or choking, particularly at night.
When to Seek Medical Advice
Seek medical attention if breathlessness is severe or accompanied by other concerning symptoms. Immediate medical care is necessary for symptoms such as severe chest pain that does not subside, bluish discoloration of the lips, skin, or nails, increased difficulty staying awake, or confusion.
For persistent or worsening shortness of breath after COVID-19, contact a doctor, particularly if it interferes with daily activities or occurs at rest. A healthcare professional can assess the situation, rule out serious conditions, and provide an accurate diagnosis. Managing breathlessness can involve strategies like relaxation techniques, improving sleep hygiene, and avoiding known triggers. Discussing symptoms with a medical professional ensures appropriate guidance and treatment tailored to individual needs.