Paroxysmal nocturnal dyspnea (PND) is when you wake up suddenly feeling like you can’t catch your breath. You might also cough. Sitting up helps you breathe normally again within 10 to 15 minutes. Heart, lung and neurological conditions can cause 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.”

Possible Causes

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

Care and Treatment

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.