Nocturnal Choking

Nocturnal choking sensation is a symptom that occurs at night. It can last anywhere from 15 to 45 seconds, causing the patient to awaken from sleep with a sense of anxiety and also cause the patient to cough. Nocturnal choking is one of the many well established diagnoses of sleep disorders. Aside from sleep choking syndrome, this symptom may appear with nocturnal laryngospasm, nocturnal panic attacks, seizure (insular epilepsy), and gastro-esophageal reflux disease (GERD).

GERD is a condition in which acid that usually stays in the stomach flows back into the food pipe (esophagus) and causes irritation and inflammation in the lining of the food pipe and the throat. Physicians sometimes do esophageal pH monitoring and endoscopy to look for GERD. Simple measures can be taken to help with reflux symptoms like avoiding lying down for two to three hours after a meal, eating small meals more frequently throughout the day, wear loose-fitting clothing to avoid pressure on abdomen, lose excess weight, quit smoking, and raise the head of the bed by six to eight inches.

Laryngospasm is a sudden and involuntary closure of the vocal cords, which can lead to choking and difficulty in breathing. It can be triggered by various factors, including acid reflux. Physicians perform laryngoscopy to rule out laryngospasm and also to look for any anatomic disorders. Nocturnal panic attacks can be manifestation of anxiety.

High levels of stress or anxiety can lead to muscle tension, including the throat muscles, which can result in choking episodes during sleep. Talk to your physician about stress and anxiety as this can be very difficult to diagnose and treat without a physician getting full history.

Generalized shaking and confusion immediately after nocturnal choking sensation can be suggestive of seizure disorder. Neurologists can diagnose seizure disorders by doing a test called EEG however, confirming a diagnosis of seizures can be difficult, especially if the only presenting symptom is choking sensation without loss of awareness or confusion.

A lot of patients who present to their primary care physician with nocturnal choking sensation might be told that they have sleep apnea. Sleep Apnea is a sleep disorder characterized by brief interruptions in breathing during sleep. The most common type is Obstructive Sleep Apnea (OSA), where the airway becomes partially or completely blocked, leading to difficulty in breathing – gasping for air. This is mostly due to decreased oxygen flow to the brain.

Most patients with sleep apnea having underlying risk factors that include obesity, male sex, large neck circumference, diabetes, hypertension, and a family history of sleep apnea. A sleep specialist can diagnose sleep apnea by doing a sleep study called polysomnography.

If you are suffering from nocturnal choking, please see your doctor to make sure that it is not something serious.

By Dr Tasaduq Hussain Mir

Dr Tasaduq Hussain Mir (MD) is based in the USA.