August 1, 2023
Wheezing on Exhale When Lying Down
Wheezing at night can be an alarming situation. You may find that you are struggling to breathe normally while lying down. Wheezing can interrupt sleep, which leads to feeling tired during the day. Long-term lack of sleep can have negative effects on your mood, health, or quality of life.
Wheezing is a whistling sound made while breathing. It’s often associated with difficulty breathing or shortness of breath. Breathing problems such as wheezing are typically caused by the narrowing of your airway anywhere between the throat and the lungs. You may notice wheezing as you inhale, exhale, or both.
Breathing difficulties are often a sign of another health condition, and you should ask your doctor what may be causing nighttime wheezing as you exhale. Understanding why you’re having trouble breathing at night can help you manage the issue and figure out how to get more restful sleep.
7 Causes of Wheezing When Lying Down
If you’re wheezing on exhale when lying down, you may have an underlying health condition that’s causing your breathing difficulties. Symptoms such as heartburn, snoring, or fluid retention can offer clues about what’s causing your wheezing when you exhale.
1. Sleep Apnea
Sleep apnea is a common sleep disorder that affects breathing patterns while you are sleeping. The condition causes you to repeatedly stop breathing while you sleep. It can lead to snoring, gasping for air, wheezing, problems staying asleep, and not feeling rested after sleep. Obstructive sleep apnea can happen when throat muscles relax and obstruct your airway. Central sleep apnea is caused by the brain not sending proper signals to maintain regular breathing. Sleep apnea can be managed by using a continuous positive airway pressure (CPAP) device to assist with breathing. Some cases of sleep apnea can be improved with a mouthguard that prevents the tongue or throat from causing breathing obstructions. 1
2. Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease, also called GERD or chronic acid reflux, is a condition that causes the acid from your stomach to flow upward into the tube that connects your throat and your stomach. It can cause painful heartburn, difficulty swallowing, coughing, chest pain, a sore throat, and hoarseness. GERD can cause inflammation in the throat, which affects breathing. GERD can also exacerbate existing asthma or cause new asthma symptoms in adults. GERD symptoms may be worse when lying down, leading to wheezing when you exhale and other breathing problems at night. Treating GERD can reduce asthma-type symptoms and improve nighttime breathing. Your doctor can suggest over-the-counter or prescription medicines to help with GERD.
3. Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a chronic condition that causes lung and airway inflammation and obstructs airflow from the lungs. Emphysema and chronic bronchitis are the most common causes of COPD. The inflammation of the airways from COPD results in breathing difficulty, such as wheezing on exhale while lying down. The symptoms become progressively worse over time. There is no cure for COPD, but your doctor may be able to prescribe medications that reduce the inflammation and make it easier to sleep. 3
Asthma is a condition that affects your lungs and causes repeated episodes of wheezing, shortness of breath, and coughing. It can be worse at night. If you have asthma, you may find yourself wheezing when exhaling lying down. Asthma can be a lifelong condition, or it can develop in adulthood. Many people with asthma also have GERD, which can make wheezing on exhale more likely. You can control asthma symptoms by avoiding triggers such as allergens or dust. Your doctor can prescribe medications such as steroid inhalers to control asthma. 4
Bronchitis is a condition where the bronchial tubes in the lungs become inflamed, which causes coughing and excessive mucus. The inflammation can lead to wheezing on exhale and shortness of breath, and symptoms may be worse while lying down. Acute bronchitis is often caused by an infection, and symptoms go away once the infection is treated. Chronic bronchitis is when symptoms last for at least three months and return at least two years in a row. It may be a symptom of other conditions, such as emphysema or COPD. Acute bronchitis can be treated with over-the-counter cough and cold remedies. If the infection is caused by bacteria, your doctor may prescribe antibiotics. If you have chronic bronchitis, your doctor can give you strategies to manage symptoms, such as breathing exercises. 5
Carrying excess body weight can complicate breathing, and breathing may become more difficult when lying down. Fat deposits around the lungs can restrict normal lung function and lead to wheezing when you exhale, as well as shortness of breath. Obesity can also be a cause of sleep apnea, which makes nighttime breathing more difficult. You may benefit from a CPAP device to reduce breathing issues at night. Your doctor can also advise you on lifestyle changes that may reduce your weight and relieve nighttime wheezing. 6
7. Heart Failure
Congestive heart failure is a condition where your heart cannot pump blood effectively enough to meet your body’s needs. This can cause fluid to back up in the lungs, making it hard to breathe and leading to wheezing, coughing, and shortness of breath, all of which are worse when lying down. Your doctor can prescribe medications that relieve some of the symptoms related to heart failure. You might need medicine to reduce inflammation, decrease fluid build-up, or manage blood pressure. You may benefit from surgery to repair damage to your heart or blood vessels.
How to Get Sleep With Wheezing
You may be able to improve your sleep by making changes to your routine. If GERD is the reason for wheezing on exhale when lying down, you may find it helpful to stop eating several hours before bedtime. Keeping a food diary may help you understand any connections between what you eat and nighttime wheezing. Avoid alcohol and caffeine, as they can make sleeplessness worse. Keeping your sleep area free of allergens or asthma triggers can lower the risk of wheezing when you exhale when you’re trying to sleep. Sleeping with your head raised can improve airway function so you breathe more easily at night.
When to See a Clinician
If nighttime wheezing is a persistent problem that’s stopping you from getting the rest you need, speak to a doctor. They can help you figure out why you’re wheezing when you exhale while lying down.
You may need a sleep study to determine the cause of your breathing issues. You may also need testing to check your lung function. This might include X-rays, blood tests, an EKG, or exercise tests to see how your lungs work while you’re moving. Once your doctor has diagnosed the cause of your breathing problems, they can help you develop a treatment plan.
The doctors at Healthcare Associates of Texas can answer all your questions about breathing and sleep difficulties. Contact us to set up an appointment at any of our locations.
- Mayo Clinic. “Sleep Apnea.” No date. https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636
- Cleveland Clinic. “GERD (Chronic Acid Reflux).” No date. https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview#management-and-treatment
- Mayo Clinic. “COPD.” No date. https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679
- Centers for Disease Control and Prevention. “Asthma.” No date. https://www.cdc.gov/asthma/
- National Heart, Lung, and Blood Institute. “Bronchitis.” No date. https://www.nhlbi.nih.gov/health/bronchitis
- Çolak Y, Afzal S, Lange P, et al. Obese individuals experience wheezing without asthma but not asthma without wheezing: a Mendelian randomization study of 85 437 adults from the Copenhagen General Population Study. Thorax https://thorax.bmj.com/content/71/3/247
- Mayo Clinic. “Heart Failure.” No date. https://www.mayoclinic.org/diseases-conditions/heart-failure/diagnosis-treatment/drc-20373148
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