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Sleep Disorders

Unable to sleep because of strangeling

06/26/2008

Question:

How come when I lay down to sleep I get a prikley feeling that turns into a strangling feeling that makes me cough and only goes away when I drink something?

Answer:

The symptoms you describe sound very annoying and you are right to seek help. As these symptoms occur when you lie down to go to sleep, but not during sleep, it is unlikely that they represent a primary sleep disorder. However, there are a number of possible explanations for what you are describing, including gastroesophageal reflux (also known as GERD or heartburn), post-nasal drip, upper airway spasms or a mobile anatomic abnormality. Given that the symptoms subside with drinking something, I suspect this most likely represents GERD.

GERD is due to gastric contents coming up into the esophagus and irritating the esophagus and/or the upper airway. This condition is often aggravated by lying supine, especially if one eats near bedtime. As a result, individuals may be prone to unusual sensations of the upper airway and coughing when they lie supine. Treatment of GERD includes lifestyle changes, diet changes and medications. Often, avoiding food and caffeine intake 3-6 hours before bedtime and elevating the head of the bed can help.

Post-nasal drainage frequently occurs in the setting of ongoing nasal congestion, which can be related to a number of factors (such as allergies or infections), and is worsened by lying down on your back. Drainage down the back of the throat may or may not be noticed. Typically, nasal sprays or other medications can effectively control this symptom.

Upper airway spasms are quite rare and, when they do occur, usually occur during sleep, not when awake, and are not relieved with drinking water. A large uvula (the thing that hangs down in the back of the throat) or a polyp in the upper airway can lead to symptoms similar to what you describe, though these are quite uncommon.

I recommend you discuss your problems with your doctor. Further history and a good nose and throat exam can often determine what the problem might be and how best to treat it.

If you would like information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website.

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University