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Sleep Disorders

Sleep-related laryngospasm

11/05/2008

Question:

I have diagnosed allergies airborn and food allergies and chronic post nasal drip. I am talking Flonase and ventolin PRN (about once per monthon average). The frequency of nighttime awakenings with either high pitched whistling sound and obstruted air is happening almost nightly and usually twice per night and almost exactly as described in Sleep-related laryngospasm. R. Thurnheer, S. Henz, A. Knoblauch. ©ERS Journals Ltd 1997.

What has evolved in the treatment and diagnosis of this problem since that article was written? This regular nightitme awakenings are disconcerting.

Sleep apnea test found "no sugnificant sleep apnea". I am 45 female (regular periods) and in otherwise good health.

Please take the time to answer my question. Thank you very much.

Answer:

It sounds as if you've already done some research! Waking up with a sensation of choking or gasping in sleep can be caused by a number of conditions and may not necessarily represent laryngospasm (a sudden narrowing of the upper airway which results in obstruction during inspiration), though laryngospasm would certainly be in the list of disorders to consider. The addition of "whistling" to the symptom complex can again be explained by other disorders than laryngospasm, though this problem must be considered. The reason to include a number of other possible explanations for your symptoms is that true laryngospasm is thought to be relatively rare, whereas other conditions that could mimic laryngospasm are much more common.

Conditions that can present with a sensation of airway choking and "whistling" at night include obstructive sleep apnea, sleep-related worsening of asthma, gastroesophageal reflux, congestive heart failure, an upper airway anatomic abnormality and anxiety. Many of these conditions will worsen at night or only be experienced at night and thus can mimic laryngospasm.

In true laryngospasm, the individual tends to awaken with a sensation of choking or smothering followed by a very characteristics sound referred to as stridor. Stridor is a high pitched noise heard over the trachea (in the front of the neck), usually only or predominantly during inspiration. Stridor is different from the symptoms of asthma, in which more of a wheezing sound is heard over the chest (and not so much the neck) predominantly during expiration (though can be during inspiration as well). Anxiety often accompanies the attacks and one would not expect to get relief with the use of a ventolin inhaler.

As you likely read, the true cause of nighttime laryngospasm is not clearly known, though there does appear to be a correlation with the presence of gastroesophageal reflux disease (also known as GERD or heartburn) in many individuals. GERD can be difficult to detect as it may be "silent" during the daytime and only manifest itself at night during sleep. As reported in the literature, it appears that treating individuals with laryngospasm for GERD often improves their symptoms.

So, why did your sleep study not record any of these spasms? One might expect that something should have been picked up, though occasionally one night of monitoring is not sufficient to capture an event. The fact that no sleep apnea was seen makes sleep apnea less likely to be a cause of your symptoms.

To know how best to evaluate and treat you, additional information will be needed. You should discuss your case with your doctor and perhaps see a Sleep Specialist to help sort out the issues. Making sure your asthma is under optimal control will be important as an initial step. Sometimes, just a trial of treatment for GERD may be all that is needed. Repeat testing, perhaps with measurements to assess for GERD during sleep, may need to be considered. Evaluation of your vocal cords by an Ear Nose and Throat specialist may also be helpful.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University