Nightime shallow breathing

I'm 46 and have a 4cm hiatal hernia daignosed by endoscopy. Every night at between about 1am and 3.30am, I wake up because my breathing has become very shallow and more rapid.  I just don't seem to begetting enough air. This often persists for several hours and I have trouble getting back to sleep.  I take Nytol tablets to help me sleep every night now.  The breathing problem is worse if I lie on my side and front and improved by lying on my back. For some reason, I can't sleep on my back though.  I have tried sleeping in a bed with the back legs raised on bricks by 15cm, but this hasn't helped. About twice per week, my breathing becomes shallow as soon as I lie down and so I'm awake most of the night.  The symptoms seem to be aggravated be certain foods (e.g. chilli), but eating an apple during the night seems to help.  I don't suffer from any other symtoms (symptoms), apart from feeling a little sick when hungry. I have tried PPIs and H2 blockers, but these have always only worked for about 5 days.  I have changed mattress and pillows to hypoallergenic types, but this has not helped either.  I've even had my heart investigated by a cardiologist, and it's ticking away nicely.

I am in the process of being examined by a surgeon with a view to carrying out keyhole surgery to repair the hernia.  He suspects that my symptoms are caused by my inhaling stomach acid into my lungs at night, which causes irritation.  However, a 24-hour monitor with a pH metre suspended in my oesophagus just above my stomach has indicated that there is no acid reflux. I am about to be fitted with a 48-hour pH monitor in the same position.  If this doesn't show acid reflux, I think my surgeon will not operate.  I have no symptoms of reflux.

I wondered if the symptoms could simply be due to the hernia pressing against my lungs when I lie down, which irritates them and brings on the rapid, shallow breathing.  Could this be the case?  Any help would be most welcome.

[Kevin Pho, MD]

I agree with the suggested workup.

You can also consider problems outside the GI system.  Sleep apnea and other pulmonary conditions can lead to the symptoms.

I would consider a sleep study, which can be arranged by a lung specialist.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com