Lungs

Ever Wake Up Struggling to Breathe – Could It Be Due to Floppy Airways?

People with the genetic condition known as Alpha-1 Antitrypsin Deficiency can suffer from a breakdown of elastin and collagen which can lead to airway collapse such as tracheomalacia (weakness in the windpipe cartilage). This condition is sometimes referred to as ‘floppy airways’.

This type of airway obstruction can lead to breathing challenges and is sometimes present in people with chronic obstructive pulmonary disease (COPD), bronchitis, gastroesophopageal relux (GERD) and asthma too.

Why Sleeping Lying on Your Back Can Make Breathing Difficult

Lying on your back (supine position) while sleeping can add pressure to a weak airway (i.e. the tracheal wall), with the weakness and gravity making the airway collapse inward – narrowing the airway sometimes up to 90%.

Options to Consider if You Are Waking Up Struggling to Breath

  • A sleep study
  • Dynamic flexible bronchoscopy
  • Imaging such as a CT scan

Potential Interventions to Consider

  • Airway clearance in the afternoon/evening to reduce airway mucus/sputum before bed
  • Side-sleeping to keep the airways open
  • Use of a CPAP machine to keep the airways open (prescribed by your respiratory specialist)
  • In more severe cases, stents or splints can be placed in the airway.

Conclusion

Ensuring a good supply of oxygen to your organs is important as is a good night’s sleep. Knowing the severity and type of airway collapse can assist a respiratory physician determine what medical investigations and treatment options are best for you if you are struggling to breath at night from airway obstruction.

Frequently Asked Questions

Common questions about Alpha-1 liver disease, diagnosis and treatment in Australia.

What are floppy airways in Alpha-1 Antitrypsin Deficiency?

Floppy airways, also called tracheomalacia or airway weakness, occur when the walls of the windpipe or larger airways become weak and can collapse inward. In people with Alpha-1 Antitrypsin Deficiency, airway weakness can contribute to breathing difficulties.

Why can floppy airways make it difficult to breathe at night?

Breathing can become more difficult when you are lying down because a weakened airway may narrow or collapse more easily. This can make it harder to move air while sleeping and may cause some people to wake up struggling to breathe.

What are the signs of floppy airways during sleep?

Signs may include waking up struggling to breathe, shortness of breath when lying down, disturbed sleep or difficulty breathing at night. These symptoms can have different causes, so persistent breathing problems should be discussed with a healthcare professional.

How are floppy airways diagnosed?

A doctor may use tests such as a sleep study, dynamic flexible bronchoscopy or a CT scan to examine the airways. These tests can help determine whether the airways are collapsing and how severe the problem may be.

What can help keep floppy airways open at night?

Depending on the cause and severity, treatment may include sleeping on your side, clearing mucus or sputum before bedtime, or using CPAP to help keep the airways open. More severe airway collapse may require other treatments recommended by a respiratory specialist.

Should I see a doctor if I regularly wake up struggling to breathe?

Yes. Regularly waking up struggling to breathe should be discussed with a healthcare professional, particularly if you have Alpha-1 Antitrypsin Deficiency or another lung condition. A doctor can assess your symptoms and determine whether further testing is needed.

References
Buitrago DH, Wilson JL, Parikh M, Majid A, Gangadharan SP. Current concepts in severe adult tracheobronchomalacia: evaluation and treatment. J Thorac Dis. 2017 Jan;9(1):E57-E66. doi: 10.21037/jtd.2017.01.13. PMID: 28203438; PMCID: PMC5303067.

McGinn J, Herbert B, Maloney A, Patton B, Lazzaro R. Quality of life outcomes in tracheobronchomalacia surgery. J Thorac Dis. 2020 Nov;12(11):6925-6930. doi: 10.21037/jtd.2020.03.08. PMID: 33282396; PMCID: PMC7711398.