Wheezing at night: causes, and when it needs a medical check

A wheeze is a high-pitched whistling sound made as you breathe, usually when the airways are narrowed. When it happens mainly at night, asthma is the first thing most clinicians consider. The NHS says asthma symptoms of wheezing, coughing, shortness of breath and a tight chest usually come and go and may be worse at night and early in the morning.

Asthma is not the only possibility. Heart failure, COPD, reflux and chest infections can also cause wheeze, breathlessness or cough at night. The sections below describe what the NHS says about the main candidates.

Wheeze that is new, keeps coming back or wakes you from sleep is worth discussing with a GP. A sudden, severe breathing problem is an emergency.

The NHS describes asthma as a common condition that affects breathing, which cannot currently be cured but should not cause problems if well treated. Triggers it names include exercise, high levels of air pollution, cold air and contact with something you are allergic to, such as pollen, dust, mould or animals. Viruses such as flu can also make symptoms worse.

The NHS says to see a GP if you or your child have asthma and treatments are not helping, you need your inhaler more often, or symptoms are waking you up at night. If you have not been diagnosed, a GP or nurse will ask questions, listen to the chest and may arrange a simple breathing test or a peak flow meter to use at home for a few weeks. The NHS notes that asthma can take some time to diagnose because symptoms vary over time and breathing problems have different causes.

For an attack, the NHS advises sitting up straight, staying calm and using the reliever inhaler as set out in your action plan. It says to call 999 if you feel worse at any time, do not feel better after the maximum dose, or do not have an inhaler.

Wheeze at night is not only a lung symptom. The NHS lists the symptoms of heart failure as feeling out of breath when doing everyday activities or lying down, weakness and tiredness, swelling in the feet, ankles, legs or tummy, sudden weight gain, coughing at night and coughing up frothy pink phlegm.

The NHS advises seeing a GP if you think you have symptoms of heart failure, an urgent GP appointment or NHS 111 if you feel breathless when lying down or from everyday activity, are coughing up frothy pink phlegm or have suddenly gained weight, and 999 for severe difficulty breathing such as gasping, choking or not being able to get words out. If nights are being disturbed by breathlessness when you lie flat, rather than a purely noisy chest, that distinction is worth telling the GP.

The NHS describes COPD as a group of lung conditions that cause breathing difficulties, mainly affecting middle-aged or older adults who smoke. Its main symptoms are shortness of breath particularly when active, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing. It advises seeing a GP if you have persistent symptoms, particularly if you are over 35 and smoke or used to smoke, and says not to ignore them.

For bronchiectasis, the NHS lists a cough that does not go away, coughing up a lot of phlegm and frequent chest infections as the main symptoms, with wheezing, shortness of breath and noises such as crackling or squeaks among other possible symptoms. Chest infections commonly cause wheezing and shortness of breath alongside a chesty cough, chest pain, high temperature and tiredness, and the NHS says they usually get better on their own in about 7 to 10 days.

The NHS pneumonia page lists a cough, shortness of breath, high temperature, chest pain, wheezing, feeling confused and tiredness among the symptoms, and advises an urgent GP appointment or NHS 111 if you are short of breath or have chest pain that comes and goes.

The NHS says acid reflux can cause a cough or hiccups that keep coming back, a hoarse voice and bloating, and that symptoms are often worse after eating, when lying down and when bending over. It advises not eating within 3 or 4 hours before bed and raising the head of the bed by 10 to 20cm using blocks, rather than extra pillows.

Reflux does not always feel like heartburn, so a night-time cough or tight chest can be the only clue. For asthma specifically, the NHS lists allergens such as dust, pollen, mould and animals, smoke, cold air and infections such as flu among the triggers.

Keep a note of when the wheeze happens, how long it lasts, what you were doing, whether you are also coughing, breathless or bringing up phlegm, and whether you have heartburn, a cold or swelling in your legs. The NHS says asthma is assessed from symptoms and breathing tests, so a short note of when symptoms happen gives the clinician useful detail.

See a GP about wheeze that keeps recurring, wakes you at night, or comes with breathlessness lying flat or a cough that lasts more than 3 weeks. For the NHS, an urgent GP appointment or NHS 111 is appropriate for breathlessness when lying down, frothy pink phlegm or sudden weight gain. Call 999 for gasping, choking, not being able to get words out, lips or skin that are pale, blue or grey, or an asthma attack that does not improve with the reliever inhaler.