Sleep Chest Pain – Causes of Pain in the Chest when Sleeping

Pain in the chest area frequently causes considerable anxiety. This is because chest pain is usually thought to arise from a problem with the heart and the lungs, two vital organs in the thoracic cavity. Indeed, a problem with these vital organs can be deadly, and should be taken seriously. For example, lung cancer and heart attacks could be the reason for chest pain.

However, not all cases of chest pain are caused by problems with the heart and the lungs. In some cases, chest pain may simply be due to soreness of the muscles of the chest or due to anxiety. Furthermore, not all cases of chest pain arise due to causes that reside within the chest cavity. For example, chest and shoulder pain can also be due to the presence of gallstones. Therefore, other signs and symptoms that accompany chest pain should also be noted.

Chest pain, along with other accompanying signs and symptoms, may either worsen or ease off during sleep. The worsening or easing of the chest pain and other symptoms may be caused by fluctuations in the body’s internal clock (circadian rhythm), changes in body position, dietary habits and even certain lifestyle or environmental factors. Sometimes it may occur for no clearly identifiable reason.

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Causes of Chest Pain during Sleep

Chest pain during sleep can be caused by a variety of conditions. Two common causes of chest pain during sleep are gastroesophageal reflux disease and a heart attack. The latter is far less common. Based only on the symptom of chest pain, it is often difficult to distinguish between these two conditions. Therefore, diagnosis of the exact cause of chest pain depends on consideration of other accompanying signs and symptoms. The following are some of the common causes of chest pain that occurs during sleep.

Gastroesophageal reflux disease

Commonly known as acid reflux, gastroesophageal reflux disease (abbreviated as GERD) is one of the most common causes of chest pain that occurs during sleep. Gastroesophageal reflux disease is a very common condition that is characterized by a backward reflux of gastric acid and stomach contents into the esophagus. Under normal conditions, this backward flow of stomach acid into the esophagus is prevented by the presence of gastroesophageal (or lower esophageal) sphincter.

Exposure of esophageal wall to the highly corrosive stomach acid leads to pain in the chest region. This pain sensation is also commonly referred to as “heartburn”. Acid reflux increases while lying down, and this causes the pain to worsen. Stomach acid production also increases during early morning hours (a circadian pattern), which further increases the chances of chest pain while sleeping.


Angina pectoris refers to pain arising from the heart muscles. This condition is mainly caused by coronary artery disease. Coronary arteries are the main blood vessels that supply the heart muscles. Narrowing of the lumen of coronary arteries (mostly caused by plaque buildup) restricts blood supply to the heart muscles, which can result in injury to the heart muscle cells. This leads to chest pain that is a characteristic symptom of angina pectoris. The chest pain increases during stress and physical exertion. Chest pain may also worsen while sleeping (especially during early morning hours) in some types of angina, such as variant angina and unstable angina.

Heart attack

Technically known as a myocardial infarction, a heart attack refers to a condition in which the heart muscles die due to a lack of blood supply. The coronary artery is the main blood vessel that supplies the heart muscles. Reduction of blood supply due to narrowing of the coronary artery results in injury to the heart muscle, causing angina. Complete blockage of the coronary artery leads to death of the heart muscles, resulting in heart attack. Although heart attacks can occur at any time, they are found to occur more frequently during the early morning hours (especially between 1 AM to 5 AM). This is thought to occur due to changes in the autonomic nervous system, circadian rhythm and the sleep cycle.

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Pulmonary embolism

The term “embolus” mostly refers to a blood clot. Pulmonary embolism refers to blockage of the artery that supplies the lungs, mostly due to the presence of blood clots. The blood clots that block the pulmonary artery are frequently break-away clots from the lower limbs (in persons suffering from deep vein thrombosis). Pulmonary embolism is a potentially lethal condition that requires immediate medical treatment. This condition can occur at any time of the day. However, it seems to occur more frequently in the early morning hours. Chronically immobile people are especially at risk for developing pulmonary embolism.


Pericarditis refers to inflammation of the lining of the heart (also known as the pericardium). Inflammation of the pericardium causes chest pain, which usually worsens when lying down. The pain is not due to sleep, but due to the position of the body. Sitting upright generally eases the pain of pericarditis. Chest pain may also worsen due to increased heart activity during sleep (such as during nightmares).

Pulmonary edema

Fluid accumulation within the lungs is technically referred to as pulmonary edema. Diseases of the lungs, heart, and kidneys are common causes of pulmonary edema. Shortness of breath that increases when lying down is frequently a symptom of this condition. However, chest pain is not a typical symptom of pulmonary edema. Shortness of breath and strained breathing may at times be described by the patient as chest pain.


Pleuritis refers to an inflammation of the lining of the lungs (also known as the pleura). Chest pain, which may worsen when lying down flat, is a common symptom of pleuritis. Fluid accumulation around the lungs (effusion) increases the intensity of the pain felt in pleuritis. Sometimes, the pain may subside while lying down on the affected side. The pain may also worsen while lying on the unaffected side.

Chest wall pain

Pain in the chest may also be caused by an injury or disease affecting the structures of the chest wall (skin, muscles, and bones). Generally, breathing deeply worsens the pain in such conditions. Lying on the chest while sleeping may also aggravate the pain by exerting extra pressure on the injured chest wall. Diseases such as shingles can cause tenderness and pain in the chest.


Anxiety attacks can also result in chest pain. Nightmares during sleep may also cause chest pain. Persons suffering from heart diseases are especially prone to having chest pain with anxiety attacks or nightmares. This is because anxiety causes increased heart activity.

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