Sleep Chest Pain – Causes of Pain in Chest When Asleep

Chest pain is usually a cause for concern as the vital organs (heart and lungs) are located in the chest cavity. It is not always due to anything serious. Sometimes chest pain may be due to anxiety or sore muscles that lie on the chest wall. However,  there are instances where chest pain may be due to serious conditions like a heart attack or even lung cancer.

Why does sleep cause chest pain?

Although chest pain is a symptom of several conditions involving the chest cavity, it can sometimes arise with problems outside of this region. For example, gallstones can cause lower chest pain and even shoulder pain. Therefore it is important to consider other symptoms that may accompany the chest. The pain and these other symptoms may also ease or worsen during sleep.

When we sleep, the change in position and other fluctuations associated with the circadian rhythm can trigger or worsen certain conditions which may present with symptoms like chest pain. The circadian rhythm is essentially the 24 hour biological clock and various organs become more or less active at certain times within this cycle. There are various other reasons why chest pain or other symptoms may appear or worsen during sleep.

Causes of Sleep Chest Pain

A host of different conditions may present with chest pain and specifically chest pain that tends to worsen while sleeping. The more common causes have been discussed below. It is often difficult to differentiate between these conditions, especially with the two most common causes – acid reflux and angina or a heart attack. Therefore it is important to correlate the chest pain with other symptoms and seek medical attention to confirm the underlying cause.

Read more on chest pain when lying flat.

Acid Reflux

One of the more common causes of sleep chest pain is acid reflux or gastroesophageal reflux disease (GERD). This is a very common upper digestive condition where the stomach acid flows backward into the esophagus. It usually presents with a burning chest pain (heartburn). The pain may worsen when sleeping due to lying flat which allows easier backward flow of stomach acid as well as increased stomach acid secretion which occurs in the early hours of the morning as part of the circadian rhythm.


Angina pectoris is chest pain that arises from the heart and is associated with coronary artery disease. This occurs when the coronary arteries that supply blood to the heart muscle becomes narrowed. As a result there is heart muscle injury and chest pain usually during stress and physical exertion when the heart has to work harder. In some types of angina, like unstable angina and variant angina specifically, the chest pain worsens at night and in the early hours of the morning.

Heart Attack

A heart attack (myocardial infarction) is where a portion of the heart muscle dies due to a blockage in the coronary artery. In angina on the other hand, the narrowing causes muscle injury but there is usually no death of this muscle tissue. Heart attacks can occur at anytime in the day but one of the more common time periods when it happens is in the early hours of the morning, between 1AM and 5AM. This is associated with changes in the sleep cycle and autonomic nervous system as well as fluctuations in the circadian rhythm.

Read more on heart attack chest pain.

Pulmonary Embolism

Pulmonary embolism is a condition where an artery to the lung becomes blocked with a blood clot. This blood clot usually arises in the leg (deep vein thrombosis or DVT), breaks away and travels to the smaller pulmonary artery which it may then block. This can be life threatening without prompt medical attention. Although it may occur at any time of the day, it tends to be more common in the early hours of the morning. People who are immobile for a long time tend to be at a greater risk of a pulmonary embolism.


Pericarditis is a condition where the lining around the heart becomes inflamed usually due to injury or infection. The chest pain in pericarditis tends to worsen when lying down and eases with sitting upright. Therefore the problem is not due to sleep but rather due to the lying position that is the natural sleeping position. However, any increase in heart activity like during certain parts of the sleep cycle or with nightmares could also worsen the chest pain.

Pulmonary Edema

Fluid in the lungs is known as pulmonary edema and occurs with lung, heart and kidney diseases among other conditions. Although this does not typically cause chest pain, the shortness of breath in this conditions tends to worsen when sleeping. It results in labored breathing at times, depending on the extent of the fluid accumulation. Sometimes a person can incorrectly describe this shortness of breath and strained breathing as chest pain.


Pleuritis is inflammation of the lining around lung usually due to an infection. Chest pain is a common symptom and when there is an effusion (fluid around the lungs) then this pain may worsen when lying flat. However, the pain often eases to some degree when lying on the affected side. Sometimes the opposite may occur where the pain appears to be more intense when lying on the unaffected side.

Chest Wall Pain

Injury, strain or disease of the chest wall (skin, muscles, bones) can also cause chest pain. The pain tends to worsen when breathing in deeply or with movements of the upper torso. Lying on the chest when sleeping can aggravate the pain due to the pressure of the torso weight. Sometimes infections like shingles may also be responsible for chest pain and tenderness.


Chest pain is a common symptom in anxiety attacks. This is often not due to an disease or disorder of the chest organs. Should an anxiety attack occur or worsen when asleep then a person may experience chest pain. This may occur with nightmares as well, and a person may awake with chest pain. People with heart disease may experience chest pain with a nightmare due to the strain on the heart as it beats faster.

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  • Mikaela

    Hi! I’ve been waking up in the middle of my sleep (3x) with numbed right arm and chest pain in the left side. I’m a female; 41 years old; not smoking; working and with 2 kids. The first time it happened at around 3 am, I went to ER. An ECG and Troponin I test were done and the results were normal. But still the symptoms persist. What could be the problem. Thank you.

    • Hi Mikaela. You may want to consider a stress ECG to rule out a heart condition and the cardiologist may also deem it necessary for further investigations like an angiogram. Although these symptoms may seem to be characteristic of a cardiac (heart) condition, there are other possible causes. It may even be more than one condition responsible for these symptoms. For example it could be muscle strain, a pinched nerve in the neck and so on. We cannot diagnose you through an online platform. Speak to your doctor about other conditions and what tests may be necessary.