I cannot breathe at night

I am a 36 y.o. male and I have not been able to sleep at night due to lack of breath when I lay down and I feel like I'm drowning or can only get rapid breaths. This has only happened occasionally over the past couple of years. I have also noticed a slight swelling of my feet when I can’t breathe. When I sit up I am ok and during the day I breathe just fine. I am physically active and take part in half marathons.  

I am glad you wrote to me! I am definitely concerned something is happening with your heart; your symptoms do not sound "pulmonary". From what you tell me, I don't think this is a problem with your coronaries, although I of course don't know nearly enough about you (such as height, weight, blood pressure, pulse etc.).
Unless you have risk factors for Coronary Artery Disease, I am more concerned that you may have a heart valve or congenital heart problem. For that, your doctor needs to listen for murmurs of your heart and do an ECHO, because it sounds that the right side of your heart is not working quite the way it should.
The heart is divided into a right and a left side. When blood returns to your “right” heart, it gets pumped next to your lungs, where CO2 is removed and O2 added to your blood. It then flows back to your “left” heart. From there, the “arterial” blood leaves to supply your blood with energy and the cycle repeats itself.  In order for the system to work, your heart has a system of valves to prevent blood from leaking backwards. Sometimes heart valves don’t open or close properly and either restrict flow into the next chamber, or when not closing properly, allow blood to leak backwards. This often causes heart function problems that usually shows as fatigue, exercise intolerance or trouble breathing.

Take a look here for more info about how your heart works:

In some patients with congenital heart defects, abnormal openings between the right side and the left side of your heart may exist as well other problems. Depending on how much blood “escapes” into the other side, this may either increase or severely limit the blood flow to your lungs. Whatever the cause, if less blood saturated with O2 is available for your body, it translates into a diminished supply of energy to your body. Likewise, insufficient blood flow on one side means too much on the other, most often the right side:

The right heart is not as strong a pump as the left side and sometimes cannot handle this extra blood, just like the lungs cannot handle too much flow. If the right heart cannot pump adequately, your returning blood may back-up, which may cause swelling in your legs. If there is not enough blood to your lungs, you may notice a blue discoloration of your lips and the tips of your fingers. On the other hand. if your lungs are flooded with too much blood, you will notice trouble breathing. Congenital heart problems are usually discovered during early childhood.

Your doctor will need to do a number of tests
In case you have cholesterol problems, take a look here:

My website is not really set up for the type of problems you may have, but I'd be happy to steer you to the right places, so contact with more questions any time.
Hope this helps,
Dr T


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