Dear Doctor,

When I sleep for long I get chest pain. Is this something to worry about? Dean

Dear Dean,

You have not mentioned your age, how does the pain feel like and how long does it last? Is there any associated sweating, breathlessness, nausea, e.t.c. symptoms.

The most common cause for chest pain in a young adult is muscular or skeletal problems. Muscle pull or muscle tear, other soft tissue injuries, fracture of one or more ribs can cause pain coming on with slight movements or inactivity.

Functional dyspepsia or acid reflux can cause burning pain in the chest while sleeping. This may be associated with nausea and or vomiting. Taking a meal late in the evening, taking a heavy meal in the evening, drinking binge of alcohol before sleeping, constipation, are some of the factors causing an acid reflux in night. There may be one or more factor present.

A young adult can feel pain at the junction of top of breast bone with ribs (Costochondritis) due to mental stress.

Infections of the lungs or lung coverings can cause pain in chest during breathing in. Pain is located over the site of infection and inflammation and is associated with fever and breathing trouble, cough with bloody sputum. Chest pain is also caused by infection and inflammation of the coverings of the heart, where pain occurs along with breathlessness and palpitations and swelling of the feet in chronic cases. These conditions can be diagnosed by a complete blood count and X-rays of the chest. They are curable by suitable antibiotic and anti inflammatory drugs.

Angina is a serious problem manifesting as chest pain. Here there is associated sweating, restlessness and palpitations for the duration of pain. Normally pain of angina occurs on exertion. But in a variant(prinzmetal’s angina), pain occurs on rest. Angina is the result of blood supply to part of heart being reduced due to the blood vessels going into spasm or blocked due to fat deposits. High blood pressure, high lipids, diabetes, lack of exercise, fatty meals, obesity, alcohol, tobacco and hereditary factors are risk factors. Untreated angina attacks can continue into a full fledged heart attack. Angina can be diagnosed by various tests like electrocardiography, cardiac echo, treadmill test and various scans. It can be corrected by life style changes and various anti angina drugs and good control of high blood pressure and diabetes.