Waking up with tightness in chest and shortness of breath all the time from 2 to 3 o’clock in the middle of the night may be caused by physiological factors or pathologic factors, such as cardiovascular diseases, pulmonary diseases, mental diseases, digestive diseases, etc., which need to be treated according to different situations by improving lifestyle, taking medication or surgery. 1. Physiological factors: Some patients may have bad habits such as emotional excitement, drinking strong tea and coffee before sleep, and the symptoms can be significantly relieved by adjusting their lifestyle. 2. Pathologic factors: (1) Cardiovascular diseases: such as coronary heart disease, arrhythmia, etc., need to follow the doctor’s prescription of oral medication, such as aspirin, atorvastatin, isosorbide mononitrate, metoprolol, etc., and further aggravation of the condition may require placement of a cardiac stent, cardiac catheter ablation surgical treatment. (2) Lung diseases: such as chronic obstructive pulmonary disease, lung infections, sleep apnea hypoventilation syndrome, etc., need to follow the doctor’s instructions for the application of drugs, such as terbutaline, budesonide, aminophylline, etc., and may also need to be assisted by a ventilator to breathe the treatment. (3) Mental illness: such as anxiety disorder, depression, etc., need to be professional psychological counseling, if necessary, need to be treated with medication, such as amitriptyline, haloperidol melittin, etc.. (4) Digestive system diseases: such as gastroesophageal reflux disease, gastric ulcer, etc., gastric contents reflux into the esophagus, causing chest tightness, shortness of breath, it is recommended to perform gastroscopy as soon as possible to clarify the cause of the disease, and to take oral medications such as omeprazole, mosapride, etc., or surgical treatment. It is recommended to consult the hospital as soon as possible to clarify the cause of the disease and then carry out targeted treatment.