There are many causes of chest pain in bed, including heart, lung, gastrointestinal tract, soft tissue inflammation, trauma and other causes that may cause symptoms. Elderly patients who experience chest pain and chest tightness at night should consider the presence of heart disease, especially the common occurrence of coronary heart disease and angina pectoris. Because the vagus nerve tone increases significantly during sleep, vasoconstriction and spasm may occur. Patients are advised to have an ambulatory electrocardiogram to clarify whether they have unstable angina. Diseases of the lungs may also cause pain in the chest, such as pneumonia, tuberculosis, pleurisy, pneumothorax, pleural effusion, and tumors. You need to go to the hospital for chest CT, bronchoscopy, chest X-ray, etc. for judgment. Digestive tract diseases, such as gastric ulcer, reflux esophagitis, pancreatitis and other diseases may also cause this phenomenon, which requires gastrointestinal endoscopy and abdominal ultrasound to confirm the diagnosis. Uncomfortable soft tissues caused by incorrect sleeping posture and pressure on the local area may also trigger pain in the chest in sleep. Chondromalacia and intercostal neuritis can also present with sleeping chest pain. Herpes zoster can also present with chest pain if it occurs in the chest. In conclusion, if you have recurrent chest pain in bed, you need to go to the hospital for further testing to confirm the cause and then treat the cause.