The causes of chest tightness in the middle of the night are excessive stress, anxiety, heart disease, gastroesophageal reflux disease, thoracic disease and so on. 1. Excessive pressure: when the recent stress, or physical activity before going to bed, nightmares in the middle of the night, resulting in neurological instability, there will be tightness in the chest, can be relieved after sufficient rest. 2. Anxiety: If suffering from insomnia, you can take oxazepam. If panic attacks, you can take eszopiclone, etc. 3. Heart disease: If you are suffering from heart disease, you can take nifedipine and nitroglycerin. 4. Gastroesophageal Reflux Disease (GERD): This can occur when there is a reflux of stomach contents into the esophagus, resulting in damage to the esophagus. 5. Thoracic diseases: pain in the precordial region can occur with intercostal neuritis and strained thoracic muscles. If there is a sudden chest congestion and severe pain, you should call an ambulance in time. If it happens frequently, you should also go to the hospital in time, and drugs should be used under the guidance of a physician.