Why Does My Asthma Get Worse at Night?
Medically reviewed and edited by Summary
- Asthma is one of the costliest chronic diseases in the U.S., but deaths related to asthma are largely preventable with the right treatment.
- People who struggle to manage asthma during the daytime are likely to experience nocturnal asthma at some point in their lives.
- There are many ways to prevent nocturnal asthma, such as removing nighttime triggers.
- Allergies can make it more difficult to manage nocturnal asthma.
According to the Asthma and Allergy Foundation of America (AAFA), around 25 million people in the U.S. have asthma.
Asthma is one of the costliest chronic diseases in America — between 2008 and 2013, the economic cost of the condition was almost $82 billion (medical bills and missed school and work days).
In a study on nocturnal asthma, around 75% of test subjects had their sleep disturbed by asthma once per week, while 40% had nightly asthma symptoms.
Over 4,000 people died of asthma in the U.S. in 2020, but nearly all these deaths could have been prevented with the proper treatment.
In this article, we’ll explain what nocturnal asthma is, its symptoms, treatment, and preventative measures that can be taken.
What is Nocturnal Asthma?
Also called nighttime asthma, nocturnal asthma refers to the worsening of asthma symptoms — such as chest tightness, coughing, shortness of breath, and wheezing — during the night.
Breathing difficulties and coughing caused by nocturnal asthma create sleep disturbances that leave you feeling sluggish and tired the next day.
Uncontrolled nighttime asthma can seriously impact your quality of life.
How do I know if I have nighttime asthma?
Most asthma patients will at some point be awoken by asthma symptoms at night. There are a few things to watch out for if you suspect you have nocturnal asthma.
You probably have nighttime asthma if:
Your asthma symptoms get worse as the evening approaches.
You experience shortness of breath before bedtime or during sleep.
You wake up one or more times during the night.
You have difficulty controlling your daytime asthma.
You wake up feeling tired in the morning.
What are Nocturnal Asthma Symptoms?
The symptoms of nocturnal asthma can be slightly different for children and adults.
Below are some of the symptoms to watch for if you think you or your child may have nighttime asthma:
Symptoms in Children
Waking up at night
Sleepwalking
Abnormal movements
Obstructive sleep apnea (OSA)
Erratic or extreme emotions
An inability to learn or focus at school
Symptoms in Adults
Coughing fits
Chest tightness
Shortness of breath
Increased wheezing
Irritability during the day
Sleep disturbances
Difficulty focusing during waking hours
Key Point: What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) occurs when someone stops breathing during their sleep due to an upper airway blockage.
Some symptoms of OSA include:
- Intermittent snoring
- Heavy breathing during sleep
- Wetting the bed
- Unusual sleep positions
- Learning problems
- Sleepiness during the daytime
- Sleepwalking
- Night terrors
What are Some Nocturnal Asthma Triggers?
Cold air
The temperature naturally drops in the evening, and cold air is dry, so it can irritate your airways and cause increased mucus production.
Air-conditioned rooms can also dry out the air and make asthma symptoms more severe.
Allergen exposure
Where you sleep can also affect nocturnal asthma. For example, if your bedding contains dust mites or you share your sleeping quarters with a furry friend — such as a dog or cat — this could make your asthma worse.
In addition, if you also have allergic rhinitis: pollen and other allergens left on your clothes or bedding can increase mucus production. This can make nighttime asthma harder to control.
Sleeping position
Lying flat on your back can trigger an asthma attack by causing a postnasal drip. An inclined sleeping position is better as it can help keep your airways open while you sleep.
Poorly controlled asthma
If you don’t follow your asthma treatment plan during your waking hours, it can make your symptoms worse at night.
Taking your asthma medications on time, using your inhalers correctly, and keeping your living space clean during the daytime, will help you control nocturnal asthma.
Changes in lung function
The very act of sleeping can narrow the airways, which alters the bronchial function, causing higher airflow resistance. This can lead to increased coughing and wheezing during the night.
Key Point: What Am I Doing That Makes My Asthma Worse?
To properly treat asthma and keep it under control, it’s important to look at the bigger picture. During the day — and night — there are several asthma triggers around us.
You may be unknowingly worsening your asthma by:
- Wearing strong perfume or being exposed to harsh cleaning chemicals
- Not controlling your acid reflux, which is another trigger of asthma
- Leaving mold to grow in your living spaces
- Consuming certain foods that might trigger your asthma, such as eggs, cow’s milk, and peanuts
- Not keeping stress levels in check (hyperventilation can bring on an asthma attack)
How Can I Sleep with Severe Nighttime Asthma?
Sticking to a good asthma treatment plan during the day can keep your nocturnal asthma under control and greatly decrease the likelihood of nighttime asthma attacks.
There are also a few other things you can do to manage your nighttime asthma symptoms and get a good night’s rest.
Top tips for sleeping with nocturnal asthma:
Keep your house and sleeping quarters clean and free from dust mites.
Keep your windows closed for most of the day.
Change your sheets regularly or at least once per week.
Don’t hang your bedding and clothing outside to dry when it's pollen season.
Take a shower before bedtime each night to wash any allergens from your hair and body.
Avoid playing too much with your pets after you’ve had your nighttime shower or bath.
Use a sterile mattress cover, and make sure your bed’s raised off the floor.
Use dust-proof mattresses and pillowcases.
Use a pillow wedge or reading chair to elevate your chest when you sleep.
Do not sleep in the same room as your pets.
Make sure to keep humidity levels at around 45% as too much humidity can cause mold and dust mites to accumulate.
Key Point: How Do I Survive a Nighttime Asthma Attack Without My Inhaler?
It’s very good practice to keep a few inhalers around the house and one on your nightstand. If you find yourself having an asthma attack and there’s no inhaler at hand, following these steps could save your life:
- Don’t panic.
- Sit up straight to keep your airways clear; lying down can make it harder to breathe.
- Focus on your breathing and draw slow, steady breaths.
- Step away from your triggers, like cigarette smoke or pet dander.
- Call 911 if your symptoms worsen, you can’t speak, your chest muscles are under strain, you start feeling tired, or your lips and face are blue when you’re not coughing.
What Are the Treatment Options for Nocturnal Asthma?
To properly treat nocturnal asthma, it's important to follow the plan outlined by your physician during the daytime and remove your asthma triggers at night.
If your quality of sleep doesn’t improve despite following the tips outlined in this article and your doctor’s recommendations, then you should get tested for sleep apnea or other underlying conditions that may be disturbing your sleep.
When Should I See a Doctor for Nocturnal Asthma?
Nighttime can worsen asthma symptoms, making it difficult for you to get the rest you need to function during the day.
As a general rule, if you’re waking up more than once a week due to nocturnal asthma symptoms, it’s time to talk to your doctor about a revised treatment plan.
Where Can I Learn More about Nocturnal Asthma?
Have you been feeling sleepy during the day? Do your asthma symptoms feel worse at night? If you find yourself tossing and turning, or experiencing difficulty breathing at night, you may have nocturnal asthma. LifeMD can help. Head over to LifeMD to schedule an appointment, and meet with a board-certified doctor from your smartphone, computer, or tablet.
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