If you have asthma, you may have noticed that your symptoms are often worse in the evening. Your sleeping position, bedroom temperature, and other bedtime factors can all be asthma triggers.

Nocturnal asthma is common, and up to 75 percent of people with asthma say that their symptoms wake them up at least once per week.

The good news is, there are steps you can take to sleep safely and comfortably, even if you have asthma. Here are the best sleep positions for people with asthma, as well as some other strategies to for sleeping soundly.

1. Lie on your back with your shoulders and neck elevated.

Elevating your neck and shoulders with two, three, or more pillows can open up your airways as you sleep. If your sinuses drain more during the night, sleeping with pillows under your shoulders gives the drainage a gravity boost so that you can keep breathing easy while you sleep.

2. Lie on your left side with a pillow between your legs.

If you’re a side sleeper with asthma, lying on your left side may help — particularly if you have gastroesophageal reflux, also known as heartburn, which can trigger asthma especially at night. Sleeping on your left side uses gravity, the shape of the stomach, and the angle of the connection between it and the esophagus,which can reduce reflux. Lying on your left side with your head elevated may be enough to keep you comfortable through the night, but if it’s not, experiment by adding a pillow between your legs.

Adding the pillow may keep your spine stable throughout the night and may improve your sleep posture, which can help you breathe easily.

3. Lie on your back with your head elevated and your knees bent with a pillow under knees.

For some people, sleeping in the side position is just too much of a change. If you prefer sleeping on your back with your head and shoulders propped up by pillows, you can add another pillow under your knees.

This additional pillow may improve circulation and keep your body stable throughout the night, so that you don’t shift out of your elevated position as you sleep.

As important as it is to find a sleeping position that works for you, it’s also important to rule out sleep positions that could make your asthma symptoms worse.

Sleeping on your right side, which is also called the right lateral decubitus, position, can make asthma symptoms worse. In 1990, researchers concluded that sleeping on the right side increases resistance in the airways of your lungs as you breathe in and out during the night. This was based on the theory that sleeping on your right side may increase vagal tone, which activates the parasympathetic nervous system that results in airway constriction. However, it doesn’t apply to everyone, so those with asthma should experiment to see what works for them.

You may also want to avoid sleeping on your stomach. While some people find stomach sleeping to be comforting, this position does not allow free airflow into your lungs while you’re asleep.

Sleeping flat on your back without any elevation from pillows behind your neck and shoulders may also make your symptoms worse.

Other ways to reduce asthma symptoms at night include:

  • Cut down on allergens in your bedroom. Consider using an air purifier next to your bed and keep airflow in your room through the night.
  • Wash your bedding in hot water every 1-2 weeks to get rid of dust mites and other irritants that may be on your sheets.
  • Consider switching to bedding made of natural cotton, as opposed to synthetic polyester depending on your allergies.
  • Keep pets off your bed, especially when you’re in it.
  • Keep asthma medication on your nightstand or another easily accessible place, and take them as directed by your doctor.
  • Set the thermostat in your bedroom slightly higher in the evenings. Sleeping in a cold environment can be an asthma trigger.

Nocturnal asthma might be common, but there are times when you should discuss symptoms with a doctor.

If you’re waking up in the night with asthma symptoms more than once a week, even with treatment, you should speak with a medical professional. It’s possible they will need to modify your treatment plan.

A medical professional might also have other advice about setting up a healthy sleep schedule, managing GERD, and minimizing stress to help improve sleep quality and minimize nocturnal asthma symptoms.

Switching up your sleep position may not completely get rid of your asthma symptoms. But by reconsidering the way that you sleep — as well as other factors about your sleep environment — you may find a way to greatly reduce the amount of time that you spend waking up at night.