Overview

Asthma symptoms are often worse at night and may disrupt sleep. These worsened symptoms may include:

  • wheezing
  • chest tightness
  • difficulty breathing

Clinicians often refer to this as “nocturnal asthma.” Nocturnal asthma is common in people diagnosed with asthma. It can occur with any form of asthma, including:

  • occupational
  • allergic
  • exercise-induced

One study in the Journal of Asthma involving about 14,000 patients suggests that 60% of patients with continuous asthma have nocturnal symptoms at some point.

Symptoms

Nocturnal asthma shares many symptoms similar to regular asthma. Typically, these symptoms are worse at night and include:

  • wheezing, a squeaky sounds that occurs when you breathe due to constricted airways
  • coughing that makes it difficult to sleep
  • tightness in the chest
  • shortness of breath, called dyspnea

In children

Research published in Academic Pediatrics studied the effect of nocturnal asthma on urban children aged 4 to 10 years who had persistent asthma. It found that 41% of the children had nocturnal asthma symptoms, as well. Those with moderate to severe nocturnal asthma symptoms had much poorer sleep. They also had other symptoms, including:

  • night waking
  • sleep-disordered breathing, or obstructed breathing caused by various forms of sleep apnea
  • parasomnias, or unusual experiences while falling asleep, sleeping, or waking up, such as:

The study concluded that nocturnal asthma symptoms were prevalent among children with asthma. These caused poor sleep for them and worsened quality of life for their parents.

Causes

Doctors are not entirely sure what causes nocturnal asthma. However, the following factors are thought to contribute to it:

  • a reclining position during sleep
  • increased mucus production
  • increased drainage from sinuses, called sinusitis
  • lower levels of the hormone epinephrine, which helps relax and widen airways
  • higher levels of the hormone histamine, which restricts airways
  • a late phase response, or delayed response to an allergen encountered during the daytime
  • exposure to allergens such as dust mites in the mattress at night
  • gastroesophageal reflux disease (GERD)
  • psychological stress
  • sleep-related conditions, such as obstructive sleep apnea
  • inhaling a greater level of cold air from an air conditioner or outside source
  • obesity and excess fat

Risk factors

Certain groups of people with asthma are more likely to experience nocturnal asthma than other groups, including those who:

  • have allergic rhinitis
  • do not see their doctor regularly
  • are young
  • are obese
  • smoke regularly
  • live in an urban environment
  • have certain mental health conditions
  • have gastrointestinal problems

One large study published in the American Journal of Respiratory and Critical Care Medicine noted an increased risk of nocturnal asthma among people of African origin, but it was hard to separate genetic and lifestyle factors.

When to see the doctor

A good rule of thumb is you should visit your doctor if you have asthma and you wake up in the night more than once per week after using treatments. Your doctor can evaluate what may be causing your symptoms and help modify your treatment plan. Checking your breath in a peak flow meter at night may also be helpful.

If you are not diagnosed with asthma but have asthma-like symptoms at night, you should report the episodes to your doctor. While you may not have asthma, your doctor can point you in the right direction for treatment.

Treatment

Like regular asthma, there is no cure for nocturnal asthma. It is a chronic condition. You can manage nocturnal asthma through a variety of methods that treat standard asthma, however.

One of the most important treatments is medication called inhaled steroids, which reduce inflammation and other symptoms of asthma. You should take an inhaled steroid every day if you have nighttime asthma.

Taking daily oral medications, such as montelukast (Singulair), is also helpful. A fast-acting bronchodilator, such as albuterol or a nebulizer, can help treat any nighttime episodes that occur.

The other way to treat nocturnal asthma is to treat the factors that may be contributing to it. Here are some specific methods you might use, depending on the cause:

Minimize psychological stress: Seeing a therapist and using relaxation exercises such as yoga and journal writing are good ways to lower stress. If you have a clinical condition, such as generalized anxiety disorder or depression, certain medications may be helpful.

Treat GERD: You can start treating GERD by avoiding foods that are high in both saturated fats, such as fatty meats, fried foods, whole milk, and chocolate. Caffeine in coffee or tea, spicy foods, some acidic citrus juices, and soft drinks can irritate the esophagus, as well, so limit or avoid them. Over-the-counter medications, such as Tums, Maalox, Prilosec, or Zantac, are helpful for decreasing GERD symptoms. If these methods don’t help, you can also visit your doctor for a prescription medication, such as Axid.

Maintain a healthy weight: Obesity is a risk factor for both nocturnal asthma and GERD. Eating a balanced diet is important. Swap foods high in saturated fats and refined carbohydrates for foods that are high in protein, unsaturated fats, and fiber. A registered dietitian is a helpful person to consult, and most insurers cover these visits. Starting an exercise routine is also important for getting to your optimal weight. Try incorporating the following types of exercise into your program:

Cut smoking: Nicotine patches are a useful first step in cutting out tobacco. Seeing a therapist involved in smoking cessation for one-on-one sessions can be useful, as can be attending a group support program.

Clear out the allergens: Dust mites in your mattress can worsen your symptoms at night. It is helpful to wash your mattress and blanket periodically. If you are allergic to pets and sleep next to one, it might be helpful to have them sleep outside of your bedroom.

Regulate your room’s temperature at night: In some locations, the temperature can drop quite a bit during the night. To regulate your room’s temperature, try these:

  • Make sure your room is well-insulated.
  • Make sure your windows are closed, sealed tight, and don’t have any cracks or leaks.
  • Use a humidifier for better moisture.

What is the outlook?

Nocturnal asthma symptoms are common and more pronounced in people with more severe forms of asthma. It can result from many factors, including:

If you have more intense symptoms of asthma during night, you can use a variety of treatments:

  • Use standard asthma treatments, which can help during the night.
  • Treat underlying conditions that may be contributing to your symptoms, such as GERD.
  • Keep a healthy sleeping environment.

If your asthma symptoms at night frequently disrupt your sleep pattern and quality of life, it is important to contact your doctor or asthma specialist to learn about the causes and possible treatments.

Tips for a better night’s sleep

Whether or not you have asthma symptoms at night, you might try some of these techniques for a better night’s sleep:

  • Unplug from electronic devices at least 30 minutes before bedtime.
  • Consider meditation the hour before sleeping.
  • Perform high intensity exercises at least a few hours before sleeping.
  • Avoid sleeping with your pet if you are allergic to them.
  • Control the temperature of your room.
  • Sleep with a humidifier on.