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What Makes Asthma Worse at Night?

Many people associate the worsening of asthma symptoms with factors like air quality or exercise. However, the time of day can make a big difference too. Just when you’re getting ready for bed and relaxed, your asthma symptoms can get worse.

Often referred to as nocturnal asthma, the worsening of asthma at night is very common and can be extremely disruptive for sleep. Understanding how nocturnal asthma works (and how to treat it) can make a huge impact on your overall health.

What Causes Nocturnal Asthma? 

As asthma and allergy specialist Ronina Covar, MD, notes, there are many factors which predispose patients to asthma symptoms at night. “Studies have found that nighttime symptoms during sleep are associated with circadian changes in airway inflammation and physiology,” explains Dr. Covar. “These circadian alterations are also affected by hormones.”

For instance, after you fall asleep, your muscles relax, which causes your upper airways to narrow. This narrowing can lead to increased airflow resistance and make asthma attacks more likely. There are also a number of environmental exposure and triggers that can make asthma worse.

Nocturnal Asthma Factors

  • Exposure to allergens in the bedroom, particularly dust mites
  • Delayed allergic responses, which may occur 3–8 hours after exposure
  • Postnasal drip (from chronic sinus problems and/or allergies)  can worsen with lack of gravity as you lay flat at night
  • Gastroesophageal reflux, which can worsen with lack of gravity as you lay flat at night
  • Airway cooling from a drop in body temperature
  • Decreased effect of evening medications as they wear off during early morning hours
  • Sleep apnea — brief repetitive pauses in breathing during sleep caused by an upper airway obstruction

Nocturnal Asthma Symptoms

The symptoms during asthma attacks at night are similar to daytime episodes. These symptoms include shortness of breath, coughing and chest tightness. During an asthma attack, these symptoms can be severe and can develop suddenly. You will often notice early warning signs before asthma attacks occur, including:

  • Breathing changes 
  • Chin or throat itchiness
  • Coughing
  • Dark circles under eyes
  • Downward trend in peak flow numbers 
  • Feeling tired
  • Headache
  • Moodiness 
  • Poor tolerance for exercise
  • Runny/stuffy nose
  • Sneezing
  • Trouble sleeping

The symptoms of nocturnal asthma should not be ignored, as they can negatively impact your quality of life and sleep disruption also can complicate daytime asthma symptoms.

Treatment and Management

Keeping nighttime asthma under control does not have to be hard. Use these tips from our experts to prevent asthma issues during sleep.

1. Follow your asthma action plan day and night. This will help keep your asthma under control overall and be less prone to issues at night. The asthma action plan addresses symptoms, peak flow meter, medications and emergency care. “The better you control your asthma severity at baseline, the better we can control their nighttime symptoms,” says Dr. Covar.

2. Using a peak flow meter to monitor lung function between day and night can illuminate changes in lung function. Tracking peak flow readings can help you and your doctor understand how lung function patterns change and identify what’s triggering your asthma at night.

3. Removing allergens from the bedroom is also an important step for preventing and treating nocturnal asthma. Enclosing mattresses, pillows and boxsprings in zipped, dust-proof encasings can prevent dust mites from accumulating. Washing your bedding in hot (130° F) water weekly can stop the spread of dust mites. You also want to avoid exposure to common asthma triggers such as pollen and pet dander. Taking a shower at night will wash away those allergens and can help improve sleep.

4. Make sure the room you sleep in is not too cold. Cold, dry air can trigger an asthma attack.

5. Pay attention to your sleeping position and problems with your asthma. Sleeping on your right side or facedown can restrict your lung function and sleeping on your back may cause sinus drainage and trigger a nighttime cough. Sleeping on your left side keeps your airways open and reduces heartburn and reflux. Adding a pillow between your legs supports your spine.


Managing Health and Asthma

Treating the underlying causes of asthma can decrease your asthma symptoms at night. Treating sinusitis and/or allergic rhinitis to decrease postnasal drip also can help immensely. Additionally, you can adopt lifestyle changes to decrease gastroesophageal reflux, which can contribute to nocturnal asthma.

“Treating your reflux won’t necessarily get rid of nocturnal asthma entirely,” according to Dr. Covar. “But when combined with removing allergens and other factors, it can go a long way to reducing symptoms.”

Ask your doctor about medications that can help reflux by minimizing acid production in the stomach.

Your doctor also may adjust the type and timing of allergy, asthma, and reflux medications to give extra protection during the night.

Asthma Care at National Jewish Health

If you or someone you know suffers from nocturnal asthma, you can learn more about asthma care at our Cohen Family Asthma Institute or make an appointment with any of internationally renowned asthma specialists.