asthma at night

Overview

Asthma at night, also called nocturnal asthma, is when asthma symptoms get worse while you sleep. It can make it hard to breathe, cause coughing, or wake you up.

Yes, it is very common. Many people with asthma experience worse symptoms at night.

It can affect anyone with asthma, but it is more common in people with moderate to severe asthma.

Symptoms

Common symptoms

• Coughing, especially at night
• Wheezing – a whistling sound when breathing
• Tightness in the chest
• Shortness of breath that wakes you up

Symptoms in children

• In children, symptoms may include restless sleep, coughing during play or at night, and complaining of chest tightness.

Symptoms in older adults

• In older adults, symptoms may be similar but can be mistaken for other conditions like heart problems. They may also have increased breathlessness at night.

Causes

Main causes

• Exposure to allergens in the bedroom (dust mites, mold, pet dander)
• Changes in body temperature and lung function during sleep
• Lying down can make it harder to clear mucus from the airways
• Hormone changes that affect airways at night
• Acid reflux (heartburn) that can irritate airways

Risk factors

• Having poorly controlled asthma
• Living in a home with carpets or soft furnishings that trap allergens
• Being exposed to tobacco smoke or air pollution
• Having a history of allergies
• Being overweight or obese

When to see a doctor

See a doctor urgently if:

• If you have night-time symptoms that are new, getting worse, or not relieved by your usual medication
• If you need to use your reliever inhaler more than usual at night
• If you wake up coughing or wheezing more than once a week

Book a routine appointment if:

• Book a routine asthma review with your doctor or asthma nurse to check your asthma control and action plan.

Diagnosis

Diagnosis is usually made by your doctor based on your symptoms, medical history, and breathing tests.

Tests that may be done

• Spirometry – a test that measures how much air you can breathe out
• Peak flow meter – a handheld device to measure how fast you can blow out air
• Allergy tests to identify triggers
• Maybe a sleep study if other sleep disorders are suspected

What to expect at your appointment

Your doctor will ask about your symptoms, when they happen, and what triggers them. They may also check your peak flow at home in the morning and evening to see if there is a pattern.

Treatment

Treatment for nocturnal asthma focuses on controlling your asthma overall and reducing triggers in your bedroom. Your doctor may suggest changes to your daily asthma medicines or add a treatment to help you sleep better.

Self-care at home

• Keep your bedroom clean and free of dust and allergens
• Use hypoallergenic mattress and pillow covers
• Keep pets out of the bedroom
• Avoid eating large meals close to bedtime
• Elevate your head with extra pillows if acid reflux is a trigger
• Use a humidifier if the air is dry, but keep it clean to avoid mold
• Stop smoking and avoid secondhand smoke

Medical treatments

Your doctor may adjust your asthma medicines. This could include taking a daily controller medicine (usually an inhaler) to prevent symptoms, or using a combination inhaler that helps with both prevention and relief. They may also recommend a leukotriene receptor antagonist pill if allergies are a trigger. Always follow your asthma action plan and do not change medicines without talking to your doctor.

When is surgery considered?

Not applicable for nocturnal asthma itself; surgery might be considered for related conditions like severe acid reflux if it is a trigger.

Living with this condition

Asthma at night can affect your sleep and energy during the day. Keeping a daily routine of asthma management can help you feel more in control. Keep a peak flow diary and note any triggers.

Lifestyle tips

• Sleep in a dust-free, cool room
• Avoid smoking and vaping
• Manage stress which can trigger asthma
• Exercise regularly during the day to improve lung health

Diet and exercise

A healthy diet rich in fruits and vegetables may help reduce inflammation. Avoid foods that trigger reflux or allergies. Exercise such as walking, swimming, or yoga can strengthen your lungs. Always warm up and cool down, and use your reliever inhaler before exercise if advised.

Mental health and emotional wellbeing

Poor sleep from nocturnal asthma can lead to tiredness, irritability, and anxiety. It's important to talk to your doctor if you feel overwhelmed. Many people find that better asthma control improves their sleep and mood.

Prevention

It may not always be fully preventable, but you can reduce the chance of night-time symptoms by managing your asthma well and avoiding triggers.

Vaccines

Make sure you have your annual flu vaccine and any other recommended vaccines like the pneumonia vaccine, as infections can worsen asthma.

Screening programmes

Routine monitoring of peak flow at home can help detect worsening early.

Complications

If left untreated

• Poor quality sleep and daytime tiredness
• Worsening of asthma control over time
• Increased risk of severe asthma attacks
• Hospital visits for breathing problems

Long-term outlook

With proper treatment and self-care, most people with nocturnal asthma can achieve good control and enjoy restful sleep. Asthma is a chronic condition, but many people manage it well and live active lives.

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