Within the spectrum of asthma symptoms, there is a condition known as “nocturnal asthma,” which is shortness of breath, wheezing, and a cough that happens at night. One study shows 60% of patients with asthma also suffer the condition at night.
We may not know exactly why asthma worsens at night, but we do know of many ways to alleviate the symptoms.
What is Nocturnal Asthma?
Asthma is a chronic condition that causes inflammation in the airways that carry air in and out of your lungs. Nocturnal asthma is asthma that worsens in the evening hours, but especially when you are trying to sleep.
The disease can affect people of all ages and can develop at any life stage, but often starts during childhood. In chronic asthma, certain triggers set off an attack, such as allergies or cold air. The disease requires long term management by a doctor.
Asthma often gets worse at night when we’re sleeping. The symptoms of nocturnal asthma include:
- Chest tightness
- Coughing that makes it hard to rest
- Shortness of breath called dyspnea
- Wheezing due to constrict airways
Children often suffer from nocturnal asthma, which is hard for them and their parents. One study showed that 41% of children from four to 10 years old who had persistent asthma also had nocturnal asthma. They also had symptoms that included:
- Night waking
- Parasomnias, which include sleepwalking, hallucinations, abnormal movements, and extreme emotions
- Sleep apnea or obstructed breathing
Why does asthma seem to get worse at night in some patients? Is there anything that can be done to help?
What are the Causes of Nocturnal Asthma?
For reasons that we don’t completely understand, the chances of experiencing asthma symptoms at night are higher. It’s a serious problem; studies show that most deaths related to wheezing or other asthma symptoms happen at night.
Some of the factors that may contribute to nocturnal asthma include:
- Dust mites or exposure to other allergens
- Gastroesophageal reflux disease (GERD)
- Higher histamine, which is a hormone that restricts airways
- Increased mucus production
- Increased sinus drainage
- Inhaling cold air from air conditioners or an open window
- Lower levels of epinephrine, which is a hormone that relaxes the body’s airways
- Obstructive sleep apnea
- Psychological stress
- Sleeping in a reclined position
Even sleeping itself can cause nocturnal asthma by causing changes in the bronchial function. As we sleep, our airways narrow which creates a little more resistance for the air coming in and out of our bodies. This can cause coughing, which tightens the airways further. Then your sinuses may drain, which can trigger an asthmatic response. For all these reasons, the research shows that breathing worsens for about four to six hours after you go to sleep.
Research is currently being conducted to find out how our hormone production affects nocturnal asthma. The body’s rhythms that control a continuous cycle of hormone activity have a big impact on lung function, particularly when we’re sleeping.
For example, we know that epinephrine is the hormone that helps keep the muscles found in the walls of the airways relaxed. However, the body’s production of this hormone is lowest at around 4:00 a.m., which could increase the body’s asthma symptoms. The body naturally lowers steroid production at night, so inflammation can elevate during that time. Since inflammation is a key signal for asthma to occur, scientists believe there is a correlation.
Lying in a reclined position can cause an asthma attack. Several things can cause this, from sinus drainage, increased lung blood volume, and increased airway resistance. GERD, or heartburn, causes the stomach acid to be pushed back into the esophagus when you lie down. Some asthma medications relax the valve between the esophagus and stomach, so stomach acid can back up into your throat and even drip into the airways. This can cause a severe asthma reaction.
What’s it Like Living with Nocturnal Asthma?
Living with nocturnal asthma symptoms can be hard. This condition disrupts sleep and leaves patients feeling tired and irritable during the daytime. If you are a parent with a child suffering from nocturnal asthma, it can also impair your quality of life, in addition to the child. It’s a scary condition for both the child and parent. Anytime someone wakes up struggling to breathe is terrifying.
Staying observant to what kinds of factors seem to trigger nocturnal asthma can help control symptoms. A pet sleeping on the bed could make asthma worse or an open window could trigger symptoms. Plants, fabrics, and scents can trigger airway constriction, so be aware and take steps to remedy any triggers you find.
Certain groups seem to be more at risk for nocturnal asthma. For example:
- If you have allergic rhinitis, which is an inflammation of your nasal cavities
- Younger people are prone to develop asthma
- Obese adults can develop the condition
- Smoking is a risk factor for nocturnal asthma
- Even living in an urban environment with pollution can be a trigger
An adult suffering from nocturnal asthma may not notice asthma symptoms, but if another person is sleeping within earshot, they may hear the coughing and wheezing. The adult sufferer of nighttime asthma may experience the disease primarily as tiredness during the daytime. The symptoms of the condition can be chronic and happen every night or can come and go throughout the week.
Long-term, this condition can increase the risk of other health problems such as heart disease and even an increased risk of dying. The data tells us that 70% of asthma-associated deaths and 80% of respiratory arrests happen during nocturnal asthma events. Yet nocturnal asthma doesn’t affect all asthma sufferers; some people never have night symptoms.
Fortunately, treatment is available to help with nocturnal asthma.
Can Nocturnal Asthma be Treated?
There is no cure for nocturnal asthma but symptoms can be controlled so you can live a more comfortable, symptom-free life. Daily asthma medications, including inhaled steroids, can reduce the inflammation caused by an asthma attack. Your doctor may prescribe a longer acting asthma inhaler with a bronchodilator aimed to prevent nocturnal asthma symptoms.
For GERD sufferers, doctors may prescribe a medication to reduce stomach acid production, in addition to an inhaled corticosteroid. Avoiding potential allergy triggers, such as the feathers in a down comforter, can also help.
When Should You See Your Doctor?
If you or a loved one are waking up at night or having difficulty breathing, your doctor can evaluate, diagnose, and provide treatments that help you rest more comfortably and safely at night.
Kevin Farnam, M.D., board-certified allergist at the Adult & Children Allergy Asthma Center specializes in treating these conditions. Nocturnal asthma, like all chronic asthma symptoms, is controllable so that you can have the quality of life you deserve.