Asthma at Night: Causes, Symptoms, Treatment and More Information

If you have asthma, you may notice that your symptoms are worse at night – you are not alone. More than five million people in the UK have asthma and night-time asthma, also known as nocturnal asthma, is thought to affect up to three quarters of them.

Symptoms of nocturnal asthma include coughing fits, tightness in the chest, wheezing and shortness of breath just before and during sleep. Sufferers can be woken up several times, leading to tiredness, poor concentration and difficulty controlling asthma symptoms during the day, in both adults and children. This can have a significant impact on quality of life.

More asthma-related deaths and severe attacks happen at night, so nocturnal asthma is a serious condition that requires preventative steps and effective treatment. The exact reason why asthma might be worse for some people at night is unclear although certain factors are thought to play a role and there are things you can do to minimise your risk.

Causes and triggers of Night-time asthma

It is not known exactly why asthma is worse at night for some people, although there are certain factors that can make asthma attacks at night more likely. Triggers for asthma attacks at night are:

• Sleeping position. Certain sleeping positions, such as lying on your side or your front, can constrict your lungs, potentially making nocturnal asthma symptoms worse. Meanwhile, sleeping flat on your back can cause mucus in your nose to drip to the back of your throat and trigger a night-time cough.
• Breathing in cold air. A cool room is better for sleep but your night-time asthma might be worse in winter or if you sleep in an air-conditioned room. This is because cold air is dry – loss of moisture and heat in the airways can trigger an asthma attack.
• Exposure to allergens at night. House dust mites in your bedding or mattress, and pet dander, dust particles or mould in your bedroom can all irritate your airways and make you more prone to nocturnal asthma.
• Exposure to allergens during evening. Being exposed to allergens in the evening , from pollen to pet hair, can cause a delayed or ‘late phase’ response. You may experience airway obstruction several hours later, increasing your risk of an asthma attack during the night.
• Poorly controlled day-time asthma. Not following your asthma treatment plan properly during the day can put you at greater risk of suffering from night-time asthma attacks.
• Lung function changes. Natural bodily processes during sleep can make you more prone to nocturnal asthma. Lung function is naturally lower at night. As muscles relax during sleep, the upper airway narrows and leads to increased resistance in the lungs. This means you are more likely to suffer breathing difficulties and coughing fits during the night.
• Hormonal changes. During sleep, your body goes through hormonal changes that might make your asthma worse. Some studies, for example, have shown that decreased levels of cortisol during sleep contribute to airway obstruction.

Nocturnal asthma symptoms

Asthma symptoms occur when the airway becomes inflamed and constricts to make breathing difficult. Common nocturnal asthma symptoms are:

• Shortness of breath
• Wheezing
• Chest tightness
• Coughing

In addition, other effects of nocturnal asthma on adults and children include:

• Lack of concentration during the day
• Excessive daytime sleepiness
• Difficulty controlling daytime asthma symptoms.

If you have asthma symptoms at night, but have not been diagnosed with asthma, you should see a doctor or nurse specialist. If you do have a diagnosis, you should make sure that potential night-time triggers have been addressed in your asthma plan.

Risk factors

Certain groups of people with asthma are more likely to experience nocturnal asthma due to certain risk factors which include:

• Excess weight around the chest and abdomen might constrict the lungs while fatty tissue produces inflammatory substances that could affect lung function. Some studies have shown people with asthma who lost weight had improved lung function at night.
• Smoking damages your lungs and will make you more prone to asthma symptoms including asthma attacks at night.
• Allergic rhinitis. One study found poor treatment of allergic rhinitis was linked to a 50% increase in asthma symptoms at night. The condition causes excess mucus to accumulate during sleep and this irritates the throat, which could trigger a coughing fit.
• Sinusitis has been linked with more severe cases of asthma. The condition, a type of viral infection of the sinuses, causes a nasal discharge that can aggravate your asthma as you sleep and wake you with the need to cough.
• Obstructive sleep apnoea (OSA). With this condition, the throat muscles relax during sleep, obstructing the airways, and research has shown a link between OSA and nocturnal asthma.
• Acid reflux. People with asthma are twice as likely to develop a form of chronic acid reflux that flares up at night, known as gastroesophageal reflux disease (GERD). One theory is that acid reflux can cause a bronchial spasm making it harder to breathe and this is worse when you lie down.
• Although the evidence is still inconclusive, some research suggests that stress triggers an immune response that might inflame the airways, leading to an increased likelihood of an attack in people with asthma.

How to prevent night-time asthma

While there is no cure for asthma, there are plenty of way to help prevent night-time asthma and remedies to stop an asthma cough at night. Tips for reducing the symptoms of nocturnal asthma are:

• Keep your bedroom environment clean and free of allergens. Do not allow pets in your bedroom; wash bed linen regularly at a hot temperature to remove house dust mites; air your bedroom and treat any mould on walls; avoid using duvets and pillows with feathers.
• Regulate bedroom room temperature at night. Make sure windows are closed, avoid air conditioning and invest in an air purifier for better quality air in your bedroom.
• Treat underlying conditions: If you suffer from an underlying condition such as GERD, allergic rhinitis or obstructive sleep apnoea, make sure you are taking steps to treat and control it. Research shows, for example, that people who take medication for GERD have fewer asthma attacks and night-time asthma symptoms. Take the appropriate medication and any lifestyle steps such as dietary changes to ease acid reflux.
• Keep your reliever inhaler close by. Keep your inhaler next to your bed so that you can use it if you have a coughing fit during the night.
• Keep water by your bed. Sip some water when your symptoms start to flare up. Moisture will soothe the airways and help relieve your night-time cough.
• Breathing exercises. Different breathing techniques are used to alleviate asthma symptoms and can help you stop an asthma cough at night. If you wake up coughing, you could try a breathing exercise to help control your cough.
• Have an asthma review with your GP or practice nurse. They can check you are using your inhalers correctly and discuss any possible triggers for your nocturnal asthma.
• Follow an asthma treatment plan. Keep your asthma under control by using your medication properly, tracking your symptoms, following an effective asthma treatment plan and adjusting medication if necessary, with the advice of your doctor.
• Maintain a healthy weight. Eat a balanced diet and exercise to keep your weight under control.
• Quit smoking.

What is the best position to sleep with asthma?

Alleviating some of your nocturnal asthma symptoms can be as simple as changing your sleeping position. One study found that the supine sleep position (lying on your back) improved night-time asthma symptoms and constricts your lungs less than lying on your stomach or side.

The best sleeping position for asthma patients is to prop yourself up with extra pillows. This will help to keep the airways open and reduce your risk of a night-time cough.

Nocturnal asthma medical treatment

There is no cure for nocturnal asthma, although there are treatments to get it under control. Discuss your symptoms with your GP or asthma nurse and they will be able to recommend the best treatment plan for you. Medical treatment for nighttime asthma could include:

• Preventer inhaler. This delivers a dose of steroid medicine that you breathe in to damp down inflammation and swelling in the airways. Using a preventer inhaler regularly builds up protection so you are less sensitive to triggers. Good day-time control of your asthma will reduce flare-ups at night.
• Reliever inhaler. This delivers a dose of fast-acting medicine such as salbutamol that will open up the airways and help relieve the symptoms of nocturnal asthma. Keep it beside your bed so you can use it as soon as you have an attack at night.
• Combination inhalers.  If your other inhalers are not helping, you might need a combination inhaler that mixes the medication and stops symptoms occurring while also providing relief if they do occur.
• Leukotriene Receptor Antagonists (LTRAs). This medicine is given in tablet-form and sometimes used in addition to inhalers to help with severe asthma symptoms and night-time attacks.

7 Tips to Prevent Nighttime Asthma Attacks

Many people with severe asthma find that symptoms like coughing, wheezing, and breathlessness are worse at night. “There are a number of reasons why this is so,” says Sonali Bose, MD, an assistant professor in the division of medicine, pulmonary, critical care, and sleep medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York City.

Some key factors that contribute to nighttime asthma attacks include:

• Your body’s internal clock. Your circadian rhythm causes some of your hormone levels to fall at night. Lower levels of hormones can cause your airways to narrow slightly. These narrowed airways can exacerbate your asthma symptoms, according to the Asthma Society of Canada (ASC).

• Dust mites. Your pillows, blankets, and mattress can all be a haven for these microscopic insect-like pests and their waste. Allergies to dust mites can worsen asthma, and you could be wallowing in them as you sleep, according to the ASC.

• Gravity. When you lie down, your chest and lungs naturally experience extra pressure, the ASC says.

If you have trouble sleeping due to severe asthma, be sure to talk with your doctor, Dr. Bose says. “It’s important to share your nighttime symptoms with your doctor because it’s one of the ways he or she can determine how well your asthma is controlled,” she says. “People with asthma tend to underreport their nighttime symptoms, which can be a sign that you need more of your medication or a change in treatment. ” Your doctor may need to make adjustments to your asthma treatment plan so you feel better, day and night, Bose says.

How to Sleep Better With Severe Asthma

In addition to taking asthma medications as prescribed, here are seven steps you can take to lower your chances of having a nighttime asthma attack:

1. Clean your bedroom regularly. Use a vacuum with a high-efficiency particulate air (HEPA) filter to trap mites and their waste and get them out of your bedroom. If your vacuum doesn’t have a HEPA filter, you can buy one from an allergy supply company, according to the Asthma and Allergy Foundation of American (AAFA).

2. Wash your bedding in hot water weekly. Make sure the water is at least 130 degrees Fahrenheit so it will kill dust mites. Finish the job in a hot dryer.

3. Invest in dust-proof mattress and pillow protectors. These zippered covers are woven tightly to keep dust mites out of bedding. You can find them at bedding and housewares stores, the AAFA says.

4. Invest in a humidifier. Cold air is drier and more troublesome for people with severe asthma. Depending on where you live, you might benefit from a humidifier to add moisture to the air in your bedroom in the winter, Bose says. What’s more: Dust mites thrive in low humidity, so boosting humidity by using a humidifier in your bedroom can help keep dust mites at bay.

5. Don’t sleep with pets. “If you have pets, keep them out of the bedroom so their dander doesn’t collect or stick to the carpeting and bedding,” Bose says. You may also need to keep the door to your bedroom shut to keep your pet — and its dander — out.

6. Keep your head up. If you have a cold or a sinus infection, lying flat can exacerbate postnasal drip, which can trigger an asthma attack, Bose says. Also, if you have acid reflux, lying flat can allow more acid to creep up into your throat, she says. When you sleep, keep your head slightly elevated, the AAFA suggests.

7. Get tested for sleep apnea. People with asthma may be at increased risk for sleep apnea, according to the American Thoracic Society. Sleep apnea causes repeated breaks in your breathing while you sleep. It can also worsen asthma symptoms. Talk with your doctor about testing and treatment if necessary.

By taking these steps to create a sleeping environment free of asthma triggers, you should find it easier to prevent nighttime asthma attacks and get better sleep.

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Nocturnal bronchial asthma: causes and symptoms

Bronchial asthma can be safely attributed to one of the most common diseases in the world. About five percent of the population suffer from this disease. Some people constantly experience attacks of suffocation, shortness of breath, incomplete inhalation, difficulty in inhaling, etc.

Many patients are well aware that seizures usually make themselves felt most often at night or in the early hours of the morning. They affect the general condition of the patient, the quality of sleep worsens, the quality of life decreases. The patient, instead of sleeping, is struggling with bronchial obstruction. Bronchial patency may decrease between 10 p.m. and 8 a.m.

This is how nocturnal asthma manifests itself, which is characterized by a decrease in patency in the bronchi during the night’s sleep. When we sleep, we are all unconscious and quickly help ourselves.

For the first time, this type of asthma was discussed at the end of the 17th century. John Floyer, suffering from a disease, noticed that the attacks make themselves felt at night, and the first came at about the first or second hour. According to the descriptions of the patient, the sensations in the area of ​​the diaphragm were especially unpleasant.

It took about 250 years for the disease to come under the scrutiny of medical scientists. The reason for this was the increased mortality of patients. In the course of research, it turned out that death overtook patients precisely at night, when they were sleeping. Studies have shown that 8 out of 10 people with asthma die in hospital conditions at night. This figure is very significant, and therefore it was impossible not to pay attention to the statistics. It is worth noting that in general, at that time, 5% of patients in the world died from the disease.

Many people with nocturnal asthma have a severe decrease in peak flow readings. Expiratory (expiratory) volume can drop by 50% overnight. At the stage of remission, spasms can occur at night, a third of patients experience them at bedtime. Interestingly, some healthy people can sometimes suffer from nocturnal bronchospasms caused by a change in the caliber of the bronchial passages.

Cause of airway narrowing

One of the theories explaining the narrowing in the bronchi is the wrong posture during sleep. The theory of allergens that may be present in bedding remains very likely. The first assumption, however, is often refuted, since asthma patients undergoing medical examinations can lie all day long, changing their position, which does not affect their condition in any way. Severe attacks occur precisely at night.

Some scientists see the cause of the problem in the irregular intake of drugs, but the facts prove that there is no fundamental difference in the intervals. Even with constant and timely administration of drugs, significant improvements are not observed. The allergen theory is also questioned, since their removal did not bring results. It is possible that they may be the root cause, but there is no evidence that allergens contribute to the development of nocturnal asthma.

Spasm can be triggered by inhaling cold or dry air. There is a simple explanation for this: when a patient with asthma breathes in cool air, the effect of bronchial hyperreactivity appears, which leads to bronchospasm. The decrease in temperature occurs in the late afternoon, hence this assumption follows. However, they have already managed to refute it, proving that the temperature does not have a significant effect, keeping it at a certain level during the day. It did not help to avoid seizures. However, it seems that it is the change in the air temperature gradient at night or daytime that provokes bronchospasm.

Another study found that at 36°C and 100% humidity, patients felt better. Asthma did not manifest itself. However, the number of participants was too small.

Symptoms and complaints

Complaints of asthma patients, characterized by the manifestation of nocturnal attacks, can be reduced to sleep disturbances, the appearance of excessive daytime sleepiness, such indications were given by patients during examinations in Europe.

An indicator of the severity of bronchial asthma is the appearance of nocturnal asthma attacks, their daily occurrence. Spasmodic nocturnal cough can also be considered equivalent, with a cough variant of bronchial asthma. In some cases, patients may be diagnosed with obstructive sleep apnea syndrome , which manifests itself in respiratory arrest lasting 10 seconds or more. The presence of such a syndrome further aggravates the course of asthma.

Quite often, patients have a decrease in lung ventilation, depending on the various stages of dreams. During the so-called NREM sleep, the lowest level of ventilation is observed. Recent studies have established that the presence of asthma leads to chronic hypoxia. Nocturnal hypoxia in an asthmatic can be measured by performing night pulse oximetry .

Nocturnal asthma provokes a change in the bronchi in accordance with a specific daily rhythm.
In Delhi, India, a large-scale study was conducted at a local university, the purpose of which was to determine the relationship and nature of sleep disorders in patients with bronchial asthma. The control group consisted of 30 young people with various forms of the disease. The results of the study revealed problems with sleep and breathing during sleep in 90% of the subjects. In parallel, studies were conducted in the United States, which made it possible to establish the negative impact of sleep problems from asthma on a person’s performance, his physical and mental activity.

Nocturnal asthma is a serious disease that impairs quality of life and is difficult to treat. The medical community did not single it out as an independent nosological unit. nevertheless, this is an inflammatory disease, but really with certain modalities and the nature of the course. The presence of nocturnal bronchospasm indicates insufficient or poor-quality asthma treatment. In this case, it is necessary to urgently begin treatment of the patient and conduct constant monitoring of his condition. Therapy in this case is carried out using inhalations with long-acting β-agonists in combination with inhaled glucocorticosteroids. Taking this drug can reduce the symptoms of this disease and improves sleep with nocturnal asthma.

With the right choice of drugs and adequate treatment, it is possible to completely remove sleep disorders and the existing symptoms of the disease. In the event that the treatment of the acute form of the disease does not work, this leads to a chronic sleep disorder. It will be necessary to correctly determine the therapy that has a positive effect on respiratory functions. If nocturnal asthma is accompanied by apnea attacks, special therapy should be used, which involves increasing pressure on the upper respiratory tract. This treatment technology has received is the name of CPAP therapy and is performed using special equipment.

Nocturnal asthma is a serious medical problem, the solution of which and the search for new treatment technologies will improve the quality of life of many people in different countries of the world.

Nocturnal Asthma: Causes, Symptoms, Treatment and More Information

If you have asthma, you may find that your symptoms worsen at night – you are not alone. Over five million people in the UK have asthma and nocturnal asthma, also known as nocturnal asthma, is thought to affect up to three-quarters of them.

Symptoms of nocturnal asthma include coughing spells, chest tightness, wheezing and shortness of breath just before and during sleep. Patients may be awakened multiple times, leading to fatigue, decreased concentration, and difficulty controlling asthma symptoms throughout the day in both adults and children. This can significantly affect the quality of life.

More deaths and severe asthma attacks occur at night, so nocturnal asthma is a serious disease that requires preventive measures and effective treatment. The exact reason why asthma may get worse at night in some people is unclear, although certain factors are thought to play a role and there are things you can do to minimize your risk.

Causes and triggers of nocturnal asthma

It is not known exactly why some people’s asthma worsens at night, although there are certain factors that may increase the likelihood of asthma attacks at night. The triggers for asthma attacks at night are:

• Sleeping position. Certain sleeping positions, such as lying on your side or in front, can compress your lungs, potentially exacerbating nocturnal asthma symptoms. Meanwhile, sleeping on your back can cause mucus from your nose to enter the back of your throat and cause a nighttime cough.
• Inhalation of cold air. A cool room is better for sleeping, but your nighttime asthma may get worse in winter or if you sleep in an air-conditioned room. This is because cold air is dry – loss of moisture and heat in the airways can trigger an asthma attack.
• Exposure to allergens at night. Villa/Bungalow dust mites in your bed Mattress infestation, pet dander, dust particles or mold in the bedroom can irritate the airways and make you more prone to nocturnal asthma.
• Exposure to allergens in the evening. Exposure to allergens in the evening, from pollen to pet dander, may cause a delayed or “late” response. After a few hours, you may develop airway obstruction, which increases the risk of an asthma attack at night.
• Poorly controlled daytime asthma. Failure to properly follow an asthma management plan during the day may increase the risk of asthma attacks at night.
• Changes in lung function. The body’s natural processes during sleep may increase the susceptibility to nocturnal asthma. Lung function naturally deteriorates at night. When the muscles relax during sleep, the upper airways constrict, resulting in increased resistance in the lungs. This means that you are more likely to suffer from shortness of breath and coughing spells at night.
• Hormonal changes. When you sleep, your body undergoes hormonal changes that can make asthma worse. Few studies, for example, have shown that lowering cortisol during sleep contributes to airway obstruction.

Nocturnal asthma symptoms

Asthma symptoms occur when the airways become inflamed and constricted, making breathing difficult. General symptoms of nocturnal asthma:

• Shortness of breath
• wheezing
• Chest tightness
• Coughing

In addition, other effects of nocturnal asthma in adults and children include:

• Lack of concentration during the day
• Increased daytime sleepiness
• Problems with controlling daytime symptoms of asthma.

If you have asthma symptoms at night but have not been diagnosed with asthma, you should contact your doctor or nurse specialist. If you have a diagnosis, you should make sure that your asthma management plan takes into account possible nighttime triggers.

Risk factors

Certain groups of people with asthma are more likely to develop nocturnal asthma due to certain risk factors that include: inflammatory substances that can affect lung function. Few studies have shown that people with asthma who lost weight had improved lung function at night.

Smoking damages your lungs and makes you more susceptible to asthma symptoms, including nighttime asthma attacks.

Acid reflux. People with asthma are twice as likely to develop a chronic form of acid reflux that worsens at night, known as gastroesophageal reflux disease (GERD). One theory is that acid reflux can cause bronchospasm, making it difficult to breathe, and it’s worse when you lie down.

How to Prevent Nighttime Asthma

Although there is no cure for asthma, there are many ways to prevent nighttime asthma and remedies to stop asthma from coughing at night. Tips for Reducing Nocturnal Asthma Symptoms:

• Keep your bedroom clean and free of allergens. Keep pets out of your bedroom; regularly wash bedding at a hot temperature from house dust mites; ventilate the bedroom and treat the mold on the walls; avoid using duvets and pillows with feathers.
• Control the nighttime temperature in your bedroom. Make sure windows are closed, avoid air conditioning, and get an air purifier for better air quality in your bedroom.
• Treat underlying conditions: If you suffer from an underlying condition such as GERD, allergic rhinitis, or obstructive sleep apnea, make sure you take steps to treat and control it. Research shows, for example, that people who take GERD medications have fewer asthma attacks and nocturnal asthma symptoms. Take appropriate medications and take any lifestyle measures, such as diet changes, to help relieve acid reflux.
• Keep a relief inhaler handy. Keep your inhaler near your bed so you can use it when you have a coughing fit at night.
• Keep water by the bed. Drink some water when symptoms start to worsen. Moisture soothes the airways and relieves nighttime coughs.
• Breathing exercises. Other Breathing techniques are used to relieve asthma symptoms and may help stop asthma coughing at night. If you wake up with a cough, you can try breathing exercises to help control your cough.
• Talk to your GP or asthma nurse for advice. They can check to see if you are using your inhalers correctly and discuss any possible causes that are causing your nocturnal asthma.
• Follow your asthma management plan. Keep your asthma under control by taking your medications correctly, monitoring your symptoms, following an effective asthma management plan, and adjusting your medications as needed with your doctor’s advice.
• Maintain a healthy weight. Eat a balanced diet and exercise to keep your weight under control.
• Quit smoking.

What is the best way to sleep with asthma?

To relieve some of the symptoms of nocturnal asthma, just change your sleeping position. One study found that sleeping on your back (lying on your back) improved symptoms of nocturnal asthma and constricted your lungs less than lying on your stomach or on your side.

The best sleeping position for asthmatic patients is to refresh themselves with extra pillows. This will help keep your airways open and reduce the risk of nighttime coughing.

Nocturnal asthma treatment

There is no cure for nocturnal asthma, but there are treatments.