What’s Nocturnal Asthma and How Do I Prevent It?

There’s a name for those particularly bad asthma symptoms you may have experienced during the night: nocturnal asthma, or nighttime asthma. A survey from asthma.org.uk found that 45% of asthma sufferers report difficulty sleeping because of their asthma at least once a week, and just under half said they had had an asthma attack at night^[1]. Although the exact causes of nocturnal asthma are debated, there are a handful of reasons why there’s a greater chance of getting asthma symptoms during sleep. In this article, we’ll outline the likely triggers and suggest tips to improve your sleep quality.

What is Nocturnal Asthma?

Nocturnal asthma, as the name suggests, is when asthma causes issues in the night whilst you’re asleep and is often characterised by similar daytime asthma symptoms. Nocturnal asthma should be seriously addressed as it is a sign that you might be at risk of an asthma attack. It can reduce your quality of life by leaving you feeling tired and irritable the next day, having been disrupted by asthma throughout the night. Waking up with asthma symptoms could indicate your asthma has been aggravated during the night, even if you weren’t aware of it.

The common asthma symptoms, that are often worse at night, include:

• Coughing
• Wheezing (breathing with a whistling or rattling sound in the chest, due to constricted airways)
• A tightness in the chest
• A shortness of breath, otherwise known as dyspnea

What causes Nocturnal Asthma?

Doctors and healthcare professionals are unsure of the exact reasoning behind asthma symptoms often being worse during the night, but there are a number of likely contributing factors.

Hormones

Our circadian rhythm is well-known for regulating the production of certain hormones. The hormone epinephrine helps to keep the walls of the bronchial tubes relaxed so that the airway remains wide, and also suppresses histamines that cause mucus secretion. Epinephrine levels are at their lowest during the night, whilst histamine levels typically peak, which may contribute to greater asthma symptoms^[2].

Mucus and Sinusitis

Increased production of mucus during sleep, coupled with the natural narrowing of the airways during sleep, can prevent normal breathing. In sensitive airways, excess drainage from your sinuses may also trigger asthma, and sinusitis with asthma is fairly common^[3].

Allergens

The quality of air in your bedroom will affect the asthma symptoms you’re experiencing at night. Be conscious of dust mites in your pillows and mattress, pet hair (especially if your pet sleeps on your bed) and patches of damp on the walls or mould on the window frames. Similarly, pollen in your room may trigger your asthma, but it’s also possible that nighttime symptoms are a delayed response to allergen encountered during the day.

Reclining Position

Being reclined as you sleep may exacerbate your asthma symptoms for a number of reasons. These include encouraging a build-up of secretions in the airways, greater volumes of blood to the lungs, decreased lung volumes, and increased resistance in the airways.

Acid Reflux

If you regularly experience heartburn, known chronically as Gastroesophageal Reflux Disease (GERD), then the stomach acid from your stomach can irritate the lower oesophagus and larynx, causing bronchial spasms and airway tightening. Treating both acid reflux and asthma with appropriate medication will reduce nocturnal asthma.

What are the Risk Factors related to Nocturnal Asthma?

A number of factors may be contributing to your nocturnal asthma, putting you at increased risk of experiencing more frequent and more severe symptoms. These include if you:

• have allergic rhinitis
• do not see their doctor regularly
• are young
• are obese
• are a regular smoker
• live in a built-up urban environment
• have gastrointestinal issues

What Can I Do After Waking Up in the Night with Asthma Symptoms?

Whilst it’s best to have taken all the recommended precautions to reduce asthma symptoms throughout the day and in your lifestyle in general, sometimes this can be advantageous, or perhaps symptoms occur regardless of doing all your can. If you wake up in the night with asthma symptoms, you should try the following:

• Sit upright, and use your reliever inhaler as prescribed, such as the popular Ventollin Evohaler. Make sure this is by your bedside so it’s easily accessible at night.
• Stay awake for a short while to check that the medication is taking effect before heading back to sleep, this way you’ll reduce the chance of waking up again in the night with further symptoms.
• You may find propping yourself up with additional pillows could help open your airways and maintain this throughout sleep.
• Sipping a glass of water may ease a dry throat.
• Some people find that nasal saline rinses or decongestants such as Vicks Vaporub can help, although others find these to trigger their symptoms, so make sure to try this out during the day first.

How Else Can I Prevent Nocturnal Asthma?

There’s plenty you can do before heading to sleep to reduce the likelihood of nighttime interruptions. Try to do the following:

• Exercise regularly to build lung resilience and improve your breathing.
• If prescribed, you should use your preventer inhaler each day to keep your symptoms at bay and build up protection in your airways.
• Use a humidifier to regulate the air moisture.
• Use a fan during high pollen months to keep cool without needing to open your window.
• Keep your pet out of the bedroom, or at least off of your bed, if you are allergic to them.
• Don’t do high-intensity exercise in the last few hours of the day.
• Try meditation in the hour before sleeping, focusing on deep, controlled breathing.

Conclusion

It can be difficult to spot your personal triggers when so many factors are at play, so always keep your reliever inhaler nearby for when you suddenly need it. Changes to your environment can help remove likely triggers from the bedroom, and remaining active will build greater resilience in your lungs and prevent obesity.

We advise that if you are regularly having asthma symptoms at night, or feel these symptoms when you first wake up, that you visit your doctor to discuss the best cause of action. Nocturnal asthma is a sign that you may be at risk of having an asthma attack, which in some cases can be fatal, and your doctor will be able to help outline the internal and environmental triggers tailored to you and your situation.

For more articles exploring other aspects of asthma, check out our health centre blog.