Asthma is a lung condition in which bronchi swell and airways become narrow due to inflammation. It creates breathing difficulties such as shortness of breath, chest tightness, wheezing, and cough. Asthma affects sufferers of any age and usually begins in childhood. Asthma attacks can occur at any time day or night, after exposure to the patient’s irritant or allergen. For some people symptoms occur during sleep, and this is known as nocturnal asthma.
Asthma attacks are brought on by allergens or irritants, also known as asthma triggers, and triggers may vary in each patient. Some triggers include cold or flu, dust, dust mites, mold, pet dander, smoke, strong odors, certain medications, weather, and emotions.
Symptoms of asthma include shortness of breath, cough, and chest tightness. With nocturnal asthma, these symptoms also occur at night, keeping asthma sufferers awake. This can make them irritable and tired the next day and as a result, may affect the overall quality of life and cause daytime symptoms to be harder to control. In children with nocturnal asthma, they may do more poor than usual in school and have psychological issues. Studies show these issues in children can be corrected when nocturnal asthma symptoms are under control.
The exact cause of nocturnal asthma is unknown, but certain factors play a role in worsening symptoms.
Increased mucus production and sinusitis may worsen nocturnal asthma. When we sleep, our airways are already likely to be narrowed, increasing resistance to airflow. This can activate nighttime coughing, causing airways to narrow even more. Sinusitis along with asthma is also common since asthma can be triggered from excess drainage from sinuses.
Lying flat may also worsen nocturnal asthma. Accumulation of secretions in airway from post nasal drip or sinus drainage can trigger symptoms. Also, lying flat increases blood volume in lungs, decreases lung volumes, and increases airway resistance, all making it harder to breathe.
Cool air from cold weather or air conditioning may also trigger nocturnal asthma from loss of heat and moisture in the airways.
Many people with asthma also suffer from acid reflux. Stomach acid backed up to the esophagus and to the larynx can cause bronchospasm, and stomach acid from the throat can drip down into the trachea, airways, and lungs resulting in a flare-up of symptoms.
Many times when exposed to a trigger, an asthma attack will occur quickly after exposure. Studies show that about half of asthma patients with immediate attacks will also experience an attack later on, known as late phase response. Some studies also show that exposure to triggers in the evening will increase the chance of late phase response and these later attacks may be severe.
There is no known cure for asthma but it can be controlled, and it is possible to get some good quality sleep. You can have asthma and maintain a normal life and not have to give up activities, including exercise. The goal with asthma is to reduce attacks.
Medications can be given to reduce swelling of airways. Some medications are taken on a regular basis, long-term as “maintenance” medications to keep symptoms under control. If symptoms flare up, there are “rescue” medications that can be taken to give quick relief of symptoms and last for a few hours.
To keep asthma under control, take medications on time. Some asthma medications may interfere with sleep, so it’s important to discuss this with a doctor who can make adjustments if needed. Always have a rescue inhaler on hand for when an attack occurs. Be aware of what your triggers are. Everyone’s triggers are different so if you are not sure what is causing the attacks, keep a diary of possible triggers, rescue medication use, and symptoms. Also, keep track of lung function using a peak flow meter. Using it daily can let you know when you have decreased lung function and may help you predict an attack.
Kristina Diaz, RRT is a Registered Respiratory Therapist and a health and wellness enthusiast and writer.
© 2021 American Sleep Association.