Nocturnal Asthma | Sleepopolis

Asthma is a chronic condition in which the bronchial tubes repeatedly become swollen, causing a series of uncomfortable symptoms for the individual. Typically, most of the attention on asthma has focused on daytime symptoms. But those symptoms don’t stop when the sun goes down. Nocturnal asthma can be even more bothersome, as the shortness of breath, coughing, and wheezing associated with the condition can prevent you from getting the shut-eye you need.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Long Story Short

Nocturnal asthma is asthma that worsens at night.
You can have both daytime asthma and nocturnal asthma, or one can be worse than the other.
Poor sleep and asthma share a bidirectional relationship. Asthma symptoms can impede sleep, and insufficient sleep can exacerbate asthma symptoms.
There is no cure for nocturnal asthma, but lifestyle changes, improved sleep hygiene, and pharmacological interventions can help manage symptoms.

What Is Nocturnal Asthma?

“Nocturnal asthma is asthma that causes symptoms at night,” says Dr. Monique May, a board-certified family physician and Medical Advisory Board member at Aeroflow Sleep. It can also be a “sign of poorly controlled or severe asthma,” she adds. It’s also not uncommon—out of those with asthma, 44 to 61 percent show signs of nocturnal asthma. (1) “The most common symptoms of nocturnal asthma are night-time wheezing, cough, shortness of breath, or chest tightness,” May says.

The Relationship Between Sleep and Asthma

By narrowing your airways and making it hard to breathe, asthma can deliver a substantial blow to your sleep. (1) However, research indicates that asthma and sleep share a bidirectional relationship.

A 2021 study found that people who logged fewer than six hours of sleep had a greater likelihood of asthma attacks, symptoms like dry cough, and overnight hospital stays. (2) Moreover, shorter sleep times have been linked to increased inflammation in the body, impaired lung function, and an uptick in asthma symptoms. (3)

Meanwhile, the chronic wheezing, coughing, and chest tightness associated with asthma can understandably turn falling and staying asleep into a pipe dream.

Some common side effects of nocturnal asthma on adults and children include:

Excessive daytime sleepiness (4)
Sleep fragmentation (4)
Difficulty controlling daytime asthma symptoms
Impaired cognitive performance
Poor concentration

Asthma and Obstructive Sleep Apnea

In addition to a bidirectional relationship with sleep itself, nocturnal asthma shares a bidirectional relationship with obstructive sleep apnea (OSA). Obstructive sleep apnea is a chronic sleep disorder, the most prevalent symptom of which is an airway collapse during sleep. (5) OSA is usually a result of the muscles at the back of the throat relaxing too much, interfering with proper breathing. (5)

On the one hand, researchers speculate that OSA may contribute to airway inflammation, which has the effect of compounding asthma symptoms. (6) On the other, asthma is thought to increase the collapsibility of the upper airway, ultimately leading to the development or worsening of OSA.

Causes of Nocturnal Asthma

“Environmental allergens, laying in a supine position to sleep, and obesity are common causes of nocturnal asthma,” says Terry Cralle, MS, RN, and clinical sleep health educator. (1) Other contributors include hormones and sleeping in a cold environment.

Allergens

“Common household allergens such as dust mites, pet dander, mold, mildew, and pollen can trigger nighttime symptoms,” says May. Add in the fact that outdoor allergens can get trapped in your clothing and hair and transferred to surfaces around your home (including your bedding), and you have the ideal environment for nocturnal asthma symptoms to worsen.

Cold Air

Doctors and other clinicians often recommend air conditioners to asthma patients because they can regulate temperatures and reduce indoor allergens, but May tells us (and research confirms),“Sleeping in a cold environment from an air conditioner or open window has also been known to trigger symptoms.” Specifically, research suggests that extreme heat and cold can play a role in the development of asthma and can thereafter serve as a trigger for asthma attacks. (7) Ultimately, air conditioners can become a double-edged sword for some people with asthma.

Sleeping Position

“Lying flat (particularly after a large meal close to bedtime) can trigger acid reflux, which can exacerbate symptoms of nocturnal asthma,” says May, adding that “if that meal contained beer, wine, seafood, or dried fruits—all of which contain sulfites—then people who are sensitive to them are even more likely to have worsening asthma symptoms at bedtime.” (8)

“Lying in a supine position (flat on your back) also increases the chance for mucus and drainage from the sinuses, which can also lead to common asthma symptoms like coughing and wheezing,” May concludes.

Obesity

According to May, obesity is a risk factor for nocturnal asthma and sleep apnea. This is largely a function of excess fat and relaxed muscles in the upper airway, combining forces to aggravate and worsen nocturnal asthma symptoms.

Other causes of nocturnal asthma include:

Seasonal allergies (9)
Tobacco smoke and secondhand smoke (1)
Illnesses and infection (like the common cold, flu, or other respiratory infections)

Nocturnal Asthma in Children

According to Cralle, “Asthma is more common in children than adults, and it’s the most common chronic disease in children.” (10) Similar to adults, the symptoms of nocturnal asthma in children include breathlessness, coughing, wheezing, and chest tightness. (11)

And while sleep fragmentation and excessive daytime sleepiness (the most common side effects of nocturnal asthma in children) match their adult counterparts, Cralle says accurate diagnosis and treatment are crucial for kids, as those same effects are associated with behavioral and developmental difficulties in kids. (12) (13)

Tips for Reducing Nocturnal Asthma Symptoms

To reduce nocturnal asthma symptoms, May suggests addressing reversible causes, such as “removing allergens from the bedroom, elevating your head, and controlling allergy and sinus symptoms.”

Reduce allergens in your bedroom

Indoor allergens can trigger or worsen asthma symptoms, so Cralle suggests “cleaning your bedroom regularly to reduce dust mites, mold, and pet dander, and consider upgrading to a vacuum with a high-efficiency particulate air (HEPA) filter.”

Don’t allow pets in your bedroom

Speaking of pet dander, if nocturnal asthma is stealing your sleep, you might have to boot your furry bedmates. If sleeping without your pet is a non-starter, then be sure to wash your bed linens frequently in hot water, vacuum regularly, and invest in an air purifier.

Treat underlying conditions

Whether we’re talking about dietary changes, medication, or CPAP therapy, those dealing with underlying conditions such as GERD or obstructive sleep apnea should consider taking steps to treat or control these conditions as best they can.

Keep your inhaler close

Your inhaler is your first line of defense against an asthma attack in the wee hours, so be sure to keep it next to your bed and easily within reach.

Change your sleeping position

If your asthma symptoms worsen at night, you might be surprised to hear that relief may be as easy as changing your sleeping position. The best sleeping position for nocturnal asthma is to prop yourself up with extra pillows—this helps keep your airways open and reduce your risk of a nighttime cough.

Treatments for Nocturnal Asthma

There is no cure for nocturnal asthma, but there are plenty of treatments available to help you keep it under control.

“Nocturnal asthma is treated the same way as asthma in general,” says May. “Typical treatments include fast-acting medicines called bronchodilators that relax and open the airways quickly (rescue medicines), and inhaled medicines such as long-acting bronchodilators and steroids, which work more slowly and steadily to control asthma (maintenance” medicines).”

May adds that antihistamines and allergy shots are another alternative if allergies are a concern.

For those dealing with both nocturnal asthma and sleep apnea, research shows that continuous positive airway pressure (CPAP) therapy can significantly improve symptoms. (1)

FAQs

What is the best treatment for nocturnal asthma?

The best treatment for nocturnal asthma may be a combination of lifestyle changes and pharmacological treatments.

What is the best sleeping position for nocturnal asthma?

The best sleeping position for nocturnal asthma is to prop yourself up with extra pillows—this helps keep your airways open and reduce your risk of a nighttime cough.

The Last Word

Nocturnal asthma is essentially asthma that occurs at night, often interfering with your sleep. There is no cure, but a combination of lifestyle changes and medications could help you get improved rest.

Sources

Nocturnal asthma – apjai-journal.org. (n.d.-a). https://apjai-journal.org/wp-content/uploads/2021/07/6_AP-231020-0986-1.pdf
Luyster FS, Shi X, Baniak LM, Morris JL, Chasens ER. Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Ann Allergy Asthma Immunol. 2020;125(3):319-324. doi:10.1016/j.anai.2020.04.035
Hu Z, Song X, Hu K. The Effect of Short Sleep Duration on the Development of Asthma. Int J Clin Pract. 2022;2022:3378821. Published 2022 May 16. doi:10.1155/2022/3378821
Garza N, Witmans M, Salud M, Lagera PGD, Co VA, Tablizo MA. The Association between Asthma and OSA in Children. Children (Basel). 2022;9(10):1430. Published 2022 Sep 21. doi:10.3390/children9101430
Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459252/
Nosetti L, Gozal D. Exploring the bidirectional relationship between asthma and obstructive sleep apnea in Brazilian pediatric patients: one more piece to the Puzzle. J Pediatr (Rio J). 2024;99(5):423-424. doi:10.1016/j.jped.2023.05.004
Azhu Han a, a, b, c, d, & AbstractBackgroundThere is rapidly growing evidence indicating that extreme temperature is a crucial trigger and potential activator of asthma; however. (2022, October 5). Asthma triggered by extreme temperatures: From epidemiological evidence to biological plausibility. Environmental Research. https://www.sciencedirect.com/science/article/pii/S0013935122018163
Administrator. (2021, July 28). Sulfite Sensitivity Frequently asked questions (FAQ). Sulfite Sensitivity FAQ – Australasian Society of Clinical Immunology and Allergy (ASCIA). https://www.allergy.org.au/patients/other-allergy/sulfite-sensitivity-faq
Benjamin J. Ulrich et al.,Allergic airway recall responses require IL-9 from resident memory CD4<sup>+</sup> T cells.Sci. Immunol.7,eabg9296(2022).DOI:10.1126/sciimmunol.abg9296
Centers for Disease Control and Prevention. (2009, April 24). CDC – asthma – parents. Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/parents.html
Centers for Disease Control and Prevention. (2018, February 8). Vital signs: Asthma in children – United States, 2001–2016. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/67/wr/mm6705e1.htm
Garza N, Witmans M, Salud M, Lagera PGD, Co VA, Tablizo MA. The Association between Asthma and OSA in Children. Children (Basel). 2022;9(10):1430. Published 2022 Sep 21. doi:10.3390/children9101430
Hosokawa R, Tomozawa R, Fujimoto M, et al. Association between sleep habits and behavioral problems in early adolescence: a descriptive study. BMC Psychol. 2022;10(1):254. Published 2022 Nov 5. doi:10.1186/s40359-022-00958-7

Cralle, Terry. Personal Interview. October 12, 2024.

May, Monique. Personal Interview. October 11, 2024.