Why is asthma worse at night?
Exactly why asthma tends to get worse at night is not fully understood, but several theories exist. “Nocturnal asthma” may be due to one or more factors that interact:
- The tubes that carry air into your lungs and back out again (airways) grow more resistant to air flow during the night due to normal hormonal fluctuations. Airway function tends to decrease during sleep (and daytime) in people with nocturnal asthma. This is known as reduced forced expiratory volume (FEV) rate.
- Higher levels of blood cells known to promote inflammation, including eosinophils and neutrophils, are present in the blood of individuals with nighttime asthma symptoms.
- Exposure to triggers at night such as dust mites in the bedding or mattress, or animal dander if pets sleep in the bed, may trigger nighttime symptoms. Some people may also be triggered by mold, pollen or cold air.
- Sleep position may also play a role. Back sleeping puts extra pressure on the chest and lungs.
- Nighttime flares may also be due to poorly controlled asthma by day.
Alone or together, all of these factors can set the stage for nighttime asthma symptoms, including coughing, wheezing and chest tightness that can disrupt sleep.
More than 75 percent of individuals with asthma report nighttime symptoms.
Nocturnal asthma tends to be associated with more severe disease. Researchers continue to explore other risk factors that may give rise to nocturnal asthma symptoms.
Keeping a rescue medication in easy reach at night, taking steps to control bedroom asthma triggers and discussing nighttime symptoms with a doctor can help improve sleep and stave off nighttime asthma flare-ups. Asthma treatment, which typically involves a long-term daily controller/s plus another rescue inhaler for asthma attacks, may need to be adjusted to control nighttime asthma symptoms.
References
- National Sleep Foundation. Asthma and Sleep. Available at: https://www.sleepfoundation.org/articles/asthma-and-sleep. [Accessed November 13, 2020].
- Levin AM, Wang Y, Wells K, et al. Nocturnal Asthma and the Importance of Race/Ethnicity and Genetic Ancestry. American Journal of Respiratory and Critical Care Medicine. 2014;190(3): 266-273. https://dx.doi.org/10.1164%2Frccm.201402-0204OC.
- The Asthma UK and British Lung Foundation Partnership. Nocturnal asthma. September 2019. Available at: https://www.asthma.org.uk/advice/living-with-asthma/sleep-and-asthma/. [Accessed November 13, 2020].
Read next
Can severe asthma lead to COPD?
Severe and poorly controlled asthma can lead to damaged lungs which may increase the risk of developing chronic obstructive pulmonary disease (COPD). Symptoms of asthma and COPD may frequently co-exist in smokers and the elderly. Continue reading
What is considered severe asthma?
Severe asthma is when you require medium to high-dose inhaled corticosteroids combined with other longer-acting medications. Severe asthma can also be defined as having a peak expiratory flow rate (PEF or PEFR) less than 50% of your personal best. This shows severe narrowing of your large airways and is considered a medical emergency and you should get help right away. Your symptoms may include coughing, being very short of breath, wheezing while breathing in and out, or retractions (this is when you can see the muscles between the ribs working hard to keep you breathing). Walking and talking may also be difficult. Continue reading
How is severe asthma treated?
Severe asthma is treated by using higher doses of inhaled corticosteroids or using inhaled corticosteroids more frequently; taking oral corticosteroids or being given corticosteroid injections; with continuous inhaled nebulizers; using ipratropium bromide aerosols; taking long-acting beta-agonists (LABAs) such as albuterol or formoterol, which help keep the airways open for about 12 hours; leukotriene receptor antagonists (LTRAs), such as montelukast or zafirlukast; slow-release theophylline; long-acting muscarinic receptor antagonists (LAMAs) such as tiotropium bromide or glycopyrronium bromide; with biologics such as omalizumab, mepolizumab, reslizumab, benralizumab, or dupilumab.
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