Roughly 6% of children and 8% of adults in the U.S. have asthma. And up to 70% of people with asthma say they have symptoms of nocturnal asthma at least one night a month. Nighttime awakenings from asthma symptoms may lead to daytime sleepiness or feeling groggy in the morning.
Nocturnal asthma and sleep apnea can present with similar symptoms. And both sleep apnea and not getting enough sleep can make asthma symptoms worse, suggesting there’s a complex relationship between asthma and sleep.
What Is Nocturnal Asthma?
Nocturnal asthma refers to asthma symptoms that occur during the night and may interfere with sleep. Having asthma symptoms at night at least once per week can be a sign of poorly controlled asthma.
Asthma symptoms may intensify during sleep, because they are affected by circadian rhythms. Circadian changes in lung function may lead to increased asthma symptoms at night that peak around 4 a.m.
Identifying nocturnal asthma symptoms and reporting them to a doctor is an important part of managing asthma.
Nocturnal Asthma Symptoms
In adults, nocturnal asthma symptoms accompany nighttime awakenings and can include:
- Shortness of breath
- Chest tightness
What Triggers Asthma at Night?
For some people with asthma, certain health problems or sensitivity to inhaled allergens can contribute to nocturnal asthma symptoms.
- Upper respiratory infections: Colds and viruses are the most common cause of an asthma flare-up. This may be due in part to additional inflammation in the airway, which can make asthma symptoms worse.
- Nasal or sinus problems: People with chronic sinus issues from allergies and infection can have worsening asthma symptoms because of drainage or postnasal drip that irritates the upper airways.
- Inhaled allergens: Sensitivity to inhaled allergens, such as dust mites, mold, mildew, pollen, trees, grass, and dog and cat allergens, are thought to be a trigger for asthma symptoms at night for certain people.
- Gastroesophageal reflux disease (GERD): Reflux during sleep can trigger asthma symptoms. Reflux happens when the contents of the stomach along with stomach acid go up the esophagus and into the upper airways causing excess irritation.
Some people may have difficulty controlling their asthma symptoms, either because of exposure to triggers or difficulty using treatments as prescribed. Asthma that is not well controlled can also lead to nighttime symptoms. Talk with a doctor if you have concerns about whether your asthma symptoms are being appropriately managed.
Nocturnal Asthma in Children
Nocturnal asthma may go undiagnosed in children. Nighttime asthma symptoms may not be reported by parents or caregivers, or parents and caregivers may be unaware of a child’s symptoms. Problems with sleep in children with nocturnal asthma can lead to learning difficulties as well as poor school performance and attendance.
Parents should be aware of the common symptoms children experience when they have nocturnal asthma, which can include:
- Trouble breathing
- Waking up during the night
- Poor sleep
- Daytime sleepiness
Symptoms of nocturnal asthma and sleep apnea in children may overlap. Snoring, difficulty breathing during sleep, and daytime sleepiness often occur in children who have either nocturnal asthma or sleep apnea. Reporting a child’s sleep difficulties or other symptoms to a doctor is important, so the proper disorder can be identified and treated.
How Sleep Affects Asthma
Short sleep duration may make managing asthma more difficult and increase a person’s risk of other related disorders, like obesity and depression. However, getting seven to eight hours of sleep per night may reduce the risk of certain asthma symptoms.
Short sleep duration is thought to worsen asthma symptoms by increasing inflammation in the body and increasing the risk of obesity. Falling short on sleep can also weaken the immune system, which can make a person more sensitive to certain asthma triggers like infections and allergens.
Research varies regarding how much sleep may worsen asthma. Some evidence suggests that sleeping five hours or fewer per night may increase the risk of asthma symptoms and the need for treatment. Other research suggests that six hours or fewer may be linked to more asthma-related urgent medical visits and more persistent asthma symptoms.
Researchers have also looked into how sleeping longer than recommended relates to asthma. Some studies suggest that people who have asthma and sleep nine or more hours per night may be slightly more likely to limit their usual activities due to symptoms of wheezing.
The Link Between Asthma and Sleep Apnea
Obstructive sleep apnea (OSA) and nocturnal asthma have similar symptoms, such as waking during the night and having trouble breathing during sleep. It can be difficult to tell if a person waking up due to difficulty breathing has OSA or nocturnal asthma. Having both asthma and obstructive sleep apnea may make nighttime asthma symptoms worse.
Certain people with asthma may be at greater risk for obstructive sleep apnea. Also, some research suggests that asthma can be a cause of OSA. For this reason, some experts recommend people with asthma undergo screening for sleep apnea.
How to Sleep Better with Asthma
Although people experience nocturnal asthma for many reasons, taking steps to improve certain health and environmental triggers for asthma can help some people sleep better at night.
- Regularly wash and dry bedding: Reduce exposure to dust mite allergens, which can be a nocturnal asthma trigger, by washing bedding including pillow cases, sheets, mattress pads, and blankets. Aim to wash bedding once per week using hot water and detergent, then dry on a hot setting.
- Protect against upper respiratory viruses: Having the flu or another respiratory virus can increase the likelihood of having asthma symptoms. Take steps such as getting yearly vaccinations and wearing a mask in public to help protect against viruses that can trigger asthma symptoms.
- Reduce pet allergens: In houses with cats and dogs, allergens from the animals can remain airborne for long periods of time. Carpets, dust, and furniture can also harbor these allergens. Those with asthma who are sensitive to cat and dog allergens may benefit from not keeping the animals in the house or using an air purifier.
- Remove mold allergens: To reduce exposure to mold allergens, hard surfaces with visible mold can be scrubbed clean and dried thoroughly. Porous surfaces with mold, such as carpets and upholstery, may need to be replaced.
- Avoid smoking and secondhand smoke: Smoking tobacco, using e-cigarettes, and being exposed to secondhand smoke have all been linked to asthma and may affect the effectiveness of asthma treatment. Avoid secondhand smoke and take steps toward quitting if you smoke or use e-cigarettes.
- Avoid GERD triggers: To help manage GERD symptoms, which may worsen nocturnal asthma, experts recommend avoiding certain triggers. Alcohol, coffee, carbonated beverages, high-fat foods, and acidic foods may trigger GERD symptoms. Avoiding food in the two hours before bedtime may also help reduce GERD.
- Treat postnasal drip: Pollen, dust mites, and animal allergens can cause postnasal drip, which may increase nighttime asthma symptoms. An upper respiratory or sinus infection can also cause postnasal drip. A doctor can provide guidance on medications to manage postnasal drip.
- Improve asthma treatment: Nocturnal asthma occurring once a week or more is considered a sign that a person’s asthma is poorly controlled. For some people with poorly controlled asthma, adhering to a doctor-prescribed medication schedule can help improve nighttime asthma symptoms.
When to See a Doctor
Since nocturnal asthma is often a sign of poorly controlled asthma, talk to your doctor if you experience nighttime asthma symptoms like coughing, shortness of breath, or chest tightness. People often don’t mention these symptoms to their doctors, but doing so is important to properly manage asthma.
Some people wonder if it is possible to die from an asthma attack during sleep. Both daytime and nocturnal asthma can lead to complications, including death, which is another reason seeking treatment is so important.
Even people without asthma or with well-controlled asthma should talk to a doctor if they experience difficulty breathing during sleep. Nocturnal asthma and obstructive sleep apnea can have similar symptoms. If you experience obstructive sleep apnea symptoms, like snoring or daytime tiredness, tell your doctor. They can recommend appropriate testing and treatment.