Is asthma worse at night?

While not a sleep disorder itself, even the National Sleep Foundation highlights asthma as a cause of disrupted sleep in both children and adults. Up to 75% of people with asthma may experience nocturnal asthma symptoms—or, symptoms that occur during the night. Children may also be significantly affected by nocturnal asthma, with reports stating 41% of children may experience nocturnal asthma.

Why do Asthma symptoms worsen at night?

Even people without asthma experience fluctuations in their lung function throughout the day, with their best lung function in the afternoon—around 12 to 4 pm, and lowest in the early morning, between 3 and 4 am.These changes are due to hormonal fluctuations—and of course, these changes are more pronounced in people with asthma because our airways are more reactive, especially at times where levels of hormones that benefit our breathing decrease.

Allergies can be a big culprit in nocturnal asthma symptoms, exposing those with dust allergies to mites that may have taken up residence in your bedding, pillows, and mattress. If you have pet allergies, a pet to which you are allergic sleeping in your bedroom can cause asthma symptoms, just as they might during the day. As well, delayed-onset allergic reaction to triggers encountered during the day may also cause problems breathing that to occur at nighttime.

Postnasal drip is another reason asthma may worsen at night when we are lying down, and nasal secretions move from our sinuses to the back of our throat, and into our lungs, making breathing more difficult. For this reason, ensuring sinus problems like rhinitis or sinusitis are treated can be key to avoiding nocturnal asthma symptoms.

Other related reasons for asthma symptoms at night include stress, inhaling cold air from an open window or air conditioner, sleeping in a reclined position, acid reflux—specifically gastroesophageal reflux disease (GERD), where stomach acid reflux may flow to the lungs while laying prone and sleep apnea. Many of these problems (not including stress and cold air) may be worsened by carrying excess body fat or being overweight or obese, which itself can worsen asthma by making it more effort to breathe against the resistance of your body weight.

How to improve sleep with Asthma

A few basic steps can help control asthma at night.
  • Control sinus issues and post-nasal drip, as mentioned
  • Ensure acid reflux or GERD are kept under control; do not eat later than 3-4 hours before sleep
  • Decrease allergen exposure:
    • Use dust-mite proof mattress/pillow encasings
    • Wash bedding regularly (weekly) if you have a dust mite allergy
    • Hard floors versus carpet can minimize dust mite accumulation
    • Shower before bed if you have been exposed to pollen and are allergic, or to remove other triggers (such as pet dander)
  • Take medication as prescribed by your doctor
Hopefully understanding more about how asthma may worsen at night—and following these tips—helps you minimize nocturnal asthma symptoms!

The information on this page is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For more information about asthma, talk to your doctor or primary care provider.

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