Asthma, COPD, and other chronic lung diseases often aggravate at night causing breathing difficulties, more coughing, and more wheezing. Nocturnal asthma is defined as the subtype of asthma where symptoms mostly occur or aggravate at night. Nearly 75 % of individuals with asthma note that the symptoms are worse at night. Poor sleep leads to fatigue the next few days, which can become chronic and impact day-to-day life. Let’s review in this article why the asthma symptoms get worse and simple solutions for a good night’s sleep.
Reasons why asthma symptoms worsen at night
Sleeping position is one of the main reasons why symptoms aggravate at night. When a person lays downs in bed, the mucus from sinuses drips down the throat, causing coughing, which makes breathing more difficult. There is extra pressure on the lungs and heart due to gravity, which further increases shortness of breath.
Bodily’s changes. The sleep wake cycle (circadian system) has a significant impact on the body physiology and behavior, influencing lung function, inflammation, the nervous system and more. The hormone/neurotransmitter norepinephrine keeps the airways widen and relaxed and its levels naturally decrease during sleep. Histamine levels also change during the sleep, leading to increased mucus and constriction of the airways. The body’s temperature is a little bit cooler during the night as well. Overall, symptoms are worse around 4 am.
Allergens. Many allergens that trigger asthma are hiding in the bedroom- including dust mites, dust, pet dander, and pollen brought indoors on clothes.
Room temperature and humidity. Asthma is associated with increased sensitivity of the airways. Whether the air is too dry, too cold, too humid or sudden changes in the air temperature can worsen the symptoms.
Five tips to sleep better with asthma
1. Consider sleep positions to reduce shortness of breath. Specialists from the Centers for Respiratory Health recommend two sleeping positions to reduce shortness of breath.
Position nr 1. Lie down in bed, on your back. Place one pillow under your knees, so you can maintain your knees bent. Use a couple of pills under your head, to keep it elevated. Relax, and use your breathing techniques.
Position nr 2 involves lying on your side. Place a pillow between your knees and keep your head elevated by using a couple of pillows/ Try to maintain your position with your back as straight as possible. Now you can relax and use your breathing techniques.
2. Improve your sleep habits. Be consistent and go to bed every night and wake up in the morning at the same time, including the weekends. Your bedrooms should be quiet, completely dark, relaxing, and at a comfortable temperature. Ideally, you should not have a TV, phone, or any electronic device in your bedroom. Avoid eating 3-4 hours before bed, avoid caffeine after 2-4 pm, and excess alcohol. Stay active, regular exercise during the day can help you sleep better – just make sure you choose an asthma-friendly workout. What should you do if you can’t fall asleep or stay asleep? Keep a journal and include what time you go to bed/wake up, your diet, caffeine, alcohol intake as well as your stress levels. Also, record your asthma symptoms during the night and right down, the severity of your symptoms (ie on a scale from 1-10), and how often you wake up due to symptoms. Book a consultation with your doctor and discuss any triggers you may have identified using the journal. You may also want to get tested for sleep apnea because asthma increases the risk of this condition which also impacts your sleep. Some people experience fewer asthma symptoms (less mucus in the airways) and better sleep if they take a hot shower before bedtime. There are also some beds that allow you to sleep at an incline with a wedge pillow or beds with an adjustable base- these beds make it easier to breathe.
3. Identify and remove allergens. Get allergy tests to find any environmental or food allergies. You may want to repeat the test every couple of years, as new allergies may develop, while others may improve. Try to eliminate the allergens. Avoid fluffy blankets, and wall-to-wall carpets If you have pets, keep them out of the bedroom. Wash your bed sheets regularly. Try dust-proof mattresses and pillow covers.
4. Get an air purifier with a HEPA filter- make sure you have the right temperature (60-67 F) and humidity (30-50%). Ideally, the air purifier should cover the entire home, if not – use a portable air purifier. Vacuum steamers can also help remove some allergens and can be used on the floor, for curtains or beds.
5. Have your asthma medication handy. The reliever inhaler is the best in case of an acute attack. If you don’t have it available for any reason, try to sit upright and take deep slow breaths to prevent hyperventilation. If symptoms get worse seek medical treatment right away.