Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, which can make breathing difficult. For many individuals living with asthma, symptoms can become noticeably worse during nighttime hours.
What is Nocturnal Asthma?
Nocturnal asthma refers to the worsening or onset of asthma symptoms that occur predominantly during sleep or in the early morning. These symptoms often include coughing, wheezing, shortness of breath, or chest tightness. It is not a separate disease but a common presentation, affecting up to three quarters of people with asthma.
Factors Contributing to Nighttime Symptoms
Several physiological changes and environmental factors can contribute to the exacerbation of asthma symptoms at night. The body’s natural circadian rhythms play a role, influencing hormone levels such as cortisol and epinephrine, which help relax and widen airways. Levels of these hormones decrease during sleep, while inflammatory mediators like histamine can increase, leading to airway constriction and increased mucus production. Lung function naturally lowers at night, and airways tend to narrow as muscles relax during sleep, increasing resistance to airflow.
Environmental elements within the bedroom also frequently trigger nighttime asthma. Exposure to allergens like dust mites, pet dander, and mold can worsen symptoms, as these are often present in bedding and indoor air. Colder nighttime temperatures can irritate airways, and lying down can aggravate conditions like gastroesophageal reflux disease (GERD) or post-nasal drip, both of which can trigger asthma symptoms. Obesity and sleep-related conditions such as obstructive sleep apnea can further contribute to nighttime breathing difficulties.
Recognizing the Signs
Recognizing the specific signs of nocturnal asthma involves observing patterns in symptom occurrence. Common indicators include persistent coughing, especially a dry cough, that often begins or worsens after lying down. Individuals may also experience wheezing, a whistling sound during breathing, or a noticeable shortness of breath. Chest tightness is another frequent symptom.
These symptoms typically occur or intensify during the night, frequently waking the individual from sleep. This sleep disruption can lead to daytime tiredness and difficulty concentrating.
Approaches to Managing Nocturnal Asthma
Managing nocturnal asthma often involves a combination of medical treatments and lifestyle adjustments to control symptoms effectively. Inhaled corticosteroids are a primary long-term control medication, reducing airway inflammation when taken regularly. Long-acting beta-agonists (LABAs) can be added to inhaled corticosteroids to provide more complete 24-hour control by relaxing airway muscles. For immediate relief of acute symptoms, quick-relief inhalers, such as short-acting beta-agonists (SABAs), are used as needed. Leukotriene modifiers, taken orally, can also help prevent breathing problems by blocking inflammatory chemicals in the body.
Alongside medication, modifying the sleeping environment can significantly reduce triggers. This includes using allergen-proof covers for bedding, washing linens in hot water, and regularly vacuuming with a HEPA-filter equipped device to minimize dust mites and pet dander. Improving bedroom air quality by keeping windows closed to reduce outdoor allergens and pollutants, and maintaining appropriate temperature and humidity levels, can also be helpful.
Managing co-existing conditions like GERD through dietary changes or medication, maintaining a healthy weight, and avoiding smoking are also important. Working closely with a healthcare professional to develop a personalized asthma action plan is important for effective management.