Why Do I Have Asthma Attacks At Night Nocturnal Asthma Explained
Asthma is a serious condition that needs to be treated and monitored, but what some may not realise is that it can occur at night too.
Symptoms such as chest tightness, shortness of breath, coughing and wheezing during the night can make sleep impossible.
It affects daily life, as lack of sleep can leave us feeling tired and irritable plus, it makes daytime asthma more difficult to control.
If you believe you have nocturnal asthma, its worth seeing a doctor here is everything you need to know.
What To Do When Asthma Stops You Sleeping
- If you have asthma symptoms, sit up and take your reliever inhaler as prescribed.
- Always make sure your inhaler is beside your bed before you go to sleep, so you dont have to search for it in the middle of the night.
- Give yourself a bit of time to check your reliever medicine has dealt with your symptoms before you go back to sleep, says Dr Andy Whittamore. This is better than falling asleep straight away only to wake up soon after with asthma symptoms because your reliever didnt help enough.
- Some people find propping themselves up with extra pillows helps as it keeps the airways open.
Heres Why Your Asthma Gets Worse At Night
Having your sleep interrupted is annoying at best and, especially if it happens often, meltdown-inducing at worst. But when you wake up in the middle of a coughing fit or because you feel like youre breathing through a straw, the whole experience can take a terrifying turn.
Unfortunately, thats what some people with asthma have to deal with. It is very common for asthma to get worse at night, pulmonologist Ryan Thomas, M.D., director of the Multidisciplinary Severe Asthma Team at Michigan State University, tells SELF. This phenomenon, which experts sometimes refer to as nocturnal asthma, can make it far too difficult to get the amount of rest you need. It can also be a sign that you need to take steps to subdue your asthma before it gets even worse.
Your airways, which extend between your nose and mouth and your lungs, carry air in and out of your body, according to the National Heart, Lung, and Blood Institute . Pretty key job, huh? But if you have asthma, those airways can get all puffy and inflamed when youre exposed to triggers like animal dander , pollen, mold, cold air, cigarette smoke, exercise, and respiratory infections like the flu, the NHLBI says. That swelling can then cause the muscles around your airways to tighten, and your airways may also expel more mucus than they usually do. The end result is the opposite of breathing easy: You might experience asthma symptoms like wheezing , coughing, shortness of breath, and chest pain or tightness.
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How To Sleep Better With Severe Asthma
In addition to taking asthma medications as prescribed, here are seven steps you can take to lower your chances of having a nighttime asthma attack:
1. Clean your bedroom regularly. Use a vacuum with a high-efficiency particulate air filter to trap mites and their waste and get them out of your bedroom. If your vacuum doesnt have a HEPA filter, you can buy one from an allergy supply company, according to the Asthma and Allergy Foundation of American .
2. Wash your bedding in hot water weekly. Make sure the water is at least 130 degrees Fahrenheit so it will kill dust mites. Finish the job in a hot dryer.
3. Invest in dust-proof mattress and pillow protectors. These zippered covers are woven tightly to keep dust mites out of bedding. You can find them at bedding and housewares stores, the AAFA says.
4. Invest in a humidifier. Cold air is drier and more troublesome for people with severe asthma. Depending on where you live, you might benefit from a humidifier to add moisture to the air in your bedroom in the winter, Bose says. Whats more: Dust mites thrive in low humidity, so boosting humidity by using a humidifier in your bedroom can help keep dust mites at bay.
5. Dont sleep with pets. If you have pets, keep them out of the bedroom so their dander doesnt collect or stick to the carpeting and bedding, Bose says. You may also need to keep the door to your bedroom shut to keep your pet and its dander out.
Care Advice For Asthma Attack
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What Causes An Asthma Attack
An asthma attack can happen when you are exposed to asthma triggers. Your asthma triggers can be very different from someone elses asthma triggers. Know your triggers and learn how to avoid them. Watch out for an attack when you cant avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and infections like flu.
Factors That Contribute To Nocturnal Asthma
The most common reasons asthma is worse at night:
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Exposure to allergens. Bedbugs. Pet dander. Dust mites. All are common in the bedroom, and all can trigger asthma attacks. You probably spend 6 to 9 hours in bed every day thats a long time to be exposed to potential allergens. Some people also experience delayed allergic reactions at night. Its not uncommon for an allergic response to occur 3 to 8 hours after exposure to an allergen. If youre exposed to pollen, for instance, in the early evening, you might experience shortness of breath and wheezing when youre trying to fall asleep.
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Supine position and acid reflux. When we lie down, its easier for stomach acid to travel back up into the esophagus, the tube connecting the mouth and stomach.Instead of being swallowed, some of this fluid can enter the large airways and provoke an irritating cough. Reflux of stomach acid can also cause the airways to constrict, which leads to more difficulty breathing.
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Postnasal drip. People are more susceptible to postnasal drip at night. When you lie flat, its easier for fluid to drip down the back of your throat and cause coughing. Lying down also causes fluid to shift from the legs to the chest, which can lead to increased fluid accumulation in the airway walls and narrowing of the breathing passages.
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Medication timing. If your asthma medication wears off during the night, youre likely to experience nocturnal asthma.
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Does Steam Or Vaporizer Reduce Chances Of An Asthma Attack At Night
Generally, steam or vaporizer can liquefy mucus when breathing problems are caused by an allergy or cold. This can help a person feel better. On the other hand, asthma is caused by chronic inflammation of the airways, making it difficult to breathe. Steam or vaporizer can cause irritations and worsen breathing problems.
Inflammatory Changes At Night
Recent studies examining inflammation in nocturnal asthma have shown that the pattern and location of inflammation in nocturnal asthma are different compared to non-nocturnal asthma. Bronchoalveolar lavage fluid from asthmatic individuals with nocturnal symptoms shows significantly more prominent inflammation in the airways. Nocturnal asthmatic individuals have been shown to have an increase in the total leukocyte count, neutrophils, and eosinophils from 4 pm to 4 am however, cellular components from a non- nocturnal asthma control group did not change. Further analysis showed that between groups, the 4 pm cell differentials were similar however, at 4 am, the nocturnal asthma group had significantly higher total leukocyte, neutrophil, eosinophil, lymphocyte, and epithelial cell counts. This study suggests that the nocturnal worsening of asthma has an associated cellular inflammatory response that is not seen in patients without overnight decrements in lung function.
Inflammation in asthma is typically treated with corticosteroids. Studies suggest that glucocorticoid receptor binding affinity and steroid responsiveness also have circadian variation in subjects with nocturnal asthma. It has been suggested that this may contribute to nocturnal airway inflammation by inhibiting the anti-inflammatory effects of glucocorticoids.
Richard B. Berry MD, in, 2012
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Coughing At Night With Asthma
May 25, 2018
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So, everybody coughs at night when they have asthma, right? I mean, its perfectly normal, right?
Actually, no.
I met a woman with asthma who coughed all night long, all winter long. She and her husband slept in separate rooms in the winter because her coughing was so severe. FYI, thats NOT normal!1
Unless you are sick, you shouldnt be coughing at night. A night cough is one of the red flags of asthma to let you know something is wrong with your asthma. It usually means there is inflammation in your lungs.2
What Happens During An Asthma Flare
During a flare-up, you might have:
- trouble breathing
- a whistling sound when you breathe
- a cough
Flare-ups happen when the airways in the lungs get more irritated and swollen than usual. Your lungs might make a sticky mucus, which clogs the airways. The muscles around the airways will also tighten up, making them really narrow. This clogging and narrowing make it tough to pull air in and push air out.
Some flare-ups are mild, but others are serious. If the flare-up is severe, a person might:
- struggle to breathe or have fast breathing even when sitting still
- not be able to speak more than a few words at a time without pausing
- have retractions while breathing in
Flare-ups can happen suddenly. They also can build up over time, especially if you haven’t been taking your asthma medicine.
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What’s An Asthma Flare
An asthma flare-up is when asthma symptoms get worse, making someone wheeze, cough, or be short of breath. An asthma flare-up can happen even when asthma is controlled.
Asthma flare-ups are also called asthma attacks or exacerbations.
Triggers like allergies, respiratory infections , cigarette smoke, exercise, or even cold air can cause a flare-up and make asthma symptoms worse.
How Is Asthma Prevented And Treated
There is no cure for asthma. Control symptoms by taking asthma medicines and avoiding your triggers. With proper treatment and an asthma management plan, you can reduce your symptoms and enjoy a better quality of life.
Talk to your health care provider about your asthma symptoms and be sure to discuss any changes in your asthma management or status.
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What Is Nocturnal Asthma
Asthma is a long-term, chronic respiratory disease, caused by the inflammation of the airways. When this condition worsens overnight, we call it nocturnal asthma or nighttime asthma. Regardless of the type of asthma you have, including allergic, non-allergic, occupational, and exercise-induced asthma, nocturnal asthma can occur more than once a month.
Over the past decade, the prevalence of asthma in adults and children has increased in the United States. The California Health Interview Survey states that 15.9% of asthma cases were reported in Orange County in 2015-2017. Although there is no cure for asthma, the symptoms can be managed through long-term medications and short-term quick-relief inhalers. A few home remedies and other tips can also help patients with nocturnal asthma sleep better.
How Do I Handle An Asthma Flare
If you feel like a flare-up is about to happen, stay calm. Let people around you know what’s going on. Then remember your asthma action plan. That’s the written plan that tells you what to do next.
Stay calm and focus on what your asthma action plan says. Your doctor probably told you to use your quick-relief medicine, so do that first.
If you can figure out what triggered your symptoms , remove the trigger or yourself from the area. Sometimes that’s all you need to get your asthma under control again.
If a flare-up is more severe, you might need to get help.
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Asthma And Obstructive Sleep Apnea
Obstructive sleep apnea is a disorder in which the airways narrow or collapse during sleep. Asthma and OSA share similar symptoms and appear to have a bidirectional relationship. This means that having one of these respiratory conditions increases the likelihood of being diagnosed with the other. OSA is particularly common in people with asthma who also snore and those with poorly-controlled asthma symptoms.
People with asthma may find it helpful to talk to their doctors about obstructive sleep apnea. Because asthma puts a person at an increased risk of developing OSA, research suggests that periodic evaluations for OSA may help patients with asthma. Fortunately, treating OSA can often reduce asthma symptoms.
Avoiding Nighttime Asthma And Improving Sleep
Asthma can make it challenging to get quality sleep, so its helpful to cultivate habits that support sleep health. Focusing on improving sleep hygiene is a significant first step. By developing a regular sleep schedule and healthy daytime routines, people with asthma can reduce unnecessary daytime fatigue and focus on controlling their asthma symptoms.
Asthma triggers in the bedroom may increase the risk of nocturnal asthma and lost sleep. In addition to working with a doctor to find solutions for reducing or eliminating asthma triggers, below are a few tips specific to designing the ideal bedroom environment and avoiding nighttime asthma:
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Use Both A Humidifier And An Air Purifier
Dry air can worsen asthma symptoms by irritating the throat and nasal passages, and allergens in the air can cause sneezing and morning congestion. Without humidifiers and air purifiers, youre more likely to wake up with a sore throat or post-nasal drip, since the body overproduces mucus to protect passageways from debris. Investing in a humidifier and air purifier means more moisture in the air and less chance of irritation to the nose and throat.
Talk with a healthcare provider first before buying either of these devices. A humidifier can sometimes increase dust mites in the bedroom because it provides an ideal living environment. Air purifiers do balance those out, but some people, depending on the severity of their asthma, may want to avoid humidifiers entirely.
Why Do I Wake Up In The Morning With Asthma
Early morning asthma symptoms may also be a sign that your asthma has been difficult through the night, even if you werent aware of it. Here are some simple steps you can take to stop asthma getting in the way of a good nights sleep. If you have asthma symptoms, sit up and take your reliever inhaler as prescribed.
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Other Tips For Sleeping With Asthma
Other ways to reduce asthma symptoms at night include:
- Cut down on allergens in your bedroom. Consider using an air purifier next to your bed and keep airflow in your room through the night.
- Wash your bedding in hot water every 1-2 weeks to get rid of dust mites and other irritants that may be on your sheets.
- Consider switching to bedding made of natural cotton, as opposed to synthetic polyester depending on your allergies.
- Keep pets off your bed, especially when youre in it.
- Keep asthma medication on your nightstand or another easily accessible place, and take them as directed by your doctor.
- Set the thermostat in your bedroom slightly higher in the evenings. Sleeping in a cold environment can be an asthma trigger.
Why Do Some People Cough At Night
Well, it’s normal to cough at night if you are sick. But if you don’t have a cold, bronchitis, or pneumonia, you shouldn’t be coughing at night. Nocturnal asthma can be caused by a variety of things, such as:3,4
- Allergies
- Laying down
- Changes in the circadian rhythm that can cause hormone changes
- Sinuses draining
- Increased airway resistance due to airways narrowing during sleep
For the last couple of weeks, I have been waking up coughing during the night. This is not like me at all. And I’m not sick, so I shouldn’t be coughing.
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