Nocturnal Asthma: Symptoms, Causes, Diagnosis, And Treatment

Approximately 25 million,¹ or 1 in 13, Americans suffer from asthma, which is caused by inflammation in the lungs and airways. Asthma makes it difficult to breathe, and it can also lead to wheezing and tightness in the chest. It can be a serious condition, but there are many treatment options that can keep attacks at bay.

What if you have asthma and you notice your symptoms more at night? You may have what is known as nocturnal asthma, and a high percentage of people who have asthma also struggle with it. Learn more about what nocturnal asthma is, its causes, treatment options, and more below. 

What is nocturnal asthma?

Nocturnal asthma is a type of asthma that shows more severe symptoms during nighttime and sleep. Many people with asthma may or may not experience noticeable symptoms throughout the day but suddenly suffer from wheezing and trouble breathing when they lay down to sleep at night. 

Although having difficulty breathing at night is frustrating enough, nocturnal asthma can prevent people from getting adequate sleep, which can affect their concentration and performance at work or school. 

Nocturnal asthma shouldn’t be taken lightly, as it can have significant impacts on everyday life. It can also cause more severe attacks and asthma-related deaths. Fortunately, keeping asthma well-controlled and making certain lifestyle changes can keep nocturnal asthma and its risks to a minimum. 

Symptoms of nocturnal asthma

Nocturnal asthma produces symptoms that are similar to regular asthma, but they occur at night. In both adults and children, some common nocturnal asthma symptoms include:

• Wheezing

• Shortness of breath

• Unproductive cough

• Chest tightness

• Increased daytime asthma attacks

• Daytime sleepiness

• Difficulty concentrating

If you have not yet been diagnosed with asthma, but you suffer from some or all of the above symptoms, consult your doctor to see whether asthma is causing your symptoms or if you are suffering from another condition that impacts your ability to breathe. 

Once you receive an asthma diagnosis, your doctor can recommend treatment options to help keep your symptoms under control. 

Causes of nocturnal asthma

Although the exact cause of worsened asthma symptoms during sleep for some individuals is not yet understood, there are some possible explanations that may contribute to the presence of symptoms at night. 

One explanation² for nocturnal asthma is that a lying position, especially on your side or front, may restrict the airways more than sitting or standing, while another is that lung function changes during sleep. 

Still another explanation is that you go through hormonal changes while you sleep, which could impact your airways. Some people may experience increased asthma symptoms at night, too, due to dust mites, allergens, and other triggers. 

Perhaps the cause of nocturnal asthma is one of the above possible explanations, or maybe it’s a mix of all three. Either way, there are some risk factors that can increase your risk of developing nocturnal asthma, such as:

• Smoking or being exposed to cigarette smoke secondhand

• Having acid reflux

• Suffering from obstructive sleep apnea

• Having rhinitis or sinusitis

• Being overweight

If you have any of the above risk factors, that doesn’t necessarily mean that you will develop nocturnal asthma. It simply means that you have a higher chance of suffering from the condition. Knowing this, you can make positive lifestyle changes to prevent the development of nocturnal asthma or lessen your symptoms if you already have it. 

Diagnosis

There are various ways that doctors test your lung function and come to a diagnosis of asthma. Here are the two most common diagnostic tests:

Peak flow

A peak flow test³ involves breathing forcefully into a tube to determine how much air you can breathe out and how quickly you can breathe it out.  

If your peak flow score is lower than normal, it may indicate that your airways are narrowed or that your lung function is not where it should be. A peak flow test can be done in the doctor’s office as diagnosis criteria, and you can also have a peak flow meter to use at home to check your lung function throughout the day. 

Your doctor can explain how to use a peak flow test to measure your breathing at home if they recommend using it regularly at home.  

Spirometry

Your doctor may also recommend a spirometry test,⁴ which measures how much air you can inhale and exhale and also how quickly you can release air from your lungs. It involves you breathing into a tube that is connected to a machine, which gives your doctor measurements of your breathing. It can be used to diagnose asthma as well as COPD and other respiratory conditions. 

If, after undergoing the tests your doctor orders, you are given a diagnosis of asthma, your doctor will go over treatment options to try to keep your daytime and nighttime symptoms under control. It may take trial and error to find the treatment plan that works best for you, and it helps to stick with the treatment plan consistently for the best results.  

Management and treatment

Although there is no cure for asthma, there are plenty of treatment options that can help reduce or alleviate your asthma symptoms, such as:

Long-term medications

Long-term asthma medications are taken regularly to control chronic asthma symptoms. These may include corticosteroids, theophylline, long-acting beta-agonists, and combination inhalers. 

If your doctor prescribes you long-term medications to keep your asthma under control, take them consistently for the best results. These types of medications may help reduce nighttime asthma symptoms as well as those you may experience during the day. 

Quick-relief medications

Quick-relief medications for asthma may include short-acting beta-agonists, which work to relax your airway muscles and keep them open to let more air inside of your lungs with each breath within a matter of minutes. New guidelines recommend using combination inhalers⁵ for those over six years old or in adults to treat asthma flare-ups in place of the short-acting beta-agonist. 

If your asthma attack does not improve with inhalers, your doctor may prescribe oral steroids to help during prolonged or severe flare-ups. It’s important to have quick-relief medications on hand in case of a flare-up, and many find it helpful to keep their quick-relief medications on their nightstand in case they have an asthma attack at night. 

Quitting smoking

Smoking can negatively impact your lungs and airways, and quitting the habit can help you feel better and get more sleep. 

Quitting smoking isn’t easy, but your doctor may be able to recommend a smoking cessation program or medication that can help you quit for good. Many people use smoking as a way to cope with stressors, so you may also find it helpful to seek counseling to discover other ways of coping with difficult emotions.

Quitting smoking may also reduce the symptoms your family members feel if they also suffer from asthma. 

Maintaining a healthy weight

Being overweight is a risk factor for both asthma and nocturnal asthma, but you can reduce your symptoms by making various lifestyle changes to reduce your weight over time. This may be due to the fact that fat tissue tends to facilitate inflammation throughout the body, which may impact your asthma symptoms. 

Weight loss isn’t easy, and asthma can make it more difficult to integrate physical activity into your day, but it can improve your body’s ability to manage your asthma symptoms day or night. 

You may also want to try an asthma-friendly diet,⁶ which is high in fruits, vegetables, and vitamin D, while staying low in allergy-triggering foods.

Leukotriene Receptor Antagonists

Leukotriene receptor antagonists⁷ (LTRAs) are a class of medications that can treat chronic asthma by reducing the amount of inflammation produced in the body due to the presence of leukotrienes. These medications can also reduce the amount of swelling in the airways and prevent excess mucus production, which can both make it more difficult to breathe. 

LTRAs usually come in the form of tablets, and they can also help with rhinitis. If your other treatment options have not worked to curb your asthma so far, your doctor may prescribe an LTRA. Remember to take these medications consistently for the best results. 

How to prevent nighttime asthma

Besides taking the medications your doctor prescribes and undergoing the above lifestyle changes, there are a few additional simple actions you can take to prevent nocturnal asthma from occurring.

Adhere to your daytime asthma treatment plan

One of the best ways to prevent nocturnal asthma is to keep your asthma well managed during the day. Having poorly controlled daytime asthma can increase your risk of suffering from nocturnal asthma too. If your current asthma treatment plan doesn’t seem to be working well, make an appointment to talk to your doctor about other possible solutions. 

If your nighttime asthma may be caused by allergic rhinitis, getting that under control can greatly reduce your nocturnal asthma symptoms. Allergic rhinitis can also be caused by pet dander and other allergens, and it can be treated by your doctor with medications. 

Keep your room at a comfortable temperature

Cold air can sometimes make asthma symptoms worse, so keeping your bedroom at a comfortable temperature at night may help reduce your nocturnal asthma symptoms. If you notice that your air conditioner seems to be making your symptoms worse, avoid having it on throughout the night if possible. 

Avoid cigarette smoke exposure

Cigarette smoke can worsen asthma symptoms at any time of day, even if you are only exposed to secondhand smoke. Quit smoking, or avoid exposure to cigarette smoke as much as possible. Ask others not to smoke in your home or car, too, and keep your distance from smokers in public spaces. 

Reduce allergens in the bedroom

Allergens, like dust, pollen, or pet dander, commonly trigger asthma symptoms, so keeping allergens to a minimum in your bedroom may help reduce your nocturnal symptoms. 

You can do this by keeping pets out of your bedroom, washing your bedding in hot water regularly, and investing in an air purifier. Avoiding bedding made from feathers may also help with nocturnal asthma symptoms. 

Keep your inhaler handy

Fast-acting inhalers⁸ can reduce inflammation in the airways and lungs quickly, helping you breathe easier within minutes. If you wake up suddenly from an asthma attack in the middle of the night, it would be helpful to have your inhaler right by your side to avoid a frantic search for it while you struggle to breathe. 

These solutions may not work for everyone, but they may help reduce the severity or the frequency of your symptoms.

When to visit a doctor?

You should make an appointment to talk with your doctor if your nocturnal asthma frequently interferes with your sleep or if your daytime asthma seems to be poorly controlled. Your doctor may have to change your treatment plan, or they may offer additional tips that have worked for other patients to prevent asthma attacks during the day and night. 

You should also visit a doctor if you have not yet been diagnosed with asthma but you experience many of the symptoms listed above. Difficulty breathing and chest tightening are common symptoms, but they may also indicate other medical conditions that require other forms of treatment. 

It also never hurts to reach out to your doctor with questions about side effects from medications or concerns about recent changes in your asthma symptoms. 

The lowdown

Asthma can make your everyday life more difficult, especially when it also interferes with your ability to get a decent night of sleep. There are some lifestyle changes you can make to address your symptoms, and your doctor may be able to recommend various treatment options as well to keep your symptoms under control. 

If you or a loved one suffers from nocturnal asthma, following the above tips and lifestyle changes may help you feel and breathe better.