What Is Nocturnal Asthma?

If you wake up at night coughing, wheezing, and feeling breathless, you could have nocturnal asthma. So, what is nocturnal asthma? Also called nighttime asthma, it is the type of asthma that gets worse at night.

It’s not unusual for asthma symptoms to worsen after dark. Even in healthy people, “your best lung function is between noon and 4 p.m.,” said Ileen Gilbert, MD, a pulmonary specialist at Froedtert & The Medical College of Wisconsin. “And it is at its worst between 3 and 4 in the morning.”

One reason for the decline in lung function is your body’s circadian rhythm, or natural clock, which causes hormone production to ebb and flow. During the wee hours of the morning, levels of the hormones that protect against asthma symptoms are at their lowest, Dr. Gilbert explained. If you have asthma, you're more likely to wake up coughing and wheezing as these levels fall.

A sinus infection or postnasal drip could be another cause of nocturnal asthma. When you lie down, nasal secretions can accumulate in your airways and make it harder for you to breathe.

Also, if you have allergies to pet dander, sleeping in the same room as your cat or dog can make your asthma worse at night.

Dust mites lurking in your mattress or bedding could be yet another trigger, said Clifford Bassett, MD, medical director of Allergy & Asthma Care of New York.

Peak Flow Meter for Diagnosis

Peak flow meter measurements are used to diagnose asthma, including nighttime asthma. “A peak flow meter is a handheld device provided to asthma patients as part of their asthma care plan,” said Jameel F. Durrani, MD, of the Regional Lung and Sleep Clinic in Allentown, Pa. “These devices help to compare the severity of airway narrowing or spasm at different times of the day.”

Studies show that anywhere from 30 to 70 percent of patients with asthma tell their doctors about waking up with nighttime asthma symptoms at least once a month. You can have nocturnal asthma regardless of the type of asthma you have – including allergic, nonallergic, occupational, and exercise-induced asthma.

If you have nighttime asthma, chances are it’s because your asthma is poorly controlled. “All asthmatics can get nocturnal asthma if their asthma is out of control,” Gilbert said.

The best way to control nighttime asthma is to control your asthma in general. “If you wake up more than twice a month with asthma symptoms, then you need to be on [long-acting] controller therapy,” Gilbert said. “If you wake up in the middle of the night, you can take your rescue inhaler to ease your symptoms. But that won’t prevent it from happening again.”

“If you’re waking up more than twice a night with cough, wheezing, or chest tightness, then your asthma is poorly controlled and you need to review your asthma treatment plan with your health care provider,” Dr. Durrani added.

Asthma and Sleep

Having difficulty sleeping with asthma can be serious. When you are sleep-deprived, you can be extremely fatigued during the day. “In children this can lead to increased learning difficulties, reduced attention span, and mood swings,” Durrani said. “In adults it can lead to reduced performance at work.” Also, he said, when you’re overtired at work, you’re more prone to accidents.

According to the National Sleep Foundation, people who have nocturnal asthma tend to have more severe asthma, and the more severe your asthma, the greater your risk of death.

Try these tips for getting a good night’s sleep:

  • Use mattress and pillow covers that keep dust mites away.
  • Look for allergy-free pillows.
  • Keep animals (live and stuffed) out of the bedroom.
  • Use a humidifier to keep the air moist.
  • Time your medications and adjust doses so they will continue working throughout the night.

What Isn't Nocturnal Asthma

Some people wake up coughing and wheezing but may not have nighttime asthma. Other conditions that can cause you to wake up coughing and wheezing include: heartburn, gastric reflux, untreated or undiagnosed sleep apnea, heart failure, and abnormalities of the vocal cords, Durrani said. See a sleep specialist to determine what's causing your nighttime asthma and find the treatment that's right for you.

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