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Asthma is a respiratory illness that affects over 25 million Americans. It can inhibit breathing, restricting the airflow and causing wheezing, coughing, and shortness of breath. Asthma attacks can be triggered by a variety of factors, such as illness, allergens, smoke, exercise, weather changes, drugs, food, and even laughter. How do sleeping and asthma affect you?
The effects of daytime asthma are well-known, but how does this respiratory disease affect your sleep? Over half of asthma sufferers experience nocturnal asthma, which produces symptoms that worsen at night and cause difficulty sleeping. Individuals with allergic rhinitis or GERD, those who are young, obese, or smoke, and people who live in a city are particularly susceptible to nocturnal asthma.
Finding the causes of – and treatment for – nocturnal asthma is especially important due to its association with an increased risk of death.
Studies have revealed that our body’s optimal airway function occurs around 4:00 in the afternoon. Conversely, the worst functioning of our airways is at 4:00 in the morning, while most people are asleep. During sleep, our airways tend to restrict as resistance develops in both upper and lower airways. Most people continue to sleep without a problem, but for asthmatics, the narrowing airways trigger an episode.
While the causes of nocturnal asthma are still being researched, the following factors could potentially create or worsen the symptoms of asthma, particularly if combined:
Hormones: Our brains produce less epinephrine at night, while secreting more histamines. Epinephrine is a hormone that works to open the airways, but histamines close them. Additionally, there is more mucus and drainage throughout the night, which may block our airways and restrict the flow of air.
Environmental Allergens: Our bodies could be reacting in real-time to allergens in the bedroom, such as dust mites, that may be in our mattress, carpeting, or drapes. Or it’s possible that nocturnal asthma is a delayed response to allergens we’ve encountered earlier in the day. Approximately half of all asthma sufferers have a late phase response to triggers, experiencing effects up to eight hours after the initial trigger exposure.
Stress: Stress on its own can make sleeping difficult. It is also a trigger for asthma, increasing the chance of a nocturnal asthma attack.
Indoor Air: The atmosphere that is most conducive to sleep is cool without being dry. If your bedroom is too warm or too cold, it can interfere with your ability to sleep well. Air conditioning tends to dry the air in your home, which can trigger an attack. Use a humidifier to keep the air cool without having it dry out.
Sleep Position: When we lie down, particularly if we sleep on our backs, our lungs and chest feel more pressure from gravity. The longer we lie in a horizontal position, the greater the effects of drainage, post nasal drip, and accumulated mucus in our airways. These factors, along with decreased lung function, can combine to trigger a nocturnal asthma attack.
GERD: Gastroesophageal reflux disease, or GERD, tends to increase at night. Some asthma medications relax the valve between the esophagus and stomach, allowing stomach acid to enter the trachea, airways, and lungs. This not only irritates the passageways, but can also trigger an asthma attack.
All asthma sufferers, whether they experience nocturnal asthma or not, may have difficulty falling asleep or staying asleep, coupled with lower quality sleep and excessive sleepiness throughout the day. At least a third of asthma sufferers report having insomnia, which may lead to mental health issues such as anxiety or depression. There may also be a link between obstructive sleep apnea and asthma. Asthmatics are 70% more likely to develop sleep apnea and their risk may increase if they don’t follow their asthma treatment.
Individuals with asthma may not be getting enough quality sleep each night due to nocturnal asthma symptoms or sleep apnea. The resulting sleep deprivation may be associated with difficulty focusing, decreased mood, and worsened cognitive functions. Over time, sleep deprivation may cause serious health issues, like obesity, diabetes, and cancer.
While sleeping with asthma may feel overwhelming, there are some things that you can do to help reduce your nighttime symptoms, helping you breathe – and sleep – better.
Always follow your doctor’s orders, including the asthma treatment plan that was laid out for your symptoms. This means taking prescribed medicines and using inhalers as directed, even for attacks in the middle of the night. If you experience nocturnal asthma, ask your doctor if prescription inhaled steroids or bronchodilator inhalers are right for you. You may also wish to discuss the possibility of a sleep study to rule out sleep apnea.
Stress can affect your sleep patterns and potentially causing nocturnal asthma. It’s important that you take steps towards reducing your stress levels to help lower the quantity or severity of nocturnal asthma attacks.
Relaxation techniques, like yoga or meditation, can help you relieve stress. Some individuals turn to prayer or write down problems as a method of releasing issues and managing the associated tension. A calming nighttime routine will also help soothe you and prepare you for sleep. Take a bath, drink a cup of caffeine-free tea, listen to music, or read a book. Shut off all electronics at least an hour before bed. Watching TV or scrolling through social media on your phone before bed is not conducive to a good night’s sleep.
If your stress is related to anxiety or depression, meet with your doctor to see if medication or counseling could help improve your situation.
A healthy diet and proper exercise plan is the ideal solution for many medical issues. As obesity contributes to nocturnal asthma, working to lose weight and improve your overall health can help alleviate nighttime breathing issues. Plan your exercise routine for the morning or early afternoon, as it will energize you. Choose healthy foods for nighttime snacking, like yogurt, nuts, or leafy greens rather than sugary or fatty alternatives, which can disrupt your sleep.
Reduce the amount of alcohol or caffeine that you consume. Coffee and similar drinks will affect your sleep, as most people know. However, what many people don’t know is that while alcohol may help you fall asleep, it interferes with a good night’s sleep. Alcohol can also relax your airways, narrowing them and affecting snoring, sleep apnea, and nocturnal asthma. If you smoke, you should try to quit. Cigarettes not only disrupt sleep, they are also a trigger for asthma attacks.
If you have asthma, you should be especially attentive to managing other medical conditions which could interfere with your sleep.
If you’ve been diagnosed with GERD, be sure to take your medication as prescribed. You’ll be less likely to experience nocturnal asthma symptoms if your GERD is under control. It might also be a good idea to get some support pillows or even purchase an adjustable bed frame so that you can sleep with your head elevated, keeping your airways open.
Use your CPAP machine if you have sleep apnea to help regulate your breathing by opening your airways while you sleep, potentially reducing your asthma symptoms in the process.
The bedroom may be home to numerous allergens which are affecting the severity of your nocturnal asthma symptoms. Pet dander is a common asthma trigger, so it’s recommended that you keep your pet out of your bedroom, regardless of whether or not you are allergic to the dander.
Focus on regularly removing other allergens, such as dust mites, by regularly sweeping, dusting, and washing your bedding. Get a HEPA filter to help clear your bedroom air of additional allergens which may worsen your nighttime asthma.
In addition to regularly cleaning your sheets and blankets, you should also protect against dust mites with hypoallergenic bedding options. Latex options are available as pillows, mattress toppers, or mattresses. All-latex bedding is made with organic materials and are naturally 100% hypoallergenic and antimicrobial, so they don’t get dust mites or bed bugs and tend to last longer than regular mattresses.
Asthma makes day to day living difficult, but with nocturnal asthma, you may also have difficulty sleeping as well. Understanding your triggers is an important step in improving your symptoms, but simply following good sleep etiquette will help.
Keep your room cool, dark, and comfortable and allow yourself time to wind down before bed by avoiding strenuous activity, heavy foods, or electronics with bright screens. Soon you will find yourself breathing easy and sleeping soundly throughout the night.