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Nocturnal Asthma (Nighttime Asthma)

Nocturnal asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma symptoms.

Nocturnal or nighttime asthma is very serious. It needs a proper asthma diagnosis and effective asthma treatment.

The chances of experiencing asthma symptoms are higher during sleep. Nocturnal wheezing, cough, and trouble breathing are common yet potentially dangerous. Many doctors often underestimate nocturnal asthma or nighttime asthma.

Studies show that most deaths related to asthma symptoms such as wheezing happen at night.

The exact reason that asthma is worse during sleep are not known, but there are explanations that include increased exposure to allergens; cooling of the airways; being in a reclining position; and hormone secretions that follow a circadian pattern. Sleep itself may even cause changes in bronchial function.

Increased Mucus or Sinusitis

During sleep, the airways tend to narrow, which may cause increased airflow resistance. This may trigger nighttime coughing, which can cause more tightening of the airways. Increased drainage from your sinuses can also trigger asthma in highly sensitive airways. Sinusitis with asthma is quite common.

Internal Triggers

Asthma problems may occur during sleep, despite when the sleep period is taking place. People with asthma who work on the night shift may have breathing attacks during the day when they are sleeping. Most research suggests that breathing tests are worse about four to six hours after you fall asleep. This suggests there may be some internal trigger for sleep-related asthma.

Reclining Position

Lying in a reclining position may also predispose you to nighttime asthma problems. Many factors may cause this, such as accumulation of secretions in the airways (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, and increased airway resistance.

Air Conditioning

Breathing colder air at night or sleeping in an air‑conditioned bedroom may also cause loss of heat from the airways. Airway cooling and moisture loss are important triggers of exercise‑induced asthma. They are also implicated in nighttime asthma.

GERD

If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. It's worse when lying down or if you take medications for asthma that relax the valve between the stomach and esophagus. Sometimes, acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. If stomach acid backs up to your throat, it may drip down to the trachea, airways and lungs, leading to a severe reaction. This can involve airway irritation, increased mucus production, and airway tightening. Taking care of GERD and asthma with appropriate medications can often stop nighttime asthma.

Late Phase Response

If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. This acute asthma attack ends within one hour. About 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. This phase is called the late phase response, and it is characterized by an increase in airway responsiveness, development of bronchial inflammation, and a more prolonged period of airway obstruction.

Many studies report that when allergen exposure occurs in the evening instead of in the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity.

Hormones

Hormones that circulate in the blood have well‑characterized circadian rhythms that are seen in everybody. Epinephrine is one such hormone, which exerts important influences on the bronchial tubes. This hormone helps keep the muscle in the walls of bronchi relaxed so the airway remains wide. Epinephrine also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. Your epinephrine levels and peak expiratory flow rates are lowest at about 4:00 a.M., while histamine levels tend to peak at this same time. This decrease in epinephrine levels may predispose you to nocturnal asthma during sleep.

There is no cure for nighttime asthma, but daily asthma medications, such as inhaled steroids, are very effective at reducing inflammation and preventing nocturnal symptoms. Since nocturnal asthma or nighttime asthma may occur anytime during the sleep period, asthma treatment must be sufficient to cover these hours. A long-acting bronchodilator delivered in an asthma inhaler can be effective in preventing bronchospasm and symptoms of asthma. If you suffer from nocturnal asthma, you may also benefit from a long-acting inhaled corticosteroid. If you suffer with GERD and asthma, ask your doctor about medication that reduces acid production in the stomach. Avoidance of potential allergy triggers such as dust mites, animal dander, or feathers in a down comforter may also be very helpful in preventing allergies and asthma and nocturnal asthma attacks.

In addition, using your peak flow meter, you can monitor how your lung function is altered throughout the day and night. Once you notice this altered pattern of lung function, talk with your doctor about a plan to resolve your nighttime asthma symptoms. According to your type of asthma and asthma severity (mild, moderate, or severe), your doctor can prescribe treatment to help you resolve your nighttime asthma symptoms so you can sleep like a baby.

How To Distinguish And Manage Nocturnal Asthma And Sleep Apnoea

When it comes to maintaining our overall health, a good night's sleep is essential. However, many factors can affect sleep quality and quantity.

Both nocturnal asthma and sleep apnoea can affect breathing. These are two chronic respiratory conditions that obstruct airways and cause sleep disruption, which can lead to daytime fatigue and drowsiness. However, the two are not the same and have different causes, symptoms, and treatments. The only shared link between the two conditions is that sleep apnoea can worsen or exacerbate asthma symptoms. So, how do you distinguish the two conditions and manage them separately for better sleep? Here's what an expert has to say.

Also Read: Why Does Winter Worsen Asthma Symptoms? Doctor Shares Tips To Combat

What Is Nocturnal Asthma?

Dr Sanjay Manchanda, Chairperson - Sleep Medicine, Gangaram Hospital, New Delhi, defines asthma as an inflammatory or allergic condition that affects the airways, causing difficulty in breathing out due to the narrowing of the airways.

Nocturnal, or nighttime, asthma is a type of asthma that occurs when a person is sleeping. According to a review article published in the Asian Pacific Journal of Allergy and Immunology, up to 60% of asthma patients are said to suffer from nocturnal asthma.

What Is Sleep Apnoea?

Sleep apnoea is a sleep disorder that causes abrupt interferences in the breathing during sleep. It can be characterised by loud snoring, waking up gasping for air, daytime tiredness even after a full night's sleep, and headaches. Obstructive Sleep Apnoea (OSA) is a common type of sleep apnoea that affects 9-38% of the global adult population, according to a study published in the Sleep Medicine Reviews.

The Link Between Sleep Apnoea And Asthma

According to Dr Manchanda, there isn't a direct correlation between sleep apnoea and nocturnal asthma. However, sleep apnoea can exacerbate asthma.

Breathing through an open mouth during sleep apnoea can cause dryness in the throat and allow bacteria and dry air to irritate the airways, potentially triggering asthma symptoms, the doctor explains.

Also Read: Can Sleep Apnoea Increase The Risk Of Cancer? Doctor Explains

Key Differences Between Nocturnal Asthma And Sleep Apnoea

While asthma and sleep apnoea may have certain similarities, the two conditions are different.

While nocturnal asthma is an inflammatory condition often triggered by allergens, sleep apnoea is a structural issue, where the airways collapse due to anatomical problems like a small or receding jaw, shares Dr Manchanda.

The two conditions are also diagnosed differently. Asthma is diagnosed with lung function tests, whereas sleep apnea is diagnosed with sleep studies, also called polysomnography, that measure breathing patterns during sleep.

Additionally, asthma symptoms include wheezing, coughing, chest tightness, and shortness of breath. However, sleep apnoea can be identified by loud snoring and interruptions in breathing during sleep.

How To Manage Nocturnal Asthma And Sleep Apnoea Separately?

When it comes to nocturnal asthma, Dr Manchande recommends identifying and avoiding known allergens. Starting medication 2-3 weeks before anticipated worsening periods (e.G., seasonal changes) can be beneficial, he adds.

On the other hand, a healthy weight, especially in obese people, can significantly improve sleep apnoea, though it's rarely a complete cure. Other treatments include the use of Continuous Positive Airway Pressure (CPAP), a machine that helps keep airways open, and surgery, in severe cases.

Takeaway

Dr Manchanda emphasises that asthma and sleep apnoea are distinct conditions that require separate diagnoses and management strategies. While sleep apnoea may worsen asthma symptoms, there's no direct relationship between the two. Still, the two conditions need to be managed effectively, especially for long-term respiratory health and better sleep.

Night-Time Asthma Attack: Expert Lists Tips To Prevent It

For individuals with asthma, nighttime can be particularly challenging as the body naturally undergoes changes that can trigger symptoms and lead to nighttime asthma attacks. This includes chest tightness, coughing, wheezing, or shortness of breath. If you are looking for ways to prevent night-time asthma attacks, you have come to the right place. 

We spoke to Dr Kuldeep Kumar Grover, head of critical care and Pulmonology, CK Birla Hospital, Gurugram, who listed tips to help prevent nighttime asthma attacks and improve overall asthma management.

Regular use Of medicine

Dr Grover said that it is important to maintain consistency in taking prescribed asthma medications. Adhering to your prescribed treatment plan will help keep your airways open and minimise the risk of night-time asthma symptoms.

Identify and avoid triggers

Dr Grover said that it is necessary to identify and avoid triggers to avoid worsening your condition. The allergen exposure occurs in the evening instead of the morning. You are more likely to experience a late-phase response and to have one that is more severe. Consider using air purifiers to filter out allergens and keep the air in your bedroom clean.

Also Read: From Easing Asthma To Relieving Period Pain: Expert Lists Benefits of Asafoetida You Must Know

Manage sinusitis

Dr Grover noted that sinusitis can trigger asthma symptoms, therefore, it is important to keep it in check. Increased nasal drainage can potentially promote asthma in very sensitive airways.

Air conditioning

Dr Grover said that breathing cooler air at night or sleeping in an air-conditioned room may also result in heat loss from the airways. This is because cold air is dry and leads to more coughing.

GERD

Dr Grover said that Gastroesophageal Reflux Disease (GERD) and acidity can trigger night-time asthma attacks. Acid from the stomach can irritate the lower oesophagus and cause airway obstruction. If stomach acid backs up into your throat, it could seep down into your trachea, airways, and lungs, causing a serious reaction. Therefore, take medications to manage GERD and avoid eating spicy food at night.

Hormones

Another factor that can trigger night-time asthma attacks is your hormones. The hormone epinephrine inhibits the release of other chemicals like histamines that result in mucus secretion and bronchospasm.

Also Read: 7 Morning Rituals You Should Practice To Balance Your Hormones

Practise good sleep hygiene

Establishing a regular sleep routine can positively impact your asthma symptoms. By going to bed and waking up at the same time each day, you can maintain a regular sleep routine.

Exercise regularly

Engaging in regular physical activity can strengthen your respiratory muscles and improve overall lung function. However, avoiding exercising too close to bedtime can trigger symptoms and disrupt sleep. 

Create a bedroom conducive to good sleep

Creating a sleep-friendly environment can help promote better sleep and minimise asthma symptoms at night. Keep your bedroom well-ventilated, maintain a comfortable temperature, and ensure proper humidity levels. To get rid of house dust mites, wash bed linens regularly at a high temperature.

Drink water

You should keep water near your bed and sip some water when you notice the symptoms. Moisture will relax the airways and help you stop coughing at night.

Disclaimer

The information in this article is provided by an expert, however, we advise you to consult your expert for a treatment based on your body type and medical history.

Disclaimer

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