Why Is My Asthma Worse at Night?

What Is Asthma?

Asthma is an inflammatory condition of the airways, which, in turn, results in excess production of mucus. Asthma leads to difficulty breathing, and one’s daily routine and physical activities can become challenging or even impossible. It is a chronic condition that requires medical attention. Unfortunately, there is no definitive cure for this condition; however, it can be managed.

What Are the Symptoms of Asthma?

The common symptoms of asthma include,

• Coughing.

• Shortness of breath.

• Tightness in the chest.

• Difficulty in talking.

• Fatigue.

• Trouble sleeping.

• Panic.

• Chest pain.

• Frequent infections.

What Are the Causes of Asthma?

The definite causes of asthma are unknown, but genetics and the environment play a role in causing asthma. An asthma attack can happen on exposure to asthma triggers (any activity or object that can worsen asthma symptoms).

The following triggers can precipitate different types of asthma.

1. Allergic Asthma- It is caused by the allergens like,

• Dust mites.

• Molds.

• Pets.

• Pollen.

• Waste from pests like cockroaches and mice.

2. Nonallergic Asthma- It is caused by triggers (not the allergens). Asthma triggers can be different for each person and can change over time.

Triggers can be,

• Inhalation of cold air.

• Some medicines.

• Household chemicals.

• Colds and flu.

• Air pollution.

• Smoking tobacco.

3. Occupational Asthma- Inhalation of chemicals or industrial fumes at work.

4. Exercise-Induced Asthma- Occurs during physical exercise and strainful activities.

Why Does Asthma Get Worse at Night?

Asthma that gets more pronounced at night is nighttime asthma or nocturnal asthma. Nocturnal asthma causes symptoms like chest tightness, shortness of breath, cough, and wheezing at night, creating sleep difficulty at night and irritability during the day. These problems can affect the person’s overall quality of life.

What Factors Increase the Risk of Nocturnal Asthma?

Asthma symptoms are higher during sleep, like nocturnal wheezing, cough, and trouble breathing. The exact cause of nighttime asthma is unknown, but the following factors can be held responsible.

1. Increased Mucus or Sinusitis - During sleep, the airways tend to become narrow, which may cause decreased airflow. This can trigger nighttime coughing, which can cause a further tightening of the airways. Increased drainage from the sinuses can also trigger asthma.

2. Sleeping Position - Lying down on the back may trigger nighttime asthma problems. Many factors can cause this, like accumulation of secretions (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, acid reflux, and increased airway resistance. In addition, sleeping on the back puts pressure on the chest and lungs, making breathing more difficult. However, one must try to sleep in a supine position with extra pillows to elevate their head and shoulders. This helps to keep the airway unblocked and reduce nocturnal asthma symptoms.

3. Air Conditioning - Breathing cold air at night or sleeping in an air‑conditioned room may cause heat loss from the airways. Airway cooling and loss of moisture are essential triggers of nighttime asthma. On the other hand, hot air can cause airways to narrow and thereby cause trouble breathing.

4. Gastroesophageal Reflux Disease (GERD) - The reflux of stomach acid up through the esophagus can initiate a bronchial spasm (airway muscle contraction). It worsens lying down or on the consumption of medications for asthma (that relaxes the valve between the stomach and esophagus). Sometimes, acid from the stomach irritates the lower esophagus and leads to constriction of the airways. If stomach acid backs up to the throat, it may drip down to the trachea and lungs, causing severe reactions like airway irritation, increased mucus production, and airway tightening. Dealing with GERD and asthma with proper prescriptions can help to manage nighttime asthma.

5. Late Phase Response - Exposure to an allergen or asthma trigger increases the chances of airway obstruction or allergic asthma afterward. This acute asthma attack can end within an hour. However, after an immediate reaction to an allergen, people experience the second phase of airway obstruction within three hours to eight hours. This is called the late phase response. The late phase shows an increase in airway responsiveness, the development of bronchial inflammation, and a prolonged period of airway obstruction.

6. Internal Triggers - Asthma can also occur during sleep. For example, asthmatic people who work at night shift may have breathing attacks during the day when they are sleeping.

7. Hormones - The hormones in blood circulation have a well‑characterized circadian rhythm(24-hour internal clock in the brain). Hormones like epinephrine exert important influences on the bronchial tubes. This hormone helps keep the muscle in the bronchial walls relaxed so that the airway remains wide. It also suppresses the release of other substances like histamines (responsible for mucus secretion and bronchospasm). As a result, the epinephrine levels and peak expiratory flow rates are lowest at about 4:00 AM, while histamine levels tend to peak simultaneously. This decrease in epinephrine levels can cause nocturnal asthma during sleep.

How to Manage Asthma at Night?

• There is no definitive cure for asthma at night, but routine asthma medications like inhaled steroids can help in reducing inflammation and preventing nocturnal symptoms. A long-acting bronchodilator or inhaled corticosteroid can effectively prevent bronchospasm and symptoms of asthma.

• For people with GERD, the medication that reduces acid production in the stomach should be taken after consulting doctors.

• Avoiding potential allergy triggers like dust mites, pollens, animal dander, or feathers can help prevent allergies and asthma.

• A peak flow meter can monitor lung function throughout the day and night. After getting the altered pattern of lung function, the doctor can help plan and resolve the nighttime asthma symptoms.

• Other measures to prevent worsening asthma at night include sleeping with a humidifier, not sleeping near pets, controlling the room temperature, meditation and breathing exercises before sleeping, unplugging the electronic devices 30 minutes before sleeping, and changing the sleep position.

Conclusion:

Asthma is a chronic inflammatory condition of the respiratory tract that affects a person’s breathing ability. Environmental and hereditary factors often trigger asthma. It tends to get worse at night due to many factors. Nighttime asthma can lead to poor sleep and fussiness in the daytime. The asthmatic symptoms at night can be managed by proper medication, avoiding allergens or triggers, and making lifestyle changes. The outcome is usually good depending on the severity of asthma. If you are asthmatic, reach out to a healthcare provider to get the best possible solution.