Asthma is a condition in which it becomes difficult for a person to breathe, and it often manifests as coughing, wheezing, and shortness of breath.
Asthma or bronchial asthma is a respiratory condition characterized by reversible airway obstruction or narrowing of the person’s airway (trachea) due to hyperreactivity of the trachea, which might result in excessive production of mucus or may even cause it to swell effectively, leading to difficulty in breathing and shortness of breath. Characteristic features of asthma are wheezing (whistling sounds), difficulty in breathing, coughing, tightness of the chest, chest pain, heaviness or weight on the chest, excess production of mucus, and shortness of breath.
The severity of the disorder varies, as mild symptoms often settle by themselves and pass by with one or two episodes as such. However, as the severity of the disease increases, so does shortness of breath. Decreased saturation levels are a marked feature of severe asthmatic episodes and require emergency treatment, such as oxygen therapy (extra oxygen to breathe in), bronchodilators (medications that help in widening airways and relaxation of lung muscles), and corticosteroids (medications that help in reducing the inflammation). Severe asthmatic episodes cause difficulty in one’s life as it renders the sufferer unable to continue with their lives. Asthma is a complex respiratory syndrome that is treatable yet has proven to be fatal when left untreated and unattended.
Nocturnal asthma, also known as nighttime asthma, is a condition that is characterized by coughing fits, difficulty breathing, shortness of breath, and wheezing, specifically at night during or before sleeping. Nocturnal asthma creates a difficult environment for an individual to sleep in, leading to certain sleeping disorders, eating disorders, and certain other mental health disorders. The symptoms of nocturnal asthma render an individual incapable of sleeping comfortably, leading to difficulty managing their daily life activities. While sleeping or lying down, the airway is obstructed, leading to increased resistance in airflow, which triggers an episode of nocturnal asthma. Increased sinus drainage also plays a role in triggering nocturnal asthma attacks.
Nocturnal asthma does not state that the episode gets triggered at night only; it means that it gets triggered before and during an individual is sleeping. In cases where an individual suffering from bronchial asthma works a night shift and sleeps during the day, the episode will get triggered while the person tries sleeping during the day.
The severity of bronchial asthma and nocturnal asthma is not quite the same; as often noticed and reported, a severe episode of nocturnal asthma can often lead to sleep dyspnea (difficulty in breathing while sleeping) which might result in being fatal and life-threatening.
Common factors triggering an episode of asthma are:
Exposure: When an individual is exposed to an allergen or substances instigating an allergy attack such as dust, mites, animal hair, or other allergens.
Natural Phenomenon: While sitting or relaxing, the chances of an asthma attack increase. When an individual’s body is at rest and their muscle relaxes, their upper respiratory tract relaxes and narrows. This increases the possibility of an asthmatic attack.
Hormones: Many hypotheses have proven that a decrease in the cortisol level also affects the trachea leading it to constrict and hence an asthma attack.
Cold Air: Individual is at risk of being more susceptible to an attack when he or she is exposed to cold air or dry air with less to no moisture.
Not Following a Treatment Plan: Managing the symptoms of asthma and living with asthma is a critical part of everyday life. If the treatment plan is not followed, the symptoms worsen, and the illness tends to be severe.
Trigger factors that instigate an episode of nocturnal asthma are:
Swelling of the airway while sleeping.
Excessive secretion of mucus (due to pathology or hyperactive physiology).
Sleeping posture and positions also trigger an attack.
Individuals suffering from asthma have difficulty breathing and managing the symptoms with their daily routine. However, researchers have suggested that laying down triggers episodes of asthma. It not only disrupts good sleep, but also leads to sleeping disorders that have severe health-related complications. The episode triggered while lying down or sleeping comes under nocturnal asthma. Taking medications such as bronchodilators, oxygen therapy, and corticosteroids have proven to reduce the severity of the episode and reduce the triggering capacity of allergens or pollutants.
Certain sleeping positions have been suggested to ease up the symptoms of asthma, making it easier for an individual to get a good sleep. Some of the positions are:
1. Lying On The Back:
Lying on one’s back with shoulders and neck elevated has proven to be effective in case of a nocturnal asthmatic attack. Elevating one’s neck and shoulders with two to three or more pillows helps open up the airways as we sleep. When sinuses drain more during the night, sleeping with pillows under the shoulders provides better drainage due to gravity, making breathing easier and shortening and avoiding asthmatic attacks.
2. Lying On The Left Side: The Best Sleeping Position For Asthma.
Most people find sleeping on the back uncomfortable and prefer side sleeping. Sleeping on the left side with a pillow wedged between legs is a proven effective way of reducing the chances of nocturnal asthmatic episodes. Not only does side sleeping prevent an episode, but it also helps with gastroesophageal reflux and is commonly known as heartburn which has proven to be a trigger factor in instigating an asthmatic attack.
The physiology behind laying on the left side is that gravity plays a crucial role; as the shape of the stomach and the angle between the stomach and the esophagus is pretty steep, gravity helps alleviate the digestive acid stressing the stomach. Lying on the left side with the head elevated enough to support an individual through an asthmatic attack. If not possible, adding a pillow between the legs often helps, too, as adding the pillow keeps the spine stable throughout the night and improves the posture which proves essential in the long run while supporting the back.
In addition, sleeping on the side prevents the tongue from falling back and moving down into the throat, hindering breathing, proving to be an effective position to sleep on.
3. Lying On Back With Head Elevated:
Often people with shoulder or arm pain have difficulties sleeping on the side (possibly one or even both), and this makes it harder and even cumbersome while sleeping on the side and so lying on the back with an elevated head and keeping the knees bent with a pillow under the knees have proven to be effective in both the cases. The additional pillow under the knees improves circulation and keeps the body stable and comfortable throughout the night.
4. Sitting Position:
As bronchial or nocturnal asthma worsens, the occurrence of episodes increases, and so do complications related to health. Hence, individuals suffering from severe asthmatic attack refrains from lying down and occluding to sitting and sleeping. Some of the different ways an individual can sleep while sitting are:
Resting feet flat on the floor.
Slightly leaning chest forwardly.
Resting our elbows on the knees
Resting the chin on the hand is a way to support the head while relaxing or sleeping.
Relaxing muscles, including both neck and shoulder muscles.
5. Prone Position:
With different positions tried and tested, the prone position has proven to be effective in calming the chest muscles and relaxing the trachea while sleeping in certain cases. The prone position is the patient lying on the stomach. It has proven to be effective as it improves the oxygen saturation of an individual and enhances the functional residual capacity of the lungs. However, sleeping on the stomach can cause some difficulties, too, such as strain in the back and neck, and in worst-case scenarios, the pillow can block the airway and disturb sleep.
Asthma is a chronic respiratory condition that is fatal yet treatable. Treatment for asthma consists of the three basic components: oxygen therapy, bronchodilators, and corticosteroids. Treatment has proven to be effective; however, treatment helps with the severity of the disease, not the onset of an episode. The trigger factors setting up an episode of nocturnal asthma often worsen when an individual is sleeping or trying to sleep, and this is where sleeping positions come in handy. A sleeping position has proven to reduce the severity of an episode.
The best sleeping position for an asthmatic patient has effectively been proven to be sleeping on the left side. Sleeping on the left side increases the airway space and reduces excessive mucus production, and reduces sinus drainage. Opting to sleep in a better position is a proven and effective way to manage an episode of bronchial and nocturnal asthma.
Last reviewed at:
06 Feb 2023 - 6 min read
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