Symptoms That Get Worse at Night

How Sleep Problems Make Asthma Worse

Asthma symptoms can worsen at night if you have sleep-disrupting problems such as snoring and sleep apnea. Find out how to address health issues that can be robbing you of a good night's sleep.

By Katherine Lee

Medically reviewed by Pat F. Bass III, MD, MPH

Asthma attacks may cause you to miss school and work, but asthma can also put you at risk for a more basic problem — getting enough sleep.

“Asthmatics frequently have trouble at night,” says Stanley Fineman, MD, an allergist with the Atlanta Allergy and Asthma Clinic, in Georgia.

Studies have shown a link between asthma and sleep problems such as snoring and obstructive sleep apnea, as well as such sleep-robbing symptoms as coughing, wheezing, and breathing issues. Addressing these challenges can help you get more and better sleep — and possibly improve your asthma symptoms.

What’s Keeping You Awake?

Certain factors in particular can worsen or trigger asthma symptoms at night, including:
Increase in airway resistance. One of the normal changes in the body’s nighttime biological rhythm is a natural increase in inflammation of breathing passages. “Airways tend to have more spasms at night due to normal hormonal fluctuations,” says Dr. Fineman. “They tend to be more open in the afternoon and then more closed at nighttime.”
Decrease in airway function. Another bodily function that is affected by the body’s biological clock or circadian rhythm is how well the airway works. “Respiratory drive goes down at night,” says Todd Rambasek, MD, an adult and pediatric allergist at ENT and Allergy Health Services, in Cleveland, Ohio. That means that the body has to work harder to breathe to make up for the decreased airflow.
Decrease in the body’s natural steroids. “Internal natural steroid production goes down at night,” says Fineman. People who do not have asthma may not be affected by that natural decrease in steroids, which are powerful anti-inflammatory agents, but it can have consequences for people with asthma. Asthma occurs when the airways become inflamed, making breathing difficult. When the levels of the natural steroids decrease, the risk for airway inflammation goes up.
Congestion. A stuffy nose can make sleep apnea and snoring worse and can exacerbate asthma symptoms.
Allergens in the bedroom. Pet dander, dust mites, and other allergens may be the cause of asthma symptoms.


When a Medical Condition Is To Blame


Certain disorders can also make it even harder for people with asthma to sleep well:
Sleep apnea. Sleep apnea is a sleep disorder in which people stop breathing for periods of time and fail to get enough air into the lungs. Sleep apnea leads to increased inflammation in the bronchial tubes, which leads to asthma symptoms.
GERD. One of the more surprising asthma triggers is gastroesophageal reflux disease, or GERD. “Reflux is a big trigger for asthma,” says Dr. Rambasek. “It tends to get worse at night.” Here’s how the conditions are related: The esophagus and lungs have the same nerve supply, similar to the way nerves connect the heart to the arms, says Rambasek. “If the acid gets high enough, it can go right into the windpipe and into the lungs, triggering asthma symptoms.”
Obesity. Being overweight can also increase the risk for sleep apnea, which leads to fatigue and lethargy in the daytime and contributes to decreased activity and exercise. Lack of exercise contributes to obesity, creating an unhealthy cycle of obesity, sleep apnea, and asthma.


How to Get a Better Night’s Sleep


Taking these steps to control your asthma and its triggers can translate to more restful sleep:
Pinpoint the trigger. “Find out what is triggering your asthma,” says Fineman. “If it’s dust mites, take precautions. For pet dander, do not have animals in your bedroom. For pollen, wash your hair and change clothes when you come inside, keep windows closed, and so on.”
Be vigilant about asthma medications. “Take asthma controller medications regularly and as directed,” says Rambasek. If you have sleep problems that are causing asthma, it is especially important to take your control medications to reduce inflammation in airways during the night.
Take steps to prevent GERD. “To prevent reflux, elevate the head of your bed and avoid late night meals and alcohol,” says Rambasek.


While sleep problems do not affect everyone with asthma, if they’re getting between you and your needed forty winks, work with your doctor to find solutions that will bring you sweet dreams.


Learn more in the Everyday Health Asthma Center.