Why Is My Asthma Worse at Night?

When it’s time for bed, the last thing you want to worry about is an asthma attack. Unfortunately, asthma can — and often does — flare up at night. This condition, known as nocturnal asthma, can affect adults and children alike.

Why does asthma sometimes get worse at night, and how can you get relief? Pulmonologist Emily Pennington, MD, explains nocturnal asthma and how you can learn to manage it.

What is nocturnal asthma?

Asthma is a chronic condition that causes inflammation and narrowing of the airways in your lungs. When someone with asthma is exposed to a trigger like an allergen or a strong odor, they can have an asthma attack.

“An asthma attack can cause wheezing and difficulty breathing, so it’s often very stressful,” says Dr. Pennington. “Asthma attacks can be life-threatening in severe cases.”

Nocturnal asthma means you have asthma attacks at night.

“It’s an asthma attack when you’re asleep or early in the morning,” she clarifies. “And it’s a common occurrence. More than half of adults and a third of children with asthma have nighttime attacks.”

Nocturnal asthma symptoms

Nocturnal asthma usually feels like daytime asthma, except the symptoms wake you up at night. You might experience:

• Coughing
• Wheezing
• Shortness of breath or trouble breathing

Regular nocturnal asthma attacks will tire you out, too, because they can disrupt your sleep cycle.

“Children with nocturnal asthma may have daytime sleepiness or behavior changes due to lack of sleep,” says Dr. Pennington. “Adults may feel groggy or have low energy.”

What causes nocturnal asthma?

It seems like resting should improve asthma symptoms, not make them worse. But the causes of asthma attacks are complex.

“Certain things happen when you’re sleeping that can lead to an asthma attack,” Dr. Pennington says.

Your asthma might get worse at night because of the following triggers.

Allergens

If dust triggers your asthma, your bedroom could be making things worse. “Beds, pillows and blankets can be major sources of dust mites,” relays Dr. Pennington. “Many people are exposed to high dust levels in their bedroom and don’t realize it.”

Acid reflux

If you have acid reflux or gastroesophageal reflux disease (GERD), lying down can make it worse. The regurgitation of stomach acid isn’t just painful — it might also worsen asthma.

“GERD and asthma have a complex relationship,” says Dr. Pennington. “It’s possible that GERD can make asthma worse.”

Hormonal changes

Your body’s hormones, or chemical messengers, are in a constant state of flux. As hormones naturally shift throughout the night, your asthma can flare up.

“When you sleep, epinephrine levels decrease,” Dr. Pennington explains. “Epinephrine helps fight inflammation in your airways.”

Cortisol also dips when you’re sleeping. “Some evidence suggests cortisol could help keep your airways open, but the link between cortisol and asthma is complex,” she continues.

It’s also possible that melatonin, the hormone that tells your body to sleep, could make asthma worse in some people.

“Research is mixed on how melatonin affects people with asthma,” she notes. “Higher levels of melatonin could decrease lung function enough to trigger an asthma attack.”

Sleeping position

If you’re living with asthma, some sleeping positions may feel uncomfortable. Your sleep directly impacts your overall health, so if you’re having trouble sleeping, try making certain modifications.

“Some people benefit from using a wedge-shaped pillow to prop up their upper body, which could help with reflux symptoms and make it easier to breathe,” shares Dr. Pennington.

How is nocturnal asthma diagnosed?

There’s no specific test for nocturnal asthma. The tests to diagnose it are the same as those for daytime asthma and include:

• Physical exams
• Discussions of your symptoms and medical history
• Imaging tests, like a chest X-ray
• Lung function tests, including spirometry

“Most of the time, nocturnal asthma doesn’t occur on its own,” says Dr. Pennington. “People with nighttime attacks will usually also have daytime attacks. Your provider may diagnose you with nocturnal asthma if you have a nighttime attack at least once a week.”

Children may not always tell you if they have a nighttime attack, especially if it’s a mild one.

“Tell your child’s provider if you notice tiredness or other changes in your child’s behavior,” she adds. “These could be clues that asthma is interfering with your child’s sleep.”

Can you develop nocturnal asthma?

It’s possible to develop nocturnal asthma after you’ve had daytime asthma for months or years.

“Hormone levels, environmental exposures and triggers can change over time, leading to new nighttime attacks,” states Dr. Pennington. “Managing your asthma is the best way to prevent this from happening.”

Nocturnal asthma treatment

Treating any type of asthma is a two-step approach: management and rescue. Nocturnal asthma is usually a sign that you need a different medication.

“Regular nighttime attacks usually don’t occur if asthma is well-controlled,” Dr. Pennington says.

There are several different asthma medications, so your provider will determine the type and dose you need.

“Your provider may change your dosage or switch medications to help decrease nighttime asthma attacks,” she continues. “Take your medications every day, even when you feel well.”

You also need a rescue inhaler, which you use when you feel an asthma attack coming on.

“Keep your rescue inhaler next to your bed so you can quickly use it if you have a nighttime attack,” she advises.

Management is key

Nocturnal asthma can be stressful — and deprives you of much-needed sleep. But you don’t have to face it alone.

“We have many effective medications available to treat asthma,” reassures Dr. Pennington. “With the right medical care, most people can manage their asthma symptoms.”

See your provider regularly and be open about your asthma symptoms.

“We want to know how your plan is working, so be honest about how many attacks you have,” she encourages. “We’re here to help you find the treatment that will help you feel your best — day and night.”