Nocturnal asthma, which causes symptoms to worsen at night, can lead to daytime sleepiness and fatigue and is potentially life-threatening. The causes are unknown, but physiological phenomena such as decreased levels of natural bronchodilators and hormones may contribute. Treatment involves medication and reducing allergens in the sleeping environment.
People with asthma often find that their symptoms get worse at night. Asthma symptoms such as chest tightness, difficulty breathing, coughing and wheezing interfere with sleep at night and can cause daytime sleepiness and fatigue. Nocturnal asthma also makes it more difficult to control daytime asthma symptoms. Nocturnal asthma attacks are potentially life-threatening, and studies indicate that asthma-related deaths are more likely at night than during the day.
Nocturnal asthma is associated with several physiological phenomena. Nocturnal levels of nitric oxide, as well as some cell receptors, decrease at night, resulting in reduced availability of natural bronchodilators. Nocturnal asthma is also associated with low levels of melatonin, as well as low levels of hormones such as adrenaline, which helps keep the airways relaxed.
While these associations are well established, the causes of nocturnal asthma attacks and the reasons why asthma symptoms worsen at night remain unknown. There are several possible explanations. One is that due to the physiological phenomena mentioned earlier, the airways are more likely to narrow during the night. Another possible trigger is that nasal and lung secretions are more likely to accumulate in the airways and lungs during the night. Decreased lung volume and increased pulmonary pressure due to lying down may lead to increased airway constriction. Loss of moisture and heat in the airways is also thought to trigger nocturnal asthma.
People are more likely to have asthma attacks at night if they also have gastroesophageal reflux. This condition can exacerbate nocturnal asthma symptoms, because regurgitated stomach acid sometimes seeps into the windpipe, causing irritation and constriction of the airways. People who suffer from both asthma and gastroesophageal reflux often find that their nocturnal asthma symptoms lessen in severity or disappear altogether when their reflux is treated effectively.
Treating asthma at night cannot cure the condition, but it can help reduce the frequency and severity of nocturnal asthma attacks. Typical treatment involves tighter control of both day and nighttime asthma symptoms with medication. Long-acting medications are the most effective, as they continue to provide anti-inflammatory effects while you sleep.
Reducing the allergenic potential of the sleeping environment can also help prevent nocturnal asthma. Keeping your bedroom free of dust, pet hair, pet dander, and other known asthma triggers can reduce nighttime symptoms. It can also be helpful to change the temperature or moisture content of the air if it is too dry or too cold.
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