Asthma is a chronic lung condition affecting people of all ages. People with nocturnal asthma experience asthma symptoms at night which may disrupt their sleep.

Some figures suggest that around 60% of people who have continuous asthma experience nocturnal symptoms at some point, and approximately 30-70% of patients with asthma report nocturnal asthma symptoms at least once a month. Common symptoms include wheezing and shortness of breath.

Although the cause of nocturnal asthma is unknown, it may be linked to neurohormonal changes in a person’s body at night.

This article looks at the causes, symptoms, and treatments of nocturnal asthma.

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Asthma is a condition that causes continuously inflamed airways. Even minor triggers and allergens can cause those airways to constrict.

Nocturnal asthma means that a person’s asthma symptoms worsen at night. This can negatively affect sleep quality.

Sometimes, the emergence of nocturnal asthma means a person has severe asthma, or poor control over their symptoms. They may have worsening lung function and increased airway sensitivity.

A healthy individual’s lung function varies throughout the day. According to one study, peak lung function occurs at 4 p.m., while minimal lung function occurs at 4 a.m.

Doctors can determine if someone has nocturnal asthma by looking at their changes in lung function. By using a simple device called a peak expiratory flow (PEF) meter, a person can take measurements of airflow during the day and at night. PEF is typically first thing in the morning and again before bed. However, it is also useful for a person to take their PEF measurements if they wake up during the night.

If the difference between the measurements is greater than 15%, the individual likely has nocturnal asthma. It is important to note that even if a person does not have PEF variability, they may still have nocturnal asthma.

While doctors do not fully understand why some people’s asthma worsens at night, some think it may be linked to neurohormonal changes.

Hormones, such as cortisol, epinephrine, and melatonin, all have circadian rhythms, which are the body’s internal 24-hour cycles. The levels of these hormones fluctuate on a nightly basis, which can cause inflammation in the airways, increasing the risk of nocturnal asthma symptoms.

According to the American Lung Association (ALA), hormonal changes that occur during pregnancy can also influence asthma symptoms.

Some individuals experience insomnia during pregnancy. A lack of sleep causes inflammation in the body and affects lung function, increasing the chance of an asthma attack. Individuals who get less than 6 hours of sleep every night have 1.5 times more asthma attacks than those who get the recommended 7 to 9 hours of sleep.

Obesity is another factor that increases the risk of nocturnal asthma. Doctors do not fully understand the connection between obesity and asthma, but excess fat around the throat and general inflammation in the body may increase the risk.

Some general triggers for nocturnal asthma include:

  • bedroom allergens like dust mites, pet hair, or mold
  • lying face up
  • cold air
  • dry throat
  • other medical issues

Symptoms of nocturnal asthma are generally the same as for regular asthma. The key difference is that they become worse at night. Symptoms include:

  • coughing
  • wheezing
  • shortness of breath

The above symptoms disrupt an individual’s sleep, which can cause issues during the day. Those issues include:

  • daytime sleepiness
  • lack of concentration
  • worsened daytime asthma symptoms

According to the World Health Organization (WHO), asthma is more common in children than adults. It is the most common chronic disease diagnosed in children.

Learn more about childhood asthma here.

The negative effects of nocturnal asthma can worsen behavioral and developmental difficulties in children. Because of this, it is important that doctors diagnose and treat nocturnal asthma in children accurately.

Nocturnal asthma often goes undiagnosed in children because they tend to conceal or downplay their symptoms. Parents should monitor their children for symptoms such as wheezing, daytime sleepiness, disturbed sleeping, and difficulty concentrating in school.

Doctors usually diagnose nocturnal asthma with at-home testing, such as the PEF meter discussed above. If the doctor suspects obstructive sleep apnea, a condition where an individual stops breathing for brief periods of time during their sleep, then the doctor may order polysomnography (PSG). This is a sleep study that takes place in a laboratory setting.

Individuals should talk with a doctor, allergist, or pulmonologist, which is a respiratory specialist, for advice and treatment options. Those professionals can assist in creating an asthma action plan to control and treat symptoms as they appear.

The main treatment goals are finding an effective medication and reducing exposure to allergens. The ALA recommends people with asthma visit a doctor annually to review and potentially revise their asthma treatment plan.

It is also important that people address any underlying disease that can make nocturnal asthma worse, such as rhinosinusitis, heartburn, and sleep apnea.

People with infrequent nocturnal asthma symptoms can use a short-acting, inhaled beta agonist medication for quick relief of symptoms.

For people who have nocturnal asthma symptoms one or more times a week, treatment will look similar to normal asthma treatment, and it is tailored to the severity of a person’s asthma.

Once a medical professional has determined the severity, they will prescribe medications progressively, keeping inhaled corticosteroids as the foundation of treatment. They may also add a long-acting beta agonist (LABA) if inhaled corticosteroids aren’t sufficient.

Quick-relief medications

Fast-acting drugs control asthma attacks as they happen. Generally these medications are known as short-acting beta agonists (SABA). A person inhales these medications and they reduce symptoms by relaxing the muscles around the airways.

Long-term medications

Other medications do not provide quick relief but aim to control a person’s asthma. They reduce the severity and frequency of future asthma attacks.

The types of medications someone may use include:

  • Inhaled corticosteroids: These reduce airway swelling and mucus. These medications are the foundation of asthma therapy
  • Inhaled long-acting beta agonists (LABA): These work by relaxing the muscles around the airways.
  • Agents affecting leukotriene synthesis or action: These oral agents are typically used as add-on therapy in patients who don’t get enough relief from the previous two medications.
  • Oral corticosteroids: These are for people with severe asthma that doesn’t respond to other treatments. Oral corticosteroids, generally in the form of pills, have many side effects and are only prescribed long-term as a last resort.

Learn more about over-the-counter inhalers here.

Remedies and lifestyle factors

Although medications can help control and treat symptoms, they are just one part of an effective treatment plan. A person should identify triggers and avoid them to help prevent future asthma attacks.

Physical activity helps to reduce the frequency and severity of nocturnal symptoms, which improves nocturnal asthma in both children and adults.

Learn more about home remedies for asthma here.

Asthma is very common and affects about 1 in 12 individuals in the United States. People with the condition have a lot of treatment and support options.

People with nocturnal asthma should be on the lookout for signs of other related conditions, such as acid reflux and obstructive sleep apnea (OSA). These conditions have a bidirectional relationship with nocturnal asthma, which means that having one condition increases the chance of having the other.

As many as 80% of those with asthma also experience acid reflux.

Some related conditions can be hard to spot. For example, nocturnal asthma and OSA have many of the same symptoms. If an individual thinks they may have OSA, they should contact their doctor.

Managing nocturnal asthma is important for a person’s health and quality of life. Nocturnal asthma can result in inadequate asthma control and increased morbidity, meaning a state of poor or decreasing health.

According to the WHO, most deaths related to asthma symptoms occur during the night. Although asthma-related deaths are rare, they pose a real risk, so it is important that a person with asthma talk to a doctor and establish an effective treatment plan.

Below are some commonly asked questions about nocturnal asthma.

Is an asthma cough wet or dry?

An asthma cough is typically dry and produces minimal mucus or phlegm.

However, some people with asthma can also produce a lot of mucus. This might be linked to a faster decline in lung function over time.

Why do asthmatics cough at night?

People with asthma may cough at night due to certain triggers, such as:

  • Sleeping position: Certain sleeping positions can constrict the lungs, potentially making asthma symptoms worse.
  • Breathing in cold air: Cold air is dry – loss of moisture and heat in the airways can trigger an asthma attack.
  • Exposure to allergens: House dust musts, pet dander, and mold may be present in the bedroom.
  • Poorly controlled day-time asthma
  • Lung function changes: As muscles relax during sleep, the upper airway narrows and leads to increased resistance in the lung.
  • Hormonal changes: During sleep, the body goes through hormonal changes that might make asthma worse.

How can a person stop an asthma cough at night?

A person might benefit from the following to prevent a night-time asthma cough:

  • keeping the bedroom environment clean and free of allergens
  • closing windows at night
  • treating underlying conditions such as GERD or obstructive sleep apnea
  • keeping water by the bed to sip when symptoms flare
  • doing breathing exercises
  • maintaining a healthy weight

How can a person know if their cough is an asthma cough?

If a cough keeps coming back and is accompanied by other asthma symptoms, such as wheezing, breathlessness, or chest tightness, then it is more likely to be asthma.

Asthma is a chronic lung condition that causes wheezing, breathlessness, and coughing. People with nocturnal asthma experience symptoms or worsening of their symptoms at night.

The cause of nocturnal asthma could include neurohormonal changes due to the body’s circadian rhythms.

Diagnosing and treating children is particularly important, as nocturnal asthma symptoms can lead to behavioral and developmental challenges.

Because nocturnal asthma can negatively impact someone’s quality of life, it is essential that a person who believes they may have nocturnal asthma consult a doctor and find a successful treatment regime.

Doctors treat nocturnal asthma by creating an asthma action plan. People with nocturnal asthma need to find a medication regimen that reduces and prevents their symptoms. Certain lifestyle habits, such as exercise and meditation, can also help.