Can you imagine if someone puts a polythene bag around your neck or over your head and tightens it with all its strength, what will happen? Asthma symptoms are quite similar to that experience. Shortness of breath, coughing, wheezing, and annoying irritation during the day and of course at night.
If you know someone experiencing the same, you must have heard them asking ‘Why does my asthma get worse at night?’ Unfortunately, around 30%-70% of people with these conditions suffered from nocturnal asthma (symptoms of asthma getting worse at night).
Doctor Floyer shared a thesis on asthma in 1698. It was the first focused work on any disease at that time. He warned that those who remain sad or angry are more reluctant to get asthma attacks. During his research, he found that in an asthma attack not only do air passageways that take air to a patient’s lungs contract to make them difficult to breathe but also the condition gets severe at night.
Hundreds of years have passed and scientists’ theories are backing his findings, A study shared in 2005, showed that 75 percent of asthma patients experience worsening breathing complications at night. However, a survey of London Hospital taken in 1970 revealed that early morning and nighttime asthma attacks are life-threatening.
According to Dr. Steven Shea, the Director of the Oregon Institute of Occupational Health Sciences, nobody is sure what causes asthma severe at night. Although we may not know the reason, we can surely tell you the factors and routines that may alleviate the symptoms of asthma at night.
What is Nocturnal Asthma?
Shortness of breath or having trouble breathing can be because of many reasons but if you are an asthma patient, then this could be because of nocturnal asthma. In chronic asthma, the airways that carry air in and out of the lungs get inflamed and block air to cause shortness of breath. In nocturnal asthma, the conditions begin getting worse as the evening approaches and lead to its heights when you try to sleep at night. This disease is getting common and can happen in all ages at any stage of life but usually, starts in childhood. Asthma triggers an attack due to many types of allergies and lifestyle changes such as cold air and exposure to dust. Besides, asthma requires continuous and long-term treatment by a pulmonary physician.
Asthma often triggers at night when you are sleeping. Nocturnal asthma symptoms include;
- Wheezing because of constricting airways
- Chest tightness
- Dyspnea – shortness of breath
- Cough – making restless
Most individuals affected by nocturnal asthma are children that get hard for them to spend time at night and try to sleep and equally for their parents to deal with the condition. Another study on asthma showed that 40% of children having persistent asthma aged between four to ten have nocturnal asthma. They complain of similar symptoms such as;
- Parasomnias – including hallucinations, sleepwalking, extreme emotions, and abnormal movements
- Night walking
- Obstructed breathing
- Sleep apnea
But why does nocturnal asthma get severe at night with patients of almost all ages? Is there any solution or treatment that can help? A simpler answer to the question lies in determining the causes of nocturnal asthma.
Causes of Asthma and Nocturnal Asthma
As we don’t know the reason why asthma occurs at night or why the chances of asthma get worse at night. Studies have proved that it is a serious problem and many times the severity of the diseases caused death to many patients and the symptoms of wheezing and asthma symptoms led to death at night.
Some factors that contribute to triggering nocturnal asthma include;
- Gastroesophageal reflux disease (GERD)
- Dust and mites and exposures to other allergens
- Sinus drainage
- Mucus production
- Increased Histamine
- Reclined position sleep
- Obstructive sleep apnea
- Lower epinephrine levels
- Psychological stress
- Inhaling cold air from a window or air conditioner
Even if any of the mentioned conditions do not make the situation worse, just sleeping can cause nocturnal asthma due to the change in the function of bronchitis. As we sleep in different positions, our body squeezes and makes it hard for the air to pass on and provide oxygen to the body. This is why mostly our arms and different parts of our body feel numb when we awake. But things don’t keep on doing well for asthma patients as this air resistance tightens the airways causing cough and triggering nocturnal asthma. All these reasons at night play their role in aggravating asthmatic symptoms at night. Research shows that breathing begins to worsen for up to six hours when you go to sleep.
Research is still working to find out how the change in hormones and production in hormones affect nocturnal asthma. For this, it is necessary to understand the rhythm of the body that works to continuously control hormonal activity while we are sleeping which has a greater impact on lung function.
For instance, epinephrine is the hormone that keeps the muscle of the airways relaxed when we are asleep. However, this hormone production in the body reaches its lowest level of production around 4 am at night and this is the high time when asthma attacks the most. Thus, the natural process of producing steroids decreased at this time which elevates the chances of asthma due to inflammation.
Scientists found that when inflammation occurs in the airways, the symptoms of asthma increase. This made them believe that asthma and inflammation have a direct relation.
In addition, lying in a reclined state will also trigger asthma attacks. Several reasons also take part for this such as sinus drainage, increased airway resistance, increased lung blood volume, heartburn, GERD, and also when you lie upside down, stomach acids are pushed back to the esophagus which creates inflammation and eventually trigger asthma.
Some recommended medications relax the stomach and esophagus valve so the acids from the stomach go back into your throat or drip into your airways. When this happens, asthma can also trigger in no time.
In addition, certain groups of people are more prone to have nocturnal asthma. They include;
- Young children
- Smoking individuals
- Living in an urban environment with environmental pollution
- People with allergic rhinitis
Is Nocturnal Asthma Treatable?
Unfortunately, there’s no defined treatment for nocturnal asthma or asthma of any kind or type. But by keeping in control the indications and symptoms, it is possible to live a relaxed and symptoms-free life. For this, continuous doctor visits, inhaling steroids, and asthma medications are essential to know your allergies and prevent them from happening. Your pulmonary physician will recommend you use a longer-acting inhaler with a strong bronchodilator for preventing nocturnal asthma mainly at night.
For sufferers of GERD, the doctors would prescribe medications that decrease acid production in the stomach along with the inhaled corticosteroid. Also, analyzing the lifestyle changes that trigger your asthma such as playing with furry animals or in a dusty area or using perfumes or anything else that activates your symptoms for asthma will also help in dealing with the disease.
When must you visit your doctor?
You must keep a check on your loved ones suffering from asthma, especially at night. When they wake up at night due to shortness of breath or difficulty in breathing, they should contact their doctor who can evaluate the symptoms and provide treatment after a complete diagnosis that can restore a comfortable night’s sleep.