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Why Does My Asthma Get Worse When I Sleep?

Reading time | 5 mins
Nighttime asthma can be a nightmare. Cróna Tansey explains why this happens and shares 3 tips for getting a restful night’s sleep.

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Asthma has some obvious and understandable triggers known to set off attacks. People understand that breathing in cold air is a common trigger and how items like masks or scarves work as practical barriers.

Exercise is another well-known and well-understood asthma trigger. Understandably, a person doing intense cardio may have asthma issues while training. But I think it can sometimes be difficult to understand the relationship between asthma and sleep.

Surely, when an asthmatic is breathing deeply and relaxing in their warm bed, their asthma should be at its best level of control?

Nighttime asthma can be a nightmare

On the contrary, nighttime can be an asthmatic's worst time of day. I've always been a big lover of sleep. My friends often tease me about being comfortable enough to fall asleep anywhere! However, this is not the case when I'm having an asthmatic episode, when I'm unwell with a cold or the flu, or when my asthma is poorly controlled.

Most of my memories of childhood asthma happened at night. I'm sure my parents used to dread bedtime and the nights when I struggled with asthma symptoms.

I have many memories as a very young child of getting up at night because I couldn’t sleep due to persistent coughing. I remember my mother boiling water so I could inhale the steam and reduce my symptoms. This was often the case when I was unwell with a cold or flu, a time when I needed to sleep more than usual.

It's a horrible feeling when you need to sleep but are kept awake with what feels like constant coughing and tightness in your chest.

It's also a spectacularly awkward time to fall ill because your GP is most likely asleep - the same as the rest of the country. Your first ports of call are not available, and this can be stressful at a time when you need advice or reassurance from someone you know and trust.

3 tips for handling asthma symptoms at night 

There are a couple of reasons why nighttime and being in bed can cause asthma symptoms to worsen.

The good news is that some simple changes can reduce our triggers and lessen the risk of asthma symptoms at night.

1. Make your bedroom asthma-friendly

As disgusting as it is to believe, our beds, cushions, and blankets can be breeding grounds for dust mites! Dust has always been a big trigger for my asthma. Entering a dusty place has often brought on asthma symptoms for me, and I will do all I can to avoid being exposed to too much dust.

I change my bed clothes regularly and wash them in an allergy-friendly wash to reduce the risk of dust mites. I also vacuum everywhere (including my mattress!).

My mother gifted me an air purifier for my bedroom, which I use to reduce triggers like dust and pollen where I sleep. I've also invested in allergy-safe bedding and pillow covers.

In the spring and summer, when pollen levels are high, I dry my bedding indoors to avoid unnecessary amounts of pollen entering my home.

The time and expenses certainly add up, but I can't begin to describe the comfort of knowing my bedroom is safe from triggers like dust and pollen.

2. Change the way you sleep

When I have trouble with asthma, I often find it tough to get comfortable when I lie down at night. Nothing is worse than tossing and turning while dealing with persistent coughing and chest tightness. It can be an exhausting experience.

I also get self-conscious about keeping others awake. But the more pressure we put on ourselves to relax and get to sleep, the harder it is to do it.

I've often wondered why sleeping with pillows propping me up has been recommended when my asthma gives me trouble. The Asthma Society of Ireland's 5 Step Rule recommends that a person having an asthma attack does not lie down.

I've done various first aid courses over the years, and the facilitators have also given me this advice.

I recently learned that we put extra pressure on our chest and lungs when we lie back. This makes it difficult for us to breathe.

I often find it harder to sleep with asthma when I'm unwell with colds or infections. Lying flat on our backs can cause mucus from our noses to drip down our throats, which is exceptionally unpleasant and sets off coughing.

It’s to have this explanation of why sleeping can be so difficult when I'm sick. It's often more comfortable to lie on my side or with my neck and head propped up with pillows. In my experience, it has been very helpful in improving the quality of my sleep and my ability to fall asleep.

3. Be prepared for nighttime asthma flare-ups

I always find it helpful to be as organised as possible when it comes to asthma. It's beneficial to have a bedtime routine for asthma, particularly during bad patches or when I'm nervous about getting a good night's sleep.

I find it helpful to inhale steam before bed, perhaps by taking a hot bath or a shower. This really helps to settle my chest and relaxes my breathing.

It's also a great idea to leave some water and any GP-prescribed reliever medication by the bed. I like to give myself plenty of time to see if my symptoms are well controlled before settling down.

This can help me to relax, confident in the knowledge that I've done all I can to ease my asthma symptoms.

It was also important to discuss sleep and symptoms with my doctor. Using the Asthma Action Plan, I can identify when my asthma is poorly controlled and when I'm likely to have asthma symptoms. My doctor and I have also gathered strategies to help manage symptoms as and when they flare.

The takeaway

The emotional impact of asthma cannot be overlooked. Nighttime attacks can be very stressful, particularly when our healthcare teams aren't available. Asthma also has physical consequences.

Missing out on sleep as a result of exhausting asthma symptoms can take its toll on us asthmatics. As with all my asthma triggers, finding out why I have asthma flare-ups helps me reduce the risks in my environment.

Some of the changes I've made have been small and simple, but they have greatly improved my sleep and quality of life.

NPS-IE-NP-00479 September 2022