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Between 1-18% of the population worldwide is affected by asthma, with a higher prevalence reported in more developed countries. Coughing, wheezing, chest tightening and difficulties breathing are just some of the symptoms people with asthma have do deal with in their day-to-day lives. What’s worse, these symptoms often get even naughtier at nighttime, prompting for a distinctive diagnosis of nocturnal asthma. Representing a level of worsening of the regular asthma symptoms during the night and the increased risk for other medical conditions and asthma-related incidents, nocturnal asthma affects 60% of the individuals with asthma, if not more. This phenomenon naturally causes a lot of sleep issues, and the occurrence of sleep disorders in said circumstances is not rare.
This article will focus mostly on sleep issues with the presence of nocturnal asthma. Learn more about the types of disorders that frequently comorbid this condition, as well as how they might be recognized and treated.
What is Asthma?
Asthma is a chronic inflammatory disease that affects the lung airways of our body, making them highly sensitive and easily triggered into an asthma attack. During such an episode, an individual’s mucus production goes overboard, and their normally open airways start swelling and narrowing, reducing or completely stopping the oxygen flow into their lungs. If not properly and timely managed, such an episode can result in death. In fact, over 345 thousand people around the world die from this disease every year, the majority of this number making people who have lower incomes and live in developed countries (putting them at a higher chance to get asthma than people in developing countries, but a lower chance to be able to afford medical help whenever necessary).
Triggers for an asthma attack vary from person to person, but the possibilities are many; some common ones include:
- Allergens like mold, dust, pollen, animal hair, etc.
- Polluted air or strong odors – such as smoke or perfume
- Illness. Virus, flu or even a common cold may trigger an attack due to the increased mucus production, worsened coughing, etc.
- Temperature and weather changes
- Specific foods or food groups
- Certain medications like aspirin or beta blockers
This disease can be traced all the way back to Ancient Egypt when it got its name with the meaning “panting” in Greek. In modern years, the incidence rate has increased significantly – one in every thirteen people in America has asthma, making up the staggering number of 25 million Americans suffering from this disease. Statistically speaking, severe asthma strikes boys and girls equally, but in adults, it’s more prevalent in women.
Still, the cause of this increased rate isn’t known. Possibilities include some epigenetic changes (changes made in non-DNA genes and not affecting the DNA) in the patients and some environmental changes. The cause of asthma is also the subject of ongoing research; it is believed to be a combination of genetic predisposition and some environmental factors like exposure to allergens or respiratory infections at an early age, before one’s immunity got a chance to form properly. Arguably, changes in our surroundings into a more polluted, urban landscape as the industrialization progressed contributed to the increased rate of this disease, triggering already present “risk” genes into onsetting asthma in the many people who suffer it. It would also explain why developed countries have a heightened incidence rate of this disease than developing countries.
Asthma first occurs in one’s childhood and may resolve in time, although in many cases, it is a lifelong condition that can’t be cured. However, treating asthma is possible and effective, keeping it under control and enabling individuals with this disease to have normal, happy lives.
All people have more difficulties breathing during sleep, particularly around 4 A.M. but these issues are not big enough to stop our body from functioning normally and having a sound rest. For people with asthma, who struggle with breathing even during daytime, this time of night comes with additional problems and significant danger – statistics show that over 70% or respiratory arrests and deaths caused by asthma happen at night. Coughing, wheezing and other asthmatic symptoms happening persistently and worsened at nighttime is what over 75% of people with asthma experience at least once a week. For others, it gets even worse. Perhaps this is the reason why many children with asthma first start to show symptoms at bedtime or during sleep.
Nocturnal asthma is problematic in more than one way. To begin with, it disrupts one’s sleep; struggling to fall asleep, only to be woken up a few hours later by a sudden cough attack is not the least bit pleasant, especially if it keeps happening night after night. People who regularly experience nocturnal asthma over time become sleep deprived and often develop other sleep-related issues or sleep disorders. Furthermore, sleep deprivation has a negative impact on one’s overall health, impairing the immune system and thus increasing the risk of an asthma attack during any time of the day. Nocturnal asthma is often trickier to handle because other people are sleeping; this poses an even bigger threat for a child with nocturnal asthma as an attack might be triggered with nobody available to react in time.
The cause of nocturnal asthma is unknown. Researchers are pointing to a few possible factors which, combined, could cause or worsen the existing symptoms in an individual.
- Hormonal factors. At night, our brain naturally secrets a smaller dose of epinephrine and a higher dose of histamine. The first of these hormones has a role in keeping our airways open, while the latter one shuts them down. In effect, the consequence of this combination is airway obstruction, if only partial.
- Environmental factors. An allergen present in one’s bedroom could trigger nocturnal asthma. Another possibility is that an allergen was initially encountered earlier during the day, but an individual’s organism is reacting to it several hours later. Many people with asthma experience the so-called “late phase response” which makes it harder to identify what triggers their symptoms.
- Stress. A factor with direct impact to all aspects of one’s life, and frequently the one most difficult to address; stress is regularly listed as an asthma attack trigger. By extension, exposure to stress before bedtime could result in nocturnal asthma and even some sleep disorders.
- Indoor air. Cold and dry air, as regulated by an air condition system, can trigger asthma symptoms. The room in which one sleeps should be cool, but not below that. To address the dryness of the air, introducing a humidifier into the bedroom might be a good idea.
- The body’s position during sleep. The lying position is tougher for our airflow. Mucus production, drainage, and post nasal drip tend to build up in our body’s pipe system more while we are in that position. Combine that with the previously mentioned hormone production and breathing becomes quite a challenge.
- Gastroesophageal reflux disease (GERD), or acid reflux, is a chronic condition which causes one’s stomach acid to rise into the esophagus, frequently resulting in vomiting, acid-like taste in the mouth, heartburn, teeth and breathing problems. The majority of people who have asthma also have acid reflux. In the lying position, the acid can reach all the way to your throat, blocking airways and triggering an asthma attack. The side-effect of many asthma drugs is loosening the path your stomach contents pass through if you have GERD, making it even easier for this problem to happen.
Some additional risk factors include living in a city, smoking, being obese or having allergic rhinitis.
Nocturnal Asthma in Children
This phenomenon is potentially dangerous for all people with asthma, but particularly so for children. A child will often underreport what happens during the night, and as a result, their parents might not be aware of the full extent of the issues the child faces. Because of this, many children will go without appropriate treatment, heightening their mortality risk and aggravating daytime symptoms unnecessarily.
A study researched the effect of nocturnal asthma on children and their parents alike. The children displayed poorer academic performance and increased incidence of problematic behavior, as well as reduced overall quality of their and their parents’ lives. The more bad nights the child had, the lower was the quality and the length of sleep in the parents as well; both the parents and kids were also more likely to miss work and school than non-asthmatic children and their parents.
Children with nocturnal asthma are more likely to develop sleep disorders than their peers without such a condition. The most common sleep issues in children include:
Adults and children who have asthma are more likely to have sleep-related issues such as difficulties maintaining sleep, lower quality of sleep and excessive sleepiness due to those or other issues. Obstructive sleep apnea strikes about 70% more people who have asthma than people without it and remains the most common issue for children with asthma. Many adults with asthma get diagnosed with insomnia as well, resulting in sleep deprivation, unhappiness and a higher risk of mental health disorders like depression or anxiety.
How to Sleep Better with Asthma
Try to follow at least a few of the tips below to help ease your asthma symptoms and promote healthy sleep.
- Follow your asthma treatment plan. Take prescribed medication in appropriate doses and keep your inhaler by the bed. Start writing an asthma diary. Keep track of what you did during the day, what you were doing when your symptoms got triggered, what made you feel better, etc. After a while, a pattern will form, giving you a more precise overview of what’s going on, and it will certainly be of help to a doctor should you need to see one. If your nocturnal asthma is waking you up during the night more than once a week even though you are taking measures to subside the issue, consider scheduling another appointment with your doctor; it may turn out that your problem is caused by a second condition additional to asthma. Sleep disorders and other medical conditions are not rare to comorbid this disease.
- Treat secondary conditions like acid reflux or sleep disorders. Medication used to treat GERD often relieve asthma symptoms as well. Besides medication, you can try to slightly elevate your head when lying down to make sure stomach acid can’t reach your throat. For obstructive sleep apnea, CPAP therapy is recommended. It works via a mask that is connected to a machine designed to keep check of breathing and regulate the airflow during your sleep – you simply put the mask on and go to bed. To get a prescription for CPAP therapy, you will need to be diagnosed with obstructive sleep apnea first. This treatment might even help with your asthma symptoms, but it’s intended only for OSA.
- Make sure your room is allergen-free. This includes changing your bedding frequently, avoiding fabric softeners or other potentially irritating substances, using a mattress encasement, keeping pets out, regularly dusting and cleaning the room. Finally, consider getting a HEPA filter to help keep the air in your room clear of any other allergens that might be conspiring against you.
- Maintain a cool, dark and comfortable setting in your room. Get a humidifier if the air is dry, install dimmable lights, adjust your thermostat to maintain a cool (not cold) temperature and save the smartphone use for outside the bedroom.
- Deal with stress. Do all you can to avoid it: practice mindfulness and gratitude, try meditating or doing yoga. These methods also help release stress once the damage is already done. Stress doesn’t include just the things that annoy you; watching a horror movie or getting otherwise stimulated before bedtime will keep you alert, making it difficult to wind down and fall asleep. Instead, do such activities earlier during the day, and set up a bedtime routine to follow every day. This should be a healthy but not overly-complicated ritual: simple things like brushing your teeth, taking a shower, changing into your PJs and turning off your phone are enough to make a difference in your relationship with sleep. As your mind gets more used to repeating this set of tasks, it will learn to expect sleep soon after and reduce the amount of time you spend tossing and turning in bed before falling asleep. If you take these measures, not just the onset will be faster, but also the quality of your sleep will improve.
- Eat well and exercise. You heard this one before but it’s worth reminding – foods high in sugar and fat do nothing to promote good sleep. Eat a balanced diet that highlights vegetables, fruits and leafy greens in the evening, or any other time of day for that matter. It will also help keep your weight in check, which is significant for asthma as obesity is a known trigger for this disease. On top of that, working out at least two or three times a week is sure to help you sleep, as long as you don’t do it in the late afternoon or evening. Regular exercise has been shown to improve one’s immune system and overall health, acting as a supporting line of defense against colds and viruses and thus minimizing any potential asthma flare-ups.
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Michael is a professional writer based in Boston and someone who has always been fascinated with the mysteries of sleep. When he’s not reading about new sleep studies and working on our news section, you can find him playing video games or visiting local comic book stores.