Woman asleep in a bed with a cat. Nighttime Asthma

You asked: Why is my asthma worse at night?

If you are experiencing multiple nighttime asthma attacks, then it might be time to touch base with your health care provider
March 13, 2019

Suddenly, your chest tightens, and your breathing starts to resemble wheezing. Asthma attacks can be a startling experience, especially if they happen while you are asleep or nearly asleep. Genny Carrillo, MD, ScD, associate professor at the Texas A&M School of Public Health, director of the Program on Asthma Research and Education, discusses how nighttime asthma attacks can be avoided.

What is an asthma attack?

According to the American College of Allergy, Asthma and Immunology, asthma attacks occur when an inflammation or obstruction of the bronchial tubes exists. Since these tubes allow air to enter and leave the lungs, asthma happens when air movement in and out of the lungs is restricted.

Asthma attacks are most commonly recognized by severe wheezing, consistent coughing and rapid breathing. However, people experiencing asthma attacks may also notice tightness in their chest and neck. If not enough oxygen reaches their lungs, then they may turn pale and their lips and fingernails could turn blue.

Asthma symptoms vary from person to person, but you can control them with a proper prevention routine. “If your asthma is under control, then the likelihood of you experiencing an asthma attack decreases,” Carrillo said.

What triggers an asthma attack?

People with asthma have different triggers. Some people are triggered due to exposure of allergens like dust mites or grass. Other people can be triggered by irritants in the air like chemicals or strong odors. Carrillo notes that respiratory illnesses with mucus drainage like sinus infections or colds increase the likelihood of an asthma attack. Exercise and changes in the weather also trigger attacks as well. Some people may find that more than one thing increases their chances of having an attack, and any type of asthma can get worse at night.

The importance of medication adherence

“One of the most important things to prevent asthma attacks is medication adherence,” said Carrillo. “Often, people find their medication reduces the occurrence of their symptoms, so they think they do not need their medication anymore.” This is not true, because asthma has no cure—the prescribed medication only controls your asthma symptoms.

Health care providers usually prescribe two key medications: a long-term control inhaler and a rescue inhaler. Since asthma triggers are highly specific to the individual, people should speak with their health care provider to find an asthma care plan that works for them. Many health care providers prescribe both types of inhalers.

The first medication is a long-term asthma control inhaler like a corticosteroid. People with asthma should regularly take this medication to control their chronic symptoms and prevent asthma attacks. If people stop their medication, then their risk of an asthma attacks increases.

The second medication is a rescue inhaler. This inhaler will provide a quick relief of symptoms during an asthma attack. The medication relaxes the airway muscles, which opens the lungs and allows unconstructed airflow.

If you or your child wakes up with an asthma attack, do not panic. You should simply begin administering the rescue medication. If for whatever reason, you do not have a rescue inhaler, then call emergency services. Also, people with asthma and parents of those with asthma should keep in mind that only the rescue inhaler can stop an asthma attack. The two types of medications are not interchangeable. If the attack does not subside after a couple uses of the rescue inhaler, then call emergency services for further help.

Other ways to prevent asthma attacks at night

“If a person’s asthma is under control, then it would be rare for them to have a nocturnal asthma attack,” said Carrillo. “However, everybody has their own asthma triggers, so it is important to be mindful of your triggers, even when sleeping.”She recommends four steps you can take to create an asthma-friendly sleep:

  • Avoid sleeping near strong odors like perfumes or bed linen sprays
  • Use pillow covers to prevent dust mites
  • Wash your bed linens in hot water on a regular basis
  • Keep pets out of the bedroom, especially if you are sensitive to their dander
  • Get your flu shot and stay ahead of any respiratory illnesses

When to seek help about your asthma symptoms

Asthma attacks can happen any time and in any place. If you are experiencing asthma symptoms multiple times per week, then see your health care provider to discuss adjustments to your asthma care plan.

For people that do not have health insurance, Carrillo recommends looking for medication assistance programs in your area. “It is important for people with asthma to have access to the proper medication,” said Carrillo. “In south Texas, we have the Medication Assistance Program through Healthy South Texas. These types of programs do exist, and they are ready to help.”

— Mary Leigh Meyer

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