What is Nocturnal Asthma?

Nocturnal asthma is in simple terms, a type of asthma very similar to regular asthma, but which gets worse during the night, also referred to as “night-time asthma”. If you aren't familiar with nocturnal asthma, this article will detail all its facets.

With this primer, you must ensure that if you have symptoms of nocturnal asthma, you seek medical help for the same.

Characteristics of Nocturnal Asthma

Night-time asthma can stem from regular asthma, be it allergic, non-allergic, exercise- induced, occupational, or heat-induced in nature.

At night, due to the circadian rhythm, the protective hormones available to keep your asthma under control are fewer and less active. As a consequence, symptoms become more severe, and additional problems present themselves interrupting your sleep.

These symptoms could include tightness in your chest, shortness of breath i.e., dyspnoea, wheezing, and persistent coughing. Children may exhibit some additional symptoms such as sleep apnoea (intermittent stops and starts in breath), night awakening, hallucinating, and exhibiting abnormal movements.

Adults may suffer daytime sleepiness and also sleep-maintenance insomnia wherein going back to sleep after awakening suddenly becomes difficult.

Many fatal asthma attacks occur during the night, contributing to a large chunk of asthma- centric mortality. Between 30-70% of people suffering from asthma will have a nocturnal asthma episode at least once a month.

Causes of Nocturnal Asthma

Nocturnal asthma can be attributed to a range of factors. These include −

Mucus Accumulation and Sinus Drainage

At night, there may be increased mucus production due to underlying conditions like allergic rhinitis or increased sinus drainage due to sinusitis. These can block nasal passages, the throat, and airways, causing irritation, nasal dripping, and an increased urge to cough.

Sleeping Position

A reclining position during sleep worsens the build-up of mucus in the nasal passages. Lying flat on your back may increase the volume of blood in your lungs while simultaneously decreasing the volume of air in the lungs.

Sleeping on your stomach also restricts airflow to your lungs, and airway resistance is greater when you sleep on your right side.

Changes in Temperature

Temperature alteration during the night can also trigger asthma attacks. The drop in night-time temperatures or using the air conditioner brings in cold air that dehydrates your airways triggering breathing problems and coughs.

Gastroesophageal Reflux Disease

GERD entails acid reflux which in turn could cause bronchial spasms. Stomach acid can seep into your trachea causing a burning sensation and tightening your airways.

Hormone Fluctuations

Protective hormone levels like those of epinephrine drop the most at night, particularly between 3-4 a.m. Epinephrine relaxes the bronchial tube muscles and widens them to allow free airflow, apart from inhibiting histamine production that rises at night and provokes.

Similarly, if cortisol levels decline during the night, it spurs attacks, while higher melatonin levels can mitigate the severity. Lung activity/function reduce at night which makes you prone to asthmatic episodes.

Late Phase Allergic Reaction

You may have been exposed to an allergen earlier in the day -mostly during the early evening hours. 50% of people who have allergic reactions will have one attack within an hour of exposure, and a second between 3-8 hours after exposure.

So, you may have a secondary attack at night caused by breathing obstruction and bronchial inflammation. Indiscipline/ irregularity in asthma medication management can also lay the groundwork for a serious nocturnal episode.

Exposure to Allergens

Dust mites ensconced in your mattress, pet fur/ dander, and cigarette smoke are all indoor allergens that can aggravate your symptoms.

Obesity

Those who struggle with obesity are more prone to fits of nocturnal asthma. The excess fatty tissue around the chest and upper abdomen can restrict the unhindered airflow in your lungs.

Solutions to Minimize Nocturnal Asthma

Minimize Stress

Psychological distress such as anxiety or depression, or stress makes asthma worse. Use relaxation techniques like deep breathing or journalling and take medications to address any underlying medical conditions (if prescribed by your doctor).

Stress provokes an immune response that inflames your airways and panic/ anxiety only heightens your difficulty.

Maintain Clean Rooms with Ample Ventilation

Make sure your room is free of cigarette smoke, the windows are open and there is fresh air through ample ventilation. Wash your sheets with hot water and dry them thoroughly to remove dust mites and pet dander.

Don’t let your pets inside your bedroom wherever possible, and certainly don’t let them sleep next to you. Avoid down pillows and feather-filled blankets/comforters - use zippered pillow covers instead.

If you have issues with mold, get it fixed to prevent the spread of fungal spores.

Regular Medical Check-Ups

Consult your doctor regularly to ensure your symptoms are diagnosed and treated on time. If you have one or more nocturnal asthma episodes in a week consult your physician to identify the cause, and construct a specific care plan to improve your quality of sleep and life.

A peak flow meter is used to diagnose asthma and its intensity.

Doctors may recommend a BiPAP (Bilevel Positive Airway Pressure) ventilation device or a Continuous Positive Air Pressure (CPAP) that provides modulated air pressure, oxygen, and ambient air to help you breathe in a non-invasive way, and to tackle disorders like sleep apnoea.

Sleeping Position

Sleep in an inclined position with your neck and head slightly elevated and propped up using pillows. Use pillows under your knees, if necessary, as well. This way problems of a suffocated airway/trachea or GERD-induced breathlessness can be resolved to a large extent.

Temperature Modulation

Keep the temperature at a suitable degree to prevent the room from becoming too cold and remove moisture. You can turn the air conditioner lower, make sure your windows and doors are tightly sealed so brisk air doesn’t come in, keep your bedroom well-insulated, and use a humidifier to maintain ambient water vapor.

Conclusion

In addition to following the guidelines above, you must keep your inhaler and a glass of water beside you on your bedside table, to be prepared in the event of an asthma attack. Apparently, a hot cup of coffee also works wonders to clear your airways!