3 Sleep Strategies to Ease the Nightmare of Night-Time Asthma

Night-time asthma can be a nightmare. Experiencing worsened asthma symptoms at night is surprisingly common, leading to sleep disturbances and further declining respiratory health.

Having experienced night-time asthma flare-ups since childhood, Cróna Tansey explores why asthma can worsen when it's time for bed. She also offers three “sleep strategies” for controlling asthma at night. Sweet dreams!

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

Exercise is another well-known asthma trigger. Understandably, a person doing intense cardio may have asthma issues while training. But why does our asthma flare up so often at night or during sleep?

When someone is breathing deeply and relaxing in their warm bed, surely their asthma should be at its best level of control? 

Asthma symptoms at night are (unsurprisingly) a nightmare

On the contrary, night-time can be an asthmatic's worst time of day. I've always loved my 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 exacerbated by 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 night when I struggled with nocturnal asthma.

I have many memories as a very young child of being unable to sleep due to persistent coughing at night. I remember my mother boiling water so I could inhale the steam and reduce my symptoms. This was often the case when I had a cold or the flu and needed to sleep more than usual. 

It's horrible when you need rest, but constant coughing or wheezing means sleep won't come. 

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 Sleep strategies for controlling asthma at night 

There are a few reasons why just being in bed can cause night-time asthma symptoms to worsen. 

However, 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 asthma triggers such as dust mites! Dust and dirt have certainly caused my asthma to flare up.

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 pollen and dust when I sleep. I've also invested in allergy-safe bedding and pillow covers. 

When pollen levels are high in the spring and summer, I dry my bedding indoors to stop unnecessary amounts of allergens like pollen from 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 these triggers.

Of course, the focus shouldn’t be on only reducing triggers in the bedroom. Regular cleaning, vacuuming, and clothes washing is an ideal start to asthma-proofing the entire home.

2. Change the way you sleep 

When I'm having trouble with my asthma and sleeping, 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 using pillows to prop me up is recommended when asthma gives me trouble at night. 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 lying down. This can definitely contribute to asthma and breathlessness.

I struggle to manage my asthma and sleep hygiene when I have a cold or infection. Lying flat on our backs can cause mucus from our noses to drip down our throats, which is exceptionally unpleasant and sets off coughing. 

This explains why resting is so difficult when I'm sick and why poor-quality sleep can trigger my asthma symptoms. It's often more comfortable to lie on my side or with my neck and head propped up with pillows. It has been very helpful in improving my sleep quality and my asthma symptoms at night.

3. Be prepared for night-time flare-ups

It is always helpful to be as organised as possible regarding asthma. Having an "asthma bedtime routine" is beneficial, particularly during bad patches or when I'm nervous about getting a good night's sleep. 

It can be 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. 

Leaving some water and any GP-prescribed reliever medication by the bed is also a great idea. I like to give myself plenty of time to control my asthma symptoms at night before settling down. This can help me relax, confident that I've done all I can to ease my symptoms. 

Telling my doctor how asthma impacts my sleep (and vice versa) was also important. Using the Asthma Action Plan, I can identify when my asthma is poorly controlled and when I will likely have asthma symptoms. We have also gathered strategies to help manage symptoms when they occur. 

The takeaway 

The emotional impact of a respiratory condition cannot be overlooked. Night-time asthma attacks can be very stressful, especially when our healthcare teams aren't available. Asthma also has physical consequences. 

Missing out on sleep due to exhausting asthma symptoms can take a toll on asthmatics. As with all my asthma triggers, finding out why I have flare-ups helps me reduce the environmental risks. 

Some of my changes have been small and simple, but they have greatly improved my sleep and quality of life.

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Date of preparation: August 2023
D: COB-GB-NP-00130 (V1.0) / T:COB-GB-NP-00146 (V1.0) / M: COB-GB-NP-00145 (V1.0)