Having your sleep interrupted is annoying at best and, especially if it happens often, meltdown-inducing at worst. But when you wake up in the middle of a coughing fit or because you feel like you’re breathing through a straw, the whole experience can take a terrifying turn.
Unfortunately, that’s what some people with asthma have to deal with. “It is very common for asthma to get worse at night,” pulmonologist Ryan Thomas, M.D., director of the Multidisciplinary Severe Asthma Team at Michigan State University, tells SELF. This phenomenon, which experts sometimes refer to as nocturnal asthma, can make it far too difficult to get the amount of rest you need. It can also be a sign that you need to take steps to subdue your asthma before it gets even worse.
It’s important to cover some asthma basics before we dive into the rude awakening portion.
Your airways, which extend between your nose and mouth and your lungs, carry air in and out of your body, according to the National Heart, Lung, and Blood Institute (NHLBI). Pretty key job, huh? But if you have asthma, those airways can get all puffy and inflamed when you’re exposed to triggers like animal dander (particles of skin and saliva that they’ve shed), pollen, mold, cold air, cigarette smoke, exercise, and respiratory infections like the flu, the NHLBI says. That swelling can then cause the muscles around your airways to tighten, and your airways may also expel more mucus than they usually do. The end result is the opposite of breathing easy: You might experience asthma symptoms like wheezing (a whistling sound when you breathe), coughing, shortness of breath, and chest pain or tightness.
It’s possible that your asthmatic reaction to a trigger will be mild and go away on its own, but if your symptoms get worse and don’t respond to treatment, you can have what’s known as an asthma attack or asthma exacerbation, which can be life-threatening.
Depending on its severity, your asthma can fall into one of four categories. Some of this classification hinges on how your asthma acts at night.
Mild intermittent asthma means you have minor symptoms up to two days a week and up to two nights a month, according to the Mayo Clinic. Mild persistent asthma takes it up a notch, so you have symptoms more than twice a week but not more frequently than once in a day. Moderate persistent asthma involves symptoms at least once a day, along with more than one night a week. Finally, severe persistent asthma means you’re having signs of asthma throughout the day on most days, along with frequently at night.
No matter your asthma classification, you might notice that when you experience symptoms, they’re more likely to strike at night, or that they seem to be worse after the sun has set than they are during the daytime. There are a few reasons this may happen.
Doctors aren’t 100 percent sure why asthma can flare up at night, but there are some theories, including how prevalent triggers may be in your bedroom, hormonal fluctuations, and more.
Certain asthma triggers are more likely to pop up where you sleep. For instance, dust mites, which are microscopic creatures that feed on your old skin cells, are a common asthma trigger, according to the Mayo Clinic. If these gross little dudes incite your asthma, spending hours in your bed as you sleep raises the risk that you’ll have symptoms, Timothy McGee, D.O., a pulmonologist at Northwestern Medicine Central DuPage Hospital, tells SELF. That’s because dust mites adore living in areas like your bed, as that’s the exact type of warm, humid environment in which they thrive. Plus, there’s a ton of food for them there. (Remember, that food is your old skin cells.)
In a similar vein, if you have a sensitivity to animal dander but you also have pets that spend a lot of time in your bedroom, they can leave dander all over your bed, Dr. Thomas says, so your asthma symptoms might arise as you sleep.
Your body also goes through hormonal changes while you sleep, which may make your asthma worse. During the the night, your body can release higher levels of the stress hormone cortisol, which can cause more inflammation in your airways, Dr. McGee explains. Cue the coughing, wheezing, chest pain, overall trouble breathing, whatever your specific asthma symptoms may be.
Another theory holds that, at night, people with asthma may have higher than usual numbers of various kinds of white blood cells linked with the onset of asthma symptoms. “This seems to correlate with lung function decline,” Dr. Thomas says.
Finally, if you have both asthma and a different condition that can affect your sleep, like sleep apnea, the interplay between the two can boost your propensity for nighttime wakeups. “Sleep apnea increases airway inflammation and can make asthma worse, which may contribute to worsening asthma control in general, especially at night,” Dr. Thomas says.
It’s a similar story with something like gastroesophageal reflux disease (GERD), which is an asthma trigger in some people. GERD happens when your stomach acid reverses course into your throat, and it can happen at night, affecting your sleep, the Mayo Clinic explains. If you have both GERD and asthma, a nighttime GERD episode can elicit asthma symptoms.
No matter the reason, if your asthma is waking you up at night, that’s a sign that it’s not well-controlled.
If you find that you’re frequently waking up at night with issues breathing, you need to see your doctor about tweaking your asthma treatment. Yes, even if it seems like you’re dealing with something relatively innocent, such as a minor uptick in coughing. It’s not uncommon for nocturnal asthma to progress from a cough that wakes you up to issues like wheezing or difficulty breathing, Dr. Thomas says. So, even if you’ve started to notice that you’re waking up with “only” a cough when you didn’t before, it’s time to check in with your doctor.
Beyond disrupted sleep in the short-term (and the various potential consequences), in the long run, letting your asthma go without sufficient treatment can lead to something called airway remodeling, which is a permanent change in your airways that can make it harder to breathe all the time, not just during asthma flares.
So, talk to your doctor about changing your treatment. They may try you on different asthma medications to control your symptoms, like a stronger preventive drug to reduce overall inflammation in your airways, or a different quick-relief drug that might be better at opening up your constricted airways when you need it. If your doctor does change your treatment protocol, be sure you two update your asthma action plan accordingly so you have a written record of how to keep your symptoms at bay and also what to do if they’re spiraling.
Your doctor may also want to test you for something like a dust mite or animal dander allergy. Depending on the results, they may suggest using dust mite-proof pillow cases, mattress covers, and the like, Dr. McGee says, or designating your bedroom as a no-pet zone. Figuring out how to deal with nocturnal asthma can clearly involve some experimentation, but getting a good night’s sleep is well worth it.