Severe Asthma: What to Do About Nighttime Symptoms

If your severe asthma symptoms are keeping you up at night, you need to talk to your healthcare provider.

woman with no sleep

Asthma symptoms that occur during the nighttime are sometimes referred to as “nocturnal asthma” and are fairly common—a significant number of asthma patients report that asthma symptoms interfere with sleep, causing them to wake up during the night or wake up earlier in the morning. Nighttime asthma complaints are also one of the five criteria on the Asthma Control Test (ACT), a patient questionnaire used to determine if asthma is poorly controlled. If asthma regularly interferes with sleep, it is a sign that asthma is not well controlled.

There are a number of reasons asthma may not be under control. It could be exposure to asthma triggers, improper inhaler technique or not adhering to a treatment plan. Symptoms may be aggravated by a coexisting health condition, such as GERD or COPD. It may also be because the person has severe asthma.

Between 5 and 10 percent of asthma patients have severe asthma, type of difficult-to-control asthma. Asthma is classified as intermittent, mild, moderate or severe based on the type of treatment required to get the asthma under control. Asthma that is severe requires treatment with multiple control medicines, including medium- or high-dose inhaled corticosteroids, or low-dose oral corticosteroids. But some patients with severe asthma are unable to get symptoms under control even with these treatments.

Why asthma may worsen at night

Healthcare providers do not know the exact reason why asthma symptoms get worse at night for some people. It is known that lung function peaks and dips throughout the day, usually reaching the lowest point around 4:00am. This occurs in people without asthma too, but these fluctuations may be more pronounced and may influence airway inflammation in people with asthma. Hormone levels also fluctuate throughout the day, and may influence airway inflammation and respiratory function.

Other health conditions—including sleep apnea, obesity and gastroesophageal reflux disease (GERD)—are associated with nighttime asthma. Asthma symptoms may also be caused by triggers in a person’s bedroom, such as dust mites or pet dander.

Getting asthma under control

If asthma symptoms are waking you up in the night (or very early in the morning), it is important to talk to your healthcare provider. Sleep is an important component of health. Too little sleep can have a number of negative impacts on a person’s health—including weight gain, an increased risk of health conditions like heart disease and diabetes, and an increased risk of accidents. Insufficient sleep also takes a toll on quality of life, increasing irritability and feelings of depression, and lowering job performance and productivity.

While healthcare providers may not fully understand why asthma symptoms can worsen at night, there are steps you and your healthcare provider can take to better control your asthma symptoms and get better rest. These may include:

  • Making changes to your sleep environment, such as taking steps to eliminate asthma triggers (like dust mites or dander), adjusting the temperature in your bedroom or adding a humidifier to make the air less dry.
  • Identifying and addressing other coexisting health conditions, such as GERD, obesity or sleep apnea, that may be interfering with sleep and exacerbating asthma symptoms at night.
  • Making changes to your asthma treatment plan, including the type of asthma medication you take. People with severe asthma may need multiple controller medications, high-dose corticosteroids and/or biologic therapies (also called immunomodulators) in order to control airway inflammation.

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