Coughing asthma at night

7 Tips to Prevent Nighttime Asthma Attacks

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Many people with severe asthma find that symptoms like coughing, wheezing, and breathlessness are worse at night. “There are a number of reasons why this is so,” says Sonali Bose, MD, an assistant professor in the division of medicine, pulmonary, critical care, and sleep medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York City.

Some key factors that contribute to nighttime asthma attacks include:

  • Your body’s internal clock. Your circadian rhythm causes some of your hormone levels to fall at night. Lower levels of hormones can cause your airways to narrow slightly. These narrowed airways can exacerbate your asthma symptoms, according to the Asthma Society of Canada (ASC).
  • Dust mites. Your pillows, blankets, and mattress can all be a haven for these microscopic insect-like pests and their waste. Allergies to dust mites can worsen asthma, and you could be wallowing in them as you sleep, according to the ASC.
  • Gravity. When you lie down, your chest and lungs naturally experience extra pressure, the ASC says.

If you have trouble sleeping due to severe asthma, be sure to talk with your doctor, Dr. Bose says. “It’s important to share your nighttime symptoms with your doctor because it’s one of the ways he or she can determine how well your asthma is controlled,” she says. “People with asthma tend to underreport their nighttime symptoms, which can be a sign that you need more of your medication or a change in treatment.” Your doctor may need to make adjustments to your asthma treatment plan so you feel better, day and night, Bose says.

How to Sleep Better With Severe Asthma

In addition to taking asthma medications as prescribed, here are seven steps you can take to lower your chances of having a nighttime asthma attack:

1. Clean your bedroom regularly. Use a vacuum with a high-efficiency particulate air (HEPA) filter to trap mites and their waste and get them out of your bedroom. If your vacuum doesn’t have a HEPA filter, you can buy one from an allergy supply company, according to the Asthma and Allergy Foundation of American (AAFA).

2. Wash your bedding in hot water weekly. Make sure the water is at least 130 degrees Fahrenheit so it will kill dust mites. Finish the job in a hot dryer.

3. Invest in dust-proof mattress and pillow protectors. These zippered covers are woven tightly to keep dust mites out of bedding. You can find them at bedding and housewares stores, the AAFA says.

4. Invest in a humidifier. Cold air is drier and more troublesome for people with severe asthma. Depending on where you live, you might benefit from a humidifier to add moisture to the air in your bedroom in the winter, Bose says. What’s more: Dust mites thrive in low humidity, so boosting humidity by using a humidifier in your bedroom can help keep dust mites at bay.

5. Don’t sleep with pets. “If you have pets, keep them out of the bedroom so their dander doesn’t collect or stick to the carpeting and bedding,” Bose says. You may also need to keep the door to your bedroom shut to keep your pet — and its dander — out.

6. Keep your head up. If you have a cold or a sinus infection, lying flat can exacerbate postnasal drip, which can trigger an asthma attack, Bose says. Also, if you have acid reflux, lying flat can allow more acid to creep up into your throat, she says. When you sleep, keep your head slightly elevated, the AAFA suggests.

7. Get tested for sleep apnea. People with asthma may be at increased risk for sleep apnea, according to the American Thoracic Society. Sleep apnea causes repeated breaks in your breathing while you sleep. It can also worsen asthma symptoms. Talk with your doctor about testing and treatment if necessary.

By taking these steps to create a sleeping environment free of asthma triggers, you should find it easier to prevent nighttime asthma attacks and get better sleep.

(Picture: Getty)

Asthma is a serious condition that needs to be treated and monitored, but what some may not realise is that it can occur at night too.

Symptoms such as chest tightness, shortness of breath, coughing and wheezing during the night can make sleep impossible.

World Asthma Day 2017: What is asthma, symptoms and treatment

It affects daily life, as lack of sleep can leave us feeling tired and irritable – plus, it makes daytime asthma more difficult to control.

If you believe you have nocturnal asthma, it’s worth seeing a doctor – here is everything you need to know.

What causes nocturnal asthma?

(Picture: Getty)

During sleep, the airways often narrow, which can cause an increased resistance to airflow.

This can trigger coughing at night, which can in turn tighten the airways even more.

Sinusitis with asthma is quite common, as increased drainage from the sinuses can trigger the condition if you have sensitive airways.

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Those who work night shifts may find they have breathing attacks during the day, when they’re asleep.

Existing research has shown that breathing becomes more difficult for those with nocturnal asthma around four to six hours into sleep, which suggests there is an internal trigger.

What is deep sleep and how much of it should you be getting?

Breathing in colder air at night, or having an air-conditioned bedroom, can result in a loss of heat from the airways.

A cooling of the airways, along with moisture loss, are key triggers of exercise induced asthma, and they are also seen in nocturnal asthma.

Those with heartburn may find that the reflux of stomach acid through the esophagus, up to the larynx, can cause a bronchial spasm.

Stomach acid can irritate the lower esophagus, leading to the airways becoming restricted.

Why do asthma attacks happen at night?

There are several reasons why you may experience symptoms during sleep, including:

  • Increased exposure to allergens
  • Cooling of the airways
  • Being in a reclining position
  • Hormone secretions that follow a circadian rhythm (your body clock)
  • Sleep itself causing changes in bronchial function

How is nocturnal asthma treated?

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There isn’t a cure for night-time asthma, but asthma medication can reduce inflammation and prevent symptoms from happening during sleep.

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As nocturnal asthma can take place at any time during the sleep period, it’s important that treatment covers the entire timeframe.

For example, a long-acting bronchodilator delivered in an asthma inhaler can help to prevent bronchospasm and symptoms of asthma.

A long-acting inhaled corticosteroid can also help to alleviate symptoms.

Those with acid reflux and heartburn issues (GERD) can be prescribed medications to tackle the condition. These help by reducing acid production in the stomach.

Avoiding triggers such as dust mites can also help to prevent night-time asthma attacks.

MORE: How to stop snoring: Tips, tricks and exercises to stop the habit

MORE: What causes seizures in sleep? Nocturnal epilepsy explained

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3 Must-Have Products to Create an Asthma Friendly Bedroom

  • August 25, 2015
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  • Air Purifiers Allergy Bedding Asthma General Health
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Have you struggled with worsening asthma at night? Coughing, wheezing, and other asthma symptoms can keep you from sleeping and cause a host of health problems.

Nocturnal asthma–when asthma symptoms worsen at night–is a common ailment for asthmatics across the country. So what solutions are available to help prevent these nighttime attacks? Read on to find out.

Sources of Nighttime Asthma Triggers

Dust mites, particulate matter, and airborne dust are often at the heart of the asthma attacks that occur while you sleep. Ridding your bedroom of these pollutants can help you avoid nighttime flare-ups. The most common sources of asthma triggers in bedrooms are your mattress, carpet & rugs, and particulate matter in the air.

Here are 3 products we recommend purchasing to help prevent nighttime attacks and to create an asthma friendly bedroom:

Tips for Creating a Healthy Bedroom

Mattress covers, pillow protectors, and especially dust mite covers, are commonly suggested items for protecting you against asthma triggers that originate inside your mattress and pillows. These all-natural covers are made of a comfortable high-quality material (like silk) and are woven together tightly to completely block out dust and mites residing in your mattress. Other tips include:

  • Restricting pets in the bedroom: While not desirable, if you have pet allergies, restricting pets in the bedroom will help curb any asthma flair-ups.
  • Wash curtains & other fabrics: Regular washing of curtains and other fabrics helps eliminate and cut-down on dust and dust mites.
  • Sweep/Vacuum: Sweeping and vacuuming underneath the bed and behind the headboard cuts down on accumulated dust.
  • Launder Sheet: Of course, be sure to regularly wash your sheets, and replace with clean, crisp bedding.
  • Green Cleaners: Using detergents or soaps that are dye- and fragrance-free will also help with your asthma.

Use a HEPA Vacuum to Clean Your Mattress & Carpets

If you don’t want to change your bedding, you can also consider a HEPA vacuum. Vacuums with HEPA filters can be used to remove pet hair, dander, dust, and dust mites from your mattress and bedroom carpet.

Our suggestion for cleaning your bedding is the Dyson V6 Mattress Vac, which was designed specifically for cleaning and removing particulates from your mattress. This handheld vacuum can also be used on other furniture in your home and includes HEPA filtration, cordless operation, a motorized mattress tool, and 3 other handy accessories. While hypoallergenic bedding protects you from asthma triggers, we recommend vacuuming your mattress and carpets with a HEPA vacuum to remove them entirely from your bedroom.

Use a Bedside Air Purifier to Clean Your Air While Sleeping

Your bed and carpets aren’t the only places triggers could be hiding: Keeping your bedroom air clean is just as important. Placing an air purifier near your bedside is another great way to breathe easier while you sleep. Air purifiers complete total air changes in your room–meaning all the air will go through it. Generally filters are used to trap these unwanted particles out of your air.

One air purifier for night-time use is the Coway AP-0512NH. True HEPA filtration clears out allergens, odors (including smoke, which is another asthma trigger), and other unwanted particles. You can also add soothing sounds or lullabies as you sleep. Breathing clean air while you sleep is extremely important to preventing nighttime attacks.


Increased asthma symptoms or attacks during the night not only wreck your sleep, but can cause other health problems. The most common culprits of these attacks are dust mites hiding in your mattress, carpet, or rugs, and airborne particulates. Creating a healthier bedroom can include restricting pet access to the room, washing all soft materials often, and effective vacuuming using a machine with a HEPA filter. Green cleaners can cut down unnecessary chemicals as well, and adding a portable air purifier is a great way to keep air clean.

Other Considerations

If your nighttime asthma symptoms aren’t getting better, you may also want to talk to your doctor about adjusting your medication to ensure it works through the night

These products can help you curb your asthma symptoms as you sleep, which will increase your overall health. They’re also great tips if you’re someone who wakes up sneezing or suffering from asthma symptoms in the morning.

Have you used any of these products? Do you have other suggestions? Feel free to share them with us in the comments below or on Twitter and Facebook.

Wheezing When Lying Down


Wheezing is a high-pitched whistling or rattling sound that occurs when breathing, particularly during an exhale. The wheezing sound is the result of constricted or inflamed airways, most frequently caused by asthma or COPD (chronic obstructive pulmonary disease).

Read on to learn more about the causes of wheezing while lying down.

Wheezing when lying down

Wheezing might only occur, or get worse when lying down. For some conditions, wheezing when lying down only starts after a few hours of being reclined. If you are only wheezing when lying down, it might be a sign of one of these following conditions:

Sleep apnea is a condition where breath stops and starts throughout sleep. Symptoms of sleep apnea can include wheezing when lying down, accompanied by:

  • Loud snoring
  • Gasping for air
  • Dry mouth
  • Headaches in the morning
  • Insomnia
  • Hypersomnia (excessive daytime sleepiness)
  • Episodes of breath stopping during sleep

Heart failure, also called congestive heart failure, is the progressive decline of the heart’s ability to pump blood.

Cor pulmonale is similar, failure of the right side of the heart. These conditions might not show any symptoms, or symptoms might develop as the problem progresses. Symptoms for both heart failure and cor pulmonale include:

  • Shortness of breath or wheezing when lying down
  • Sudden shortness of breath accompanied by coughing up foamy mucus
  • Fatigue
  • Dizziness
  • More frequent urination at night
  • Irregular heartbeat
  • Productive wheezing or coughing (white or pink phlegm comes out)
  • Rapid weight gain
  • Loss of appetite
  • Difficult concentration
  • Swelling of appendages below the waist (legs and feet)
  • Chest pain (if heart failure is the result of a heart attack)

Nocturnal asthma. Asthma can be worse during sleep. Although the reason for this is not explicitly known, possible reasons include: cooler air, reclined body position, and hormone changes. Symptoms of nocturnal asthma might include:

  • Wheezing
  • Cough
  • Chest tightness
  • Difficulty or shortness of breath

GERD (gastroesophageal reflux disease) causes stomach acid to flow into the esophagus. This can result in breathing issues like wheezing. The stomach acid can trigger asthma for people who have both conditions. Symptoms of GERD are often worse at night, which might cause wheezing when lying down accompanied by:

  • Heartburn
  • Chest pain
  • Difficulty swallowing
  • Chronic cough
  • Laryngitis
  • Asthma
  • Disrupted sleep

Other causes of wheezing

Many medical conditions can cause wheezing whether or not you are lying down. Some conditions are chronic, some are acute, some are minor and manageable, and some are emergencies.

Contact a doctor if you have: wheezing symptoms for the first time; fever of 101° F or more; yellow, green, or bloody mucus that is coughed up; bluish skin; or a change in mental state or decreased alertness.

Seek emergency care if wheezing is accompanied by severe allergic reaction; sharp, localized chest pain; or a sensation of suffocation.

Additional causes of wheezing include:

  • COPD
  • Respiratory tract infections (e.g. bronchitis, bronchiolitis, pneumonia)),
  • Emphysema
  • Lung cancer

Seek immediate medical attention for wheezing caused by:

  • Foreign objects inhaled “down the wrong pipe”
  • Anaphylaxis (a severe allergic reaction)

If you are experiencing wheezing while lying down book an appointment with a PlushCare physician to get an official diagnosis today.

Read more about wheezing

  • Wheezing Symptoms
  • Wheezing Dry Cough
  • Wheezing

Causes Of Asthma Attacks At Night

The exact causes of asthma attacks in bed at night are still not known. However, there are explanations for why you have been wheezing, coughing, and sneezing in bed at night. Including environmental factors such as an increased exposure topollution or indoor allergens. Furthermore, nocturnal asthma may also cause by the reclining position, cooling of airways or hormones. Sleep itself could also cause changes in the bronchial function.

Reclining position

Sleeping in a reclining position can cause wheezing and coughing in bed at night. It can also increase the volume of blood in the lungs, increase in airway resistance, the buildup of secretions in the airways and decreased lung volumes.

Increased in Sinusitis or Mucus

Your airways tend to narrow during sleep and build up the mucus in the swollen airways. This may trigger wheezing and coughing at night, which cause even more tightening of the airways. More drainage from your sinuses can also trigger asthma in highly sensitive airways, which is quite common.

Internal triggers

Asthma symptoms may occur during sleep whether you sleep at night or day. People who work at night may experience breathing attacks during the day when they are asleep or taking a rest. Most research shows that breathing tests are worse about 4 to 6 hours after you fall asleep. It suggests that there may be some internal triggers for sleep-related asthma.

Air conditioning

Sleeping with the air conditioning on or breathing colder air at night can cause nighttime asthma. Your airways may lose heat and the colder the air, the dryer the air. This triggers asthma, especially exercise-induced asthma, and nocturnal asthma.


Increase exposure to pollution or indoor allergens can trigger asthma. For example, the allergic substance from pets or dust mites in your living or bedroom. Traditional wood burning earthen stoves and exasperating fumes from kerosene heaters may cause asthma attacks at night.

Gastro-esophageal reflux disease

If you frequently experience heartburn, then the reflux of stomach acid rises through the esophagus to the larynx. This may stimulate a bronchial spasm, and it’s even worse when you’re lying down. Certain medications for asthma which relax the valve between the stomach and the esophagus may also worsen the situation. In some cases, the acid from the stomach irritates the lower esophagus. It may activate the vagus nerve that sends signals to the bronchial tubes that result in bronchoconstriction. Taking care of Gastroesophageal reflux disease and asthma with the right medications can often cure wheezing and coughing at night.

Late Phase Responds

The changes are high that airway obstruction or allergic asthma will occur shortly after being exposed to an allergen or asthma trigger. The acute asthma attack at night ends within one hour. Approximately 50% of the people who get an immediate reaction have a second response. The second phase of airway obstruction occurs within three to eight hours after being exposed to an allergen. It is also known as the late-stage answer, characterized by the development of bronchial inflammation, an increase in the airway responsiveness and a prolonged period of airway obstruction. Researchers have shown that exposure to an allergen in the evening increase the chances of having a late phase response and more severe.


The hormone levels in your body changes according to the circadian rhythms. Epinephrine is a hormone that keeps the muscle of in the walls of bronchi relaxed, so the airways remain full. It also suppresses the release of other substances like histamine, which cause bronchospasm and mucus secretion. The epinephrine levels are the lowest around 4 A.M. while the histamine levels tend to peak at the same time. This results in narrowing and inflammation of the bronchi, which explains nocturnal asthma during sleep.

Treatments For Wheezing And Coughing At Night

There is no cure yet for nocturnal asthma yet, but it can be controlled. The best way to prevent your wheezing and coughing in bed at night is to control your asthma in general. The central part of treating sinusitis and gastroesophageal reflux is to monitor the allergens in the bedroom. This can minimize the night time symptoms, such as wheezing and coughing at night. The following treatments and lifestyle tips can help you sleep better.


  • Anti-inflammatory
  • Antihistamines
  • Bronchodilators
  • Corticosteroids
  • Inhaled glucocorticoids
  • Inhaled/oral B2 adrenergic agonists
  • Leukotriene modifiers
  • Steroids
  • Theophylline

Lifestyle adjustments

  • Use latex pillows and latex mattresses that are anti-dust mites
  • Keep your pets away and out of your bedroom
  • Install a humidifier in your room to maintain the air moist
  • Take your medicines on time so they continue to work throughout the night.

Nocturnal asthma is not uncommon since studies have shown that even healthy lungs function best from 12 P.M. to 4 P.M. and worst between 3 and 4 A.M. Doctors often underestimates nocturnal asthma while most deaths related to asthma symptoms occurs through wheezing, coughing, and sneezing at night. Nocturnal asthma needs a proper asthma diagnosis and an effective asthma treatment.

Javeed Akhter, M.D., Section Head of Pediatric Pulmonology at Hope Children’s Hospital in Oak Lawn, Ill., offers the following answer:

Image: STEVE KAGAN, M.D. MAST CELL. These large cells, filled with potent inflammation-inducing chemicals called leukotrienes, line the respiratory tract and play a central role in allergy-induced asthma.

Asthma is an eminently controllable illness. Indeed, for most sufferers, control is so effective that it amounts to a virtual cure. But asthma is not curable in the same way as, say, a bacterial pneumonia; it never entirely goes away. Also, no one cure would ever suffice. It is becoming increasingly clear that there many types of asthma–and they differ greatly in their presentation and genesis. For example, asthma that presents as a chronic cough, the “cough variant of asthma,” appears to be very different from the life-threatening variety, which results in extreme respiratory failure and sometimes death.

Nevertheless, the sine qua non of asthma–as we understand it today–is the increased sensitivity of the airways to many different agents. These agents include respiratory viruses (common cold virus), pollutants (ozone and cigarette smoke), airborne allergens (animal dander, pollens and molds) and exercise, especially in a cold and dry environment. These agents, called triggers, induce an inflammatory reaction in the airways that, in turn, results in the common symptoms of cough, wheezing, increased mucus production and shortness of breath. Successful control of asthma entails controlling the inflammation in the airways and reversing the symptoms before they get out of hand.

The greatest advances in controlling asthma may be the change in physicians’ attitudes toward using preventive medications, as well as attempts to make home rescue plans more aggressive and self-sufficient. The availability of selective and potent medications has made such changes possible. By avoiding known triggers in the environment, such as cigarette smoke, dust mites, roach antigens and dander from warm-blooded pets like cats and dogs, patients can help minimize airway inflammation. Also, newer, tighter and more energy-efficient homes, forced-air heating and wall-to-wall carpeting all contribute to higher levels of indoor triggers.

Another effective strategy for preventing inflammation is the use of certain medications either daily during a season (for most individuals with asthma, it is the fall season), during multiple seasons or year-round. One class of these medications stabilizes the mast cell, (large cells filled with potent inflammation-inducing chemicals called leukotrienes), which line the respiratory tract and play a central role in allergy-induced asthma. These mast cell-stabilizing inhalants include Cromolyn and Nedocromyl. Cromolyn is of particular interest as it is derived from the plant Ammi Visnaga, long used by American Indians as an herbal remedy for colic.

An exciting new class of oral medications, called leukotriene modifiers, neutralize the actions of leukotrienes. This class of medication is the first new class to become available for asthma management in the past 20 years and holds great promise. It includes Zafirlukast, Pranlukast and Zileuton. The most effective preventive medications for asthma belong to the family of corticosteroids. These inhaled medications are delivered either via pressurized canisters or dry powder dispensers and include Beclamethasone, Triamcinolone, Flunisolide, Budesonide and Fluticasone. Their widespread use is the single most important reason for the improved control of asthma in recent decades. Because these medications are applied directly to the surface of the airways through inhalation–and so do not affect other parts of the body as they might if taken orally–their side effects are minimized.

Another attitudinal advance in managing asthma has been the early and aggressive use of symptom relief medications, including Beta-2 receptor stimulants and short courses of oral steroids, as a part of the home rescue therapy. This form of therapy has the additional advantage of making patients and caregivers self-sufficient and confident in handling an acute episode of asthma. This type of self-sufficiency is essential in the successful control of any chronic illness. And the good news on this front is that a second class of Beta-2 medications (essentially more selective optical isomers of their parent medications) has just become available.

The past few years have also seen a concerted effort by the National Institutes of Health, especially the National Heart, Lung, and Blood Institute, and other agencies to educate physicians in the best ways to manage asthma. Community education programs, support groups and the Internet have played a major role in providing useful information to parents of asthmatic children and patients alike.

In summary, the therapeutic and attitudinal advances in managing asthma have been very substantial in the past 15 to 20 years, resulting in more effective and safer ways of controlling it. Although a cure is not on the horizon, nearly complete control is well within reach.

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