Asthma is a chronic lung condition that can cause wheezing, coughing, chest tightness and shortness of breath. Symptoms often worsen at night, leading to sleep difficulties and even asthma attacks. Thankfully, there are several effective treatments that can help control asthma overnight and prevent symptoms from flaring up.
Use controller medications as prescribed
The most important asthma treatment is taking daily controller medications as prescribed by your doctor. These long-term control medications help reduce airway inflammation and prevent asthma symptoms from occurring in the first place. Types of controllers include:
- Inhaled corticosteroids – These anti-inflammatory drugs are the preferred long-term control medication for persistent asthma. Examples include beclomethasone (Qvar), budesonide (Pulmicort), fluticasone (Flovent) and mometasone (Asmanex).
- Long-acting beta agonists (LABAs) – LABAs relax airway muscles to open up the airways. Salmeterol (Serevent) and formoterol (Foradil) are two types. They are always used in combination with an inhaled corticosteroid.
- Leukotriene modifiers – These oral medications block leukotrienes, which are chemicals that cause airway inflammation. Options include montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo).
- Biologics – Newer injectable biologic medications can be highly effective for severe asthma. They target specific immune system proteins to reduce inflammation. Omalizumab (Xolair) and mepolizumab (Nucala) are two examples.
- Theophylline – This oral medication relaxes airway muscles to open up the airways. It may be used as add-on treatment in some cases.
Taking inhaled corticosteroids regularly as prescribed is key to controlling asthma long-term and preventing nighttime symptoms. Adding in a LABA and/or leukotriene modifier provides additional control. Biologics may be an option for severe asthma. Discuss the best regimen for your individual needs with your doctor.
Avoid asthma triggers
Preventing exposure to common asthma triggers is another essential part of controlling symptoms, especially at night:
- Allergens – Such as pollen, pet dander, mold and dust mites can trigger allergic reactions. Use allergen-proof covers on mattresses and pillows. Keep pets out of the bedroom. Use an air purifier and vacuum regularly.
- Irritants – Things like smoke, air pollution, cold air, strong smells (perfumes, cleaning products) and chemicals (like paint fumes) can irritate airways. Avoid smoking and secondhand smoke. Limit use of sprays, scented products and other irritants in the bedroom.
- Weather changes – Asthma symptoms may worsen with changes in weather, temperature, humidity and air pressure. Be prepared if asthma tends to flare with weather swings.
- Illnesses – Colds, sinus infections, pneumonia and other illnesses can aggravate asthma. Wash hands frequently and get recommended vaccines to prevent infection.
- Gastroesophageal reflux disease (GERD) – Stomach acid backing up into the throat and airways can cause asthma symptoms. Avoid big meals, caffeine, alcohol and trigger foods before bedtime.
- Exercise – Some people only experience asthma symptoms with physical activity. Use a quick-relief inhaler before exercise as directed by your doctor.
- Strong emotions – Stress, anxiety, laughing or crying hard can sometimes trigger symptoms. Using stress management techniques may help.
Identifying and limiting exposure to your personal asthma triggers is key to reducing symptoms at night when triggers are often still present indoors.
Use quick-relief medications as needed
Even with consistent long-term control, quick-relief or “rescue” medications may still be needed to treat breakthrough symptoms. These medications provide rapid relief when you are having symptoms or an asthma attack occurs. Types include:
- Short-acting beta agonists (SABAs) – Albuterol (ProAir, Ventolin) is the most common type. It quickly relaxes airway muscles for up to 4 hours.
- Ipratropium (Atrovent) – This anticholinergic medication blocks acetylcholine to open up the airways. It may be used in combination with albuterol.
- Oral corticosteroids – Prednisone is used for moderate to severe asthma attacks. A short course (like 3 to 10 days) may be prescribed.
Keep your quick-relief medication by your bed at night. Use it as soon as symptoms occur to prevent a full-blown attack. More than 2 treatments per week is a sign asthma is not well-controlled and you may need an adjusted treatment plan.
Use a peak flow meter
Using a peak flow meter at home can help assess your current level of asthma control and determine if treatment adjustments are needed. A peak flow meter measures the fastest rate you can blow air out of the lungs. You blow hard and fast into the handheld device. The rate is measured in liters per minute.
Check your peak flow twice daily – in the morning and at night before bed. Compare the numbers to your personal best reading when asthma is under good control. Falling peak flow values are an early warning sign that asthma is worsening before you even feel symptoms. Nighttime readings that are 15% or more below your personal best indicate you may need additional or adjusted treatment.
Adopt good sleep habits
Poor sleep and asthma symptoms can negatively affect each other. Difficulty breathing disrupts sleep, and inadequate rest can make asthma control more difficult. Follow good sleep hygiene practices to help avoid this cycle:
- Go to bed and wake up at the same time each day to keep your body’s sleep-wake cycle regular.
- Make sure your bedroom is comfortable – cool, quiet, dark and comfortable mattress/pillows.
- Avoid electronics and screens before bedtime.
- Limit caffeine intake, especially late in the day.
- Use relaxation techniques like deep breathing, meditation or light yoga before bed.
- Try over-the-counter medications like antihistamines, melatonin or magnesium if insomnia is an issue.
Getting adequate quality sleep makes it easier to manage asthma symptoms. Aim for 7-9 hours per night for adults and 8-10 hours for children.
Use oxygen therapy as prescribed
Some people with severe asthma may benefit from using supplemental oxygen at home, especially while sleeping. This increases the oxygen levels you are breathing in. Low blood oxygen levels can trigger asthma symptoms.
Oxygen therapy is usually administered through nasal prongs or a face mask. The oxygen concentration and rate of flow are adjusted based on your needs. Oxygen levels in the blood are measured with pulse oximetry to help determine if home oxygen is required.
Using oxygen as prescribed can improve asthma control, reduce symptoms at night and prevent asthma attacks or arousals from sleep. More restful sleep may also be experienced.
Adjust the sleeping position
Lying flat can make it more difficult to breathe for some people with asthma. Gravity causes the diaphragm to press against the lungs when lying down, which can restrict breathing.
Use extra pillows to prop yourself up on an incline while sleeping. This takes pressure off the lungs. Adding pillows under the mattress to elevate the head can also help.
Sleeping upright in a recliner chair is another option. This allows gravity to pull your diaphragm down instead of pressing on the lungs.
Use a bronchodilating medication before bed
Taking a dose of bronchodilator medication right before bedtime can help prevent asthma symptoms overnight. Options include:
- Short-acting beta agonist (SABA) inhaler like albuterol
- Long-acting beta agonist (LABA) inhaler like salmeterol
- Theophylline tablet
- Leukotriene modifier tablet like montelukast
Using a bronchodilator medication before bed relaxes the airways and keeps them open while you sleep. This can reduce coughing, wheezing and shortness of breath. It may allow you to use less quick-relief medication during the night.
Use a nebulizer before bed or when symptoms occur
A nebulizer is a machine that delivers asthma medication in a mist inhaled through a facemask or mouthpiece. It is used when asthma symptoms flair to open the airways.
Using a nebulizer with a fast-acting bronchodilator before bed can prevent nighttime symptoms. If coughing or wheezing occurs in the middle of the night, using the nebulizer again can provide prompt relief without having to take an oral medication.
Nebulizers allow higher medication doses to be delivered than inhalers. The mist also penetrates deeper into the lungs. This leads to faster, more complete airway relaxation.
Consider allergy shots (immunotherapy)
Allergy shots may be an option if asthma is triggered by allergies. Allergy shots work by gradually exposing you to tiny amounts of the allergens to train your immune system to tolerate them.
After starting shots, asthma often improves in 6 to 12 months as allergies diminish. Benefits grow the longer shots are continued, with relief sometimes lasting for years after discontinuing them.
By reducing allergic reactions, allergy shots can eliminate an asthma trigger. This may lower the risk of nighttime asthma flares when exposure to dust mites or pet dander is highest in the bedroom.
Treat coexisting conditions
Other medical conditions that coexist with asthma need to be properly treated and controlled to help avoid aggravating asthma symptoms at night:
- Gastroesophageal reflux disease (GERD) – Manage with diet, lifestyle changes, antacids and medications to reduce reflux.
- Obstructive sleep apnea – Use CPAP therapy and avoid sleeping on the back.
- Chronic sinusitis – Treat with nasal steroids, saline irrigation and antibiotics if needed for infections.
- Obesity – Losing excess weight relieves pressure on the lungs and reduces inflammation.
- Stress and anxiety – Counseling, relaxation techniques, medication and exercise can help.
When coexisting conditions are properly managed, asthma control often improves, including fewer symptoms at night.
Avoid heartburn/indigestion triggers before bed
Gastroesophageal reflux disease (GERD) can exacerbate asthma symptoms at night when lying down. Stomach acid is more likely to back up into the throat and airways in the sleeping position.
Avoid anything that triggers heartburn or indigestion for 2 to 3 hours before bedtime. Things to steer clear of include:
- Spicy, fatty or fried foods
- Citrus fruits
- Tomato-based foods
- Chocolate
- Mint
- Caffeine
- Alcohol
- Large meals
Eat smaller dinners earlier and avoid problem foods and beverages to reduce reflux symptoms overnight. Raising the head of the bed on 6-inch blocks can also help prevent the backup of stomach contents.
Use air filters and purifiers
Air filters and purifiers can remove asthma triggers like dust, pet dander, pollen and mold from the indoor air. This may reduce asthma symptoms, especially at night when airborne allergens stirred up by moving in bed accumulate in the bedroom.
Portable room air cleaners with a HEPA filter are recommended for the bedroom. The HEPA filter captures tiny particles down to 0.3 microns in size. Encase mattresses and pillows in allergen-proof covers as well.
Having an HVAC system with a high-efficiency particulate air (HEPA) filter installed can filter allergens throughout the house. Consider also getting a dehumidifier to keep indoor humidity under 50% to discourage dust mite and mold growth.
Use mattress/pillow covers
Dust mites and their feces are some of the most common asthma triggers. These microscopic bugs thrive in warm, humid environments like bedding. Their waste particles become airborne when disturbed.
Covering mattresses and pillows in dust mite-proof encasings prevents them from inhabiting bedding. The pores in the fabric are too small for them to penetrate. This can greatly reduce exposure to these allergens during sleep.
Covers made from tightly-woven, breathable materials like microfiber work best. Pillow protectors with a zipper are more reliable than slip-on versions.
Remove bedroom carpet
Wall-to-wall carpeting harbors dust mites, pet dander, pollen and other asthma triggers. Replacing bedroom carpets with hard flooring can greatly reduce exposure.
Hard surfaces like wood, vinyl or tile don’t accumulate allergens as easily as carpet. They can be swept or vacuumed more thoroughly as well. Area rugs should be washable if used.
Installing wood or tile flooring is ideal, but simply removing carpet and exposing the subfloor creates a less hospitable environment for allergens. Use area rugs that can be cleaned regularly.
Use dehumidifiers
Lowering indoor humidity below 50% helps reduce mold and dust mites, two major asthma triggers. These allergens thrive in damp environments.
Portable or whole-house dehumidifiers can bring down humidity levels throughout the home. Use air conditioning as well during hot, humid months. Improving ventilation helps remove moisture too.
Use a humidity monitor to check levels in the home. Keeping humidity in the 30-50% range discourages allergen growth best in most climates. This may significantly reduce asthma flare ups.
Conclusion
Asthma symptoms like coughing, wheezing and chest tightness often worsen at nighttime. Thankfully, treating asthma properly over the 24-hour day can prevent these disruptive symptoms while sleeping.
Using controller and rescue medications as directed is key, along with avoiding personal asthma triggers. Adopting good sleep habits, positional changes and treating coexisting conditions also helps.
Devices like peak flow meters, nebulizers and air purifiers add additional control. Home modifications like dust mite covers, removing carpets and dehumidifiers also minimize exposure to nighttime allergens.
With multiple effective treatments and precautions available, asthma can often be well-managed overnight. Work closely with your doctor to find the right combination for your needs.