Reviewed by Flavia Cecilia Lega Hoyte, MD

The worsening of asthma at night, or nocturnal asthma, is very common. As you sleep, your airways will often narrow, which could lead to increased airflow resistance. This makes asthma attacks more likely. The symptoms during asthma attacks at night are similar to daytime episodes, including shortness of breath, coughing and chest tightness. Many factors may contribute to the increased symptoms, including:

  • Exposure to allergens in the bedroom, particularly dust mites
  • Delayed allergic responses, which may occur 3–8 hours after exposure
  • Postnasal drip (from chronic sinus problems and/or allergies), which can worsen with lack of gravity as you lay flat at night
  • Gastroesophageal reflux, which can worsen with lack of gravity as you lay flat at night
  • Airway cooling from a drop in body temperature
  • Decreased effect of evening medications as they wear off during early morning hours
  • Sleep apnea — brief, repetitive pauses in breathing during sleep caused by an upper airway obstruction

Treatment and Management

The symptoms of nocturnal asthma should not be ignored, as they can negatively impact your quality of life. They also complicate daytime asthma symptoms. Using a peak flow meter to monitor lung function between day and night can illuminate altered lung function patterns, allowing for more guidance as to the exact cause of your asthma at night.

Treating any underlying causes of nocturnal asthma should help you be able to sleep through the night without asthma symptoms. Controlling allergen exposure in the bedroom, treating sinusitis and/or allergic rhinitis to decrease postnasal drip and following lifestyle measure that decrease gastroesophageal reflux can minimize nighttime asthma symptoms. You can also ask your doctor about medications that can help reflux by minimizing acid production in the stomach.

Your doctor may need to adjust the type and timing of allergy, asthma and reflux medications to give extra protection during the night.

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