Can Asthma Kill You In Your Sleep?

In this article, we’ll look at whether asthma can be life-threatening during sleep and what you can do to reduce the risks. We’ll cover how common nighttime asthma (also known as nocturnal asthma) is in the UK, what typically causes it and why symptoms can become more severe overnight. We’ll also explain the potential dangers of poorly controlled asthma while sleeping and share practical steps you can take to help manage your symptoms and improve your sleep quality.

Key Takeaways

Here are the five biggest takeaways from this article about whether asthma can harm you in your sleep:

• Night-time asthma is common and affects millions in the UK

• Nocturnal asthma can be dangerous and even life-threatening

• Respiratory failure is a serious risk in severe, poorly managed cases

• Asthma symptoms that interrupt sleep can reduce lung function overnight, especially in those with uncontrolled asthma

• Following an asthma action plan, taking medications correctly, avoiding triggers, adjusting sleep position and getting medical advice can help reduce symptoms and improve sleep

How common is night-time asthma (nocturnal asthma) in the UK?

Night-time asthma, also known as nocturnal asthma, is a common issue for people living with asthma in the UK. More than five million people in the UK are affected by asthma. It’s estimated that up to three-quarters of sufferers experience symptoms during the night, roughly 3.75 million people [1]. These symptoms often occur just before or during sleep, and can include:

• Coughing

• Chest tightness

• Wheezing

• Shortness of breath

For many, nighttime asthma can have a significant impact on sleep quality and overall health, especially if it’s not well managed.

Understanding nocturnal asthma and what triggers it

Nocturnal asthma refers to asthma symptoms that become worse at night, often disrupting sleep. As mentioned, it is very common among people with asthma, with around 75% of people being woken by symptoms at least once a week, and roughly 40% experiencing these symptoms every night [2].

Although the exact reasons why asthma worsens at night are not fully understood, there are several possible explanations. 

Your hormones

One is the body’s natural hormonal cycle. Hormones like cortisol, melatonin and epinephrine follow a circadian rhythm, meaning they rise and fall at certain times of the day. In the evening, changes in these hormone levels may cause increased inflammation in the airways, which can worsen asthma symptoms [3].

Other medical conditions

Other medical conditions can make nocturnal asthma more likely or more severe. For example, acid reflux is present in up to 80% of people with asthma and is strongly linked to nighttime symptoms. Obesity is another factor, potentially due to increased inflammation and pressure around the airways [4].

Your lifestyle and environment

Environmental and lifestyle triggers also play a significant role. Common triggers include tobacco smoke, cold air and allergens in the bedroom such as dust mites, pet hair, mould and pollen. Some foods and drinks containing sulphites (like wine, dried fruit and processed foods) may also cause issues if eaten too close to bedtime.

These factors can all combine to make nocturnal asthma more difficult to manage, particularly in people who already have poorly controlled asthma. Research suggests that people with nighttime symptoms may have worse overall asthma and are more likely to need urgent care or hospital treatment [5].

Why can nocturnal asthma be dangerous?

More chance of severe attacks

Nocturnal asthma can be particularly dangerous because symptoms often become more severe during sleep, increasing the risk of serious asthma attacks. When symptoms are left untreated or unnoticed during the night, they can escalate into more serious issues. In some cases, these can be life-threatening, especially if the symptoms do not wake the person up or does not have access to quick-relief medication [6].

Research shows that asthma-related deaths are more likely to occur at night than during the day. This may be due to a combination of factors, including reduced awareness of symptoms while asleep, delays in treatment, and the natural changes in the body’s airway function and immune response that occur overnight [7].

Respiratory failure

In severe cases, nocturnal asthma can lead to respiratory failure, a life-threatening condition where the lungs are no longer able to supply enough oxygen to the body or remove carbon dioxide effectively. During an asthma attack, the airways can become inflamed and narrowed, making it increasingly difficult to breathe. This narrowing can result in poor airflow, reduced oxygen levels in the blood and a dangerous mismatch between ventilation and blood flow in the lungs, known as ventilation-perfusion imbalance [8].

As the body struggles to get enough air, the muscles involved in breathing can become fatigued. If the attack continues without proper treatment, this can lead to ventilatory muscle exhaustion and ultimately respiratory failure.

This risk is even higher during sleep, when a person may not notice early warning signs or may delay taking medication. The combination of reduced awareness, natural overnight changes in breathing, and underlying airway inflammation makes respiratory failure a serious risk for those with poorly controlled nocturnal asthma [9].

Disrupting your sleep 

Nocturnal asthma can have a profound impact on sleep. Many people with asthma find that symptoms such as coughing, wheezing and shortness of breath become worse at night, disrupting their ability to fall or stay asleep.

The link between asthma and disrupted sleep is partly due to the body’s natural circadian rhythm. Lung function tends to decline overnight, making it harder to breathe and increasing the risk of asthma symptoms while sleeping. This drop in lung function is especially noticeable in people with poorly controlled asthma and can significantly affect sleep quality [10].

How to manage and prevent asthma in your sleep

Follow your asthma action plan

One of the most effective ways to manage and prevent asthma symptoms during sleep is by following a personalised asthma action plan. This is a written plan created with your GP or asthma nurse that outlines how to manage your asthma daily, how to recognise when symptoms are getting worse and what to do in an emergency [11].

Your action plan should include details of your regular preventer and reliever inhalers, the correct doses and when to take them. It may also list your known triggers and how to avoid them, particularly those that can worsen symptoms at night, such as dust mites, cold air, or certain foods.

Take prescribed medications as recommended by your doctor

Taking your prescribed asthma medication exactly as recommended by your doctor is essential for managing symptoms, especially at night. Most people with asthma are prescribed two types of inhalers. A preventer inhaler (such as Clenil Modulite), which is used daily to reduce inflammation in the airways, and a reliever inhaler (such as Ventolin), which is used when symptoms flare up [12].

A preventer inhaler is particularly important for preventing nighttime symptoms, as it works while you are sleeping to reduce the likelihood of your airways becoming irritated or narrowed.

Identify and avoid asthma triggers

Identifying and avoiding your asthma triggers is a key part of preventing symptoms during the night. Triggers can vary from person to person, but common ones include:

• Dust mites

• Pet hair

• Mould

• Cold air

• Pollen

• Tobacco smoke

• Strong scents

Some people may also react to certain foods or drinks, particularly those containing sulphites, or to medications like aspirin [13].

When these triggers are present in your bedroom environment, they can make nocturnal asthma symptoms worse.

Seek appropriate medical attention if your symptoms get worse  

If your asthma symptoms become more frequent, severe, or start to affect your sleep regularly, it’s important to get medical advice as soon as possible. Worsening nighttime symptoms may be a sign that your asthma is not well controlled and could increase your risk of a serious asthma attack.

You should contact your GP or asthma nurse to review your current treatment and update your asthma action plan if needed. 

Try sleeping in different positions to open up your airways

The position you sleep in can have a noticeable impact on your breathing, especially if you suffer from nocturnal asthma. Lying flat on your back may cause your airways to narrow or become more easily irritated, particularly if you also experience acid reflux.

Some studies suggest that sleeping on your side or propping yourself up slightly with extra pillows can help keep the airways open and reduce the risk of symptoms during the night [14]. This position may also help reduce pressure on the lungs and improve airflow, making it easier to breathe while you sleep.

Final Thoughts

While asthma can be managed effectively with the right treatment, nocturnal asthma does carry serious risks, including the potential for life-threatening complications during sleep. With as many as three-quarters of people with asthma in the UK experiencing nighttime symptoms, it’s a common issue that should not be ignored. 

Poorly controlled asthma can lead to severe attacks, disrupted sleep and, in rare cases, respiratory failure. Following your asthma action plan, taking prescribed medication regularly, avoiding known triggers and adjusting your sleeping position can all help to reduce your symptoms and improve your sleep quality. 

Sources

[1] Asthma at Night - Global Allergy & Airways Patient Platform

[2] An Unidentified Monster in the Bed – Assessing Nocturnal Asthma in Children - PMC

[3] Understanding Nocturnal Asthma. The Plot Thickens - PMC

[4] Nocturnal Asthma - PubMed

[5] Ten-year longitudinal study of factors influencing nocturnal asthma symptoms among Asian patients in primary care - Nature

[6] Nocturnal Asthma - an overview | ScienceDirect Topics

[7] SLEEP IN ASTHMA - ScienceDirect

[8] Clinical review: Severe asthma - PMC

[9] The cell biology of asthma - Journal of Cell Biology

[10] Nocturnal asthma - Journal of Allergy and Clinical Immunology

[11] Asthma Action Plan - Medical Glossary | UK Meds

[12] Buy Asthma Inhaler | UK Meds

[13] Asthma Triggers - Medical Glossary | UK Meds

[14] Asthma at Night - Global Allergy & Airways Patient Platform

Further Reading

What Is Nocturnal Asthma? | Sleep Foundation