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Why Does Asthma Worsen At Night? Tips To Manage

Asthma is a chronic disease that causes inflammation and narrowing of the airways in the lungs. It causes wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. During an asthma attack, your airway muscles constrict, and mucous membranes produce excess mucus, blocking your breathing. Allergens such as dust, spores, animal hairs, cold air, infection and even stress can trigger asthma [1][2].

There are many different types of asthma brought on by different triggers. Some of the most common types of asthma are adult-onset asthma, allergic asthma, nocturnal asthma, asthma-COPD overlap, non-allergic asthma, occupational asthma and childhood asthma [3].

According to various studies, about 15 per cent of the Indian population is suffering from asthma. The respiratory problem is diagnosed at an early age, and since this ailment is not curable, people try to do everything they can to keep the symptoms under control in an effort to lead a normal life. Asthma can be treated with medications and lifestyle changes [4].

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Reason Why Asthma Worsens At Night

Most of the illnesses we have get worse at night - and this is something the majority, if not all of us, have noticed and experienced. Be it a fever, body pain or toothache, the irritation and discomfort worsen during the night, so why does this happen? Why do you feel sicker at night? Well, that is because, at night, there is less cortisol in your blood, causing your white blood cells to detect and fight infections at this time, resulting in the symptoms of the infection to the surface, such as fever, congestion, chills, or sweating [5].

Cortisol, the steroid hormone, is responsible for your metabolism and the immune response. So, when the cortisol levels are down, your body is vulnerable and makes you feel sicker at night [6]. Now that you know why your fever gets worse at night, let's take a look at how and why asthma worsens at night.

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So, what exactly are the reasons behind asthma getting worse at night?

  • According to the recent research published in The Proceedings of the National Academy of Sciences, the reason behind asthma getting worse at night have been linked to the influence of the circadian rhythm or system, in contrast to the sleep and physical activities - which were observed as the reasons till now [7][8].
  • Around 75 per cent of people with asthma experience the symptoms getting worse at night [9].
  • Mostly, behavioural and environmental factors, including exercise, air temperature, posture, and sleep environment, are known to impact asthma severity.
  • However, the new study took a different perspective and explored the link between asthma symptoms and the circadian system. The circadian system or rhythm are physical, mental, and behavioural changes that follow a 24-hour cycle; basically, it is a part of the body's internal clock [10]. It is important for the coordination of bodily functions.
  • Seventeen people with asthma were selected for the study, where lung function, asthma symptoms and bronchodilator use were continuously assessed.
  • The study had two parts, in one, participants spent 38 hours continuously awake, in a constant posture, and under dim light conditions, with identical snacks every two hours (constant routine), and in another, participants were placed on a recurring 28-hour sleep/wake cycle for a week under dim light conditions, with all behaviours scheduled evenly across the cycle (forced desynchrony).
  • The experiments revealed that the circadian rhythms play a significant role in regulating pulmonary function over a daily cycle. And the revealed that sleep phases play a significant role in asthma severity independent of circadian effects.
  • Study results: The influence of circadian cycles on asthma was just as relevant as sleep and wake behavioural cycles. Also, the lowest pulmonary functions were detected at around the circadian equivalent of 4 am. The finding states that the central reason why asthma tends to worsen at night is the uneven combination of sleep behaviours and circadian cycles [12].

    According to experts, "This is one of the first studies to carefully isolate the influence of the circadian system from the other factors that are behavioural and environmental, including sleep."

    "We observed that those people who have the worst asthma, in general, are the ones who suffer from the greatest circadian-induced drops in pulmonary function at night, and also had the greatest changes induced by behaviours, including sleep," they added.

    Steven Shea, the co-corresponding author on the study, said, "We observed that those people who have the worst asthma, in general, are the ones who suffer from the greatest circadian-induced drops in pulmonary function at night, and had the greatest changes induced by behaviours, including sleep. "We also found that these results are clinically important because, when studied in the laboratory, symptom-driven bronchodilator inhaler use was as much as four times more often during the circadian night than during the day" [11].

    Consequently, while the study findings linked the asthma symptoms to uneven sleep behaviours, there could also be other behaviours or factors that could impact the circadian rhythm.

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Tips To Manage Asthma Attacks At Night

In addition to taking asthma medications prescribed to you by a physician, certain steps can help improve your sleeping quality when suffering from asthma:

  • Wash your bedding in hot water weekly.
  • Invest in dust-proof mattresses and pillow covers [13].
  • Clean your bedroom regularly.
  • Buy a humidifier [14].
  • Avoid sleeping with pets (fur).
  • Sleep with your head slightly elevated [15].
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On A Final Note…

The study authors stressed that the findings could help in developing specific therapy treatments for asthma, where it could directly treat the circadian system with therapeutics or timed pharmaceuticals to improve the circadian clocks themselves in people with asthma.

What is the main cause of asthma?

Allergens cause asthma, and some common airborne allergens include pollen, dust mites, mould spores, pet dander or particles of cockroach waste, and respiratory infections such as common cold and exposure to cold air.

Does asthma make you tired?

Yes, asthma can make you feel tired and fatigued.

What is the best sleeping position for asthma?

The best sleeping position for people with asthma are:
1. Lie on your back with your shoulders and neck elevated.
2. Lie on your left side with a pillow between your legs.
3. Lie on your back with your head elevated and your knees bent with a pillow under your knees.

Is asthma worse in the morning or at night?

Normally, asthma worsens at night, between 3 and 4 in the morning.

How can I stop my asthma at night?

Ways you can manage and control your asthma symptoms are by cleaning your bedroom regularly, washing the bedding in hot water, using dust-proof bedding, avoiding sleeping with pets and keeping your head propped up with the help of a pillow, too helps.

Why asthma is worse at night?

Several behavioural and environmental factors, including exercise, air temperature, posture, and sleep environment, are known to influence asthma severity at night.

Why do you feel sicker at night?

At night, there is less cortisol in your blood, causing your white blood cells to detect and fight infections at this time, resulting in the symptoms of the infection surface, such as fever, congestion, chills, or sweating - making you feel sicker at night.

What respiratory illness gets worse at night?

Asthma is the most common respiratory illness that worsens at night.

Story first published: Wednesday, September 8, 2021, 14:04 [IST]
Read more about: asthma home remedy asthma attack