When you buy through our links, we may earn a commission. Products or services may be offered by an affiliated entity. Learn more.
Nocturnal Asthma
- Asthma symptoms often worsen at night, causing coughing, wheezing, shortness of breath, and nighttime awakenings that can interfere with sleep.
- Poorly controlled asthma may reduce sleep quality and lead to daytime fatigue, while inadequate sleep can sometimes make asthma symptoms more difficult to manage.
- Obstructive sleep apnea, insomnia, and acid reflux may occur alongside asthma and contribute to nighttime symptoms.
Asthma is a condition in which a person’s bronchial tubes become swollen. The bronchial tubes are the body’s airways and allow air to move into and out of the lungs. As the airways swell, they lead to symptoms like wheezing, coughing, chest tightness, and shortness of breath. Swollen airways are also more sensitive to allergens and irritants. When asthma symptoms are worse than usual, it’s called an asthma attack, episode, or flare-up.
It’s estimated that asthma affects 1 out of 12 people in the United States, and unfortunately, the prevalence of asthma appears to be increasing. Over the past 40 years, the global prevalence of asthma has increased 50% every decade.
While researchers don’t know why this increase is occurring, many researchers speculate that changes in hygiene practices, the use of certain medications in children, increasing rates of obesity, and vitamin D deficiencies may be to blame.
Asthma and Sleep
Whether it’s due to the symptoms of asthma or just staying up too late, missing sleep can make asthma worse. Sleep loss promotes inflammation in the body and affects lung function, increasing the chances of an asthma attack.
A recent study found that people who get fewer than six hours of sleep experience 1.5 times more asthma attacks and have a poorer health-related quality of life than those who sleep the recommended 7 to 9 hours each night. Poor sleep in people with asthma may also be related to the presence of other health conditions, including sleep disorders, and the stimulating effects of asthma medications.
The symptoms of asthma can flare up or get worse at night. Nighttime asthma, called nocturnal asthma, is an experience that can wreak havoc on a person’s sleep and may be a sign of more severe or poorly-controlled asthma.
What Is Nocturnal Asthma?
Nocturnal asthma is common, and about 75% of people with asthma are woken up by nighttime symptoms at least once per week. Around 40% of people with asthma experience nocturnal symptoms every night. Having poorly controlled or more severe asthma makes a person more likely to experience nocturnal symptoms.
The mechanisms behind asthma symptoms getting worse at night are not fully understood but may be related to normal hormonal changes in the evening. Many hormones — including epinephrine, cortisol, and melatonin — have circadian patterns, which are 24-hour cycles connected to the body’s internal clock. Changes in these hormones that occur in the evening may contribute to inflammation in the airways, increasing the risk of nocturnal asthma symptoms. Hormonal changes during pregnancy can also affect the symptoms of asthma.
Obesity can also increase the risk of nocturnal asthma and make asthma more difficult to manage. While this link is not fully understood, researchers have hypothesized that excess fat around the throat and increased systemic inflammation may contribute to nocturnal asthma in patients with obesity.
Acid reflux, also called gastroesophageal reflux disease (GERD), is another medical condition commonly associated with nocturnal asthma. As many as 80% of people with asthma also experience GERD symptoms like heartburn and regurgitation.
Nocturnal Asthma Triggers
In addition to obesity, GERD, and circadian hormonal changes, there are many environmental triggers that can provoke nocturnal asthma.
- Tobacco smoke: Smoking and exposure to secondhand tobacco smoke can weaken lung function and irritate the airways.
- Allergens in the bedroom: Many people with asthma are sensitive to dust mites, droppings from pests like cockroaches and rodents, animal dander, mold, and pollen. Even if people are exposed to these allergens during the day, a delayed allergic response can cause asthma to act up after getting into bed.
- Diet: Some people with asthma are sensitive to sulfites in foods and beverages like beer, wine, dried fruit, processed potatoes, and shrimp. If consumed too close to bedtime, these foods may trigger nocturnal asthma.
- Medications: Some medications, including certain cold medicines, aspirin, vitamins, and even eye drops can trigger nocturnal asthma when taken too close to bedtime.
- Cold air: Cold air is a common trigger during the day and can also trigger nighttime symptoms if the bedroom environment is too cold or a window is left open.
- Other medical issues: Viral infections like colds, the flu, and sinus infections are some of the most common triggers for nocturnal asthma attacks.
Nocturnal Asthma and Children
Asthma is more common in children than in adults and is the most common chronic disease in children worldwide. Accurately diagnosing and treating nocturnal asthma in children is especially important because the effects of nocturnal asthma, like loss of sleep and daytime sleepiness, are associated with behavioral and developmental difficulties.
Unfortunately, nocturnal asthma often goes undiagnosed in children because they tend to underestimate or not report their nighttime symptoms. For this reason, it’s helpful for parents to monitor and report back to the doctor any concerning symptoms in children. These symptoms may include wheezing, disturbed sleep, daytime sleepiness, and difficulties concentrating at school.
Asthma and Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a disorder in which the airways narrow or collapse during sleep. Asthma and OSA share similar symptoms and appear to have a bidirectional relationship. This means that having one of these respiratory conditions increases the likelihood of being diagnosed with the other. OSA is particularly common in people with asthma who also snore and those with poorly-controlled asthma symptoms.
People with asthma may find it helpful to talk to their doctors about obstructive sleep apnea. Because asthma puts a person at an increased risk of developing OSA, research suggests that periodic evaluations for OSA may help patients with asthma. Fortunately, treating OSA can often reduce asthma symptoms.
Controlling Asthma
Asthma symptoms can often be controlled by working with a doctor, allergist, or pulmonologist (lung specialist) to create a personalized Asthma Action Plan. Controlling asthma typically involves taking asthma medications and making a plan to avoid triggers that make asthma worse. Asthma medications come in two forms: quick-relief medicines that control asthma attacks and long-term control medicines that reduce the frequency and severity of future asthma attacks.
The American Lung Association recommends that people with asthma visit their doctor at least once a year to discuss their Asthma Action Plan. Yet even with the best plan, asthma can sometimes get out of control. If a person with asthma begins to experience new asthma symptoms or starts having trouble with routine activities — like cooking, cleaning, or bathing — it’s important to call a healthcare provider right away.
Avoiding Nighttime Asthma and Improving Sleep
Asthma can make it challenging to get quality sleep, so it’s helpful to cultivate habits that support sleep health. Focusing on improving sleep hygiene is a significant first step. By developing a regular sleep schedule and healthy daytime routines, people with asthma can reduce unnecessary daytime fatigue and focus on controlling their asthma symptoms.
Asthma triggers in the bedroom may increase the risk of nocturnal asthma and lost sleep. In addition to working with a doctor to find solutions for reducing or eliminating asthma triggers, below are a few tips specific to designing the ideal bedroom environment and avoiding nighttime asthma:
- Reducing bedroom allergens: Dust mites and pest residue in the bedroom can trigger nighttime asthma. Eliminating or reducing exposure to these triggers can make a huge difference. Wash bedding regularly and vacuum and dust weekly. Using allergen-proof bedding, like pillows and mattress covers, can help as well. For more information, the Centers for Disease Control and Prevention (CDC) offers a helpful guide to reducing asthma triggers at home.
- Keep pets outside the bedroom: Pet dander and saliva is a common asthma trigger. In addition to regular vacuuming and dusting, it’s helpful to keep pets out of the bedroom in general. For additional protection, consider changing clothes before sleep to prevent tracking pet’s dander into the bedding.
- Be careful with scented products: Strong scents from cleaning products, candles, and personal care products can be a trigger for some people with asthma. Consider making the bedroom an odor- and fragrance-free zone to reduce nighttime asthma.
- De-stress before bed: Stress is a common asthma trigger. Creating a nightly routine that incorporates relaxing activities, like soft music, a warm bath, or reading a book can help people fall asleep faster and reduce stress-related asthma attacks. Our guide to relaxation exercises to help fall asleep may be a helpful resource.
- Close the windows: Many people with asthma know that drastic changes in weather, temperature, and air quality can lead to asthma flare-ups. Reduce temperature changes, pollen, and air pollution in the bedroom by closing bedroom windows. Some people may also benefit from regulating the temperature and humidity in the bedroom environment or getting an air filter.
- Keep asthma medication nearby: Treating nighttime asthma attacks is an important part of controlling asthma. Keep asthma medications, along with a glass of water, near the bed so they are within reach if needed during the night.
Frequently Asked Questions
Can asthma kill you in your sleep?
Asthma attacks that take place while you’re asleep, known as nocturnal asthma, can be very dangerous and in some cases fatal.
In fact, most asthma-related deaths take place at night.
A proper diagnosis and finding the right combination of therapeutic strategies can help patients with asthma have fewer attacks both day and night, and improve lung function and sleep quality overall.
Why is asthma worse at night?
Asthma symptoms often worsen at night because of natural changes that occur in the body during sleep. Airway inflammation may increase overnight, and lying down can contribute to symptoms by allowing mucus to accumulate in the airways or by worsening conditions such as acid reflux or postnasal drip.
Environmental factors in the bedroom, including dust mites, pet dander, or cooler air, may also trigger nighttime symptoms. In some people, sleep disorders such as obstructive sleep apnea can further worsen nighttime breathing problems.
Can asthma cause sleep apnea?
Although asthma and sleep apnea are unique conditions, research has found links between the two. Asthma doesn’t necessarily cause sleep apnea, but patients with bronchial asthma do have a higher risk of developing obstructive sleep apnea (OSA).
Because asthma causes inflammation and congestion, it can impact the upper airways as well, which can lead to apneas (pauses in breathing). The relationship goes the other way as well, and patients who develop OSA may also have increased asthma symptoms.
Can you have an asthma attack while sleeping?
Yes, you can have an asthma attack while sleeping. In fact, some people have what’s called nocturnal asthma, meaning that their attacks primarily happen during sleep. Patients report waking up wheezing and coughing, and not able to breathe.
Asthma attacks during sleep can be dangerous or even fatal, which is why it’s so important to find treatments that can keep the condition under control. Other strategies to help prevent asthma attacks while sleeping include sleeping with your head elevated to keep airways open and taking steps to reduce bedroom allergens.
Does sleeping with a humidifier help asthma?
Sleeping with a humidifier can help asthma, but what’s more important is finding the right humidity level and ensuring the humidifier is kept clean. Adding some moisture to the air can be beneficial, especially in dry climates or times of year, but too much humidity can actually trigger an asthma attack.
Using a humidifier that lets you adjust levels could help you maintain the right amount for your space. Proper care and cleaning is important, too, as it can prevent mold or other allergens from developing. Consulting with your doctor can help you determine if you should try a humidifier to manage asthma.
Still have questions? Ask our community!
Join our Sleep Care Community — a trusted hub of sleep health professionals, product specialists, and people just like you. Whether you need expert sleep advice for your insomnia or you’re searching for the perfect mattress, we’ve got you covered. Get personalized guidance from the experts who know sleep best.
Rob writes about the intersection of sleep and mental health and previously worked at the National Cancer Institute.
Dr. Anis Rehman, MD is an American Board of Internal Medicine (ABIM) certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism who practices in Illinois. He completed his residency at Cleveland Clinic Akron General, and fellowship training at the University of Cincinnati in Ohio. Dr. Rehman has several dozens of research publications in reputable journals and conferences.
Learn more about our medical advisory boardReferences19 Sources
Centers for Disease Control and Prevention. (2023, May 10). Asthma in the US.
https://www.cdc.gov/asthma/most_recent_national_asthma_data.htmBraman S. S. (2006). The global burden of asthma. Chest, 130(1 Suppl), 4S–12S.
https://linkinghub.elsevier.com/retrieve/pii/S0012369215329524American Academy of Allergy, ASthma, and Immunology. (2020, September 28). Increasing rates of allergies and asthma.
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/prevalence-of-allergies-and-asthmaLuyster, F. S., Shi, X., Baniak, L. M., Morris, J. L., & Chasens, E. R. (2020). Associations of sleep duration with patient-reported outcomes and health care use in US adults with asthma. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 125(3), 319–324.
https://pubmed.ncbi.nlm.nih.gov/32389780/Irwin, M. R., Wang, M., Campomayor, C. O., Collado-Hidalgo, A., & Cole, S. (2006). Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Archives of internal medicine, 166(16), 1756–1762.
http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.166.16.1756Sutherland E. R. (2005). Nocturnal asthma: underlying mechanisms and treatment. Current allergy and asthma reports, 5(2), 161–167.
https://link.springer.com/10.1007/s11882-005-0091-zCalhoun W. J. (2003). Nocturnal asthma. Chest, 123(3 Suppl), 399S–405S.
https://linkinghub.elsevier.com/retrieve/pii/S0012369215352338American Lung Association. (2020, February 27). Asthma and pregnancy.
https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/asthma-and-pregnancyMcCallister, J. W., Parsons, J. P., & Mastronarde, J. G. (2011). The relationship between gastroesophageal reflux and asthma: an update. Therapeutic advances in respiratory disease, 5(2), 143–150.
http://journals.sagepub.com/doi/10.1177/1753465810384606A.D.A.M. Medical Encyclopedia. (2020, January 23). Smoking and asthma.
https://medlineplus.gov/ency/patientinstructions/000504.htmGinsberg D. (2009). An unidentified monster in the bed–assessing nocturnal asthma in children. McGill journal of medicine, 12(1), 31–38.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687912/Teodorescu, M., Polomis, D. A., Teodorescu, M. C., Gangnon, R. E., Peterson, A. G., Consens, F. B., Chervin, R. D., & Jarjour, N. N. (2012). Association of obstructive sleep apnea risk or diagnosis with daytime asthma in adults. The Journal of asthma : official journal of the Association for the Care of Asthma, 49(6), 620–628.
https://pubmed.ncbi.nlm.nih.gov/22742082/Teodorescu, M., Barnet, J. H., Hagen, E. W., Palta, M., Young, T. B., & Peppard, P. E. (2015). Association between asthma and risk of developing obstructive sleep apnea. JAMA, 313(2), 156–164.
https://pubmed.ncbi.nlm.nih.gov/25585327/Alkhalil, M., Schulman, E. S., & Getsy, J. (2008). Obstructive sleep apnea syndrome and asthma: the role of continuous positive airway pressure treatment. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 101(4), 350–357.
https://linkinghub.elsevier.com/retrieve/pii/S1081120610603092Spiro SG. Nocturnal asthma and sudden death. Am Fam Physician. 1976;14(6):62-71.
https://pubmed.ncbi.nlm.nih.gov/998470/Mehra R. Understanding nocturnal asthma. The plot thickens. Am J Respir Crit Care Med. 2014;190(3):243-244. doi:10.1164/rccm.201406-1130ED
https://pmc.ncbi.nlm.nih.gov/articles/PMC4226043/Sutherland E. Nocturnal asthma. Journal of Allergy and Clinical Immunology. 2005;116(6):1179-1186. doi:https://doi.org/10.1016/j.jaci.2005.09.028
https://www.jacionline.org/article/s0091-6749(05)02114-7/fulltextDixit R. Asthma and obstructive sleep apnea: More than an association!. Lung India. 2018;35(3):191-192. doi:10.4103/lungindia.lungindia_241_17
https://pmc.ncbi.nlm.nih.gov/articles/PMC5946549/American Lung Association. Is Your Humidifier Putting Your Health at Risk? Lung.org. Published 2026.
https://www.lung.org/blog/ultrasonic-humidifier-dangers
Learn More About Sleep-Related Breathing Disorders
