Nocturnal Asthma – Symptoms, Causes, Treatment

As per National Heart, Lung and Blood Institute (NHBL), airways extend between nose and mouth and lungs that carry air in your body, i.e. in and out. But if an individual has asthma, the airways become inflamed and puffy when exposed to allergens such as pollens, cold air, molds, the smoke of a cigarette, flu-related to respiratory infections and animal dander, i.e. the tiny particles of skin or saliva shed from the animals). The swelling results in muscles surrounding the airways get tight, and the production of mucus increases than usual via airways.

What is Nocturnal Asthma?

Nocturnal asthma is a condition which is quite prevalent and affects world-wide millions of individuals. Nocturnal asthma affects the quality of life and increased mortality, i.e. deaths. Nocturnal asthma mainly in kids cause problems in sleep and increased sleepiness during day-time.

Nocturnal asthma might cause you to get up at night while coughing, to wheeze and shortness of breath. What does nocturnal asthma mean? It is also termed as “nighttime asthma.” It is a kind of asthma that gets worse at night.

It is quite usual for the symptoms of asthma to get worst at night time and leads to sleep disturbance. As per Ileen Gilbert, MD, a Pulmonary Specialist, in healthy people lungs function the best in-between noon and 4:00 pm. Lung functioning worsens between 3, and 4 am.

In a “Journal of Asthma, it involved approximately 14,000 patients said that at some point in time, 60% of patients who had asthma did have nocturnal asthma.

Nocturnal asthma is a severe issue, as there is a high prevalence of respiratory arrest and instant death in an asthmatic individual’s in-between mid-night, and 8:00 am.

Nocturnal asthma is prevalent in individuals who have asthma. Nocturnal asthma is seen with any type of asthma, such as:

• Occupational
• Allergic
• Exercise-induced

The functioning of the lung reduces due to reasons such as “body’s circadian rhythm or natural clock.” which results in the recurrent pattern of growth and decline in the production of hormones.

As per Dr Gilbert, the hormones required to protect from the symptoms of asthma are quite low either very late at night or very early morning, i.e. “wee hours” between 1:00 am to 4:00 am. There are chances of individuals with nocturnal asthma to wake up in the middle of the night due to coughing, gasping as the levels of hormone decline.

Another cause of Nocturnal Asthma is a “sinus infection or postnasal drip.” On lying down the secretions of nose get accumulated in the airways and causes problems in breathing.

Asthma symptoms aggravate if the individual is allergic to pet dander, i.e. tiny, flecks of skin that shed from animals such as cats, dogs, rodents, birds and others who have feathers or furs. Individuals who are allergic to these bits of the skin of animals can increase the reaction in people or individuals. The condition can also aggravate if individuals sleep in a similar room as that of a cat or dog

According to Cliffford Bassett, hidden dust mites in your mattress or bedding also activates nocturnal asthma.

Symptoms

The symptoms of normal Asthma and nocturnal Asthma are quite similar.

These symptoms get worse at night and consist of:

• Chest Tightness
• Breathlessness, i.e. dyspnea
• Coughing which makes sleeping difficult at night
• Wheezing, squeaky sounds that happen while breathing due to narrowing of the airways

In kids

In one of the studies published in Academy, Pediatrics researched the “effect of nocturnal asthma on children residing in urban areas aged 4 to 10 years, with persistent asthma. 41% of kids did suffer from Nocturnal Asthma also. Sleep was affected majorly in individuals with moderate to extreme nocturnal asthma. The other symptoms included:

• Walking in the night
• Sleep-disordered breathing problems or breathing obstruction or getting up like:
• Movements become abnormal
• Hallucinations
• Walking while sleeping
• Getting extremely emotional

This study ended by saying that nocturnal asthma was usual in kids with regular asthma. Nocturnal asthma results in poor sleep, and the quality of life for parents was also affected.

Causes of Nocturnal Asthma

The physicians were not sure about the origins of nocturnal asthma.

Some of the below-mentioned factors could be causing conditions such as:

• Lying down position while sleeping
• Mucous production increases
• Sinusitis, i.e. increase in the drainage from sinuses.
• Levels of hormone such as epinephrine are low, which helps in airways to relax and widen.
• Levels of the hormone, such as histamine, is high, which causes the airways to restrict.
• During the time of day, there is a delay in response to an allergen that comes across.
• As mentioned, hidden dust mites in the mattress or bedtime at night. The dust mites live in parts like bed, as they get a similar environment where they can survive, such as warm and humid. Also, there is the presence of excess food there, i.e. food is old skin cells.
• Gastro-oesophagal disorder (GERD).
• Mental Stress
• Sleep-related issues like obstructive sleep apnea (OSA). Problems in sleep, i.e. sleep apnea, increases the inflammation of the airways and worsen the condition of asthma and controlling it at night.
• Nocturnal asthma also occurs while inhaling higher amounts of cold air either via outside source or AC.
• Nocturnal asthma causes deposition of extra fat or obesity and overweight.
• There could be various causes or reasons, but if your asthma problem is not letting you sleep properly at night, it is a sign to understand that you are suffering from uncontrolled asthma

Risk factors

Specific individuals with asthma do experience nocturnal asthma than another set of groups:

• Have allergic rhinitis
• Not seeing the doctors regularly
• Are young or obese
• Regularly smoking
• Staying in an urban environment
• Suffering from specific mental health issues
• Gastrointestinal issues

There is an increased risk of nocturnal asthma in individuals originated from Africa, but was not easy to separate the factors such as lifestyle and genetic, as mentioned by American Journal of Respiratory and Critical Care Medicine.

When to visit the doctor?

Visit your doctor, if there is the presence of asthma and get up in the night, more significant than once in a week post-treatments. The physician can help you identify the cause of symptoms and help in the modification of the plan of treatment. It would also be helpful to check the breath in a “peak flow meter.”

Important to report the doctor about asthma-like symptoms, even if undiagnosed with asthma. The physician will guide you in a proper direction for treatment, also though the individual does not have asthma.

Diagnosis using Peak Flow Meter

As per Jameel. F. Durrani, for diagnosis of asthma and night asthma, peak-flow meter measurements are used. As a part of the asthma care plan, the asthma patients use peak flow meter equipment. These equipment’s help in comparison of narrowing of the airway or spasm that occur at various times of the day.

As per studies, approximately 30 to 70% of patients having asthma inform their physicians about getting up due to nighttime asthma symptoms at least once in a month. Regardless of the kind of asthma, an individual can have nocturnal asthma such as allergic, non-allergic, occupational and exercise-induced asthma.

There are chances of nighttime asthma development if uncontrolled asthma. As per Gilbert, “Uncontrolled asthma causes, all asthmatics to develop nocturnal asthma, i.e. nighttime asthma.”

Control general asthma that helps controlling nighttime asthma also. As per Dr Gilbert, Need of long-acting controller therapy, if you get up two times in a month due to symptoms of asthma. For easing the symptoms of asthma, in the middle of the night, using a rescue inhaler. But that does not guarantee of symptoms not occurring again.

As per Dr Durrani, If getting up greater than two times in a night due to cough, cold, wheezing or tightness in the chest, it shows asthma is not well-controlled ad there is a requirement to “review” the treatment of asthma plan with your “health-care provider.”

Treatment

There is no cure for nocturnal asthma, just as regular asthma. It is a long-term condition. However, there are various ways to treat nocturnal asthma, similar to regular asthma.

One of the significant treatments used for medicines is inhaled steroids, which helps decrease inflammation and specific symptoms of asthma. If there is a presence of asthma at night, it is advisable to take inhaled steroids daily.

Also advised are oral medicines like montelukast that is helpful. The night time episodes of asthma can be treated using fast-acting bronchodilators such as albuterol or nebulizer.

Treatment of nocturnal Asthma is also possible by treating the factors resulting in it.

Depending on the causes, specific methods are used, such as:

• Decrease Mental Stress: Can visit a therapist and using particular exercises for relaxation such as yoga, writing of a journal and more are excellent ways to decrease stress. Certain medicines used for treating clinical conditions such as depression or anxiety disorders.
• GERD (Gastro-esophageal disorder): Avoid foods that cause GERD like foods high in saturated fats like fatty meats, chocolates, fried foods, whole milk and more. Avoid caffeinated drinks, spicy foods, acidic foods like citrus juices, aerated drinks, all of these act as an irritant to the oesophagus so reduce or stop them. Specific over the counter drugs (OTC) like Zantac, Tums, Maalox and Prilosec help to reduce the symptoms for GERD.
• Essential to manage a healthy weight: GERD and nocturnal asthma both are risk factors for obesity. Necessary to consume a well-balanced diet & healthy diet. Replace foods high in saturated fats and refined carbohydrates with foods high in proteins, unsaturated fats, fibre, fruits, vegetables, whole-grain cereals and pulses. Consult a registered dietitian for proper consultation and guidance. To achieve appropriate ideal body weight, start with an adequate work-out and exercise regime.
• Include work-out regimes like Medium Aerobic work-out, High-intensity cardio-work-out and resistance training.
• Reduce or stop smoking: To reduce nicotine from the diet, essential to cut the tobacco. Necessary to consult a therapist that helps to quit smoking, a one-on-one basis can be helpful and beneficial.
• Avoid or clear the allergens: The symptoms of night asthma can be affected due to the presence of dust mites in the mattress. Essential to wash the bedding and blankets regularly. Necessary to make the pet sleep outside or in other room, if there is the presence of pet allergies.
• Essential to regulate the temperature of the room at night: In a few locations at night, the temperature drops down quite a bit. For regulation of room temperature:
• The room needs to be well-insulated
• Essential to keep the windows closed, tightly-sealed, no cracks or leaks
• For better moisturizer using a humidifier

Guidelines for proper night sleep

These tips can be tried for adequate rest, whether the presence or absence of symptoms such as:

• Thirty minutes before bedtime, unplugging the electronic devices.
• Essential to meditate, an hour before sleeping.
• At-least some hours before sleeping, perform high-intensity work-out or exercises.
• Sleeping with a pet should be avoided if allergic to them.
• Essential to control the temperature of the room.
• “Sleep with a humidifier on.”
• Search for pillows that are free of allergies.

The outlook of Nocturnal Asthma

The symptoms for nocturnal asthma are quite usual and more distinct in individuals with extreme forms of asthma. The result is from various factors such as:

• Circadian Rhythm
• Shift in hormones
• Changes in the temperature
• Position of sleeping
• Multiple treatments can be used if the symptoms of asthma are intense at night:
• Using standard asthma treatment, which is helpful at night.
• Treat conditions that are leading to symptoms such as GERD.
• Environment for sleep needs to be healthy.
• It is important to consult or contact a physician or asthma specialist if the asthma symptoms at night quite often affect the pattern of sleep and quality of life.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/12035073
2. https://link.springer.com/article/10.1007%2Fs11882-005-0091-z
3. https://insights.ovid.com/article/00063198-201201000-00010