Specialist Advice — 12 minutes
Nocturnal asthma, the enemy of sleep
Asthma is characterized by inflammation and narrowing of the airways, which makes breathing difficult. The symptoms are often more intense at night, producing what is known as “nocturnal asthma.” Although the mechanisms behind this exacerbation are not fully understood, certain habits can help improve sleep quality.
While nocturnal asthma can have the same triggers as asthma, such as a cold, dust, tobacco smoke and temperature, some factors can increase symptoms at night.
Bodily functions
During sleep, the airways narrow, and the muscles relax, both natural phenomena. In asthmatics, airway narrowing, which is already a problem, can amplify asthma symptoms. At the same time, decreased muscle tone during the night can lead to shallow breathing and a decrease in the amount of air inhaled.
Circadian rhythm
The autonomic nervous system, on which lung function depends, many sleep-related hormones and even the inflammatory mechanism are circadian, meaning that their activity varies according to a 24-hour cycle linked to the body’s internal clock. Changes that occur in the evening and at night can, for example, reduce the depth and rate of breathing, reduce lung function, or stimulate airway inflammation, which increases the risk of nocturnal asthma.[4]
Obesity
Excess fat around the throat and increased systemic inflammation due to obesity may increase nocturnal asthma. Studies have shown that weight loss improves lung function and reduces nocturnal symptoms.[5]
Gastroesophageal reflux disease (GERD)
Between 33 and 89% of people with asthma have symptoms of GERD.[6] Although no causal link has been established between the two conditions, it is thought that the reflux of gastric acid into the esophagus could trigger bronchial spasms or airway constriction leading to nighttime asthma symptoms. The reflux could also enter the lungs, irritating the airways.
Obstructive sleep apnea (OSA)
OSA has also been identified as a risk factor for nocturnal asthma.[7] In patients with asthma, the snoring characteristic of apnea triggers neural reflexes that cause bronchial constriction, exacerbating asthma. In addition, repeated breathing interruptions during sleep deprive the body of oxygen and increase the reactivity of the bronchi and airways.
Is there a miracle position that will eliminate all symptoms of nocturnal asthma? Unfortunately, no. The ideal position depends on the individual and the severity of asthma. It would be best to experiment with different sleeping ways to see what works.
On your back
The supine position can put pressure on the chest and lungs, making breathing difficult and triggering mucus to flow down the throat. It can also promote gastroesophageal reflux. Therefore, it is best to elevate the neck and shoulders with one or more pillows. This helps keep the airways open, circulate mucus and prevent acid reflux. Adding another pillow under the knees helps improve circulation and maintain this elevated position throughout the night.
On your side
People with asthma who sleep on their side, especially those with gastroesophageal reflux disease, should prefer the left side, elevating the head with a pillow. The right-side position increases pressure on the vagus nerve, which causes airway constriction. Adding a pillow between the legs stabilizes the spine and helps maintain a better sleeping position.
On your front
Lying on your front is not recommended as it causes back and neck strain, compresses the rib cage, and impairs breathing. People who cannot do otherwise should consider leaving their pillow aside (or using a very flat pillow) and placing a cushion under the pelvis to prevent the back from sagging.
