Asthma attacks during sleep

Overnight symptoms can reflect poorly controlled airway inflammation, a respiratory infection, bedroom allergens, cooler air or the effect of lying down on nasal drainage or reflux. Recurrent waking deserves a treatment review even if daytime breathing seems comfortable.

Airway calibre and the body’s control of inflammation vary over the day and night. In someone with asthma, this can make already sensitive breathing tubes narrower during sleep. Dust mites, pet allergens, mould or smoke residue in the sleeping area may add irritation.

Snoring, choking sensations, heartburn, nasal blockage or symptoms only in one room are useful clues because another nighttime problem may be worsening asthma or mimicking part of the episode.

Sit upright, remain calm and follow the worsening-symptom steps in your written asthma action plan. Use the reliever prescribed to you with the instructed technique, and have another person stay nearby if breathing is difficult.

After recovery, note the time, symptoms, possible bedroom exposure and response to treatment. Arrange prompt clinical review after repeated night episodes; the clinician may reassess preventer use, inhaler technique, allergies and other sleep-related breathing problems.

Call local emergency services if the person cannot speak comfortably, is gasping, has blue or grey lips, becomes confused or very drowsy, collapses, or continues to worsen. Seek urgent help when prescribed reliever treatment is unavailable or fails to give the expected relief.

Do not leave a severely breathless person alone or let them return to sleep. Keep them upright and follow their emergency plan while assistance is on the way.

Ask whether nighttime waking indicates inadequate asthma control, when daily treatment should be taken, and how bedroom exposures can be reduced. Mention nasal blockage, reflux symptoms, snoring and missed doses, and request clear written instructions for another overnight flare.