Asthma attacks at night: what to know

Coughing, wheezing, chest tightness or breathlessness that wakes you should not become an accepted part of sleep. Follow your written asthma action plan and arrange a clinical review, even if a reliever inhaler settles the episode.

Airways naturally change during sleep, and asthma-related narrowing may become more noticeable then. A cool room, smoke, fragrance, dust mites, pet allergens, mould, or an infection can add irritation. Lying down may also expose symptoms linked with nasal inflammation or reflux.

Asthma commonly presents with wheezing, cough, breathlessness and chest tightness, but the pattern varies. Keeping a note of bedtime, possible exposures, symptoms and inhaler use can help a clinician identify the pattern.

Sit upright, stay as calm as possible and use your reliever exactly as your personal action plan or prescription directs. Do not lie flat while struggling to breathe. If the plan tells you to check peak flow, compare the reading with your own action-plan zones.

After symptoms settle, check that the inhaler is available, in date and used with the technique demonstrated by your clinician. Reduce identifiable bedroom triggers without stopping prescribed preventer medicine. Repeated night waking, extra reliever use or morning symptoms warrant an asthma review.

Seek emergency help if breathing is rapidly worsening, you cannot speak comfortably in full sentences, your lips or face look blue or grey, you become drowsy or confused, or your reliever is not helping as expected. Continue following the emergency steps in your action plan while help is arranged.

Contact a clinician promptly after a night attack, particularly if it was more severe than usual or symptoms returned. Treatment may need adjustment, and technique, triggers and other causes of disturbed breathing can be assessed.

Ask whether your current symptoms show that control has changed, whether your preventer and reliever technique is correct, and which action-plan step applies at night. Also discuss nasal symptoms, reflux, snoring, bedroom allergens, recent infections and any medicine that may affect breathing.