Why asthma can be worse at night

Repeated waking, needing reliever medicine overnight or feeling breathless on waking can indicate that asthma is not well controlled. Arrange a clinical review rather than accepting disrupted sleep as normal.

Airways naturally vary in calibre across the day and may become more reactive overnight. Bedding can hold dust-mite allergens, air conditioning may cool or dry the air, and lying down can aggravate reflux or mucus draining from the nose.

Asthma commonly presents with nighttime cough and wheeze, but cough can also accompany nasal inflammation, reflux or infection. A clinician can assess the pattern alongside inhaler use, examination findings and, when appropriate, breathing tests.

Take prescribed preventer treatment consistently and check inhaler technique with a clinician or pharmacist. Keep the reliever specified in your action plan accessible. Do not increase or stop prescribed medicine on your own solely because symptoms occur at night.

Record bedtime, waking symptoms, suspected exposures and medicine use for several nights. Wash bedding regularly according to its care label, reduce visible dust, avoid smoke and strong scents in the bedroom, and discuss blocked nose, heartburn or snoring at your review.

Use your asthma action plan and seek urgent medical assessment if symptoms do not settle as directed, return soon after reliever use or repeatedly wake you. Prompt review is also warranted when usual activity becomes harder or reliever use is increasing.

Call emergency services for severe or rapidly worsening breathlessness, inability to speak full sentences, blue or grey lips, confusion, faintness, marked chest or neck muscle effort, or exhaustion. Sit upright and do not attempt to sleep through severe symptoms.

Ask whether the nighttime pattern suggests inadequate preventer treatment, an environmental trigger or another condition. Request a technique check and a clear action plan covering which medicine to use, when to repeat it and when to obtain emergency help.