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How to Manage Asthma at Night

Woman sleeping; asthma inhaler on bedside

Have you noticed that your asthma symptoms like wheezing, shortness of breath, and tightening of the chest intensify in the nighttime? You’re not alone: nocturnal asthma symptoms are common, especially if you are living with more severe asthma. A Journal of Asthma study involving around 14,000 individuals with asthma found that 60% of those with chronic asthma experienced nocturnal asthma symptoms.

Below, we explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

Nocturnal asthma symptoms and causes

Nocturnal asthma occurs when your symptoms are noticeably worse at night. (If you experience intense symptoms at any time of day, including nighttime, you may need to reevaluate your overall asthma treatment plan with your doctor.)

If you have nocturnal asthma, you may experience the following symptoms while you sleep, and your sleep may be interrupted as a result.

  • Coughing
  • Wheezing
  • Difficulty breathing
  • Tightness in your chest

Numerous factors can contribute to nocturnal asthma, including environmental triggers and your personal health history.


The presence of allergens like dust mites and mold can trigger asthma symptoms, especially if you have allergy-induced asthma. Dust mites are small pests that generate allergens. They often live in your pillows, blankets, and mattress, so exposure to them at night is common. In some cases, nocturnal asthma may also be a delayed reaction to exposure to an allergen during the day.

Room temperature and sleeping position

Inhaling cold air from an air conditioner or outside source may contribute to more intense asthma symptoms at night. In addition, sleeping in a reclining position causes your chest and lungs to experience additional pressure, which can also contribute to asthma symptoms. Elevating your shoulders and neck with additional pillows or lying on your left side with or without a pillow between your legs may help you sleep more comfortably.

Circadian rhythm

Your circadian rhythm — the 24-hour natural process that regulates your sleep cycles — affects your nighttime levels of hormones like epinephrine, which relaxes and widens your airways, and histamine, which restricts your airways. Nightly fluctuations in these hormones may contribute to inflammation in your airways, prompting nocturnal asthma symptoms. You are most likely to experience nocturnal asthma symptoms when your epinephrine levels are at their lowest and your histamine levels are at their highest.

Personal health history

The following health conditions have also been linked to nighttime asthma:

How to manage asthma at night

If you have asthma and wake up several nights a week even after following your individual asthma treatment plan, consult with your doctor about additional treatment options. They can evaluate your symptoms, identify potential causes, and suggest modifications to your treatment plan if needed.

Asthma medications

Common daily asthma medications can also help you manage worsening symptoms at night. Inhaled corticosteroids like Flovent® HFA and Qvar Redihaler®, which reduce inflammation and swelling in the airways, making them less likely to react to asthma triggers, are frequently prescribed for people who experience nocturnal asthma symptoms.

Quick-acting bronchodilators like albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) or levalbuterol (Xopenex HFA®) may also be used to treat acute asthma symptoms at night. These inhalers relax the muscles around your airways to make it easier to breathe and are taken on an as-needed basis for immediate relief of symptoms . Common side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches.

If you have any concerns about potential side effects of asthma medications, your doctor can explain more about the potential benefits and risks of taking corticosteroids or bronchodilators.

Adjusting your environment

If allergens like dust mites are contributing to your nocturnal asthma symptoms, regularly washing your sheets, blankets, and mattress protector may help you avoid triggers. Wash bedding in hot water if possible, since this will help kill dust mites. In addition, maintain a comfortable temperature — 65-70 degrees Fahrenheit is a good range for many individuals with asthma — by making sure your room is well-insulated and shutting windows to keep cold air out. Using a humidifier to add moisture to the air inside your room can also help.

Improving your sleep

Better sleep hygiene isn’t a substitute for asthma medication, but getting a good quality of sleep at night can minimize the negative effects of any sleep disturbances you experience from nighttime asthma.

Avoid use of electronic devices like cell phones, tablets, and computers at least 30 minutes before you go to sleep, if possible. In addition to stimulating your brain, these devices emit blue light, which can affect your production of melatonin, a hormone that regulates your sleep.

Meditating and exercising before sleeping can also help you fall and stay asleep more easily, but avoid high-intensity exercise close to when you go to bed.

Create an environment that sets you up for a good night’s sleep. In addition to maintaining a comfortable temperature, make sure that your room is dark or dimly lit without distracting lights from electronic devices. You may also want to consider sleeping with your humidifier on, if you have one.

If you think you may have a sleep disorder like sleep apnea or insomnia, consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

Breathe easier with a better pharmacy

Alto is here every step of the way to make it easy to manage your asthma symptoms at any time of day. Our team of pharmacists is available to answer questions about your asthma medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your asthma treatment plan.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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