Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. Common symptoms include wheezing, coughing, chest tightness and shortness of breath. Asthma attacks or flare-ups can range from mild to severe, and in some cases can be life-threatening. While there is no cure for asthma, with proper treatment and management most people with asthma can live symptom-free lives.
One important aspect of managing asthma is getting adequate, quality sleep. But do asthmatics actually need more sleep than people without asthma? There are several factors to consider.
How does sleep affect asthma?
Sleep and asthma have a complex, bidirectional relationship. On one hand, poor sleep can exacerbate asthma symptoms. Not getting enough sleep or having disrupted sleep can increase inflammation in the airways and make people more prone to attacks. On the other hand, uncontrolled asthma can disrupt sleep due to nighttime symptoms like coughing and difficulty breathing.
During sleep, changes occur in the body’s hormone levels, immune system, and nervous system function. For those with asthma, these changes along with lying down can cause airway narrowing. Additionally, asthma attacks are more common at night or in the early morning when cortisol levels are lowest.
So in summary, poor sleep negatively impacts asthma, while poorly controlled asthma can also impair sleep. It becomes a vicious cycle.
Do asthmatics have more sleep problems?
Multiple studies show that asthmatics have a higher prevalence of sleep problems compared to the general population.
Some research findings include:
– Asthmatics report more daytime sleepiness and fatigue.
– Asthma patients are 5 times more likely to have insomnia symptoms.
– Up to 74% of severe asthmatics have trouble initiating or maintaining sleep.
– Asthmatics spend less time in restorative deep sleep stages.
– Around 40% experience nighttime asthma symptoms at least once per week.
So in general yes, asthmatics have more disrupted sleep compared to those without asthma. The more severe the asthma, the greater the impact on sleep quality seems to be.
Why might asthmatics need more sleep?
There are several reasons why getting adequate, high-quality sleep is especially important for asthma patients:
Inflammation control – Sleep deprivation is linked to increased inflammation. More sleep provides time for the body’s inflammation levels to decrease naturally overnight. Lowering inflammation helps prevent asthma flare-ups.
Airway remodeling – Growth hormones are released during deep sleep stages that promote healing and repair. For asthmatics, this helps repairdamage to the airways from chronic inflammation.
Immune function – Sleep is needed to support proper immune system function. Poor sleep weakens the immune response, while sufficient sleep strengthens it. A strong immune system helps the body fight respiratory infections that can trigger asthma symptoms.
Reduce flare-up risk – Well-rested people are less prone to asthma attacks caused by triggers like stress, exercise, allergies, cold air. Adequate sleep makes the airways less reactive to these triggers.
Medication efficacy – Several asthma medications like corticosteroids have reduced efficacy when patients are sleep-deprived. Sleep supports medication effectiveness.
For these reasons, getting extra sleep compared to non-asthmatics may provide clinical benefits in managing asthma symptoms and flare-up frequency.
How much sleep do asthmatics need?
The National Sleep Foundation recommends that adults get 7-9 hours of sleep per night for optimal health. Does this apply to people with asthma too, or should their sleep needs be higher?
Unfortunately, there is limited research on exact sleep duration requirements specifically for asthmatic adults. But here are some considerations:
Sleep duration recommendations
– The general recommendation is 7-9 hours per night for adults. This likely applies to most asthma patients too.
– Those with severe, uncontrolled asthma may need towards the higher end of the range. During bad flare-ups, up to 10 hours may be beneficial.
– Older adults need the same or slightly less sleep. So asthmatic seniors should aim for 7-8 hours.
– Children need even more sleep than adults. Asthmatic kids may need an extra 30-60 minutes beyond age norms.
So in summary, most asthmatics likely need the standard adult sleep range of 7-9 hours. Those with very severe symptoms benefit from aiming towards the higher end during bad flare-ups.
Prioritize sleep quality
Simply getting extra sleep doesn’t necessarily lead to better asthma control. The quality of sleep matters too. Here are some tips to improve sleep quality:
– Follow a regular sleep-wake schedule, even on weekends
– Limit daytime naps to 30 minutes
– Create a relaxing pre-bed routine
– Make sure the sleep environment is comfortable and free of allergens
– Avoid screens and large meals before bedtime
– Reduce caffeine intake, especially late in the day
– Use sleep aids like white noise machines, eye masks, or earplugs if needed
– Treat other conditions impairing sleep, like sleep apnea, GERD, or insomnia
Getting sufficient deep and REM sleep stages is key. If asthma is disrupting sleep quality, work closely with your doctor to get symptoms under control.
How does sleep help manage asthma?
Getting adequate high-quality sleep isn’t just an outcome affected by asthma. It’s also an important part of effectively managing asthma symptoms and flare-up frequency.
Here are some of the key ways proper sleep helps control asthma:
Lowering inflammation
Sleep helps reduce inflammatory responses in the body. During sleep, cortisol levels gradually decline. This hormone has anti-inflammatory effects. Growth hormone is also secreted, which stimulates cell repair and regeneration. Patients who sleep poorly have higher markers of systemic inflammation. For asthmatics, lowering inflammation prevents excessive airway reactivity.
Normalizing immune function
The immune system relies on sleep to function properly. During sleep, the body produces more cytokines, antibodies and immune cells. Lack of sleep disrupts this process. Weakened immunity makes asthma patients more prone to colds and respiratory illnesses which can trigger flare-ups. Adequate sleep strengthens the immune system.
Stabilizing circadian rhythms
Many bodily processes follow circadian rhythms or 24-hour cycles synchronized with day-night cycles. The sleep-wake cycle is the most obvious example. Disruption of circadian rhythms is linked to poorer asthma control. Regular sleep-wake timing helps maintain circadian rhythm stability. This leads to reduced nighttime worsening of asthma.
Supporting medication efficacy
Several medications used to manage asthma work most effectively if patients get adequate sleep. For example, corticosteroids like prednisone have reduced efficacy when sleep deprived. Maintaining proper sleep helps ensure medications work optimally to keep symptoms controlled.
Avoiding triggers
Being well-rested makes a person less likely to experience asthma attacks from triggers like stress, exercise, smoke, pollution or allergens. Sleep deprivation appears to increase reactivity. When well-rested, the airways can handle irritants and triggers better without flaring up.
So in summary, proper sleep is vital for managing asthma through its effects on lowering inflammation, boosting immunity, stabilizing circadian rhythms, enabling medications to work, and avoiding flare-up triggers.
Tips for improving sleep with asthma
Here are some tips asthmatics can follow to improve the quantity and quality of sleep:
Optimize the bedroom environment
– Use allergen-proof mattress and pillow covers
– Wash bedding regularly in hot water
– Consider a HEPA air purifier
– Keep the bedroom clean and dust-free
– Maintain the bedroom at a comfortable temperature
– Block out excess noise and light with curtains
Follow a consistent sleep schedule
– Wake up and go to bed at the same time daily
– Limit naps to 30 minutes before 3 pm
– Avoid sleeping in late on weekends
– Develop a calming pre-bedtime routine
Improve nighttime symptoms
– Take asthma and allergy medicines as prescribed
– Use bronchodilator quick-relief inhalers as needed
– Raise the head of the bed if reflux causes cough
– Try breathing exercises, relaxation techniques
Limit lifestyle disruptions
– Avoid caffeine, alcohol, and heavy meals before bed
– Don’t smoke, especially at night
– Shut off electronics 1-2 hours before bed
– Exercise earlier in the day
– Evaluate and treat other conditions impairing sleep
Consider supplemental melatonin
Some research indicates melatonin supplements may improve asthma control, likely through effects on circadian rhythms. Talk to your doctor before using.
Make sleep a priority by optimizing your sleep environment, schedule, and behaviors around sleep. Work closely with your doctor to control nighttime asthma and allergy symptoms. Treating any other conditions impairing sleep is also important.
The impact of sleep disorders on asthma
Beyond general poor sleep, having an underlying sleep disorder can also significantly impact asthma. Some of the key sleep disorders asthmatics suffer from include:
Obstructive sleep apnea
Sleep apnea causes repeated pauses in breathing during sleep due to airway collapse. This stresses the lungs and can exacerbate asthma symptoms. Treating sleep apnea with CPAP therapy often improves asthma control.
Gastroesophageal reflux disease (GERD)
Stomach acid backing up into the esophagus can cause coughing and choking at night. Managing reflux with diet, sleep position changes, or medications lessens this trigger.
Insomnia
Difficulty falling asleep and staying asleep are common complaints, especially when asthma isn’t well-controlled. Cognitive behavioral therapy for insomnia is the first-line treatment.
Restless leg syndrome
This causes uncomfortable leg sensations relieved by moving them. It disrupts sleep onset. Treatment involves improving sleep hygiene, supplements, and sometimes medications.
Nighttime cough variant asthma
Some asthmatics primarily experience coughing attacks at night. Proper treatment tailored to nighttime symptoms is key.
Identifying and treating co-existing sleep disorders is an important part of managing asthma. Discuss any sleeping problems thoroughly with your doctor. Proper treatment will improve both conditions.
The impact of medications on sleep
Medications used to treat asthma can also impact sleep, both positively and negatively. Some of the effects include:
Corticosteroids
Oral or inhaled corticosteroids such as prednisone are used to reduce airway inflammation in asthma. Potential side effects include insomnia, especially with higher doses taken at night. Adjusting the timing of doses may help.
Bronchodilators
Reliever inhalers like albuterol open constricted airways quickly during attacks. While fast-acting, some studies show they may disrupt sleep architecture due to effects on sleep stages and arousal thresholds.
Leukotriene modifiers
Montelukast blocks inflammatory leukotrienes and can be taken orally. While not directly sedating, some patients report feeling sleepy. Timing doses appropriately can minimize daytime drowsiness.
Theophylline
This oral medication relaxes airway muscles but can have stimulant effects in some people leading to insomnia. Modified-release versions with less impact on sleep are available.
Antihistamines
Commonly used for allergy symptoms, older antihistamines like diphenhydramine have sedative effects that may help nighttime asthma. However, they reduce sleep quality due to anticholinergic effects. Newer antihistamines like loratadine have less sleep impact.
Discuss any sleep-related side effects from asthma medications with your doctor. Adjusting dosages, formulations, and timing may help reduce adverse effects on sleep.
Best sleeping positions for asthma
Sleeping in certain positions may make nighttime asthma symptoms worse. The best sleeping positions for most asthmatics include:
Sleeping on the back (supine position)
Lying on the back keeps airways as open and straight as possible. This allows maximal airflow and breathing ease. It’s the best position for preventing gravity-related airway collapse. Use extra pillows as needed to maintain alignment and openness of the throat and neck.
Sleeping propped up
Elevating the head in bed 30-60 degrees reduces the chance of nighttime reflux and related asthma symptoms like coughing. Place bricks under the bed frame or use adjustable beds to create an incline.
Sleeping on the side
Lying on the side can also keep airways straight. Use a side pillow between the knees and under the head for support and neutral spine alignment. Avoid the stomach down position.
Try experimenting with these positions to determine which provides the greatest nighttime breathing relief. Combining incline therapy with side or back sleeping is optimal for many asthma patients.
Summary and conclusions
Key takeaways
– Asthma disrupts sleep, and poor sleep exacerbates asthma, creating a vicious cycle. Many asthmatics experience impaired sleep quality.
– Getting adequate sleep is particularly important for asthma patients, as it lowers inflammation, boosts immunity, stabilizes circadian rhythms, enables medication efficacy, and avoids flare-up triggers.
– Most adults with asthma need 7-9 hours of sleep per night. Those with severe asthma benefit from the higher end of the range, and may occasionally need up to 10 hours.
– Prioritizing sleep quality is essential. Optimize the sleep environment, follow good sleep hygiene, and treat nighttime asthma symptoms.
– Addressing co-existing sleep disorders like sleep apnea greatly improves asthma control. Be aware of medication effects on sleep.
– Sleeping flat on the back or propped up on the sides are usually the best positions to maintain opened airways at night.
Conclusion
In summary, the relationship between asthma and sleep goes both ways, with each condition influencing the other. Most asthma patients do need extra sleep for optimal health. But even more importantly, improving overall sleep quality through various lifestyle, environmental and medical measures provides significant benefits for managing asthma. Treating both asthma and any existing sleep disorders in parallel is key. With proper sleep, asthmatics can better control inflammation and symptoms and improve their overall well-being.
