Nocturnal asthma and sleep disturbance

Asthma symptoms worsen during sleep. Nocturnal asthma or night mare asthma needs proper diagnosis and effective treatment.

• Coughing with expectoration during night
• Wheezing during night
• Chest tightness or pressure during night
• Chest pain and pain in the lateral aspects of chest
• Sleep deprivation and day time sleepiness
• Fatigue and irritability
• Rapid and hurried breathing
• Difficulty in breathing

 Nocturnal asthma causes

• Increased exposure to allergens at night
• Cooling of airways
• Reclining position
• Hormone secretion that follow circadian rhythm

Sleep itself causes changes in bronchial function because

• Increased mucus and sinusitis
• Lying in the reclining position increases the airway resistance and decreases the tidal volume.
• Breathing cool air in nite and sleeping in air conditioned bedrooms
• Gastro esophageal reflux

 Tests and diagnosis

• Home based tests: Home allergy testing and food allergy tests
• Lung function test (Pulmonary function test)
• Chest X- ray
• Sleep apnea diagnostic test

 Complications

• Severe difficulty in breathing
• Asphyxia
• Permanent damage to airways
• Death is uncommon

Treatment

Avoid allergens and triggering factors for asthma

• Bronchodilators: Theophylline, Etiophylline, Salbutamol, Salmetrol, Ipratropium bromide etc
• Antihistamines: Cetrizine, Fexofenadine, Loratidine etc
• Corticosteroids: inhalers (Fluticasone, Flunisolide, Budesenoid). Systemic steroids (Hydrocortisone, Dexamethasone, Betamethasone).