We asked our Asthma.net experts Is there a relationship between Asthma and sleep apnea or snoring? Here is what they had to say:
Response from Leon C. Lebowitz, BA, RRT:
Asthma is a chronic condition that inflames and narrows the airways. It’s hallmark is hypersensitivity of the airways. The four major symptoms that characterize asthma are coughing, wheezing, shortness of breath and chest tightness.
Sleep apnea is a condition that causes you to have periods when you stop breathing during sleep. These pauses in breathing usually last 10 seconds or longer. It is not clear why sleep apnea may occur more often in people with asthma and/or COPD. However, you are more at risk if you have severe asthma, are overweight, have nasal congestion, acid reflux and/or use high doses of inhaled corticosteroids.5 Symptoms of asthma occur when the airway becomes inflamed and constricts to make breathing difficult. What causes asthma or why incidences of asthma are on the rise is not known, but some have suggested that it could be the result of environmental factors such as an increase in exposure to pollution or indoor allergens. Its increase may also be related to the increase in obesity that is simultaneously occurring. Many researchers are looking for a genetic factor for asthma based on the fact that a person has a higher risk of developing asthma if a member of his or her family has it. Whatever causes asthma, it is a serious and sometimes fatal condition that must be carefully managed.3
People with asthma often suffer from nighttime coughing, wheezing and breathlessness that disturbs their sleep. People with asthma and/or COPD who have a frequent problem waking up at night often have worse respiratory disease. They are also at risk for complications from their asthma or COPD. Sleep apnea can worsen asthma symptoms throughout the day, increase the need for rescue inhalers, and worsen one’s quality of life. Sleep apnea can be a serious condition by itself. In those with moderate to severe sleep apnea who do not get treatment, their risk for hypertension, heart disease and
stroke is increased.
In general, asthma is not related to snoring although it does not mean that people who have asthma will not snore. Medically speaking, asthma does not cause snoring and snoring does not cause asthma.
There are several steps you can take in order to sleep better. The first step is to make sure that your asthma is under good control. You may have to visit with your health care provider to be evaluated. This will help to insure that you are getting the right medical treatment. You can then develop a series of steps to take, to control your asthma and guide you through an episode of sudden breathlessness. Your provider will instruct you when to use your rescue inhaler or pursed lip breathing, and what questions to ask yourself about your condition, should you experience any sudden breathlessness. Also, talk to your health care provider if you have nasal congestion or get heartburn, to get them under better control. If you smoke, quitting smoking will not only help your asthma, but the quality of your sleep will also improve. Tell your health care provider if you think you may have sleep apnea so that you can be evaluated. Sleep apnea is a treatable condition!
Response from Lyn Harper, MPA, BSRT, RRT:
Different studies have definitely shown a link between asthma, sleep apnea, and snoring. First of all, if you suffer from asthma, you know that if it’s not well controlled, and even sometimes when it is, you wake up at night with difficulty breathing. You may be wheezing and your chest feels very tight.
In addition, these same studies suggest that people with asthma are at increased risk to develop sleep apnea. Sleep apnea can cause increased inflammation in the airways – a problem that can trigger irritation and constriction of the small airways, leading to worsening asthma. Many people with sleep apnea complain of nasal congestion which can also contribute to snoring and an exacerbation of asthma.
Since sleep is essential for a good quality of life, it’s very important to find the underlying cause for wakefulness at night. If it’s asthma, find out the triggers. Rid your bedroom of upholstery, pet dander, dust mites, and any other allergens that may cause worsening asthma at night. Be vigilant about taking medications as prescribed. If you suspect you have sleep apnea, speak to your doctor about it. He or she may recommend you have a sleep study. Sleep apnea can become worse if we carry extra weight around, so try to maintain a healthy weight by a good diet and regular exercise.
Response from Lorene Alba, AE-C:
According to a study published in JAMA* in 2015, asthma was associated with an increased risk of new-onset Obstructive Sleep Apnea (OSA). Over the full study period, the team concluded that asthma patients faced an almost 40 percent greater risk for sleep apnea than asthma-free participants.7 The study definitely suggests more research is needed to see if one condition causes the other. Asthma does not cause snoring, but a stuffy nose from allergies can, so take your allergy medicine as directed and reduce dust mites and other allergens in your bedroom. If you are having nighttime asthma symptoms such as restlessness, coughing or feeling panicky more than 2X a month talk to your healthcare provider about your symptoms to make sure your asthma is under good control.
Response from John Botrell, RRT:
Apparently, it has been observed among the asthma population an increased risk for obstructive sleep apnea, a medical condition that results in the stoppage of breathing for anywhere from a few seconds to a minute. This occurs when tissues of your upper airway become too relaxed, thereby collapsing and blocking the airway. Each episode ends with an audible snore or grunt, thereby interrupting sleep. This may occur over 30 times in a typical night, resulting in daytime sleepiness. The treatment is Continuous Positive Airway Pressure (CPAP). This is done by wearing a mask over your nose while sleeping. It provides a constant pressure during inhalation and exhalation to keep your airways open. A study performed in 1988 showed that CPAP improved daytime lung function in asthmatics. A study released in January of 2015 verified the link between sleep apnea and asthma. Granted, these are just two studies with small sample sizes, and that research on this subject is ongoing. Still, if you experience snoring or daytime sleepiness along with your asthma, this is one more thing to discuss with your asthma doctor.
Response from Theresa Cannizzarro, Respiratory Therapist:
There is a ton of evidence that sleep apnea can aggravate asthma symptoms. Obstructive sleep apnea occurs when the upper airway closes during sleep which causes the reduction of airflow and oxygen to the lungs. You may snore, cough, or wake up gasping for air numerous times per night. You may not realize you are waking up due to sleep apnea. This may lead to increased inflammation in the body, including the lungs. Narrowing of the small airways can lead to more irritation and constriction of the smooth muscle in the lungs, which makes asthma symptoms worse. If you suspect you have sleep apnea definitely talk with your doctor about it so they can order a sleep study to test to see if you in fact have sleep apnea.
Mihaela Teodorescu, MD, MS1,2,3; Jodi H. Barnet, MS4; Erika W. Hagen, PhD4; Mari Palta, PhD4,5; Terry B. Young, PhD4; Paul E. Peppard, PhD4
Teodorescu M, Polomis DA, Hall SV, et al. Association of Obstructive Sleep Apnea Risk with Asthma control in adults. Chest. 2010;138(3):543-550.
http://www.sciencedirect.com/science/article/pii/S0012369210604667 (Accessed July 2016)
Asthma and Sleep
(Accessed July 2016)
Obstructive Sleep Apnea Syndrome (OSAS) and Asthma: What are the links?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2637171/ (Accessed July 2016)
Sleep problems in Asthma and COPD
(Accessed July 2016)
"Asthma does not cause snoring but there are certain aspects about asthma that might contribute to snoring" http://www.esnoring.com/asthma-does-not-cause-snoring-but-there-are-certain-aspects-about- asthma-that-might-contribute-to-snoring/ (Accessed July 2016)