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Difficulty Sleeping and Fatigue

Reviewed by: HU Medical Review Board | Last Reviewed: May 2016

Nighttime waking and fatigue are symptoms of poorly controlled asthma.1 People with nighttime asthma symptoms wake up more often and spend less of the time in bed sleeping.2

Breathing changes at night are normal. People with healthy lungs breathe less frequently while they are asleep. Less air travels in and out of the lungs.3 However, people with asthma have more dramatic changes at night. Their airways narrow more than people without asthma. Air has a much harder time passing in and out of the lungs.3 During sleep, the airways become more sensitive (“hyperresponsive”) and inflammation increases.3

Sleep disruption can affect daytime functioning. Children who wake up just one to three nights per month do not do as well in school and have lower attendance than children who do not wake up at all.2 Waking up because of asthma symptoms causes a lower quality of life. People with trouble sleeping use more asthma medications and have more frequent doctor visits.4 If your asthma is well controlled, you should wake up less than once or twice per month.

What other conditions can cause difficulty sleeping?

Having multiple health conditions makes asthma harder to control and increases nighttime symptoms. Asthma often overlaps with:1

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  • GERD (gastroesophgeal reflux disease)
  • Obstructive sleep apnea
  • Overweight/Obesity

How common is difficulty sleeping in people with asthma?

A large survey showed that 75% of people with asthma have cough and wheeze at least one night a week.3 Thirty-four percent to 89% of people with asthma also have GERD, a main cause of nighttime asthma symptoms.3 People with asthma are 70% more likely than people without asthma to develop sleep apnea.5

How are asthma-related sleep problems evaluated?

It is routine practice to ask about nighttime asthma symptoms. In a first visit with your provider about asthma, you may be asked how often coughing, wheezing, or shortness of breath has awoken you at night in the past four weeks.1 At follow-up visits, the frequency of nighttime awakening is a measure of how well the medications are controlling your asthma.

If you have heartburn and nighttime asthma symptoms, the National Heart, Lung, and Blood Institute recommends checking for GERD.1 Tests for GERD are endoscopy, x-ray, or esophageal pH (acid) monitoring.6 Your health care provider may recommend a trial of medication, to see if your GERD improves.

It can be difficult to distinguish obstructive sleep apnea from asthma.1 Sleep studies are needed to diagnose sleep apnea.

How are asthma-related sleeplessness and fatigue treated?

If you are waking up frequently because of asthma symptoms, ask your provider about adjusting your asthma medications.1 Using asthma control medications can improve nighttime symptoms.7

Some people with asthma have a greater reaction to allergens in the evening than in the morning.3 A general recommendation is for people with asthma to avoid asthma triggers, such as allergens. Tips for minimizing allergens where you sleep, include:1,8

  • Keep pets out of the bedroom and keep the bedroom door closed.
  • Use a dust mite-proof (“allergen-impermeable”) mattress and pillow cover.
  • Wash sheets, blankets, and stuffed animals in hot water (>130°F) every week.
  • Do not sleep on upholstered furniture, such as couches. Pet dander and dust-mites collect on couches.
  • Remove carpets from the bedroom.
  • Keep food out of the bedroom, to avoid attracting cockroaches.
  • Consider using a HEPA air filter and/or vacuum frequently with a HEPA filter.

Treating co-existing conditions can improve nighttime symptoms, too. People who take medication for GERD have fewer nighttime symptoms and asthma attacks, and a better quality of life.1 Treatment with nasal CPAP (continuous positive airway pressure) is helpful for people with co-existing asthma and sleep apnea.1 However, CPAP disrupts sleep for people who just have asthma. Therefore, accurate diagnosis is important.