Breathlessness, wheezing and coughing can interfere with both falling asleep and staying asleep. These symptoms can flare up at night for a variety of reasons including increased exposure to triggers and your sleeping position.

Poor quality sleep will not only make you feel tired and run down, it can also further worsen respiratory symptoms. Fortunately, there are some practical steps you can take to improve your sleep.

Sleep positions

How you lie in bed affects how you sleep. Lying flat on your back can put extra pressure on the chest and lungs, making it harder to breathe. It can also trigger a post-nasal drip, when mucous drips from the nose down the back of the throat, causing coughing. For people who have acid reflux, in addition to respiratory conditions, the acid coming up from the stomach can further irritate the airways.

If you prefer lying on your back to sleep, elevate your neck and shoulders with pillows (one or more) to help open your airways. Adding another pillow under your knees can help improve circulation and maintain this elevated sleeping position through the night. You could also try lifting the head of the bed itself, instead of using pillows.

For side sleepers, lying on your left side with your head elevated may help, particularly if you suffer from acid reflux. Past research has found that for some people sleeping on your right side can worsen asthma symptoms as it increases pressure on the vagus nerve, which in turn can trigger airway constriction.

Sleeping on your stomach is also advised against, as it can restrict airflow. It is worth experimenting with different sleeping options, to see what works best for you.

Reducing exposure to triggers

Beds and bedrooms can be full of possible asthma triggers including dust mites, pet hair, mould. Pollen and cold air can also drift through open windows. Regular dusting and vacuuming will improve air quality, as will regularly washing sheets and covers in hot water (above 55 degrees if possible). A hot wash kills allergens, but be sure bedding is fully dry before putting it on the bed, as damp bedding can cause mildew and mould to grow.

It is also wise to keep your mattress off the floor, so you are elevated above dust mites, pet hair and other allergens in carpets. While your family pet might enjoy claiming your bed, if pet hair is a trigger, it is best to keep them out of the bedroom.

It is important to keep your home well ventilated during the day, however at night it is best to close your bedroom windows to keep out cold or warm air (both which can trigger respiratory symptoms), and pollen. Pollen levels are often highest in the early morning and early evening, so if this is a trigger try to keep windows shut at these times. If you are worried about air flow overnight, then you could look at purchasing an air purifier for your bedroom.

Dry air can also worsen respiratory symptoms by irritating the throat and nasal passages. Having a humidifier in your room could help, however as these can increase the presence of dust mites, they may not be suitable for everyone.

Check your medications

For people with asthma, if you are experiencing flare ups at night, or waking with wheezing and breathlessness, this is a sign that your asthma isn’t well-controlled and you need to get your healthcare practitioner to review your treatment.

Some medications can interfere with sleep, so check with your healthcare practitioner or pharmacist if you are unsure about when your medication should be taken or to check if another option is available.

Be sure to keep any medication you might need in the night near to your bed, so if you wake up, you can find it quickly. Always sit up to use your medication, and afterwards wait for the medicine to begin relieving your symptoms before going back to sleep.

Other sleeping tips

- Keep using your medicines as prescribed, to ensure your respiratory condition is well-managed.

- Visit your GP or health practitioner for regular reviews, particularly if your symptoms are changing.

- Ongoing problems with breathlessness at night can cause anxiety around bedtime. Breathing exercises before bed, can help with both anxiety and your breathing.

- If you have issues with heartburn, avoid eating large meals or drinking late in the day, to give your body plenty of time to digest food before bed.

- Turn off all electronics at least 30 minutes before bedtime.

- If you have ongoing issues with congestion during the night, then a nasal decongestant spray before bed may help. Check with your healthcare practitioner to see whether this may be suitable for you.

If insomnia or sleep disruption has become a major problem, talk to your healthcare practitioner. Your treatment plan may need to be reassessed, or you may need to be referred to a respiratory or sleep specialist to check for obstructive sleep apnoea, a condition that may overlap in some patients with asthma and COPD.

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