Woken by your child’s coughing and wheezing? Uncontrolled asthma makes it hard for sick kids - and worried moms - to sleep. But how can you stop nighttime attacks so everyone gets a better night’s sleep? Experts share which medications work best and how to control triggers lurking in your child’s bedroom.
“The scary thing is that a nighttime asthma flare-up can happen any time,” says Michele Fellows, owner of the allergy-conscious Sweet Alexis Bakery in Los Osos, Calif., named for her 9-year-old daughter, Alexis, who has severe allergies and asthma.
“I worry about having to make a middle-of-the-night hospital run,” she says.
A child’s symptoms often worsen at night. In a poll by the Asthma and Allergy Foundation of America, 45% of parents said their asthmatic children had been awakened by coughing, wheezing or shortness of breath, a condition called nocturnal asthma.
But their sleep (and yours) isn't the only thing to suffer. The effects of interrupted rest linger into the next day.
“Children with uncontrolled nighttime asthma are chronically sleepy in the daytime,” says Ron Ferdman, M.D., a pediatric allergist at Childrens Hospital Los Angeles.
“They’re more likely to fall asleep in school, with decreased concentration, learning and performance,” he says.
Overtired kids are often cranky and have trouble keeping behavior under control. Their parents are sleep-deprived too, waking every time the child has a coughing fit.
Fortunately, you and your child don’t have to take nocturnal asthma lying down.
With treatment, “children with asthma should be able to sleep through the night, and never be disturbed by nighttime asthma symptoms,” Ferdman says.
Read on to learn how.
What causes nocturnal asthma?
Even in healthy people, lung function declines at night.
"Breathing slows down, and blood oxygen levels fall during sleep,” says Jonathan Malka, M.D., assistant professor of pediatrics at National Jewish Health, a Denver academic medical center specializing in respiratory and allergic diseases.
Lung function typically reaches its low point around 4 a.m, which is why the risk of a dangerous asthma attack is highest in the early morning, Malka says.
Sleepless and Breathless
Proper and fast medical care is key to controlling nighttime asthma, so watch for these signs:
Coughing: This is the most prominent nocturnal asthma symptom, but your child might also cough for up to three weeks following a cold or other respiratory illness.
But “it’s not normal – and could be a sign of asthma – for kids to cough frequently when they’re otherwise well,” says Amy Marks, D.O., a pediatric allergist at Children’s Hospital of Michigan in Detroit.
Wheezing (a high-pitched whistling sound when they breathe), shortness of breath, or tightness in the chest: “Babies or younger children may just cough or wheeze and then wake up crying,” Ferdman says. “Older children may complain of a ‘tight chest’ or ‘not being able to take a deep breath.’ Some will simply say their chest hurts.
If these signs occur, consult a pediatrician, who will do a physical exam and ask about symptoms – for example, when and how often they occur, and possible triggers.
The doctor may also do a pulmonary function test, asking your child to breathe into a device that measures how well the lungs are working.
If your child is already under asthma treatment, tell the doctor that symptoms are occurring at night.
That’s a sign that the disorder isn’t adequately controlled, Malka says.
The physician might need to increase the dose, switch to a different drug, add another, or simply give your child more instruction in inhaler use.
Late-Night Emergencies
Some middle-of-the-night asthma attacks are medical emergencies and need immediate attention. Go to the emergency room or call 911 if your child:
Has severe breathlessness or wheezing
Experiences difficulty talking due to shortness of breath
Leans forward to breathe while sitting
Rx for Peaceful Slumber
The cornerstone of nocturnal asthma treatment is medication, which falls into two groups:
Quick-relief medication. Every asthmatic child needs an inhaled fast-acting medication to treat or prevent an asthma flare-up.
The first choice is a beta agonist (such as albuterol or levalbuterol), which quickly relaxes tight muscles around airways during a flare-up.
“For intermittent or short-term nighttime symptoms, one dose before bedtime for a few days may be enough to help the child sleep through the night,” Ferdman says.
Long-term control medication. Many children also need a daily long-term control medication to help prevent future flare-ups. Examples include inhaled corticosteroids (such as fluticasone and budesonide) and leukotriene receptor blockers (such as montelukast and zileuton).
“For chronic nighttime symptoms, we often have to start or increase daily controller medication,” Ferdman says. If that doesn’t keep nighttime symptoms in check, an inhaled long-acting beta agonist (such as salmeterol or formoterol) may be added.
Ask the pediatrician or asthma specialist for a written action plan detailing which medications your child needs and when. It also lists steps to take during flare-ups, when to call the doctor or seek emergency help.
Keep one copy next to your bed so you can find it easily at night, Fellows advises.
Controlling Allergens
Like Alexis, most asthmatic kids also have allergies, which can set off asthma symptoms. To control nighttime asthma, it’s crucial to reduce the following triggers in the child’s bedroom:
Dust mites: These tiny insects, invisible without magnification, are common bedroom pests, lurking in sheets, blankets, mattresses, pillows, carpets and cuddly stuffed toys.
To decrease dust mites, “wash bedding in hot – not warm – water once a week,” Marks says.
Also, enclose the mattress and pillows in dustproof (“allergen-impermeable”) covers.
Remove carpet from the bedroom or vacuum frequently. Buy only washable stuffed toys, launder them often in hot water, and keep them off beds.
Pets: Kids with pet allergies are sensitive to proteins in the animal’s skin flakes, urine or saliva.
“Pets such as dogs or cats should never be allowed to enter the child’s bedroom, much less sleep on the bed,” Ferdman says.
More allergens to look for:
Pollen: Shut bedroom windows to keep airborne pollen from blowing inside, says Ferdman.
Use an air conditioner to reduce pollen amounts in the air.
Indoor mold: Clean any visible mold. Then eliminate moisture sources, which feed it.
“Look for water seepage from outside walls or under floors, standing water around indoor plants, and damp areas in adjacent bathrooms,” Ferdman says.
Humidity: Don’t run a humidifier without consulting your child’s doctor.
Upper respiratory infections often make asthma worse, and increased humidity may ease the breathing of kids with these infections.
Also, “dust mites and mold grow better in a humid environment,” Ferdman says. If you run the humidifier too often, you could wind up doing more harm than good.
These steps can help minimize nocturnal attacks.
But if your child still has flare-ups, they may be caused by allergy triggers encountered during the day. See a specialist to help identify the culprit. For some asthmatic kids, Marks says, allergy medication or shots may help them breathe easier.
Tucking In
Sleeping position could affect asthma indirectly if your child also has gastroesophageal reflux disease (GERD).
In adults and teens, GERD’s main symptom is frequent heartburn. But in younger kids, it often causes asthma-like symptoms.
For those with GERD, “an inclined position with the head higher than the feet may lessen symptoms,” Ferdman says.
But don’t just prop up your child with pillows, he says; it’s better to slightly tilt the entire head of the bed by adjusting the top legs or putting sturdy blocks under them.
How Much Do You Know About Asthma?
According to the Centers for Disease Control and Prevention, 17.5 million of all American adults and 7.5 million children have asthma, the disease that makes it hard to breathe from inflammation in the lungs and airways. Doctors say understanding how to manage and treat the disease, as well as spot the symptoms, can help a person with asthma enjoy a “normal” life.
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