What to do about severe nighttime asthma attacks. Obstructive sleep apnea and bronchial asthma. Causes of an attack of suffocation at night

Can nocturnal asthma disrupt your sleep? Nocturnal asthma, with its symptoms such as chest tightness, shortness of breath, coughing and wheezing, can prevent you from sleeping at all. Symptoms of nocturnal asthma can disrupt your sleep and prevent you from getting a good rest, leaving you feeling tired and sluggish throughout the next day. Nocturnal asthma should not be ignored. This is very serious and requires an accurate diagnosis and effective treatment.

Nocturnal asthma and sleep disorders

Asthma symptoms are 100 times more severe when they worsen during sleep. Nighttime wheezing, coughing and breathing problems are common but also potentially life-threatening symptoms. Most people underestimate the seriousness of nocturnal asthma.

Studies have shown that most deaths due to asthma occur at night. Asthma attacks at night can cause serious sleep problems, resulting in sleep deprivation, drowsiness, fatigue and irritability during the day. These problems can affect your overall life and make it difficult to control your symptoms during the day.

Causes of nocturnal asthma

The exact reasons why asthma symptoms worsen during sleep are unknown. But there are still many hypotheses explaining what can cause an exacerbation of the disease. These include close contact with allergens during sleep, severe cooling of the respiratory tract, horizontal body position, or hormonal secretions that disrupt the circodian rhythm. Even sleep itself changes the performance of the lungs and airways. Reasons also include:

Excessive mucus production or sinusitis

During sleep, the airways become very narrow and mucus blocks them. This can cause coughing during sleep, which can further constrict the airways. Increased sinus congestion can also trigger an asthma attack in hypersensitive airways. Sinusitis is very common in asthma.

Internal pathogens

Asthma exacerbation can only occur during sleep, regardless of what time of day sleep occurs. For example, asthmatics who work night shifts may suffer asthma symptoms during the day while they sleep. Most researchers suggest that lung function declines 4 to 6 hours after sleep. This shows that there are internal triggers that trigger asthma during sleep.

Horizontal body position

Horizontal body position can provoke exacerbation of asthma. This can be caused by a variety of factors, such as a buildup of secretions in the airways (sinus drip or postnasal drip), increased volume of circulating blood in the lungs, decreased lung capacity, and increased airway unresponsiveness.

Air conditioned

Cold air from an air conditioner can cause severe hypothermia in the respiratory tract. The airways become cooler and drier, which is a major cause of exacerbation of tension-type asthma. And it also aggravates nighttime asthma.

GERB (Gastroesophageal reflux disease)

If you often suffer from heartburn, acid reflux from the stomach into the esophagus and larynx can cause a reflex called bronchospasm. Reflux gets worse when you lie down or, if you take certain asthma medications, that weaken the valve between your esophagus and stomach. Sometimes stomach acid irritates the lower part of the esophagus and activates the vagus nerve, which sends signals to the bronchial tubes, thereby causing bronchoconstriction (narrowing of the bronchial tube). If gastric juice constantly rises up the esophagus to the larynx and a few drops of it enter the trachea, bronchi and lungs, then the body’s reaction will be very serious. This can result in severe irritation of the airways, increased mucus production and bronchoconstriction. If you start treating GERD and asthma correctly and on time, you can stop attacks of nighttime asthma.

Delayed reaction of the body

After close contact with an allergen or asthma trigger, the airways become severely narrowed or allergic asthma worsens. But sometimes this happens with some delay. This exacerbation of the disease can last about an hour. About 50% of those who experience a sudden exacerbation of asthma experience a second phase of airway narrowing three to eight hours after exposure to the allergen. This phase is called the delayed reaction of the body. A delayed reaction is characterized by an increase in the sensitivity of the airways, the development of inflammatory processes in the bronchi and a longer blockage of the airways.

Most studies have shown that if contact with an allergen occurs in the evening, rather than, say, in the morning, then the body's reaction is more likely to be delayed, and the asthma attack can be very serious.

Hormones

Hormones circulating in the blood have characteristic circodian rhythms that differ in people who suffer from asthma. Epinephrine is one such hormonal substance that has an important effect on the bronchi. This hormone helps keep the muscle tissue surrounding the airways relaxed so that the airways remain wide enough. In addition, epinephrine inhibits the action of other substances, such as histamine, which causes mucus formation and bronchospasms. The level of epinephrine in the body and the maximum volumetric expiratory flow rate decrease by 4 am, and the level of histamine, on the contrary, increases. A decrease in epinephrine levels leads to an exacerbation of nocturnal asthma symptoms during sleep.

How to treat nocturnal asthma?

During an attack of bronchial asthma, the patient experiences a very sharp compression of the bronchial tissues, and a large amount of secretion begins to be produced, as a result of which the required amount of oxygen does not enter the lungs.

That's why it is important to take such measures of assistance, which will help suppress secretion production, relieve severe tension in the bronchial muscles and remove inflammatory processes along with an allergic reaction.

Asthma attack: features

What to do if you don't have an inhaler?

If for some reason you do not have an inhaler, you need to breathe over the steam and water in which jacket potatoes are boiled. To do this, you need to bend over the pan, after covering your head with a terry towel. This method will promote the opening of the bronchi and.

Cupping massage helps very well. To do this, you need to moisten a cotton wool wrapped around a pencil in alcohol and set it on fire. Burn the can with fire and secure it on your back. Do this until the cans cover the entire area between the shoulder blades. Before the massage, lubricate your back with Vaseline or any nourishing cream. Keep the jars for 1-2 minutes.

You can grate 2 onions on a fine grater and put this mixture on your back.

First aid

1. Be sure to free your neck and chest from constricting clothing.
2. Open the window for fresh air.
3. Use an inhaler. If there is no effect, apply it again after 10 minutes.
4. To relieve suffocation, you can take a tablet called Eufillin.
5. It is also necessary to take any antihistamine.
6. Make a hot bath with mustard. To do this, dilute a tablespoon of powder in hot water and place your feet in the water. Keep them for 5-7 minutes.
7. You can also add a spoonful of soda to a glass of hot milk and drink this mixture. This will expand the bronchi and facilitate the release of sputum.

Algorithm for providing assistance

Anyone who witnesses a person suffocating on the street should call an ambulance. But before her arrival, the person needs to provide first aid. It is divided into the following stages.

1. Be sure to sit the patient on a hard surface or hold him by tilting him forward. This will allow the asthmatic to breathe easier.
2. If the asthmatic has an inhaler with him, spray the medicine into the mouth.
3. If the effect does not occur after 10 minutes, repeat the steps again.
4. Rub the patient's back so that due to rubbing, a rush of blood to the bronchi begins.
5. It is recommended to give validol, corvalol or any other sedative.
6. Rub the asthmatic's hands vigorously so that proper blood flow begins.

The patient must study the symptoms of the onset of an attack in order to reduce suffocation. It is better to use the inhaler in advance to avoid complications. You also need to remember an important rule: always have all the necessary medications with you.

In asthmatics, as in healthy people, lung function parameters, which can be measured by spirometry or peak flowmetry, are subject to cyclic fluctuations throughout the day - circadian rhythms. The best indicators for everyone are observed around 16:00 in the afternoon, and the worst - at 4:00 in the morning. However, if in healthy people the peak expiratory flow changes by only a few percent, then in asthmatics these fluctuations can reach 50%.

In addition, at night, the reactivity of the respiratory tract increases, that is, the ability to respond with bronchospasm to various stimuli. In this article we will try to analyze the most common causes of nighttime asthma attacks and provide ways to solve this problem.

Causes of nocturnal asthma attacks

In addition, at night the activity of the parasympathetic nervous system increases, and the “kingdom of the vagus” (vagus nerve) begins. Let us recall that the autonomic nervous system regulates the activity of all internal organs and consists of the sympathetic and parasympathetic divisions.

In general, the sympathetic department is responsible for activating influences, ensuring the mobilization of the body’s forces for various activities: under its action, the pulse quickens, blood pressure rises, etc. The parasympathetic part of the nervous system provides rest and restoration of strength (including digestion).

In relation to our topic, it is important to know that under the action of the sympathetic nervous system and its mediator norepinephrine, the bronchi expand, and the action of the parasympathetic nervous system (mediator acetylcholine) causes them to narrow. Thus, the nocturnal predominance of vagus nerve activity is one of the main causes of nocturnal asthma.

What to do to prevent a nighttime asthma attack? The use of long-acting bronchodilators (these include Spiriva, salmeterol, formoterol, sustained-release theophyllines) reduces the degree of nocturnal deterioration of bronchial obstruction, but does not completely prevent it.

Asthma worsens at night

At night, the severity of inflammation in the bronchi increases and at the same time the sensitivity of receptors to glucocorticosteroids and bronchodilators of the beta-agonist class (they act on adrenaline receptors) decreases.

How to avoid nighttime asthma attacks? Improving the control of bronchial asthma with the help of optimal drug therapy reduces the severity of inflammation in the bronchi, including at night. However, changing the dosing regimen of anti-inflammatory drugs (using a hormonal inhaler immediately before bed) does not, in itself, have any effect on the frequency of nighttime symptoms.

Contact with allergens in nocturnal asthma

As part of the prevention of night attacks of bronchial asthma, it is necessary to minimize contact with the allergen. This can be achieved by using hypoallergenic bedding (pillows, blankets, various covers, etc.) and other hypoallergenic measures. The duration of action of not all medications overlaps the period of sleep. In consultation with your doctor, use long-acting medications (mentioned above).

Diseases that provoke “asthma at night”

Obstructive sleep apnea syndrome is a serious disease, the clearest sign of which is snoring. Against the background of snoring, the upper respiratory tract periodically becomes blocked (obstruction occurs), and breathing stops (this is apnea). As a result, the level of oxygen in the blood drops, and the brain, heart and other organs suffer from its lack, and the risk of vascular accidents increases. Obstructive sleep apnea syndrome can be suspected by the presence of not only snoring, but also excessive daytime sleepiness (after all, it is not possible to rest properly at night).

Allergic rhinitis and sinusitis: at night, the process of self-cleaning of the paranasal sinuses worsens, which can cause mucus to flow into the lower respiratory tract with the development of night cough and shortness of breath.

Cardiac asthma: attacks of nocturnal shortness of breath that occur after a few hours of sleep and go away when moving from a lying to a sitting position may be a manifestation of heart failure.

You need to pay attention to the characteristics of nighttime asthma attacks, remember the accompanying symptoms and tell your doctor about them. He will advise which specialist to contact for diagnosis and treatment of each of these diseases.
Now let’s finally answer one of the main questions: what to do if a nighttime asthma attack has already developed? Of course, it is necessary to inhale a fast-acting bronchodilator. It is possible to use any short-acting beta-agonist (salbutamol, Berotec), but it is better, remembering the nocturnal “kingdom of the vagus,” to use a combined drug that simultaneously acts on the receptors of the sympathetic and parasympathetic nervous systems. This combination of a beta-agonist and an anticholinergic blocker, which makes it possible to maximally resist nighttime changes in neuroendocrine regulation, is available in the form of a well-known drug - Berodual N.

Berodual N contains a beta-agonist (fenoterol) and an anticholinergic blocker (ipratropium). Thanks to fenoterol, relief from taking the drug occurs within a few minutes after inhalation, and then ipratropium comes into the fight against suffocation, the maximum effect of which develops by the end of the first hour. The total duration of action of Berodual is 6 hours, which is longer than that of single-component drugs. As a rule, this duration of action of the drug allows you to sleep peacefully until the morning without experiencing symptoms of nighttime asthma.

Palpitations, trembling and other undesirable effects are less likely to occur when using Berodual N than when using other inhalers, since Berodual N contains a reduced dose of beta-agonist. It is advisable to discuss in advance with your doctor the use of Berodual N for nocturnal attacks of bronchial asthma.

We hope this article helps you minimize your risk of nighttime attacks and achieve asthma control. However, keeping asthma under control is not always possible and can be caused by a variety of factors, such as smoking and viral respiratory infections.

These two factors also increase the tone of the parasympathetic nervous system, so night attacks against the background of ARVI or (alas!) continued smoking are another reason to use the combined inhaler Berodual N. Of course, in any case, night attacks of asthma are a signal that it is necessary visit a doctor. And we wish you good dreams and free breathing.

Nocturnal vomiting, with symptoms such as tightness in the chest and wheezing at night, can make sleep impossible and leave you tired and irritable during the day. These problems can affect your overall quality of life and make it difficult to control daytime asthma symptoms.

Nocturnal asthma is very serious. She needs a correct asthma diagnosis and effective asthma treatment.

Nocturnal asthma and sleep disorders

Nighttime wheezing, coughing and difficulty breathing are common but potentially dangerous. Many doctors often underestimate nocturnal asthma.

Research shows that most deaths associated with asthma symptoms such as wheezing occur at night.

Causes of nocturnal asthma

The exact reason why asthma is worse during sleep is unknown, but explanations include increased exposure to allergens; cooling of the respiratory tract; staying in a lying position for a long time; and hormonal secretions that follow a circadian pattern. Sleep itself can even cause changes in bronchial function.

Increased mucus or sinusitis

During sleep, the airways tend to narrow, which can cause increased resistance to airflow. This can cause coughing, which can cause the airways to become more constricted. Increased drainage from your sinuses can also trigger asthma in your highly sensitive airways. Sinusitis with asthma is quite common.

Internal triggers

Asthma problems can occur during sleep, even though you are asleep. People with asthma who work night shifts may have breathing attacks during the day while they sleep. Most studies show that breath tests are worse around four to six hours after you fall asleep. This suggests that there may be some internal trigger for asthma related to sleep.

Lying position

Lying in a supine position may also predispose you to nighttime asthma problems. This can cause many factors, such as accumulation in the airway (sinus drainage or postnasal drip), increased blood volume in the lungs, decreased lung capacity, and increased resistance to the airway.

Air conditioner

Breathing cold air at night or sleeping in an air-conditioned bedroom can also cause heat loss from the respiratory tract. Airway cooling and moisture loss are important triggers for asthma. They are also involved in nocturnal asthma.

GERD

If you frequently experience heartburn, reflux of stomach acid through the esophagus into the larynx may stimulate bronchial spasms. It is worse when you lie down or take asthma medications, which relax the valve between the stomach and esophagus. Sometimes stomach acid irritates the lower esophagus and narrows the airways. Stomach acid can drain into the airways and lungs, causing a serious reaction. This can cause irritation of the airways, increased mucus production, and tightening of the airways. Treating GERD and asthma with appropriate medications can often stop nocturnal asthma.

Hormones

The hormones circulating in the blood are well characterized by the circadian rhythms that everyone experiences. Epinephrine is one such hormone that has an important effect on the bronchial tubes. This hormone helps keep the muscles in the walls of the bronchi relaxed so the airways remain wide. Epinephrine also inhibits the release of other substances such as histamines, which cause mucus secretion and bronchospasm. Epinephrine levels and peak expiratory flow rates are lowest around 4:00 am, while histamine levels tend to peak around this time. This decrease in epinephrine levels may predispose you to nocturnal asthma while you sleep.

How is nocturnal asthma treated?

There is no cure for nighttime asthma, but daily asthma medications, such as inhaled steroids, are very effective in reducing inflammation and preventing nighttime symptoms. Because nocturnal asthma can occur at any time during sleep. A long-acting bronchodilator supplied for asthma may be effective in preventing bronchospasm and asthma symptoms. If you suffer from nocturnal asthma, you can also use a long-acting inhaled corticosteroid. If you suffer from GERD and asthma, ask your doctor about medications that reduce stomach acid production. Avoid potential triggers and allergens such as dust mites, pet dander or feathers in bedding...

Additionally, by using your peak flow meter, you can monitor how your lung function changes throughout the day and night. As soon as you notice changes in your lung function, talk to your doctor about a plan to manage your nighttime asthma symptoms. Depending on your type of asthma and the severity of your asthma (mild, moderate, or severe), your doctor may prescribe treatment to help you resolve your nighttime asthma symptoms so you can sleep like a baby.

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Bronchial asthma is a chronic disease of the respiratory tract, which is characterized by the presence of inflammatory processes in the bronchi. This disease occurs for a variety of reasons, so there are several types of it. However, classifications of bronchial asthma are based not only on provoking factors, but also on the characteristics of the manifestation of the disease. According to this approach, a type such as nocturnal bronchial asthma is distinguished.

Nocturnal asthma most often does not differ from other types of the disease in its symptoms and causes, so it is not always considered as a separate type. Its difference lies in the fact that exacerbations occur at night when the patient is sleeping. Only then is he concerned about the symptoms characteristic of bronchial asthma. Hence the origin of the name.

It is worth saying that attacks do not always occur at night. Usually they are observed during sleep, even if the patient went to bed during the day. Therefore, the term “night” is not entirely accurate.

Essence of the disease

Medicine has not yet given an exact answer to the question of why nocturnal asthma develops. There are several factors that can cause this type of disease to occur. The main ones:

However, all these factors do not explain why nocturnal asthma attacks do not occur in all patients with this disease. It can be assumed that the main reason lies in the individual characteristics of the body, which, in combination with these factors, cause nocturnal asthma.

How does it manifest?

The symptoms of nocturnal asthma are exactly the same as with any other type of asthma. Their key difference is their acute manifestation during sleep, which is why the patient may wake up several times during the night.

Among them are:

• coughing;
• suffocation;
• chest pain;
• wheezing;
• rapid heartbeat;
• shallow breathing;
• feeling of lack of air.

Their occurrence often causes severe fear in patients, since waking up due to the fact that they cannot breathe is very scary. This fear often only intensifies the reaction and also prevents the patient from taking the necessary measures to overcome the attack.

How does it affect the quality of life?

Naturally, in the absence of health problems, people live more active and freer lives than if they had this diagnosis. Due to nocturnal asthma, patients have to be very careful about their health, take medications and follow doctors' recommendations.

In addition, patients who experience asthma attacks at night have much more difficulties than those who experience exacerbations during the day. This is associated with a feeling of constant anxiety and even panic (some patients are afraid of suffocating in their sleep), which leads to nervous tension, which only aggravates the situation.

Also, the presence of frequent attacks causes lack of sleep, which reduces the patient’s performance. If this situation occurs over a long period of time, the patient develops chronic fatigue syndrome, the body weakens and is less resistant to negative influences. Therefore, it is very important to combat the nighttime manifestations of asthma.

However, if attacks occur occasionally and are not severe, then there is no point in talking about serious difficulties. Such patients live and work quite normally because they control their illness.

This depends on the individual characteristics of the patient and how correct the medical approach is chosen in the process of his treatment.

Diagnosis, treatment and prevention

To select quality treatment, it is necessary to diagnose the existing disease. This involves the usual procedures used to detect asthma.

This:

• radiography;
• blood analysis;
• tests for allergic reactions;
• provocative tests, etc.

In addition, the doctor must take into account the symptoms and features that the patient reports to him. It is from the patient himself that you can find out when he has attacks and diagnose nocturnal asthma.

Treatment for nocturnal asthma is practically no different from what is prescribed for any other form of the disease.

Doctors prescribe quick-acting medications (Atrovent, Albuterol) to stop acute attacks, as well as drugs that reduce the negative external influence on the bronchi and prevent exacerbation. The second group of drugs is prescribed for a long term and is taken by patients regularly.

Most often prescribed

• anti-inflammatory (sodium cromoglycate, Nedocromil sodium);
• bronchodilators (Salbutamol, Budesonide);
• expectorants (Ambroxol, ACC).

If you have any type of asthma, it is not advisable to self-medicate. It is necessary to inform the doctor about all the features discovered during the medical treatment. If the drug does not bring results or severe side effects occur when using it, it is necessary to replace it with another one.

The peculiarity of the treatment of nocturnal asthma is that the patient must be protected during sleep. That is why long-acting agents are considered the most effective.

It is also very important to identify the traumatic factor in order to neutralize or reduce its impact. It is worth eliminating from the bedroom everything that could be an allergen irritant.

It is important to understand that even the most effective treatment will not cure bronchial asthma completely. However, it is possible to control the disease and minimize its negative impact. Prevention plays an important role in this. The main preventive measures include:

It is also undesirable to expose your airways to cold air during sleep. Despite the fact that nocturnal bronchial asthma is an unpleasant disease that significantly complicates the patient’s life, you can learn to live a full life even with it.