If you are awakened from sleep in the early morning hours, at 2 or 3 AM for example, with uncomfortable breathing or respiratory symptoms, you are experiencing what asthma specialists refer to as “nocturnal awakenings,” or “nocturnal symptoms.” Nocturnal awakenings due to asthma are never normal and are undesirable from many points of view. Apart from interfering with sleep and rest, they indicate that your asthma is not adequately controlled and that your asthma is becoming more active.
Nocturnal awakenings should always be reported to your treating physician. In the NAEPP classification, a person whose asthma is well controlled experiences nighttime awakenings no more frequently than once a month. If a person with asthma develops nocturnal symptoms more than once a month, the asthma is considered to be persistent and thus by definition, not sufficiently controlled.
When you awaken with asthma symptoms, it is a good idea to use your quick-relief, short-acting, inhaled β2 (SABA) bronchodilator. It will begin to work within minutes as your asthma symptoms lessen and respond, allowing you to go back to sleep.
When you wake up in the morning, you need to give some thought to your asthma. If your asthma was previously under good control, try to figure out why you have developed nocturnal symptoms. Did you omit (or simply forget) your usual asthma medicine? What was your last peak flow (PEF) measurement? Have you been exposed to any known triggers? Did you eat a large, heavy meal right before bedtime, with consequent acid reflux? Are you becoming ill with a viral cold or sinus symptoms? Are your spring allergies flaring?
If you have experienced more than two nighttime asthma episodes in the last 30 days, you probably require addition-al asthma medicine to regain control of your disease and to prevent an exacerbation. Stepped-up anti-inflammatory and bronchodilator medicine should be considered, and any coincident factors, such as reflux, infection, or allergy, should also be addressed. Remember, a major goal of asthma treatment includes restful, uninterrupted sleep.