Without a doubt, more children have asthma today than they did a few generations ago. Asthma is a lung disease caused by inflammation that makes breathing difficult. It can be triggered by any number of factors, from allergens to exercise to certain types of weather. Thankfully, a new class of medications has arisen in the past decade that often does a great job of controlling asthma in children.

Children with asthma, however, often still have more difficulty with their symptoms at night, and may struggle more with sleep disorders and disruptions than other children.

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If you’re the parent of a child with asthma, you may have noticed that your child’s asthma gets worse at night. Even when they’ve had a well-controlled day with no noticeable triggers, they may go to bed and find that they are wheezing, coughing, have difficulty sleeping, or wake themselves with coughing bouts or difficulty breathing. This particular form of asthma, prevalent largely among children, is called nocturnal asthma. 

Researchers have not yet determined why there is a correlation between nighttime asthma exacerbations; some theorize that there is a circadian factor, meaning that it’s part of the body’s rhythms that set off difficulty breathing in the night. Others suggest that some process of becoming tired and sleepy actually sets off the exacerbation. 

Regardless of how well controlled a child’s asthma is during the day, nocturnal asthma indicates that the asthma, overall, is not well controlled. Your first step must be to speak to your child’s asthma specialist to evaluate whether or not their medications are adequate for them right now. 

The next, and equally important step, is to get your child evaluated by a sleep specialist. 


There are a few known factors about how we breathe during sleep that do shed light on why asthma may worsen over the course of the night. Everyone has their best breathing in the early part of the night, and gradually loses breathing quality and airway resistance over an evening’s rest. This may be worsened in children with asthma. 

Many studies have shown that children with asthma are at greater than usual risk of obstructive sleep apnea, and that the symptoms of the two conditions can overlap and be confusing to separate. Obstructive sleep apnea is easy to treat in children, however, and a study at the University of Chicago showed a 75% improvement in asthma flare-ups once the children’s OSA was properly controlled 

Almost 50% of children with asthma report that their sleep is disturbed, which can lead to sleep deficits that increase the overall inflammation in their bodies (through hormonal changes), which may cause worsening asthma symptoms. Therefore, it’s very important to make sure that children with asthma get plenty of sleep.


While most medications used to treat asthma tend to be well localized through inhalation to the lungs, they can certainly cause hyperactivity, sleep disturbance and lack of emotional control at times. Exacerbations that don’t respond to preventative or rescue medications are often treated with oral steroids like prednisone, which absolutely can cause sleep disturbances. 


If your child has been diagnosed with asthma and has difficulty sleeping, seems either tired or hyperactive during the day, or complains of poor sleep or waking frequently, it’s very important that they undergo a complete evaluation with a pediatric sleep specialist. Poor sleep or a sleep disorder such as obstructive sleep apnea can be affecting their sleep and worsening their symptoms. Contact us today to schedule an evaluation for your child.