Nighttime asthma symptoms can cause children and their parents or caregivers to lose sleep. Children with uncontrolled asthma may wake up at night with a cough that keeps them and their parents awake. Even in children with controlled asthma, 30 percent to 70 percent will have symptoms during the night at least once a month. Fortunately, there are things you can do to help prevent these nighttime awakenings.

Compared to children without asthma, children with asthma typically:

• Go to sleep later
• Take longer to fall asleep
• Wake up at night more frequently
• Have more sleep terrors
• Take more naps during the day
• Need a caregiver or parent present to fall asleep

Children who don’t get enough sleep can have daytime sleepiness, a hard time regulating their emotions, difficulty in school, and a decreased quality of life. Lack of sleep can also worsen symptoms because asthma is associated with a 24-hour pattern of lung function. Uncontrolled asthma can increase how often your child wakes up during the night. The result is a worsening feedback cycle with more problems in daytime functioning and more asthma symptoms.

When children have trouble sleeping, it often means parents or caregivers do, too. Parents of children with asthma may be more than twice as likely to have sleep problems. Inadequate sleep for adults can lead to increased depression and anxiety and decreased productivity at work.

How To Help a Child With Asthma Sleep

The following tips can help you and your child get a better night’s sleep, which can help you both be more energetic and productive during the day.

1. Use the Right Medications

The right medications will help your child’s asthma stay well controlled. Children with well-controlled asthma have fewer nighttime awakenings and sleep terrors compared to children with poorly controlled asthma. Parents and caregivers of children with well-controlled asthma are then able to get more sleep.

Asthma is considered well controlled if your child:

• Has daytime symptoms of asthma or uses their quick-relief inhaler no more than twice a week
• Wakes up at night with asthma symptoms no more than twice per month

The two main types of inhaled asthma treatments are long-term control medications and quick-relief medications.

Long-Term Control Medications

Long-term asthma control medications help prevent asthma symptoms by decreasing inflammation and swelling in the airways. These are meant to be taken consistently, regardless of whether a child’s asthma is more or less active. Long-term control medications include inhaled corticosteroids, leukotriene antagonists, and long-acting bronchodilators.

Your child needs to use their long-term control medication consistently, even if they don’t have any asthma symptoms. If your child is not experiencing symptoms, it means the medication is working well.

Although long-term control medications reduce asthma symptoms, they may not help if your child is having trouble breathing during an asthma attack. Quick-relief medications are often used with long-term control medications to improve asthma symptoms happening at the moment. Make sure you have an asthma action plan that is approved by your medical team for when your child’s asthma flares.

Quick-Relief Medications

Quick-relief asthma medications (also called rescue medications) work fast to improve symptoms by relaxing the airway muscles. These medications can stop an asthma attack and should be taken at the first sign of worsening asthma symptoms. Be sure to have these medications everywhere your child typically spends time — at school, after-school programs, family members’ homes, etc. All inhalers must be taken with the spacer so adequate medication can get into your child’s lungs.

Quick-relief medications include albuterol (sold as ProAir and Ventolin) and levalbuterol (Xopenex).

Quick-relief medications only improve symptoms temporarily. Using a quick-relief medication more often can be a sign that your child’s asthma is uncontrolled.

2. Reduce Asthma Triggers

You may not realize it, but children are often exposed to asthma triggers while they sleep. Common triggers in a child’s bedroom can include:

• Dust mites
• Feathers from pillows or blankets
• Smoke
• Dust
• Pests like cockroaches or mice
• Pets or pet dander
• Mold
• Cleaning products
• Cold air from air conditioning
• Dry air
• High humidity

To reduce asthma triggers and allergens in your child’s room, try the following:

• Use allergen covers on pillows and mattresses to prevent allergen buildup and dust mites.
• Wash all bedding and stuffed animals in hot water at least once a week.
• Vacuum once a week.
• Wipe down all surfaces once a week.
• Clean your child’s room when they are not at home. Cleaning products can irritate the airways.
• Use a HEPA filter that directs air toward your child’s head during sleep.
• Change home air filters monthly.
• Don’t eat in the bedroom to avoid attracting bugs and other pests.
• Keep pets out of the bedroom.
• Reduce clutter to avoid dust.
• Remove carpets, if you can.

High or low humidity can be an asthma trigger. Most people feel comfortable when the indoor humidity is between 30 percent and 50 percent. Keeping your home’s humidity under 50 percent can reduce dust mite growth as well. Depending on the climate where you live, you may consider using a humidifier or a dehumidifier to make the air easier to breathe.

Be sure to speak with your doctor about any illnesses that could be contributing to their asthma flares. Chronic nasal inflammation, sinusitis, reflux, and obstructive sleep apnea can make your child’s asthma worse.

3. Find the Right Sleeping Position

Raising your child’s head and shoulders while they sleep can fight the effects of gravity that might be contributing to your child’s cough and asthma symptoms at night. Breathing can be more difficult when lying down because there is increased blood in your lungs and more drainage from your nasal passages. Nasal drainage can be worse when your child has allergies or is sick.

Raising your child’s head and shoulders during sleep can also reduce symptoms caused by gastroesophageal reflux disease (GERD). GERD, commonly known as heartburn, causes a burning sensation in the chest when acid from the stomach is pushed up into the esophagus. Research shows that people with asthma, including children, are more likely to have acid reflux than those without asthma. In addition to being uncomfortable, acid reflux can trigger asthma symptoms. In children with asthma and GERD, the use of an antacid medication may reduce nighttime asthma symptoms.

Some parents find their child coughs less when propped up with a few extra pillows, which can help keep airways open. You can raise the head of your child’s bed by placing a foam wedge under the head of the mattress. If your child is under 2 years old, such bed positioners are not recommended, so speak with your doctor before making any changes to their sleep environment.

4. Create Healthy Habits

Healthy bedtime habits can also improve your child’s sleep. These habits include:

• Avoiding any nonsleep activities on the bed, such as using electronics, and reserving the bed for sleeping only
• Having a consistent bedtime routine, like putting on pajamas, brushing teeth, reading a book, and snuggling in bed
• Stopping screen time an hour or two before bedtime
• Going to sleep and waking up at the same time every day
• Participating in a relaxing activity (like yoga or breathing activities) before bed

Every child is different, and what works for one child may not work for another. You’ll want to experiment with different sleep hygiene practices and find what works best for your child.

It’s also important for kids to stay active during the day. In addition to making them tired, physical activity can increase lung function and boost their immune system.

A sleep diary can help you keep track of what works and what doesn’t in your bedtime routine. It’s best to keep a sleep diary on paper to avoid using screens at bedtime. In your child’s sleep diary, you should record:

• Whether they took their medications that day
• What time they went to bed
• When they fell asleep
• What time they woke up during the night
• What woke them up (coughing, night terror, etc.)

How Can You Manage Nighttime Cough?

Develop an asthma action plan with your child’s pediatrician. The asthma action plan will tell you what to do when your child’s asthma symptoms get worse. The information in your management plan should include asthma medicines, asthma triggers, and when to contact your doctor or go to the emergency room.

Worsening Nighttime Asthma Symptoms in Children

Worsening asthma symptoms can include:

• Coughing
• Wheezing
• Shortness of breath
• Chest tightness
• Breathing hard and fast
• Ribs pulling in during breathing
• Inability to talk

These symptoms can be a sign to give your child their quick-relief medication with their chamber.

Talk to your child’s doctor about the best treatment plan to keep their asthma under control. When your child’s asthma is well controlled, it can lead to fewer symptoms and less disruption of sleep. Consistently following an asthma action plan and managing triggers can help keep your child’s asthma under control.

Talk With Others Who Understand

MyAsthmaTeam is the social network for people with asthma and their loved ones. On MyAsthmaTeam, more than 11,000 members come together to ask questions, give advice, and share their stories with others who understand life with asthma.

Does your child experience asthma night cough? What have you tried to help them sleep better? Share your experience in the comments below, or start a conversation by posting on your Activities page.