Causes and Treatments for Wheezing When Lying Down at Night

Why You Might Experience Wheezing When Lying Down

Wheezing can be an alarming symptom, especially if it occurs or worsens at night when you lie down to sleep. Wheezing refers to a high-pitched, whistling sound during breathing, typically during exhalation. It results from narrowed or constricted airways limiting airflow.

Wheezing when lying down can have several possible causes. Understanding the potential reasons can help you take appropriate action if this symptom arises.

Asthma

Asthma commonly causes wheezing that worsens at night. This phenomenon is known as nocturnal or nighttime asthma. Airway constriction often increases during sleep due to circadian changes in hormones, body position, and exposure to allergens in bedding.

Lying flat can also worsen asthma symptoms by restricting diaphragm movement and lung expansion. Gravity no longer assists with airway drainage either.

Asthma should be evaluated by a doctor. Treatments like inhalers and avoiding triggers can help control wheezing at night.

Airway Obstructions

Partial blockages in the throat or lungs from colds, allergies, smoke inhalation, or chronic diseases can induce wheezing. The narrowed passages struggle to transport ample air.

Lying down exacerbates the obstructions by shifting respiratory structures and secretions. Mucus can specifically drip back and clog the larynx and trachea at night.

Treating the underlying sickness and using expectorants to clear congestion may relieve associated wheezing when recumbent.

Gastroesophageal Reflux Disease (GERD)

GERD occurs when stomach acid flows back up into the esophagus due to a weakened sphincter muscle. This irritates the lining and provokes coughing or wheezing.

Lying down allows more stomach contents to reflux upward. The larynx also lies directly in the path of any regurgitation.

Lifestyle adjustments and medications that reduce acid production can help control GERD and associated respiratory symptoms.

Nocturnal Asthma vs. GERD

Both asthma and GERD frequently disturb sleep with coughing and wheezing when lying prone. Distinguishing between the two causes can be challenging.

Nocturnal asthma tends to follow seasonal allergy patterns and causes chest tightness and difficulty inhaling.GERD wheezing more often produces heartburn and regurgitation.

Consulting a doctor for appropriate testing can identify whether asthma, GERD, or a combination contributes to nighttime wheezing.

Heart Failure

Fluid accumulation in the lungs (pulmonary edema) from heart failure induces wheezing and shortness of breath, especially at night. Gravity exacerbates fluid shifting into lung tissues upon lying down.

Wheezing from heart failure usually causes coughing and panicked awakening as breathing deteriorates. Immediate medical treatment is required.

Vocal Cord Dysfunction

This respiratory condition involves improper closure of the vocal cords, causing them to spasm. It can create noisy breathing and wheezing during strenuous activity or at night.

Speech therapy helps retrain muscle control. Other therapies open the airway using breathing exercises or devices that steady airflow.

When to See a Doctor About Nocturnal Wheezing

Make an appointment with your healthcare provider if you experience new onset wheezing at night. Seek prompt medical care if you have:

• Wheezing combined with chest tightness, shortness of breath, or difficulty breathing
• Nocturnal symptoms that awaken you from sleep
• Wheezing following an upper respiratory infection that worsens instead of improves
• Fever, chills, or unintentional weight loss along with wheezing

Severe or progressive wheezing indicates a more serious underlying condition requiring evaluation. Don’t assume symptoms are just asthma before being professionally assessed.

Questions Your Doctor May Ask

Be prepared to answer the following questions when discussing nighttime wheezing with your doctor:

• When did you first notice the wheezing? Does it happen every night?
• Is the wheezing worse when lying down? Does it improve when you sit up?
• Do you have other symptoms like cough, tightness, heartburn, or difficulty breathing?
• Is your wheezing seasonal or related to any triggers like allergies?
• Have you had asthma, reflux, or respiratory infections in the past?
• What medications do you take daily? Have you started any new medicines recently?

Answering openly helps your doctor make an accurate wheezing diagnosis and recommend appropriate treatment options.

Diagnostic Tests

After a physical exam, your doctor may recommend further diagnostic testing to pinpoint the cause of nighttime wheezing. Some possible tests include:

• Pulmonary function tests - measure lung capacity and airflow to diagnose asthma or other obstructions.
• Allergy testing - identifies potential environmental asthma triggers like pet dander or pollen.
• Chest x-ray - visualizes lung inflammation, excess fluid, or physical anomalies.
• pH monitoring - documents acid reflux events that could elicit wheezing.
• Sleep study - tracks sleep stages, oxygen levels, cardiac activity to reveal breathing disturbances.

Your doctor will select appropriate tests based on your history and symptoms. Proper diagnosis is crucial for effective wheezing treatment.

How to Prevent Wheezing When Lying Down

You may be able to reduce or prevent nocturnal wheezing episodes by making certain lifestyle modifications and self-care measures at home.

Use Bed Wedges or Raise Mattress Head

Sleeping propped up reduces acid reflux and asthma symptoms influenced by lying flat. Adjustable bed wedges gently elevate your head and chest by various angles.

You can also insert blocks under your mattress to raise the head 8-10 inches higher. This uses gravity to keep reflux and mucus from aggravating airways.

Control Allergies and Asthma

Follow your doctor's asthma treatment plan consistently, including any prescribed inhalers or allergy medications. This helps open airways and prevent inflammatory reactions.

Monitor pollen counts during allergy season and limit exposure. Use high efficiency filters in your HVAC system too.

Alter Sleep Position

Sleeping on your side instead of back can improve asthma and reflux symptoms for some people. Side-sleeping keeps acid and fluids from rising into the throat.

Place pillows along your back to discourage rolling onto it during the night. Yoga blocks under your mattress can also make side-sleeping more comfortable.

Watch GERD Triggers

Avoid eating large meals and trigger foods like citrus, caffeine, spicy dishes, and chocolate before bedtime. Give yourself 2-3 hours to digest.

Stop smoking, lose excess weight, and reduce alcohol which can weaken the esophageal sphincter. Over-the-counter antacids may help too.

Use a Humidifier

Dry air aggravates respiratory passages. Running a humidifier at night, especially in winter, can help moisten and soothe airways.

Keep humidity around 40-50% to avoid promoting mold growth. Make sure to clean humidifiers regularly as well.

Implementing various preventive steps offers the best chance of stopping wheezing before it interrupts sleep. But always discuss remedies with your doctor to ensure appropriateness for your situation.

Medical Treatments for Nocturnal Wheezing

If self-care strategies don't relieve wheezing at night, your doctor may prescribe certain medical treatments tailored to the cause.

Asthma Inhalers

Inhaled corticosteroids reduce airway inflammation and constriction. Long-acting bronchodilators like LABAs open passages wider. Some combination inhalers provide both effects.

Most asthma inhalers should be taken daily on a preventive basis to control nighttime symptoms. Rescue inhalers like albuterol offer quick relief for sporadic wheezing episodes.

Oral Asthma Medications

Pills like Singulair (montelukast) block inflammatory leukotriene chemicals. Steroids like prednisone systemically reduce swelling. These are taken routinely or short-term as needed.

Theophylline is an older oral medicine that relaxes airway muscles but carries more potential side effects. Biologics can treat severe asthma unresponsive to other drugs.

Reflux Medications

Acid-blocking agents like PPIs and H2 blockers ease GERD, healing irritation of the throat and larynx. Prokinetic drugs improve the esophagus’ ability to transport food and acid.

Over-the-counter antacids and alginates quickly neutralize stomach contents refluxing upward. Avoid antacids before bed that contain stimulants like caffeine.

Oxygen Therapy

Severe cases of asthma or heart failure may require supplemental oxygen at night. This increases airway dilation and improves oxygen saturation of the blood.

Oxygen can be delivered through a nasal cannula, face mask, or transcutaneous patches. Devices sense your breathing pattern to adjust flow rates accordingly.

Always comply fully with prescribed medical treatments for wheezing. Seek prompt medical care if any deterioration occurs.

When to Go to the Emergency Room

Seek emergency medical care if nocturnal wheezing is accompanied by any of the following:

• Severe shortness of breath at rest
• Chest pain or tightness
• Coughing up blood-tinged sputum
• Bluish lips or nails signaling low oxygen
• Feeling like you can’t get enough air
• Very rapid, strained breathing

Worsening wheezing that isn't relieved with rescue inhalers or other medications also warrants an ER visit. Severe asthma attacks or heart failure exacerbations require urgent treatment.

Call 911 or emergency services if breathing difficulty continues to escalate. Don't delay seeking help for critical wheezing episodes even at night.

Outlook for Nighttime Wheezing

With proper diagnosis and treatment, wheezing provoked by lying down can often be effectively managed. Avoid assuming it’s just minor asthma before being evaluated.

Following your doctor’s recommendations typically enables you to control symptoms and sleep better. Seek medical advice if wheezing persists despite optimal therapy.

Implementing preventive steps can also deter nocturnal wheezing episodes. Pay attention to any daytime or postural triggers too. Together with medications, these actions can help quiet disruptive nighttime wheezing.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.