What Causes Wheezing When Lying Down and How to Prevent It

Understanding Wheezing When Lying Down

Wheezing or whistling sounds when breathing, especially when exhaling, can be alarming. This respiratory symptom often worsens when lying down to sleep at night. Wheezing is caused by narrowed or constricted airways, making it more difficult for air to flow smoothly in and out of the lungs.

What Causes Wheezing When Lying Down?

There are several potential causes of wheezing that is triggered by lying down flat:

• Asthma - Nocturnal asthma or nighttime asthma attacks commonly lead to wheezing when trying to sleep.
• GERD - Acid reflux can cause inflammation in the airways, resulting in wheezing when lying flat.
• Heart failure - Fluid accumulation in the lungs from heart problems can obstruct breathing.
• Infection - Colds, flu, bronchitis and pneumonia often worsen at night with wheezing.
• COPD - Chronic obstructive pulmonary disease flare ups become more noticeable when lying in bed.
• Pulmonary edema - Build up of fluid in the lungs causes airway constriction.
• Medication reactions - Some drugs have wheezing as a side effect.

Tips to Prevent Wheezing When Lying Down to Sleep

If you deal with regular wheezing when trying to sleep in bed, there are some self-care remedies and lifestyle changes than can help:

1. Use extra pillows - Wheezing when exhaling lying down can be relieved by sleeping propped up at an incline with pillows.
2. Try pursed lip breathing - Breathe in through your nose, then exhale slowly through pursed lips to keep airways open.
3. Run a humidifier - Adding moisture to the air can soothe irritated airways and loosen mucus.
4. Avoid triggers - Steer clear of smoking, heavily scented products, seasonal allergies, cold air before bed.
5. Take medications - Use prescribed inhalers and nebulizers as directed prior to sleep.
6. Consider wedge pillow - Special wedge-shaped pillows are available to elevate your torso in bed.
7. Ask about singulair - Discuss taking leukotriene inhibitors with your doctor to prevent night wheezing.

How Asthma Leads to Wheezing When Lying Down

One of the most common causes of wheezing that comes and goes at night is asthma. Asthma is a chronic respiratory disease where the airways are extra sensitive and prone to inflammation and swelling.

The Asthma-Wheezing Connection

During an asthma flare up or attack, the lining of the bronchial tubes becomes inflamed and overloaded with mucus. The muscles surrounding the airways go into spasm and constrict. As you try to breath, the narrowed air passages prevent air flowing smoothly in and out, resulting in a high-pitched wheezing or whistling sound.

Why Asthma Worsens at Night

There are several reasons why the symptoms of asthma often exacerbate at night:

• Lying down puts more pressure on the diaphragm, making breathing slightly more difficult.
• Mucus drainage shifts from upright to lying down, increasing airway congestion.
• Circadian rhythms impact hormones, airways nerves, and inflammation at night.
• Allergy triggers like dust mites and pet dander collect more in bedding.
• Gastroesophageal reflux is more likely lying flat, aggravating airways.
• Falling temperature and rising humidity at night can trigger airway tightening.

Treating Nighttime Asthma Symptoms

If asthma seems to flare up when you lie down in bed resulting in wheezing when exhaling lying down, work closely with your doctor to find the right treatments. This may include:

• Inhaled corticosteroids daily to reduce airway inflammation.
• Bronchodilators like albuterol to open up airways when wheezing starts.
• Allergy medicine if night symptoms correlate with dust mite season.
• Singulair tablets to stabilize mast cells and prevent constriction.
• Acid reflux medication if GERD could be contributing to wheezing.

When to See a Doctor About Nocturnal Wheezing

Occasional mild wheezing that goes away with coughing or changing positions may not require medical evaluation. However if your wheezing at night has become more persistent or severe, do not ignore the symptoms.

Red Flag Wheezing Symptoms

Seek prompt medical care for sudden development of:

• High pitched wheezing sound, especially on exhalation.
• Difficulty breathing or shortness of breath.
• Tight, squeezing, or burning feeling in your chest.
• Significant cough with large amounts of mucus.
• Have to sleep sitting up or propped up to breathe.
• Wake up gasping for air with breathing problems.

These severe breathing issues could signal asthma exacerbation, pulmonary edema, pneumonia, COPD flare up, pulmonary embolism or other respiratory disorders requiring emergency treatment.

Questions Your Doctor May Ask

To evaluate episodes of wheezing when exhaling lying down, your physician may ask about:

• Timing, frequency and severity of wheezing.
• Triggers that seem to make it better or worse.
• Duration of each wheezing episode.
• Associated symptoms like chest tightness, shortness of breath, coughing.
• History of asthma, allergies, reflux, respiratory infections.
• Current medications you take, including inhalers.

Based on the clinical history provided, diagnostic tests like chest x-rays, CT scans, lung function tests, allergy testing or airway endoscopy may be ordered. Treatment depends on the underlying cause but may include bronchodilators for immediate relief and inhaled steroids for controlling inflammation long term. Those with moderate to severe wheezing impairing sleep or quality of life may be prescribed supplemental oxygen at night.

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.