Rhea’s nighttime sleep is often accompanied by eerie whistling sounds. Every time she reclines on her bed to catch some sleep after an arduous day, the strange rattling noises come back to haunt her. What is baffling is that these sounds do not show up when she snoozes off during the day. If you are wondering if this is some paranormal event at play, well, it is her wheezing at night.
“Come winter, my wheezing flares up in full swing,” says the 25-year-old from Bengaluru. Rhea, who hails from Kerala, moved to Bengaluru for work two years ago.
While asthma runs in her family, the hot and humid weather of her hometown had kept her asthma symptoms largely dormant all these years.
“I have heard everyone rave about the pleasant weather in Bengaluru, but for me the cold climate awakened my asthma from deep slumber,” says Rhea. “It feels like music emerging from within whenever I breathe, but is not pleasant at all.”
What causes wheezing at night?
Wheezing is caused by the inflammation and narrowing of the airways. Nighttime wheezing can happen due to various reasons.
“Night wheezing can be due to nocturnal asthma, where a person’s asthma symptoms worsen at night,” says Dr Manisha Mendiratta, HOD and senior consultant, pulmonology, Sarvodaya Hospital, Faridabad, Haryana. “During the wee hours, the steroid levels in the body can dip, increasing inflammation of the airways, which can also lead to wheezing.”
Gastroesophageal reflux disease (GERD), where the stomach acids flow back to the oesophagus, can also trigger nighttime wheezing by irritating the airways. “The chances of an acid reflux are higher when one is lying down as the throat and stomach are at the same level, making it easier for stomach acids to flow up,” she says.
According to Dr Anil MU, consultant pediatrician and intensivist, Sparsh Hospital, Bengaluru, environmental factors like humidity and air pollution combined with an innate predisposition to allergies can cause wheezing.
Obstructive sleep apnea can be another causal factor. In this condition, the muscles of the upper respiratory tract relax during sleep, causing the tongue to fall back, temporarily restricting airflow. This is common in people who are obese and have shorter necks, points out Dr Mendiratta.
“When you lie down, chest expansion — that is, the rise and fall of the chest — isn’t as smooth as compared to when you are upright,” Dr Mendiratta adds. “The inability of the chest to expand fully can obstruct airflow, causing wheezing at night while lying down. People tend to feel more anxious during the night, which can trigger asthma symptoms.”
Nighttime wheezing in children
Dr Anil says wheezing is common among children. “The diameter of our airways narrows during a certain part of the circadian rhythm, during early mornings around 3am to 4am.”
“Children already have a narrow windpipe,” says Dr Anil. “This combined with the effects of circadian rhythm can cause children to have a greater tendency to wheeze.”
Wheezing tends to subside in most children by the age of 10. If the wheezing persists, it could signify an underlying condition like asthma or atopic (allergic) tendencies. These children require close follow-ups to find the cause, triggers, familial history and prognosis, says Dr Anil.
Can winter trigger nocturnal wheezing?
“It is not the winter but the change in weather that can cause wheezing,” says Dr Mendiratta. “Temperature fluctuations in the body due to putting on and removing a sweater, moving in and out of air-conditioned rooms, [and] sweating suddenly can act as triggers for people who have weaker lungs and allergic tendencies.”
Treatment for nighttime wheezing
Rhea’s wheezing soon aggravated to full-blown asthma. The breathing difficulties prompted her to visit a doctor who prescribed antiallergens and inhalers.
“My symptoms have subsided now, and I am able to sleep peacefully during the night,” says Rhea.
Dr Mendiratta says in case of asthma and allergic rhinitis, one needs to be aware of their allergic triggers and avoid exposure to them.
She also recommends continuing with medications like antiallergens and inhalers, stressing on the importance of compliance with prescribed doses and technique. “One should seek immediate medical attention if the symptoms are newly developed,” she adds.
Sleeping in a lateral position with the head elevated can help ease wheezing. “All wheeze is not asthma, and the causes need to be probed,” says Dr Mendiratta.
Takeaways
- Wheezing at night happens due to causes such as nocturnal asthma, sleep apnea, gastroesophageal reflux disease and anxiety.
- Wheezing is caused by the inflammation and narrowing of the airways.
- Commonly seen in children due to their narrow windpipe, it usually subsides by the age of 10.
- Wheezing at night can be treated using antiallergens and inhalers regularly.
