Expert: Kevin Smith - 7/28/2009

Question
Hi Kevin, is it possible you could tell me if you have suffered from nocturnal asthma and how this has affected you?

I am particularly interested in how your asthma might effect your sleeping position in bed?

Do you find yourself adjusting your sleeping position for respiratory reasons when you are having issues with asthma, and if so what would be the most comfortable and most uncomfortable sleeping position?

Also, if your asthma is under control, would sleeping position be an issue still or not at all?

Best regards

Francis

Answer
Hi there Francis,

I honestly don't believe I truly am one of the major sufferers of nocturnal asthma persay, but I do experience it.

Back in the day, the consensus,for me, was that one should sleep with the foot-wise legs of the bed slightly elevated in order to lower the axis of the body towards the head ( say, a few books or such under the foot-side feet ). The reasoning behind this, for me personally, was mucous drainage AWAY from the bottom of the lungs. The position was thought to encourage productive coughing to help clear the lungs.

From my own experience, I have a bit of a different tale to tell. Usually when I was in ICU before being ventilated, the most comfort position I found to facilitate breathing was sitting up, bent over one of those hospital tables that goes over your legs, hunched forward. I found this position, by far, to be the most comfortable to breath in.

To a lesser extent, as in day-to-day, I find that I sleep on my side mostly. If I am having breathing issues, I definitely cannot sleep on my stomach, as I find it presses against my chest and diaphragm more in that position and only makes things worse. In that, I find on my stomach to be the least comfortable. Second would probably be on my back fully - while it's not near as bad as on the stomach, it sometimes feel a bit smothering compared to favouring one side or the other ( usually with the side-down that is giving me issues - not clinically a good idea, but gives a bit of relief as the 'good' side is being given more freedom of movement to get the air in and out ). I will, however, tend to make sure that I rotate to get the 'bad' side up for drainage reasons for a few minutes at least ( that being, the mucous will be taken by gravity and allowed to move, and thus, hopefully, be dislodged ).

Another thing to note too, I find, is that when you are suffering from an attack, it's very hard to be snuggled against another person - those who have not had breathing issues may have a hard time understanding that even an arm draped over you can restrict ( physically or psychologically ) your ability to breath that much more and make it very uncomfortable.

The other issue is a bit more of a modern one: acid reflux. Current thinking is leaning hard towards the association of high acid levels in the stomach to asthmatic symptoms. To put it plainly, if you get lots of acid, it can be breathed into the lungs and cause a lot of irritation. With sleeping, this can become pretty important. I find, if I'm having AR ( Acid Reflux ) that I HAVE to sleep more upright ( head-wise ) or I'll wheeze and cough all night. The issue is, that this can be a bit of a 'damned if you do, damned if you don't' situation - high mucous production suggests head-down, acid reflux suggests head-up - so one really has to watch their symptoms.

To answer your last question: yes, even under control, sleeping position makes a difference with me, personally - I will become symptomatic if I lie on my stomach while sleeping, and definitely breath 'easier' the night through if I'm one a side - usually one feels 'easier' then the other.

So, really, it's pretty individual - the only advice I can truly offer is for the sufferer to pay close attention to changes in different positions and keep modifying from there.

Hope this helps out!

Sleep well,

Kevin