Many patients tell me that their symptoms are worse during the night or ﬁrst thing in the morning. Some even say that it takes them hours every morning to get their breathing right. Symptoms such as a blocked nose, excessive mucus, tiredness, chest tightness, wheezing and breathlessness are common. These problems are usually caused by incorrect breathing while sleeping, and it is for this reason that we need to pay particular attention to how we breathe when we are asleep.
The risk of an asthma attack is greatest during sleep. Statistics show that most attacks occur between the hours of 3.00 and 5.00 a.m. Professor Buteyko’s theory is that the natural position for humans is upright because when we lie down, our breathing increases automatically in comparison with the needs of our metabolism. For someone who is already overbreathing, this further increase in breathing will lead to a further depletion of carbon dioxide levels, and this can in turn lead to an attack.
Oversleeping is not good either. A good rule of thumb is to sleep only when you feel tired. This is when your body is telling you that sleep is necessary and generally seven to eight hours per night is enough. If you feel the need to sleep during the day, take a nap for twenty minutes while sitting upright. Correct breathing will increase your energy level and reduce fatigue so additional sleep should not be necessary. As your CP increases, the number of hours sleep you need each night should gradually decrease – probably to somewhere between ﬁve or six.
Reduced breathing during the day will help to reduce overbreathing at night, but we have very little control of our breathing in the depths of our slumbers. Because of this, there are a number of recommendations that may be fol- lowed to help ensure correct breathing at night.
Sleeping on your back is generally the worst position for someone with asthma. Your lower jaw drops and mouth breathing is almost inevitable. In this position, there is very little restriction to breathing and so breathing becomes deeper. Snoring, which is also caused by overbreathing and breathing through the mouth, is worse while sleeping on your back.
Increased blood pressure and bad health are just some of the side effects of snoring, not to mention the strain it can put on even the most harmonious of marriages. (I was in a youth hostel one night many years ago where a severe snorer was in danger of suffering grievous bodily harm from the adjoining bunk – and the general consensus was that he would have deserved it!) Another condition which affects children especially is bed wetting. For years Buteyko advocated that bed wetting was caused by hyperventilation. Now new research, published in New Scientist, conﬁrms his view:
‘Breathing problems are to blame for many cases of bedwetting in children, and perhaps in some adults too. And a simple treatment might solve the problem within weeks.’
Changing from sleeping on your back to sleeping on your side may take some time. It may be helpful to place a number of pillows behind you while you sleep on your side. Another suggestion would be to wear a rucksack on your back ﬁlled with clothes or a football, and then there is the old wives’ tale of sewing a tennis or golf ball into the back of your nightwear. All of these options may sound a little eccentric,
but they will reduce the likelihood of you rolling onto your back and you should, over time, switch to sleeping on your side or tummy.
After years of research, Professor Buteyko came to the conclusion that people who sleep on their left side, in the foetal position, tend to breathe less deeply. The reason for this is thought to be variation in lung capacity: the lung which is closest to the bed performs most of the work and, as the left lung is smaller than the right, the volume of air brought through the lungs is reduced. Some people address the problem by sleeping with four or ﬁve pillows under the head. This has the effect of raising the head and chest above the level of the rest of the body, and a little nearer to a verti- cal position. A hard mattress, which restricts frontal move- ment of the body, can also help to reduce breathing. A soft mattress, particularly something like a water bed, is not good for correct breathing because it offers too little resistance.
Never eat before sleep
Eating a meal or drinking a protein-rich drink such as milk or hot chocolate two or even three hours before going to bed will result in increased breathing. Then you will have both an increase in breathing due to lying in a horizontal position, and an increase in breathing due to eating or drinking. Then overbreathing is guaranteed, resulting in a poor night’s sleep. Eating a meal late at night can also result in having no appetite for breakfast.
Eating late at night on a regular basis is inherently unhealthy for anyone – asthmatic or not. It contributes to increased weight gain and lethargy, and it can disrupt the appetite the following day. My grandfather was a man of much wisdom and he had a saying that you should ‘always wake up with an appetite’. I’m sure he was right.