Improving sleep quality with asthma and COPD: Tips for better rest and breathing

Sleep is when your body repairs, resets and restores balance – and your lungs are no exception.
For people living with asthma or chronic obstructive pulmonary disease (COPD), sleep quality can have a powerful effect on symptoms, flare-ups and overall wellbeing. Yet, many people with breathing conditions find nights the hardest time of day.

In this article, we explore why sleep matters for lung health, what science says about circadian rhythms (your internal body clocks), how poor sleep can worsen symptoms, and what you can do – safely – to sleep and breathe better.

Why sleep matters when you have asthma or COPD

Sleep helps your body repair tissues, regulate hormones, and strengthen your immune system. During deep sleep, your breathing naturally slows, and oxygen levels fall slightly – a normal part of rest.

But if you have asthma or COPD, this drop can become more pronounced, leading to symptoms like breathlessness, coughing or waking suddenly at night.

Research (Asthma + Lung UK, 2023; NHLBI, 2022; NICE, BTS, SIGN, 2024) shows that poor sleep in these conditions can:

• make breathlessness feel worse,
• increase flare-up frequency,
• reduce energy and concentration during the day, and
• impact emotional wellbeing.

Up to three-quarters of people with COPD and around two-thirds of people with asthma report sleep problems or night-time symptoms (Climaco DCS et al., 2022; Medarov, 2008; Have et al., 2025).

If you wake often at night with coughing, wheezing or chest tightness, it’s a sign that your condition might not be well-controlled – and it’s time for a review with your healthcare team (NICE, 2024).

Nocturnal asthma: why nights can be tougher

Asthma often follows a circadian pattern – a daily rhythm linked to your body clock. Lung function naturally dips between 2 a.m. and 6 a.m., when your airways are more likely to narrow and inflammation rises.

This happens because hormone levels, such as cortisol (which helps reduce inflammation), are lower overnight, while certain immune and nervous system signals increase (Mortola, 2004; Wang et al., 2021; Scheer, 2021).

When you combine these natural changes with other triggers – such as allergens in bedding, cool dry air or lying flat – symptoms can worsen.

This pattern is called nocturnal asthma, and it’s common: up to 75% of people with asthma experience night-time symptoms at least once a week (Scheer, 2021).

The NICE/BTS/SIGN Asthma Guideline (NG245) lists night-time waking as one of the clearest signs of poor control. If you’re waking at night due to coughing, wheezing or chest tightness, your asthma may not be well controlled, you may need a review of your preventer inhaler, inhaler technique or overall treatment plan so speak with your GP or nurse.

Sleep disorders and asthma: what’s the link?

A 2023 meta-analysis found that people with sleep disorders (like insomnia, Obstructive Sleep Apnoea or restless legs) have a higher risk of asthma and more frequent flare-ups.

However, researchers note “publication bias” – meaning the studies vary in quality – so while the association looks strong, more evidence is needed.

For now, screening for sleep disorders is sensible if you have ongoing night-time asthma symptoms or wake unrefreshed despite good medication use.

COPD and poor sleep: what’s happening overnight?

People with COPD may struggle to stay asleep because of coughing, mucus, breathlessness, or low oxygen levels.
Studies show that sleep quality is often poor, even when oxygen saturation seems stable in the daytime (Climaco DCS et al., 2022; GOLD, 2025).

Common causes of night-time issues in COPD include:

• Airway obstruction or mucus retention, making breathing more difficult when lying down.
• Drops in oxygen during deep sleep (especially in severe COPD).
• Medication effects, such as steroids or theophylline, that disrupt normal sleep cycles.
• Co-existing sleep disorders, particularly obstructive sleep apnoea (OSA) – where breathing repeatedly stops and starts during sleep.

When COPD and OSA occur together (known as overlap syndrome), people are at higher risk of heart problems, high blood pressure and hospital admissions (Marin et al., 2010; Soler et al., 2017). The GOLD 2025 Report highlights OSA as a common and treatable comorbidity (another health problem that exists alongside your main condition) in COPD, recommending assessment as part of good clinical practice (GOLD, 2025).

If you snore loudly, wake gasping or unrefreshed, or feel very sleepy in the daytime, ask your doctor if sleep apnoea screening is needed.

Your body clock and your lungs

Your circadian rhythm (your body’s built-in daily clock) acts as a 24-hour internal timer. It regulates sleep, hormones, body temperature, digestion – and even lung function.

In healthy people, lung function (measured as FEV₁, or forced expiratory volume in one second) tends to be lowest early in the morning and highest in the afternoon (Mortola, 2004).

In asthma, that variation is often much greater, with large overnight dips linked to poorer control and higher flare-up risk (Wang et al., 2021; Scheer, 2021).

For COPD, emerging studies show that symptom timing – whether breathlessness or cough peaks at night, morning, or afternoon – is related to disease severity and quality of life (Antonelli Incalzi R et al., 2022).

Although circadian-based treatment isn’t yet part of formal guidelines, this research helps clinicians tailor care around an individual’s symptom pattern.

Studies indicate that disrupted sleep and body-clock misalignment can make airway inflammation worse (Giri, 2022). In some people, sleep deprivation or chronic insomnia is associated with more daytime symptoms and poorer asthma control (Liu et al., 2023).

Sleep problems also affect the autonomic nervous system – the body’s automatic stress and relaxation response. When you’re tired or anxious, you’re more likely to breathe quickly and shallowly, which can further tighten the airways. Slow breathing and relaxation techniques before bed can help calm this “fight-or-flight” response.

Medicines and sleep

Some medicines used for asthma or COPD can affect sleep.

• Theophylline and steroids (inhaled or oral) may make you feel alert or restless.
• Some reliever inhalers (beta-agonists) can increase heart rate and cause jitteriness if used close to bedtime.
• On the other hand, sleeping tablets (benzodiazepines or Z-drugs) can suppress breathing, especially in severe COPD or when combined with alcohol.

Both NICE and GOLD recommend using non-drug treatments first, such as Cognitive Behavioural Therapy for Insomnia (CBT-I), before considering sleep medication. CBT-I is a structured programme that helps you change unhelpful sleep habits and can be safely used in people with lung disease.

Always check with your doctor before taking any over-the-counter or prescribed sleep aid. Don’t change prescribed medication timing without advice – but if you get worse at night, discuss timing with your clinician.

Ask your GP or nurse about CBT-I referral options. Some NHS-approved online tools are available.

How to sleep and breathe better

There’s no single “perfect formula,” but small, consistent habits can make a real difference.

Below are practical steps – many backed by NICE, GOLD and Asthma + Lung UK – that you can try safely.

1. Keep your condition well controlled

Use your preventer inhaler daily, as prescribed.

If you’re waking at night or using your reliever often, book an asthma or COPD review.

Tap here for more about asthma and COPD medications.

2. Create a lung-friendly sleep environment

• Keep your bedroom cool, well-ventilated and low in allergens.
• Avoid mould, dust and strong scents; wash bedding weekly at 60°C.
• Use hypoallergenic covers if you’re sensitive to dust mites.
• Avoid smoking indoors – second-hand smoke worsens symptoms and sleep quality. If you or someone else you know wants support with stoping smoking, find our article on how to quit smoking here.

Tap here for more on how nature and our living environment can affect lung health.

3. Watch what you eat and drink before bed

• Avoid heavy meals, caffeine and alcohol within 3 hours of bedtime.
• These can trigger reflux, which worsens cough and wheeze.
• Try elevating your upper body slightly if reflux is an issue.

Tap here for more on how eating habits affect lung health.

4. Use good sleep habits (“sleep hygiene”)

• Go to bed and wake up at the same times each day – even weekends.
• Keep screens and bright lights out of the bedroom.
• Try a short breathing or relaxation exercise before bed (see below).
• Save the bed for sleep and intimacy – not scrolling or work.

5. Try breathing and relaxation techniques

Slow, gentle nose breathing helps lower anxiety and ease the nervous system.

You could try:

• Pursed-lip breathing: breathe in through your nose, then out slowly through slightly pursed lips.
• Diaphragmatic (belly) breathing: place a hand on your stomach and feel it rise as you inhale.
• Buteyko breathing: gentle breath-holds and nasal breathing to calm hyperventilation.
• These are all safe to try at home; physiotherapists or pulmonary rehab teams can give guidance.

Tap here for more on breathing techniques for asthma and COPD.

6. Check for sleep apnoea

If you have COPD or asthma and experience loud snoring, morning headaches, or extreme daytime tiredness, ask your clinician about OSA screening.

Treating OSA (often with CPAP) can greatly improve oxygen levels and sleep quality (Marin et al., 2010; Soler et al., 2017).

7. Move during the day

Regular daytime activity helps stabilise circadian rhythm and improves both lung function and sleep quality.

Try a daily walk, gentle yoga, or pulmonary rehab programme suited to your ability (GOLD, 2025).

Try this: small changes for better sleep and breathing

Focus area	Small step to try tonight	Why it helps
Medication routine	Take your preventer inhaler as prescribed, not just when unwell.	Reduces overnight airway inflammation (NICE, 2024).
Bedroom air	Crack a window or use an air purifier if air feels stuffy.	Improves ventilation, lowers irritants (Asthma + Lung UK, 2023).
Reflux control	Avoid lying down straight after eating; use pillows to elevate.	Less stomach acid reaching airways (Asthma + Lung UK, 2023).
Calm breathing	Try five minutes of slow nose breathing or pursed-lip breathing before bed.	Calms the stress response and reduces tightness (link to breathing article)
Regular rhythm	Go to bed and wake up at the same time each day.	Strengthens circadian rhythm (Mortola, 2004; Wang et al., 2021).
Morning light	Open curtains or get outside within 30 min of waking.	Helps reset your body clock and improve sleep quality (Mortola, 2004).

Key takeaways

• Sleep and breathing are deeply connected – better nights mean better days.
• Asthma and COPD often worsen overnight due to natural body-clock rhythms.
• Simple changes in routine, sleep environment and medication timing can help.
• Screen for and treat sleep apnoea if suspected.
• Always talk to your clinician before adjusting medication.
• Aim for consistency: steady sleep times, calm breathing, and daily movement.

If you haven’t already, download the free Evergreen Life app to track your health, including managing your asthma and/or COPD, and get practical tips that help you take control of your overall health.

Download the app

This article is for educational purposes only and is designed to support informed self-management for adults (aged 18+) living with asthma, COPD, or overlapping respiratory conditions. It is not a substitute for personalised medical advice, diagnosis, or treatment from a qualified healthcare professional.

While improving sleep habits and aligning with natural circadian rhythms can benefit overall health, these strategies should always be used alongside, not instead of, prescribed medications and medical care. Poor sleep may be a symptom of worsening disease control, and underlying causes should always be explored with a clinician.

Common reasons to speak to your GP, nurse, or respiratory team include:
– Night-time waking due to coughing, wheezing, or breathlessness
– Needing to sit upright to breathe comfortably during the night
– Ongoing sleep difficulties, nightmares, or daytime sleepiness
– Frequent use of reliever inhalers at night
– Concerns about side effects of medicines (e.g. corticosteroids) on sleep
– Trouble falling asleep, staying asleep, or waking too early
– Concerns about sleep apnoea (loud snoring, gasping during sleep, extreme tiredness)

Sleep disturbances can worsen both asthma and COPD control and may signal a need for a medication review, inhaler technique check, or referral for further assessment.

🔴 Call 999 or seek emergency help if you or someone else:
– Experiences severe breathlessness or can’t speak in full sentences
– Has blue lips or fingers
– Becomes confused, very drowsy, or collapses
– Has an asthma or COPD attack that is not improving after using reliever inhalers

📞 Call NHS 111 or contact your GP urgently if you:
– Are waking frequently at night with breathing symptoms
– Are unsure whether your inhalers or tablets are affecting your sleep
– Need help reviewing your asthma or COPD action plan
– Have started a new medicine and notice a change in sleep, mood, or breathing

Your primary care or respiratory team can support you to balance lifestyle strategies, sleep quality, and medical treatment safely and effectively. Never stop or adjust medication without medical guidance.

If you feel overwhelmed or anxious about symptoms at night, breathing-focused relaxation techniques or talking therapies may help – ask your GP or nurse about available options in your area.

References

1. Asthma + Lung UK. Sleep and Lung Conditions (2023).
2. Clímaco DCS et al. Sleep quality in COPD: correlation with disease severity and OSA. J Clin Med. 2022;11(8):2156.
3. Giri A, Wang Q, Rahman I, Sundar IK. Circadian molecular clock disruption in chronic pulmonary diseases. Trends Mol Med. 2022 Jun;28(6):513-527. doi: 10.1016/j.molmed.2022.04.002. Epub 2022 May 1. PMID: 35508604; PMCID: PMC9167664.
4. GOLD. Global Initiative for Chronic Obstructive Lung Disease: 2025 Strategy Report. 2024.
5. ten Have, L., Fleur L. Meulmeester, Kim de Jong, Anneke ten Brinke (2025) Patient-centred outcomes in severe asthma: fatigue, sleep, physical activity and work, European Respiratory Review 2025 34(175): 240122.
6. Incalzi RA, Blasi F, Canonica GW, Foschino MP, Prediletto R, Simoni L, Ori A, Giovannetti C, Barsanti S, Scichilone N. The Prescribing Practice for COPD: Relationship to Circadian Rhythm, Disease Severity, and Clinical Phenotype in the STORICO Observational Study. Adv Ther. 2022 Dec;39(12):5582-5589. doi: 10.1007/s12325-022-02331-x. Epub 2022 Oct 11. PMID: 36219388.
7. Liu X, Hong C, Liu Z, Fan L, Yin M, Chen Y, Ren X, Gu X. Association of sleep disorders with asthma: a meta-analysis. BMJ Open Respir Res. 2023 Sep;10(1):e001661. doi: 10.1136/bmjresp-2023-001661. PMID: 37735102; PMCID: PMC10514641.
8. Marin JM, Soriano JB, Carrizo SJ, Boldova A, Celli BR. Outcomes in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome. Am J Respir Crit Care Med. 2010 Aug 1;182(3):325-31. doi: 10.1164/rccm.200912-1869OC. Epub 2010 Apr 8. PMID: 20378728.
9. Medarov BI. Diurnal Variations in Pulmonary Function. Chest. 2008;133:751–755.
10. Mortola JP. Breathing around the clock: an overview of the circadian pattern of respiration. Eur J Appl Physiol. 2004 Mar;91(2-3):119-29. doi: 10.1007/s00421-003-0978-0. Epub 2003 Oct 21. PMID: 14569400.
11. NHLBI. Sleep and Your Lungs: Fact Sheet (2022).
12. NICE / BTS / SIGN. Asthma: diagnosis, monitoring and chronic asthma management (NG245), 2024.
13. NICE, (2025) Insomnia.
14. NICE, (2024), NG245.
15. Scheer FAJL, Hilton MF, Evoniuk HL, Shiels SA, Malhotra A, Sugarbaker R, Ayers RT, Israel E, Massaro AF, Shea SA. The endogenous circadian system worsens asthma at night independent of sleep and other daily behavioral or environmental cycles. Proc Natl Acad Sci U S A. 2021 Sep 14;118(37):e2018486118. doi: 10.1073/pnas.2018486118. PMID: 34493686; PMCID: PMC8449316.
16. Soler X, Liao SY, Marin JM, Lorenzi-Filho G, Jen R, et al. (2017) Age, gender, neck circumference, and Epworth sleepiness scale do not predict obstructive sleep apnea (OSA) in moderate to severe chronic obstructive pulmonary disease (COPD): The challenge to predict OSA in advanced COPD. PLOS ONE 12(5): e0177289.
17. Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spec Psihol. 2022;11(2):123-137. doi: 10.17759/cpse.2022110208. PMID: 36908717; PMCID: PMC10002474.
18. Wang R, Murray CS, Fowler SJ, Simpson A, Durrington HJ. Asthma diagnosis: into the fourth dimension. Thorax. 2021 Jun;76(6):624-631. doi: 10.1136/thoraxjnl-2020-216421. Epub 2021 Jan 27. PMID: 33504564; PMCID: PMC8223645.