If you have obstructive sleep apnea (OSA), you may know what it feels like to have trouble breathing during the night. Some people with sleep apnea also have asthma or asthma-like breathing symptoms.

If you have trouble breathing during different activities, it can be hard to know what’s causing it. Sleep apnea and asthma can both cause breathing problems, but for different reasons.

This article will explain how these conditions relate and what to look for if you think you might have both.

What Is Asthma?

Asthma causes your lower airways to narrow, which can make it hard to breathe. This narrowing can happen because of airway swelling or too much mucus. Many different triggers can bring on an asthma attack.

Asthma symptoms consist of a tightening of the chest, shortness of breath, wheezing when trying to breathe, and coughing attacks.

Asthma can run in families, so if someone in your family has it, you may be more likely to have it, too. If you have another allergy-related condition, you may also have a higher risk of developing asthma.

Other risk factors for both asthma and sleep apnea are having a higher body weight and smoking.

An asthma attack can be triggered by:

• Particles in the air — Pollutants, smoke, pollen, dust, pet dander, mold
• Stress to the body — Physical activity or high emotional stress
• Other illnesses — Respiratory infections or GERD
• Medications — Such as beta-blockers, aspirin, and NSAIDs
• Food and drink additives — Sulfites and certain preservatives

How Is Asthma Different from Sleep Apnea?

Asthma primarily affects the lower airway. The lower airway includes the bronchi and bronchioles, which are the tubes that carry air in and out of the lungs. In asthma, a trigger sets off an attack.

OSA primarily affects the upper airway. With OSA, the pressure of the soft tissues around the throat collapses them and presses on the airway, disrupting breathing. OSA mainly happens during sleep, while asthma can happen at any time of day.

How Do Sleep Apnea and Asthma Overlap?

Asthma and sleep apnea often coincide. OSA is two to three times more prevalent in people with asthma. While they are distinct diseases, they have overlapping risk factors, and each condition acts as a risk factor for the other.

Below are some ways the conditions overlap.

Shared Risk Factors

Asthma and sleep apnea share certain risk factors. Higher body weight may increase the risk of both conditions.

For OSA, the extra weight puts more pressure on your throat and can further close your airway. For asthma, obesity can increase the frequency of asthma attacks, the severity of the condition, and lead to worse disease control.

Since physical activity is a potential trigger for an asthma attack, people living with asthma may be less physically active, which can further promote weight gain.

Inflammation

Inflammation can affect both conditions, especially rhinitis, which is inflammation inside the nose. If you’ve ever had nasal congestion, you know that it can feel like a buildup of pressure around the nose and sinuses. Rhinitis affects up to 90 percent of people with asthma and may also be a risk factor for developing asthma.

When there’s inflammation and/or congestion of the upper airway track, it changes the pressures in the system. These pressure changes can lead to further upper airway tract collapse and sleep apnea symptoms like snoring.

GERD

Gastroesophageal reflux disease (GERD) is a condition related to OSA. OSA is more likely to occur in someone with GERD than in someone who doesn’t have it.

GERD can also cause swelling and inflammation that can lead to worsening asthma symptoms.

How Does Asthma Affect Sleep Apnea?

Asthma is a blockage of the lower airway, which can lead to lower oxygen and higher carbon dioxide levels in the body. The brain senses these changes and may adjust your breathing in response.

Sometimes these adjustments are helpful, but other times they can lead to changes in how the muscles around the throat and airway work. If the brain signals for the muscles to relax, this can make you more at risk for OSA.

Asthma treatments may also affect OSA. A common form of asthma treatment is an inhaled corticosteroid (ICS) to help reduce inflammation and keep the lower airways open.

Weight gain is a side effect of high-dose ICS, which, as stated above, has a direct impact on OSA. ICS can also make the upper airway more likely to collapse, making someone using this treatment more susceptible to OSA.

How Does Sleep Apnea Affect Asthma?

OSA has been shown to make it harder to control asthma symptoms, the frequency of flare-ups, and the increase in nighttime symptoms.

OSA puts constant strain on the entire airway. The repetitive opening and closing, as well as the altered oxygen levels, can lead to inflammation and actual injury to the system. Inflammation of the airway is a known trigger for asthma.

OSA has also been linked to changes that may make asthma harder to treat.

How Do You Manage Sleep Apnea and Asthma?

OSA is most commonly treated with a continuous positive airway pressure (CPAP) machine. Other options include different types of machines, oral appliances, tongue and throat exercises, and surgical procedures.

Interestingly, CPAP is also helpful in managing asthma. People with both conditions who use a CPAP had less bronchodilator use, fewer asthma flare-ups, better airflow measurements, better daytime and nighttime symptoms, and better quality of life.

Asthma is typically treated with a combination of medications for long-term management and short-term rescue medications for flare-ups. Certain treatments commonly used for asthma, like inhaled steroids, can negatively affect OSA.

Your medical team may make adjustments to your medications if you have both conditions.

In addition to medication and CPAP use, your healthcare provider may also recommend some lifestyle changes as part of your treatment plan. These may include:

• Weight loss
• Smoking cessation
• Avoiding secondhand smoke

If you have other related conditions, such as GERD, you may also receive treatment or suggestions on ways to relieve discomfort, as part of a holistic approach to your health.

If you have any specific questions concerning your health status and treatment plans, it’s always best to consult with your medical team.

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On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

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