Certain sleeping positions, like lying on your back with your head and shoulders elevated, can support drainage and help you sleep soundly with asthma. A pillow between the legs may help side sleepers.

If you have asthma, you may have noticed that your symptoms are often worse in the evening. Your sleeping position, bedroom temperature, circadian rhythm, and other bedtime factors can all be asthma triggers.

Many people with asthma experience symptoms that get worse at night.

Specific steps may help you sleep more safely and comfortably with asthma. Here are the best sleeping positions for people with asthma and some other strategies for sleeping soundly.

If you have nocturnal asthma, certain sleeping positions can constrict your lungs or cause mucus to drip down your throat, irritating it and triggering a nighttime cough. You may want to avoid sleeping on your front or your side without proper support.

Some positions to try instead include:

1. Lie on your back with your shoulders and neck elevated.

Laying on your back can keep your lungs from constricting.

Elevating your neck and shoulders with two, three, or more pillows can open your airways as you sleep.

If your sinuses drain more during the night, sleeping with pillows under your shoulders gives the drainage a gravity boost, allowing you to breathe more easily while you sleep.

2. Lie on your left side with a pillow between your legs.

If you’re a side sleeper with asthma, lying on your left side may help — particularly if you have gastroesophageal reflux, also known as heartburn. Heartburn can trigger asthma, and heartburn can be worse when you’re lying down.

Sleeping on your left side uses gravity, the shape of the stomach, and the angle of the connection between it and the esophagus,which can reduce reflux. Lying on your left side with your head elevated may be enough to keep you comfortable through the night, but if not, experiment by adding a pillow between your legs.

Adding the pillow may keep your spine stable throughout the night and improve your sleep posture, which can help you breathe easily.

If you also have sleep apnea and asthma, sleeping on your side may help your airways stay open.

3. Lie on your back with your head elevated and your knees bent with a pillow under your knees.

For some people, sleeping in the side position is too much of a change. If you prefer sleeping on your back with your head and shoulders propped up by pillows, you can add another pillow under your knees.

This additional pillow may improve circulation and keep your body stable throughout the night so you don’t shift out of your elevated position as you sleep.

As important as it is to find a sleeping position that works for you, it’s also important to rule out sleeping positions that could make your asthma symptoms worse.

Sleeping on your right side, also known as the right lateral decubitus position, can exacerbate asthma symptoms.

In 1990, researchers concluded that sleeping on the right side increases resistance in the airways of your lungs as you breathe in and out during the night. This was based on the theory that sleeping on your right side may increase vagal tone (activity of the vagus nerve). This activates the parasympathetic nervous system, which is responsible for some of the body’s basic functions, and results in airway constriction. However, it doesn’t apply to everyone, so those with asthma should experiment to see what works for them.

You may also want to avoid sleeping on your stomach. While some people find stomach sleeping comforting, this position does not allow free airflow into your lungs while asleep.

Sleeping flat on your back without elevation from pillows behind your neck and shoulders may also exacerbate your symptoms.

Other ways to reduce asthma symptoms at night include:

  • Cut down on allergens in your bedroom. Consider using an air purifier next to your bed and keep airflow in your room overnight.
  • Wash your bedding in hot water every 1-2 weeks to remove dust mites and other irritants from your sheets.
  • Consider switching to bedding made of natural cotton instead of synthetic polyester, depending on your allergies.
  • Keep pets off your bed, especially when you’re in it.
  • Keep asthma medication on your nightstand or another easily accessible place, and take it as directed by your doctor.
  • Set the thermostat in your bedroom slightly higher in the evenings. Sleeping in a cold environment can trigger asthma.

Nocturnal asthma might be common, but there are times when you should discuss symptoms with a doctor.

If you’re waking up in the night with asthma symptoms more than once a week, even with treatment, you should speak with a medical professional. They may need to modify your treatment plan.

A medical professional might also have other advice about setting up a regular sleep schedule, managing GERD, and minimizing stress to help improve sleep quality and reduce nocturnal asthma symptoms.

Switching up your sleep position may not completely get rid of your asthma symptoms. But by reconsidering how you sleep and other factors about your sleep environment, you may find a way to greatly reduce the amount of time you spend waking up at night.