This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.
Albuterol – often sold under the brand names Ventolin, Easyhealer, and Salbulin – is a lifesaving medicine that is used to alleviate breathing difficulties and to treat conditions like asthma and COPD.
However, taking albuterol can cause insomnia and sleep disturbances – so how can you sleep better when taking this medicine?
To alleviate the insomnia caused by albuterol, talk to your doctor about switching to levalbuterol – since it has less side effects – or reducing your albuterol dose if it’s safe to do so. Sleeping with your upper body elevated and improving inhaler technique may also help.
Because albuterol could potentially save your life, it’s vital that you do NOT alter your dose or stop taking this medicine without the guidance of your own doctor first.
For information purposes, I have combined the expert medical knowledge gained from being a practicing medical doctor along with my access to scientific literature to provide you with 8 tips for sleeping better when taking albuterol.
8 Ways to Sleep Better When Taking Albuterol
Asthma and COPD affect the respiratory system, which result in the narrowing of the airways.
When symptoms are severe, the person is unable to get oxygen, and can choke to death within minutes, if not treated.
Reliever medicines are the drugs that act immediately to make it possible to breathe again.
Albuterol is the most commonly used medicine for this purpose, and is available with the brand names Ventolin, Easyhealer, and Salbulin.
It is available as an inhaler, a nebulizer solution, tablets, and syrups.
Albuterol is generally safe for most people, and can be prescribed for children and pregnant women.
One in 100 people can experience palpitations, headaches, sleep disturbance, and increased excitability.
Fortunately, most of the side effects are transient, and only last for 30 minutes to a few hours .
However, when albuterol is used frequently, its side effects accumulate, and may outweigh the benefits.
A study conducted at the Department of Respiratory Medicine, Freeman Hospital, UK, demonstrated that patients taking albuterol slept only 4 hours, and had 5 to 6 awakenings per night .
Johns Hopkins Medicine also states that albuterol use can result in frequent nighttime awakenings, and other sleep problems .
To tackle the side effects of any drug, the experts recommend withdrawing the medicine.
However, this is not always possible for some patients because it is a lifesaving medicine.
Therefore, I have prepared a list of recommendations that you can follow to manage your asthma and respiratory diseases better, and minimize the use of albuterol.
1: Sleep on Your Back with Your Upper Body Elevated
Sleeping in the supine position (on your back) with your upper body elevated – using an adjustable bed or a stack of pillows – is the best position for patients with asthma and other respiratory problems.
This position is helpful for patients with asthma because it helps to open your airways to make breathing easier and also allows your sinuses to drain for better airflow.
Gastroesophageal reflux (GERD) is one of the common conditions that can trigger asthma symptoms, especially at night.
Sleeping with an elevated head helps you reduce the chances of getting acid reflux or GERD.
Sleeping on your back helps you control your asthma, and decreases symptoms.
The frequency of inhaler use is also decreased, and all side effects are avoided.
A researcher in Tanzania reported a patient whose nighttime asthma was unresponsive to steroids and aminophylline.
They advised the patient to sleep in the supine position, and followed the patient up for a month.
The patient had marked improvement in asthma symptoms, decreased inhaler use, reduced nighttime awakening, and improved quality of life .
Use an Adjustable Bed if Possible
The safest and most effective way to elevate your upper body to reduce the symptoms of asthma and other breathing issues is by raising the upper portion of an adjustable bed.
Alternatively, you can elevate your shoulders and neck by placing pillows or cushions under the shoulders – however, this won’t be as stable as the adjustable bed option and may lead to neck pain.
Sleeping on the right side is also a good option for patients with respiratory problems.
This position decreases the chances of getting GERD, a common trigger for asthma.
2: Do Not Use Albuterol Any More Than is Required
Sleep disturbance and other side effects are directly linked to the frequency of albuterol use, and get worse as the dose increases.
Therefore, it is very important to minimize the use of albuterol whenever possible.
However, please remember that you should not delay albuterol administration when the need arises, as it could cost you your life.
The NHS advises that an albuterol inhaler should not be used more than 4 times a day.
If the inhaler is used more often, there are more chances of suffering side effects, like increased heart rate, headache, jitteriness, and nervousness.
The NHS also recommends that a patient should immediately contact a doctor if they need to use the inhaler more than 4 times per day for more than two days a week, or in the middle of the night once a week.
If you miss a dose, there is no need to take a double dose the next time, as the drug is short-acting.
Some patients are directed to take this medicine regularly for asthma flare-ups.
If they miss a dose, they should take it whenever they remember.
3: Change the Delivery Method
Taking albuterol through a nebulizer or inhaler decreases the chances of getting side effects.
When we take albuterol as a tablet, capsule, or syrup, the drug first goes through the entire bloodstream, and then reaches the lungs.
When we deliver the medicine via a nebulizer or inhaler, the drug is sent directly to the lungs.
The side effects experienced are also minimal because the drug only acts at a localized area, just like applying a cream or a lotion to the skin.
The use of a metered-dose inhaler (MDI) can further ensure the delivery of a specific amount of the drug.
We commonly advise a spacer device, along with the inhaler, for younger children and adolescents.
A spacer is a plastic or metallic container that is attached to the inhaler, to increase the delivery of the drug to the lungs.
One side of the spacer is attached to the inhaler.
The other side has a mouthpiece placed firmly over the mouth.
It decreases the dose of albuterol required, by delivering the drug directly to the lungs.
4: Use Levalbuterol Instead of Albuterol for Fewer Side Effects
Levalbuterol is a chemically similar compound that performs the same functions as albuterol, but avoids the side effects.
If we look at the chemical structure of albuterol, it is a racemic mixture of two isomers; S-Albuterol and R-Albuterol.
The R-isomer of albuterol (R-albuterol) attaches to the beta receptors present in the smooth muscles of the airways, and stimulates them.
When beta receptors are activated, the cAMP level in the cells increases, inhibiting the inflammatory mediators.
This relaxes and opens all airways, relieving asthma and COPD symptoms.
Inflammation also subsides, due to the reduced number of inflammatory markers.
The S-isomer of albuterol (S-albuterol) doesn’t affect the smooth muscles of the airways, and has no role in relieving the symptoms of asthma.
Some studies have also demonstrated that it increases the calcium concentration in the smooth muscles, resulting in constriction of the airways, which worsens asthma and other respiratory complaints.
It also influences the beta receptors present in the rest of the body, resulting in tachycardia, tremors, and insomnia.
It also persists in the body 12 times longer than the R-isomer .
Albuterol is a racemic mixture of R and S-isomers; although it relieves the symptoms of respiratory problems, it causes side effects, like tachycardia, tremors, anxiety, and excitability.
Levalbuterol has only the R-isomer of albuterol, and doesn’t contain the S-isomer.
D Handley reviewed research articles about the beta-agonist, and concluded that the potency of the albuterol could be increased.
At the same time, side effects can be completely avoided by using a single isomer of albuterol (levalbuterol) .
In my opinion, levalbuterol is not completely free of side effects, but the frequency is decreased markedly.
Although levalbuterol is a bit costly, it should be used by patients experiencing increased side effects after using albuterol.
5: Correct Your Inhaler Technique
A very important factor that results in increased frequency of albuterol use, and its side effects, is incorrect inhaler technique.
Asthma and Chronic Obstructive Pulmonary Disease (COPD) affect about 10% of the population, most of whom have poorly-controlled symptoms.
Inhaler therapy is the cornerstone of the available therapies to manage the exacerbations of asthma and COPD.
If a person shows good compliance with the inhaler, the risks of exacerbations, hospitalizations, and side effects are reduced markedly.
However, research has shown that about 90% of patients do not use their inhalers correctly .
When an inhaler is not used correctly, an insufficient amount of the drug reaches the lungs, and symptoms of the disease are not controlled.
Because the person has to use the inhaler more frequently, they experience more side effects.
The most common errors are due to a lack of guidance from health professionals, and a marked variation in inhaler types.
I always stress the importance of using the correct inhaler technique, to my patients.
Whenever we encounter a patient with poorly-controlled asthma, the first thing we do is to check their technique with the inhaler they use.
How to Improve Your Inhaler Technique
I recommend having your technique checked by an expert, like a doctor, nurse, or pharmacist.
It will also help if you read the manufacturer’s leaflet, present inside the packaging, before using the inhaler.
Let’s see how to use the inhaler correctly, in simple steps:
- Sit down comfortably on a chair or bed.
- Remove the cap from the mouthpiece of the inhaler.
- Shake the inhaler well for a few seconds.
- Hold the inhaler between your index finger and thumb.
- Tilt your head slightly backwards.
- Take a deep breath, and then breathe out gently, away from the inhaler.
- Place the mouthpiece of the inhaler in the mouth.
- Press the inhaler, and breathe in at the same time.
- Hold the breath for a few seconds, and then exhale slowly.
Research has shown that the most common error when using an inhaler is at step 6.
People do not exhale before inhalation.
The next most common error is that people exhale into the inhaler, and the third error involves incorrect placement of the mouthpiece in the mouth .
So you should pay special attention to these steps when using an inhaler.
6: Manage Your Asthma Better with Preventive Therapy
One of the best solutions for solving the problems caused by any drug is to withdraw the drug.
However, it is almost impossible for a patient with asthma to live without this drug, as it saves the patient from life-threatening bronchospasm.
The severity of the side effects of albuterol depends upon the amount of the drug that you take.
The only way to decrease your use of albuterol is to manage your asthma or COPD well.
There are two types of medications used to manage asthma: relievers, and controllers.
Reliever medications are the rescue medicines, used to immediately relieve the symptoms of asthma.
These are used on an on-demand basis, and include short-acting beta-agonists (like albuterol), and short-acting muscarinic antagonists.
Controller or preventer medications are used regularly, to avoid the exacerbations of asthma symptoms.
Examples include long-acting beta agonists (LABA), steroids, leukotrienes modifiers, and cromolyn sodium .
Controller medications help control asthma better, and decrease the requirement for relievers like albuterol.
The amount and frequency of reliever medications used help decide the necessary adjustment in the dose of controller medications.
The NHS recommends that if albuterol use exceeds 4 times a day once a week, you should consult a health professional to increase the dose of controllers.
7: Avoid Asthma Triggers
Asthma triggers are the foods, medications, diseases, or other factors that initiate the symptoms of asthma.
Some of the most common triggers described by the NHS and CDC are tobacco smoke, dust mites, pollens, pets, infections, and certain medicines.
When we are exposed to these triggers, asthma and other related diseases can worsen, and the need for albuterol increases.
I always advise my patients to pay special attention to these triggers, as asthma control is not possible without avoiding these factors.
The symptoms of some patients are exacerbated in the workplace, due to exposure to certain substances.
This condition is known as occupational asthma.
Some of the most common causes of occupational asthma are exposure to latex, dust, flour, spray paint, animals, wood dust, and fiberglass.
8: Make your Bedroom Sleep-Friendly
It is common for patients with asthma to have increased symptoms at night, due to multiple factors in the bedroom that exacerbate the disease.
Factors that are responsible for this include relaxation of the airways at night, cool air, presence of allergens, and hormonal imbalance.
Therefore, it is very important for patients with asthma to strictly follow sleep hygiene recommendations.
This is general advice for everyone to keep their bedroom, sheets, pillows, and mattress neat and clean.
A clean and healthy environment has been shown to promote sleep.
Dust mites present in the bedroom can act as a trigger for patients with asthma and allergies, and exacerbate the symptoms.
These patients need to clean their bedrooms regularly, and use fresh sheets whenever possible.
A vacuum cleaner with a high-quality (HEPA) filter is recommended to remove the dust mites, and other waste materials that can trigger asthma.
The environment should have proper ventilation, low temperature, and mechanisms to block external noise .
A humidifier is also helpful, as it adds moisture to the cold, dry air.
Albuterol is a lifesaving drug used for asthma and COPD, but it has the potential to cause sleep disturbance when used too frequently.
To sleep better while taking albuterol, you should minimize its use by better controlling your asthma.
Avoiding asthma triggers, changing the route of administration, and correcting inhaler techniques can decrease the need for albuterol.
You should sleep on your back to keep your airways open at night.
Levalbuterol is another option that provides the same benefits as albuterol, but with minimal side effects.
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Main image: ‘Close-up view of young woman with asthma using inhaler’ by LightFieldStudios – (used with permission and commercially licensed through Envato Elements).
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