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Why do sick people often feel worse at night Date published: 8/19/2007
BY REBECCA BLATT For many, they are familiar scenarios. Your daughter makes it through the day with a mild earache, only to cry out in pain at bedtime. Your allergies are bearable in the morning and afternoon, but your sinuses seem to close up when you crawl into bed at night. You don't notice your acid reflux until you begin to drift off to sleep, when heartburn radiates from your core. The list of symptoms that can get worse at night goes on and on. But why? Do we just notice these symptoms more when we're tired? Fredericksburg infectious-disease doctor Paul Fiore said yes--some symptoms feel worse at night because that's when we have the fewest distractions. "Distraction is kind of a major way we deal with pain," he said. But Fiore and other physicians said that the body's circadian rhythms--cyclical changes that occur during each 24-hour period--trigger nighttime responses as well. The discomfort we feel at night isn't just in our minds, it's in our hormones, our airways and our stomachs, too. nighttime asthmaFluctuations in lung function and hormone levels may account for why asthma patients report that their symptoms worsen at night, said allergist Dr. Seth Craig of Allergy and Asthma Center of Fredericksburg. He explained that even for those without asthma, lungs tend to work best in the morning and worst around 3 or 4 a.m. Craig suggested that the change may be due to a natural dip in a hormone called cortisol, which helps keep airways open and asthma under control. "That is one possible reason why people with asthma may have worsening at night," he said. "They don't have as much of their own protective hormone." But doctors also suggested a simpler explanation for nighttime breathing problems: posture. Our chest walls weigh on our lungs when we lie down, said Dr. Nariman Dash, a Fredericksburg ear, nose and throat specialist. That can make it more difficult to breathe and clear mucus from airways--which may leave asthmatics gasping for air. evening allergiesChanging hormone levels can cause allergies to worsen at night as well, said Richard Fiero, a Fredericksburg pulmonologist and sleep specialist. He said that while the level of protective hormone cortisol is lowest at night, the level of a chemical called histamine, which causes allergic responses including constricted airways, is, conversely, highest at night.
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