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While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

All About HIV: Stages, Symptoms and Treatment

More than 40 years have passed since AIDS, the disease caused by HIV, was first identified in the United States. While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

HIV (human immunodeficiency virus) is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV.

If untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which is also considered the last stage of HIV. When HIV progresses into AIDS, your immune system has been significantly weakened by the virus.

Currently, there is no cure for HIV, but taking HIV medicine called antiretroviral therapy (ART) as prescribed stops the progression of the disease. As a result, most people living with HIV in the U.S. do not develop AIDS. There are also HIV prevention medications, PrEP and PEP, which are effective at preventing the transmission of HIV through sex or intravenous drug use.

As the HIV epidemic emerged in the U.S. in the 1980s and 90s, gay and bisexual men were disproportionately affected — in part because the virus transmits more easily through anal sex than vaginal sex — and subsequently stigmatized as carriers of the virus. However, the medical community soon discovered that anyone can contract HIV regardless of gender identity or sexual orientation, as the virus can be transmitted through anal sex, vaginal sex, or the sharing intravenous drug equipment such as needles or syringes.

In recent years, there has been significant progress toward reducing the annual HIV infection rate, and new cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. Still, gay and bisexual men accounted for 69% of all new HIV diagnoses in the U.S. in 2019. And in recent years, Black and Latinx individuals have been disproportionately affected by HIV. Racial and ethnic discrimination and disparities in healthcare access — which can discourage people from seeking HIV prevention services and testing — factor into HIV’s outsized impact on these communities.

There are three primary stages of HIV: acute HIV infection, chronic HIV infection, and stage 3 HIV, or AIDS.

Acute HIV infection, the first stage of HIV, may develop within two to four weeks of contracting the virus. During this stage of HIV, the virus multiplies rapidly and there is a high amount of HIV in your bloodstream (also known as your viral load). While the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

Some people with acute HIV infection quickly experience flu-like symptoms including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The only way to know your HIV status is by getting tested. If you have any of these symptoms and believe you may have been exposed to HIV, seek prompt medical care and take an HIV test. Find a free and confidential HIV testing site near you..

Experiencing these symptoms does not necessarily mean that you have HIV, as they overlap with symptoms of the flu and other illnesses. And some individuals with HIV develop these symptoms later, while others never develop them at all, which is why it’s critical to get tested for HIV on a regular basis — ideally every three months. You can still transmit the virus to others even if you do not have noticeable symptoms of HIV.

During the chronic HIV infection stage, the virus replicates less rapidly than it did in the acute stage, but it continues to damage your CD4 cells and weaken your immune system.

Many people experience no symptoms or mild symptoms during this latent period, which is also sometimes referred to as asymptomatic HIV infection or clinical latency. However, just like during the acute HIV infection stage, you can still transmit the virus to others even if you are not experiencing symptoms.

Without effective treatment, your viral load will increase and your CD4 cell count will decrease as this stage of HIV progresses. You are more likely to experience symptoms of HIV when your viral load is high and your CD4 cell count is low. Taking HIV medication as prescribed can help you maintain a low or even undetectable viral load and prevent your HIV from progressing into AIDS.

AIDS is the third and most advanced stage of HIV. In this stage, your immune system is severely weakened, your viral load continues to increase, and your CD4 cell count continues to decrease. 

HIV progresses into AIDS when you have a CD4 cell count of less than 200 cells per cubic milliliter or when you develop an opportunistic infection (OI), an illness that occurs more frequently in individuals with HIV because of their weakened immune systems.

Opportunistic infections experienced by individuals with HIV include kaposi’s sarcoma, a type of cancer that develops in your blood and lymph vessels; pneumocystis pneumonia (PCP), and mycobacterium avium complex (MAC), tuberculosis-related bacteria. However, OIs continue to occur less frequently as HIV treatment becomes more effective.

There are many effective HIV treatment options that can keep you healthy and help you maintain a low viral load. The primary treatment for HIV is called antiretroviral therapy (ART), a combination of medications that lower the amount of HIV in your bloodstream.

If you take your HIV medication every day as prescribed, you can maintain an undetectable viral load. This will preserve the strength of your own immune system and prevent you from transmitting the virus to others.

Starting ART as soon as possible after you receive an HIV diagnosis is critical to lowering your risk of developing AIDS and preventing you from transmitting the virus to others. If you have tested positive for HIV, reach out to your healthcare provider right away to begin treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health: PrEP and PEP.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. Pharmacists in a growing number of states can now prescribe PrEP, including pharmacists at Alto’s California and Colorado locations.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

We’re here to help you navigate HIV treatment and prevention therapies

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the best price. Pharmacists at our California locations are also able to prescribe PrEP and PEP, and pharmacists at our Colorado location are able to prescribe PrEP.

To learn more, reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

World AIDS Day, observed on December 1st every year, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

Take Action for World AIDS Day 2021

World AIDS Day, observed on December 1st every year since 1988, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

AIDS (acquired immunodeficiency syndrome) was heavily stigmatized from the beginning of the epidemic in the 1980s. Four years passed between the first cases of AIDS in the U.S. in 1981 and the Reagan administration’s first public mention of the disease. There were many misconceptions about how HIV (human immunodeficiency virus) — the virus that causes AIDS — can be transmitted and who is at risk of contracting it.

The stigma and lack of information about transmission and prevention led to many preventable cases of HIV/AIDS in the U.S. At the peak of the epidemic in 1995, complications from the disease were the leading cause of death for adults ages 25-44, and to date, more than 700,000 people in the U.S. have died from an HIV-related illness.

The HIV and AIDS landscape looks dramatically different today than it did back when World AIDS Day was first established. With greater awareness of HIV and AIDS, and more government funding of research, new HIV infections in the U.S. decreased by 73% between 1984 and 2019. Still, the fight to end AIDS isn’t over, with more than 1.2 million people living with HIV in the U.S.

In honor of World AIDS Day 2021, take a look at what has already been accomplished in the fight against AIDS and learn about what is needed next.

There were 34,800 new HIV infections in 2019

13% of those living with HIV don’t know it

57% of those living with HIV are virally suppressed (meaning they are not at risk of transmitting the virus to others)

Milestones in the history of HIV and AIDS

AIDS first emerged in the U.S. in 1981, but researchers did not learn that HIV caused AIDS until three years later in 1984. The history of HIV medication dates back to 1986, when clinical trials for azidothymidineor (AZT), the first antiretroviral HIV/AIDS medication, began. AZT was approved to treat HIV a year later.

Highly active antiretroviral therapy, often referred to as antiretroviral therapy (ART), became the frontline treatment for HIV in 1997. ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others.

The U.S. Food and Drug Administration (FDA) first approved a PrEP medication in 2012. PrEP, or pre-exposure prophylaxis, can lower the risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

With these breakthroughs in HIV treatment and prevention therapies, the U.S. government recently announced a goal to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030, preventing an estimated 250,000 additional cases of HIV.

Next steps in the fight against HIV and AIDS

Despite the progress that has been made in the fight against HIV and AIDS, prevention, care, and treatment remain inaccessible for many individuals at risk of contracting HIV — both in the U.S. and around the world. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, in recognition of how health inequities contribute to the epidemic.

In the U.S., racial discrimination and deeper inequities in healthcare have contributed to HIV’s disproportionate impact upon people of color. Black and Latinx individuals — particularly gay and bisexual men — are among the groups disproportionately affected by HIV. A variety of factors contribute to these disparities, including income inequality, unequal access to healthcare, and lower use of HIV prevention and treatment services. According to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

Fortunately, HIV prevention medication continues to become more accessible, with generic medication options and expanded health insurance coverage of PrEP. And legislation in a handful of states, including California and Colorado, allows pharmacists to prescribe PrEP. (Pharmacists at Alto’s California and Colorado locations are now able to prescribe PrEP — see our free, same-day prescription delivery areas here). There are also a number of organizations working hard to make HIV services more accessible to communities of color, like NMAC and Black AIDS Institute.

Getting an HIV test is one of the most important things you can do for World AIDS Day. Not only will learning your HIV status give you the information you need to take control of your health, it will also help combat the stigma surrounding HIV and AIDS. Each person who makes use of testing and prevention services — and each person who speaks openly about HIV and AIDS, without perpetuating fear or stigma — brings us closer to a future without AIDS.

Search for a free and confidential HIV testing site near you.

View the CDC’s HIV stigma language guide to learn the power of the words you use when discussing HIV and AIDS.

Get support navigating HIV treatment and prevention medication

At Alto, we’re committed to doing our part to make HIV treatment and prevention services as accessible as possible. Our extensive library of HIV-focused content covers the information you need to make informed decisions about your health. And if you take PrEP or ART, our team will coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option for your health needs at the lowest price.

To learn more, reach out via text or phone at 1-800-874-5881, or in-app messaging.

How to Take Action for World AIDS Day 2021

Prioritizing your heart health becomes even more important during the holiday season. The good news? A little self-care goes a long way, and even small actions can have a big impact on your physical and mental well-being. Here are simple ways to keep your heart healthy this holiday season

How to Keep Your Heart Healthy During the Holidays

Prioritizing your heart health becomes even more important during the holiday season. Not only is it more difficult to maintain your typical exercise routine and healthy habits amid the shopping, traveling, and hosting, but the seasonal stress can also put more strain on your heart. The good news? A little self-care goes a long way, and even small actions can have a big impact on your physical and mental well-being. Here are simple ways to keep your heart healthy this holiday season.

Stress can increase your risk of heart disease both directly and indirectly. It increases inflammation, which is linked to high blood pressure, and can also lead to sleep deprivation or disruption, another risk factor for heart disease.

As you plan for heart-healthy holidays, identify potential sources of stress in advance and look for opportunities to limit it. Some degree of holiday stress is bound to occur, but try to avoid overextending yourself by setting priorities and limiting how much you take on.

Throughout the season, watch for the emotional, physical, and behavioral symptoms of stress. Each individual experiences stress differently, but common signs include headaches, chronic pain, decreased energy, changes in appetite, digestive issues, and depression.

If you find yourself feeling overwhelmed, seek out positive outlets for stress relief, like mindfulness, meditation, and exercise. Simply pausing to take a breath on a busy day can help counteract the physical effects of stress: in signaling the brain to calm, deep breathing can lower your heart rate and blood pressure.

In addition, here are some apps that can help you proactively manage stress and anxiety this holiday season:

Insight Timer, which offers a variety of free guided meditations

What’s Up?, which uses a cognitive behavioral therapy (CBT) approach to managing stress and negative thoughts

It may seem difficult to maintain a heart-healthy diet during the holidays: sodium — which can lead to high blood pressure — and trans fats — which increase your blood levels of “bad cholesterol” — are found in many popular seasonal dishes.

Prioritizing your heart health during the holidays doesn’t mean avoiding your favorite foods altogether, but rather trying to strike a balance. If you’re preparing food for holiday celebrations, look for small ingredient swaps that can transform a dish into a heart-healthy recipe. The American Heart Association has a list of holiday recipe hacks like swapping Greek yogurt for sour cream and applesauce for butter, and cooking with low-sodium or frozen vegetables.

The importance of moderation also applies to drinking, as increased alcohol consumption over the holidays can also impact your heart health. In the long term, heavy alcohol use — defined by the CDC as 8 or more drinks per week for a woman and 15 drinks or more for a man — may increase your risk for high blood pressure, heart failure, and stroke. In the shorter term, experiencing an increased heart rate as the result of drinking heavily during holiday celebrations is sometimes referred to as “holiday heart syndrome.”

Get creative with making time for exercise

It’s great to set New Year’s fitness goals, but that doesn’t mean November and December are a time to step back from your exercise routine. Regular physical activity lowers your risk for heart disease, and it’s especially important to stay active during the holidays in light of the added stress and opportunities to overindulge.

If you’re struggling to carve out time for exercise amid the hectic holiday season, get creative with how you fit exercise into your day. While it’s generally good to aim for about 30 minutes of exercise per day, your heart will benefit from even a quick 15 or 20-minute workout. Look for opportunities to fit in quick bursts of physical activity. Doing an extra lap at the mall while holiday shopping or taking the stairs instead of the escalator counts! Other daily activities that will get your heart pumping? Gardening or shoveling snow, depending on where you live, or going for more frequent walks with family.

And if you’re looking for easy ways to get in exercise during your holiday travels, browse free online workouts or try travel-friendly exercises like push-ups, planks, walking lunges, or jumping jacks.

It’s also important to continue to follow the treatment plan your doctor recommends even when celebrating or traveling. Most medications used to treat high cholesterol or blood pressure, or other conditions related to your heart health, need to be taken as prescribed every day in order to be effective. Not only that, but skipping the medication or stopping use of it abruptly may put you at risk for serious heart health issues.

During the holidays, it isn’t uncommon to accidentally leave your medication at home while traveling, or to run out of refills on a holiday. Take stock of your prescriptions well in advance of the holidays and make sure you have what you need to manage your health, especially if traveling. (We designed our app to help you stay on track with your medication, with reminders and auto refills.)

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications this holiday season. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly

Reach out any time via text or phone at 1-800-874-5881 or in-app messaging.

There’s a lot to cover during a consultation, so you may find it helpful to prepare a list of questions in advance. Our fertility pharmacy experts offer some suggestions to get you started below.

Celebrating National ERG Day at Alto

The history of employee resource groups (ERGs) in the U.S. dates back to the 1960s, when a group of Black employees at Xerox self-organized to discuss their experiences of workplace discrimination and advocate for more inclusive policies. At the time, these networks of employees united by a shared identity or experience were known as affinity groups.

Today, ERGs can be found at companies of all sizes and industries where they play an important role in shaping an inclusive culture and fostering a sense of belonging in the workplace. In honor of National ERG Day, which falls on November 17 every year, we’re highlighting the important work of Alto’s six ERGs. 

At Alto, we believe that every perspective matters, and that diversity fosters creativity and leads to innovation. Our six ERGs are part of our broader commitment to diversity, equity, and inclusion (DEI), both in creating our company culture and delivering an exceptional pharmacy experience.

"At Alto, we’re committed to building and sustaining an inclusive workplace that both supports our employees and helps us deliver on our mission to improve the quality of life for everyone who needs medicine,” shared Ty Bledsoe, Head of Diversity, Equity & Inclusion. “Our ERGs help foster authentic relationships, offer safe spaces for education and conversation, and celebrate the incredible diversity of our Altoids and our communities."

By building community, providing support, and contributing to an individual’s personal and professional well-being, these groups help ensure that every Altoid feels a sense of belonging each day at work and that we appreciate the diversity of the customers we serve.

Here are just a few ways that each Alto ERG contributes to a more inclusive culture and pharmacy experience.

Umoja’s mission is to inform, educate, and empower Black Altoids and allies. The group has deepened Altoids’ understanding of the Black experience by sharing educational resources in support of Black History Month, Juneteenth, and Pride.

They also help our team explore the intersection of identity and healthcare as it relates to our services. After Dr. Reverend Stacey Edwards, founder of Fertility for Colored Girls, spoke at Alto about the fertility journeys of Black families this spring, Umoja continued the conversation by inviting Dr. Temeka Zore, OB GYN and reproductive endocrinologist at Spring Fertility, and Esther Ebeuhi, a licensed doula and birth equity analyst, to speak on Black motherhood.

Alto Auténtico aims to build community among Latinx Altoids and ensure that they have a voice at Alto. In addition to facilitating company-wide learning about the Latinx experience and the diversity within Latinx culture, Alto Auténtico’s mentorship program connects junior and senior Latinx team members for coaching sessions and professional development. The group is also working with Alto’s operations, product, and marketing teams to establish a bilingual team to better support Spanish-speaking individuals using our pharmacy services across our communities.

Proud unites LGBTQ+ Altoids and allies in creating an environment where all Altoids can be their most authentic selves. The group has led Alto in celebrating important LGBTQ+ awareness days with events such as drag queen bingo nights for Pride and LGBTQ+ history month. Two Proud members who identify as bisexual gave a talk for Bi Visibility Day on September 23 and also shared their experiences of coming out in in observance of National Coming Out Day on October 11.

Proud also invites experts to speak at Alto about a range of LGBTQ+ issues. They recently hosted a session with Chris Tompkins, author of Raising LGBTQ Allies: A Parent’s Guide to Changing the Message from the Playground, and a fireside chat with Dr. Lisa Capaldini, who has focused on HIV since the beginning of the epidemic.

Women of Alto + Allies (WOAA) helps create an inclusive community for women at Alto with mentorship and networking opportunities that advance their leadership potential. Their newly launched initiative, WOAA Project Spotlight, celebrates female-identifying team members who have helped us deliver on our mission while living our values, and a quarterly webinar series shares how various self-identifying Altoid women launched their careers.

Working Parents + Allies facilitates discussion and collaboration in celebration of our working parents. The ERG has led Alto in supporting working parents with a variety of initiatives, including a community event with the Kids & Art Foundation’s Purvi Shah in honor of Bereaved Parents Month this July; an “Ask a Parent Anything” Slack advice hotline for parents, caretakers, and allies; and free access to Outschool’s live online classes for kids ages 3-18.

And with their second annual Holiday Giveback Program, which donates gifts to kids and families in need through Marine Toys for Tots and the Boys & Girls Club of America, Working Parents + Allies is an example of how our ERGs look for opportunities to give back and show support beyond the immediate Alto community.

During Asian American Pacific Islander month, the Asians ERG shared resources for individuals like Modern Health's Healing Asian Communities Circles and highlighted community groups for volunteerism and donations.

To learn more about any of our employee resource groups, contact the emails below.

Women of Alto + Allies: womensERG@alto.com

Working Parents & Allies: parents@alto.com

Visit alto.com/careers to learn more about our open roles and join us in delivering industry-leading pharmacy care.

When you’re happy, we’re happy. That’s why we put together a quick guide with five tips for a great delivery experience, based on what we’ve learned from making more than a million deliveries to Alto customers just like you.

How to Have an Easy Alto Pharmacy Delivery Experience

Share any information needed to access your house or apartment  — for example, your intercom, gate code or apartment number/letter — by verifying your delivery address details and completing the “Delivery Instructions'' section in the Alto app. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions to provide all of the specific info our delivery team needs to find your location. (If you don’t want us to ring the doorbell, this is the place to note that, too!)

2. Review your medication’s signature requirements

For controlled substances and medications of more than $500, either you or an authorized signer will need to be present to sign for your delivery. Many Alto customers with limited mobility choose to designate a caregiver as an authorized signer. Head to Account > Delivery Addresses > Edit Address> Delivery Instructions in the Alto app to add an authorized signer .

When required, you may sign electronically on your phone via a link you’ll receive by text, but your driver will need to physically see you during the delivery handoff. If an authorized signer is receiving medication on your behalf, they will be asked to sign for the medication and share their full name with our driver, who will note it in our delivery tracking system.

3. Designate a safe delivery space (and leave the front lights on!)

If your medication does not require a signature, you may schedule your delivery for a time when you are not at home by designating a safe space in the Alto app. Head to Account > Delivery Addresses > Edit Address >Delivery Instructions to provide all the specific info for your safe space. Pro tip: you may also designate a separate safe space in case of rain or snow!

We love pets, but please keep your four-legged friends secured when your delivery arrives, both for our drivers’ comfort and your animal’s safety.

Your health and safety is our top priority, and we kindly ask that you wear a mask regardless of vaccination status if meeting your driver in person. We ask our drivers to do the same.

At Alto, we’re more than just a pharmacy — we’re a partner in your health, and we go above and beyond to get you the medication you need at the best price possible.

Free, same-day delivery is only the beginning. Our pharmacists are available until 9 pm PST on weeknights and 6 pm PST on weekends to answer any questions you have about your medication. We also offer support with insurance and finding the best price possible on your prescriptions.

Reach out by phone at 1 (800) 874-5881 or in-app messaging to learn more or transfer your prescriptions to Alto.

We explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

How to Manage Asthma at Night

Have you noticed that your asthma symptoms like wheezing, shortness of breath, and tightening of the chest intensify in the nighttime? You’re not alone: nocturnal asthma symptoms are common, especially if you are living with more severe asthma. A Journal of Asthma study involving around 14,000 individuals with asthma found that 60% of those with chronic asthma experienced nocturnal asthma symptoms.

Below, we explain how to manage asthma at night through a combination of asthma medications, healthy lifestyle choices, and good sleep hygiene.

Nocturnal asthma occurs when your symptoms are noticeably worse at night. (If you experience intense symptoms at any time of day, including nighttime, you may need to reevaluate your overall asthma treatment plan with your doctor.)

If you have nocturnal asthma, you may experience the following symptoms while you sleep, and your sleep may be interrupted as a result.

Numerous factors can contribute to nocturnal asthma, including environmental triggers and your personal health history.

The presence of allergens like dust mites and mold can trigger asthma symptoms, especially if you have allergy-induced asthma. Dust mites are small pests that generate allergens. They often live in your pillows, blankets, and mattress, so exposure to them at night is common. In some cases, nocturnal asthma may also be a delayed reaction to exposure to an allergen during the day.

Inhaling cold air from an air conditioner or outside source may contribute to more intense asthma symptoms at night. In addition, sleeping in a reclining position causes your chest and lungs to experience additional pressure, which can also contribute to asthma symptoms. Elevating your shoulders and neck with additional pillows or lying on your left side with or without a pillow between your legs may help you sleep more comfortably.

Your circadian rhythm — the 24-hour natural process that regulates your sleep cycles — affects your nighttime levels of hormones like epinephrine, which relaxes and widens your airways, and histamine, which restricts your airways. Nightly fluctuations in these hormones may contribute to inflammation in your airways, prompting nocturnal asthma symptoms. You are most likely to experience nocturnal asthma symptoms when your epinephrine levels are at their lowest and your histamine levels are at their highest.

The following health conditions have also been linked to nighttime asthma:

Sinusitis, a condition in which there is increased drainage from your sinuses

Mental health disorders and chronic stress

If you have asthma and wake up several nights a week even after following your individual asthma treatment plan, consult with your doctor about additional treatment options. They can evaluate your symptoms, identify potential causes, and suggest modifications to your treatment plan if needed.

Common daily asthma medications can also help you manage worsening symptoms at night. Inhaled corticosteroids like Flovent® HFA and Qvar Redihaler®, which reduce inflammation and swelling in the airways, making them less likely to react to asthma triggers, are frequently prescribed for people who experience nocturnal asthma symptoms.

Quick-acting bronchodilators like albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) or levalbuterol (Xopenex HFA®) may also be used to treat acute asthma symptoms at night. These inhalers relax the muscles around your airways to make it easier to breathe and are taken on an as-needed basis for immediate relief of symptoms . Common side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches.

If you have any concerns about potential side effects of asthma medications, your doctor can explain more about the potential benefits and risks of taking corticosteroids or bronchodilators.

If allergens like dust mites are contributing to your nocturnal asthma symptoms, regularly washing your sheets, blankets, and mattress protector may help you avoid triggers. Wash bedding in hot water if possible, since this will help kill dust mites. In addition, maintain a comfortable temperature — 65-70 degrees Fahrenheit is a good range for many individuals with asthma — by making sure your room is well-insulated and shutting windows to keep cold air out. Using a humidifier to add moisture to the air inside your room can also help.

Better sleep hygiene isn’t a substitute for asthma medication, but getting a good quality of sleep at night can minimize the negative effects of any sleep disturbances you experience from nighttime asthma.

Avoid use of electronic devices like cell phones, tablets, and computers at least 30 minutes before you go to sleep, if possible. In addition to stimulating your brain, these devices emit blue light, which can affect your production of melatonin, a hormone that regulates your sleep.

Meditating and exercising before sleeping can also help you fall and stay asleep more easily, but avoid high-intensity exercise close to when you go to bed.

Create an environment that sets you up for a good night’s sleep. In addition to maintaining a comfortable temperature, make sure that your room is dark or dimly lit without distracting lights from electronic devices. You may also want to consider sleeping with your humidifier on, if you have one.

If you think you may have a sleep disorder like sleep apnea or insomnia, consult with your doctor for a diagnosis and treatment, in addition to taking the actions above.

Alto is here every step of the way to make it easy to manage your asthma symptoms at any time of day. Our team of pharmacists is available to answer questions about your asthma medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

Reach out via text or phone at 1-800-874-5881 or in-app messaging to learn how Alto can support your asthma treatment plan.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Woman sleeping; asthma inhaler on bedside

A consistent lack of sleep can also affect your physical and mental health in the long term. Here's what you can do to improve your sleep hygiene.

How Sleep Affects Heart Health & Tips for Better Sleep

If you’ve ever slept less than the CDC-recommended minimum of seven hours per night, you may have experienced short-term effects of sleep deprivation like forgetfulness, irritability, and an inability to focus. A consistent lack of sleep can also affect your physical and mental health in the long term. And just like diet choices and frequency of physical activity, your sleep habits are linked to your risk for heart disease.

Below, we explain more about how sleep affects heart health and what you can do to improve your sleep hygiene.

Sleep allows your body to recharge. As you enter a state of deep sleep, your heart rate slows down and your blood pressure drops. These physical changes give your heart a chance to recover from how hard it works when you’re awake.

When you don’t spend enough time in uninterrupted deep sleep, your heart doesn’t get the opportunity to rest. Research has found that chronic sleep deprivation and sleep disorders can contribute to numerous cardiovascular health issues including high blood pressure, high cholesterol, and a greater risk for a heart attack or stroke.

Cardiovascular health issues related to sleep

Over time, many sleepless nights can lead to higher baseline blood pressure levels during the day. High blood pressure, or hypertension, is among the leading risk factors for heart disease and stroke. If you experience consistent stress or if you have other risk factors for high blood pressure, you may be more likely to develop high blood pressure as a result of sleep deprivation.

Poor sleep may also contribute to these cardiovascular health issues:

Coronary artery disease occurs when cholesterol and other fatty material (collectively referred to as plaque) builds up in your arteries, making it harder for your heart to pump blood to the rest of your body. This accumulation of plaque is also called atherosclerosis.

Some research has found that a lack of sleep may contribute to atherosclerosis. This is partially due to the connection between sleep deprivation and hypertension, as high blood pressure strains your arteries. In addition, poor sleep can trigger chronic inflammation over time, which also contributes to the accumulation of plaque and the hardening of your arteries.

Chronic sleep deprivation may also increase your risk for a heart attack. One research study found that people who slept less than six hours per night had a 20% higher risk of a heart attack in comparison to those who got more sleep.

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