Treating Allergies at Night

Are allergies keeping you awake?

 

By Debra Fulghum Bruce, PhD

If allergies are keeping you awake at night, you're not alone.

In one study, only 17% of patients with allergies rated their sleep as optimal.  About half of all people in the study said allergies and nasal congestion woke them up at night and also made it hard to fall asleep.                                        

Why does it matter?

• Sleep deprivation is a stress that has significant consequences, such as high blood pressure and heart complications, as well as psychological consequences.
• Sleep deprivation affects every part of your life from your relationships to your ability to think and be productive to your income.

How are allergies linked with sleep deprivation?

So what's the problem with allergies and how are they linked to sleep deprivation? We asked William E. Berger, MD, MBA, professor of medicine at the University of California, Irvine, to explain more about allergies and the resulting sleep deprivation.  Berger is past president of the American College of Allergy and Immunology and author of Allergies and Asthma for Dummies.

"With nasal allergies, there are four things that happen when an allergic reaction occurs," says Berger.  "There's sneezing, itching, runny nose and mucus formation, and then nasal congestion and swelling of the mucous membranes."

Berger explains to us that when these four reactions occur with allergies, they can cause a host of other breathing problems that result in sleep deprivation. 

As an example, as soon as you crawl in bed prepared to get a good night's sleep, you realize that you can't breathe through your nose. So, you position yourself differently on the pillows and just as you get comfortable and find a good breathing position, postnasal drip (thick mucus) starts to collect in the back of your throat, causing you to cough -- and cough. The more you cough and try to breathe through your congested nose, the more miserable you feel.

Thus, all night long, you toss and turn and cough and snore instead of sleeping. The next day, you awaken feeling exhausted and irritable because your allergies have wreaked havoc with normal sleep.

Which allergy medications can help nighttime allergy symptoms?

Two types of allergy medications may help nighttime allergies.  "Antihistamines may help with sneezing and postnasal drip," Berger says, while decongestant medications help with the stuffiness and nasal congestion."

But Berger also suggests that a better approach to treating allergies might be the inhaled nasal steroids and intranasal antihistamines. "These inhaled nasal puffs and sprays address all four allergy symptoms of sneezing, itching, runny nose and mucus formation, and nasal congestion and swelling of the mucous membranes."

If you try the inhaled nasal steroids, Berger advises taking these two weeks before pollen season begins to prevent allergy symptoms. You may plan on staying on inhaled nasal steroids for months, if needed, to keep allergies at bay and avoid sleep deprivation.

If you're allergic to your pet, Berger suggests seeing an allergist before you consider giving away the family dog or cat.

"Many things can trigger symptoms of allergies such as nasal congestion, even nonallergic rhinitis caused by changes in temperature or weather. See an allergist to find out if you truly have allergies before making drastic changes at home."

Can nasal saline rinses help reduce allergies?

Arizona-based pulmonologist Paul Enright, MD, has had allergies since childhood.  During allergy seasons, when his nose gets clogged with mucus and he has postnasal drainage, he uses a salt water sinus rinse, often during an evening shower, in order to keep his nasal passages clear throughout the night. 

"If your nose is clogged, you have to breathe through your mouth all night. This eliminates the natural air conditioning function of the nose and may cause restless sleeping," Enright says.

When grass and weed pollen levels are high in Arizona, to reduce inflammation and congestion in his nose, he also uses a prescription nasal corticosteroid spray about 1/2 hour after the sinus rinse. 

"It's important to point nose sprays towards the center of your head, not towards your eyebrows.  The sinuses and inner ears drain deep inside your nose, and that's where you want the nose spray to be concentrated for maximum benefit."

Enright also recommends drinking more water, which works to thin mucus. Thin mucus does not stick to the back of the throat and cause postnasal drip. You'll know that you're well-hydrated if you're hitting the bathroom frequently.  

How do you find out what's causing your allergies?

Enright suggests that you become an allergen "sleuth" to find out which allergens are causing your symptoms. If your allergies only happen at nighttime, perhaps you are allergic to something in your bedroom. 

The most common allergens in bedrooms are microscopic house dust mites which live in bedding.

If the humidity in your bedroom is above 40%, molds may be growing in the carpet, bedding, and upholstered furniture.

If there is a smoker in your home, your nose and sinuses are probably becoming congested due to your inhaling secondhand smoke at night.  A HEPA room air purifier running in your bedroom will remove the smoke.

If you are unsure about the cause of your allergy symptoms, get a skin test or a blood test to identify the allergens that cause your problems. 

What's the link between allergies and sleep apnea?

If you feel sleep deprived, it may be that your nasal allergies cause you to snore at night. In addition to snoring interrupting your sleep, sometimes snoring is a warning sign of the more serious problem of obstructive sleep apnea (OSA).

With obstructive sleep apnea, you may snore and also have periods of suspension of breathing, called apneas. The apneas are due to an obstruction of the upper airway at the base of the tongue.

If your doctor suspects you're at risk for obstructive sleep apnea, he or she may refer you for a sleep study (polysomnography), which is done at an accredited sleep center.

The sleep test will give your doctor information about oxygen drops associated with obstructive sleep apnea or other breathing problems.

If you are diagnosed with obstructive sleep apnea, your doctor will talk to you about weight loss and nightly use of CPAP, continuous airway pressure. With CPAP, you wear a custom-fitted nasal mask during sleep that's connected to the continuous airway pressure machine. The continuous airway pressure helps prevent further narrowing or collapse of your airway, so you can get the sleep you need to feel rested.

Sleepy Time Tips to Decrease Allergies and Sleep Deprivation

During the deepest level of sleep, your body is revitalized and tissue damage is repaired. Sleep helps restore the body and strengthens the immune system. Yet difficulty sleeping may accentuate your allergy symptoms, making a congested nose feel even worse.

To get sounder sleep, it takes a combination of steps, including nasal saline irrigation, allergy medicine, and lifestyle measures, says Murray Grossan, MD, a Los Angeles-based ENT and author of The Sinus Cure. Grossan offers these tips:

Watch your diet and avoid drinking caffeine and alcohol for at least six hours before bedtime. 

• Check your medications, as some allergy medicines can cause insomnia or nervousness. The ingredients and side effects are listed on the medication label.
• Consider taking an antihistamine like diphenhydramine (brand name Benadryl) at night. It causes drowsiness in many people.  
• Get regular exercise for sounder sleep, but don't exercise at night as it may keep you keyed up. Try to exercise outside during the early morning hours to gain the extra benefit of natural sunlight. This helps to set your body's natural circadian rhythm for regular sleep.
• Keep the windows closed in the bedroom to keep out pollen and nighttime dampness.
• Raise the head of your bed a few inches. The higher the head, the less the nasal congestion with allergies.

Remember, if you have allergies, your body thermostat is off, says Grossan. "If there's any chilling whatsoever, your body will respond with sneezing, nasal congestion, and hacking." Keep your bedroom comfortably warm and sip warm decaffeinated drinks before bedtime to stay warm."

 

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