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Fri, Oct. 18

A wake-up call on sleep disorders
Rhinitis and asthma could be the culprits

Sleep disorders are common. It is estimated that 20 million Americans (1 in 15) are affected by sleep apnea. Good sleep is essential for our physical and emotional well-being. Lack of satisfactory and good quality sleep could lead to fatigue, headaches, poor concentration and daytime sleepiness. This could also result in impairment of work and learning.

Sleep-disordered breathing is associated with an increased risk of cardiovascular disease, stroke, high blood pressure, arrhythmias, diabetes and sleep-deprived driving accidents.

This also translates into $23 billion in healthcare costs a year. Sleep apnea is more common in men who are also obese.

Rhinitis and sleep-disordered breathing

The nose plays an important role in breathing. It filters the air of impurities and warms and humidifies the air before it reaches the lungs. Allergic rhinitis (hay fever) is a common disorder affecting the nose. It affects 20 to 30 percent of the population. Its prevalence is believed to be increasing.

It classically causes significant sneezing, runny nose and nasal congestion and stuffiness. In some (with an allergy to indoor allergens such as dust mites and animal dander) it could be troublesome at night.

This effect of rhinitis on the quality of life in general and quality of sleep in particular is beginning to be recognized more and more by researchers.

That is why more recent clinical assessments of rhinitis consider the impact of rhinitis on sleep quality.

Sleep-disordered breathing is also more common in children with rhinitis. One study found that 60 percent of children with rhinitis snore habitually, and 26 percent of them snore significantly. This could lead to poor daytime functioning and weakened learning at school.

Obviously, this has implications for the future of the country. Even in people with rhinitis symptoms without allergy (nonallergic rhinitis), sleep-disordered breathing is common. Interestingly, a recent study was conducted on the role of everlasting noninfectious rhinitis in the development of sleep disturbances in patients with asthma. It found rhinitis to be an important, independent risk factor for difficulty in maintaining sleep, early morning awakenings and daytime sleepiness.

Asthma and sleep-disordered breathing

Asthma is a common breathing disorder affecting lungs. Five to 8 percent of children and adults suffer from asthma. Many patients commonly have both asthma and rhinitis.

Asthma and sleep apnea could occur together. One study found that as many as 35 percent of patients with sleep apnea have asthma.

Many patients with asthma have nighttime awakening from the worsening of their asthma.

Gastroesophageal reflux disease (GERD) is also common among people who are obese and who also have asthma. The acid reflux symptoms are particularly troublesome at night. Acid reflux could make the asthma worse. It could also awaken people from sleep.

As you can see, rhinitis, asthma, GERD, obesity and sleep-disordered breathing are common disorders. Their combined happening in any given individual could be devastating!

How can you improve your sleep quality?

If you suffer from rhinitis (sneezing, runny nose, nasal congestion, stuffiness) and/or asthma (cough, wheeze, tight chest and shortness of breath) you need to get evaluated by a qualified allergist by undergoing an allergy skin test and pulmonary function test.

Treatment of rhinitis and asthma with allergen avoidance, suitable medications and, where needed, allergy desensitization injections, could lead to better control of rhinitis and asthma symptoms and better quality of life, daytime functioning and sleep.

Regular use of intranasal corticosteroid sprays could lessen congestion, improve sleep and sleep problems, and lessen daytime sleepiness, fatigue and inflammation.

Medications such as loratadine (Claritin) and montelukast (Singulair) have been shown to improve (better than placebo) difficulty falling asleep, nighttime awakening and nasal congestion on awakening.

Being obese increases your resistance to breathing by increasing soft tissue mass around upper airways. Reducing body weight by diet and regular exercise could also help lessen sleep apnea. Losing weight will also help lessen GERD symptoms.

If you have sleep apnea (loud snoring, frequent respiratory pauses lasting 10 or more seconds and frequent arousals from sleep), you need to undergo sleep studies ordered by a competent doctor.

If you have sleep apnea proven by the study, the use of CPAP (Continuous Positive Airway Pressure) or special surgical procedure (uvulopalatopharyngoplasty - UPPP) might help.

Simple measures such as learning to relax before bedtime (listening to gentle music or reading a book), taking a hot shower or drinking a cup of warm milk are some of the time-tested remedies.

Natarajan Asokan, M.D., F.A.A.P. is a board-certified allergist and immunologist and a board-certified pediatrician with more than 27 years of experience as a physician and nine years of experience as a practicing allergist and immunologist. He treats adults and children with various allergy and immunology problems. He can be reached at 1739 Beverly Ave, Suite 118, Kingman, AZ 86409; (928) 681-5800; Fax: (928) 681-5801; or

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