My family and I recently suffered a miserable cold that would not go away for over 2 weeks. It started off with a stuffy nose, which then developed into a prolonged chronic cough. Thankfully, everyone is now fine, except for a few lingering symptoms. During the peak of my cold, I had trouble sleeping because of my stuffy nose, so I had to resort to using Afrin nasal decongestant in addition to using NyQuil at night. One particular night, I felt something unusual: As I tried to breathe out through my nose, I felt a sudden complete blockage, so I had to breathe out through my mouth. This happened a few more times, until I switched my sleep position from my back to the left side.
The next morning, I realized that I had just experienced expiratory palatal obstruction (EPO), something that I’ve written extensively about in past blogposts. In brief, EPO occurs when due to excess or redundancy of the soft palate, the free edge of the soft palate (the flap of muscle that connects to your uvula, the small finger-like projection hanging down the middle of the back of your throat). In my case, because of inflammation in the back of the nose, my soft palate became swollen to the point that it led to a sudden flap-like closure as I tried to breathe out through my nose.
A viral infection like the common cold is a major reason that can cause swelling in your upper airway, leading to various degrees of narrowing. But there are a number of other reasons that can cause inflammation and swelling, anywhere from your nose to your voice-box. The more narrow your upper airway due to having a smaller mouth, the more symptoms you’ll feel with any degree of inflammation and swelling. Contrary to popular belief, the upper airway is not a rigid tube that connects your nose to your voice box. Instead, there are multiple points of narrowing and widening, along with multiple areas that can cave inwards even during normal sleep. The mucous membranes lining your nose and throat can swell significantly when irritated by these 7 factors, leading to poor breathing and poor sleep:
1. Viral infections. This is probably the most common form of irritation to the upper airway. Most viral infections are self-limiting and go away within a few days. Unfortunately, there’s no treatment for the common cold. You’ll have to treat your particular symptom (mine was nasal congestion). Needless to say, staying well hydrated and getting enough sleep are vital to faster healing.
2. Bacteria. Bacterial infections are relatively uncommon. The two areas that are most susceptible are the throat and sinuses. It’s important to remember that in the vast majority of situations, what may feel like an infection is usually not due to bacteria. This is why in general, antibiotics are not recommended as first line therapy. Oftentimes, other factors such as weather changes, or even a sinus migraine can feel like a “sinusitis.” In the throat, acid reflux is a common reason for throat “pain” or discomfort.
3. Allergies. The list of potential allergic irritants is very large. Most commonly, pollens, dust and animal dander are the biggest culprits. The first thing to do is to avoid these irritants if you know what’s causing your allergies. Nasal saline irrigation can be used to flush out your nasal cavity and also act as a mild nasal decongestant, so you can breathe better. Over-the-counter allergy medication and then a consultation with an allergist are other options.
4. Food. Your upper airway can be sensitive to certain foods as well. The most common food allergy is dairy. A simple dairy elimination diet can be a good option to consider. Sensitivity to wheat and other grains with gluten can indirectly affect your upper airway by causing inflammation in your gut. Other foods can trigger sinus migraines (see #5).
5. Environmental or neurologic. In general, not being able to sleep efficiently due to obstructive sleep apnea or upper airway resistance syndrome (UARS) can heighten your nervous system, causing your nose (and body) to ever-react to weather changes (mainly pressure changes), migraine triggers (certain foods such as chocolate, aged cheeses, MSG and red wine), smoke, chemicals or fumes.
6. Acid reflux. One expected consequence of OSA or UARS is that vacuum forces created during obstructed breathing episodes will bring up small amounts of normal stomach juices in your throat. What most people don’t realize is that these juices can also reach your nose, sinuses, middle ears, and even your lungs. It’s not only acid that comes up, but also bile, bacteria and digestive enzymes. Pepsin, a digestive enzyme, is found in middle ear, sinus and lung fluid in people with infections. Stomach juice can be a major irritant in your nose and your throat. One more thing to remember is that having a stuffy nose will cause more of a vacuum effect in your throat, which can potentially lead to more obstructed breathing and more reflux episodes. This is one reason why some premenopausal women experience throat pain just before their periods, due to lower progesterone levels leading to lower upper airway muscle tone.
7. Dental crowding with crooked teeth. This may not fit with the previous 6 sources of inflammation, but having a smaller mouth can predispose you to more inflammation of the upper airway. Going back to #6, repeated partial or total obstructed breathing can suction up your stomach juices into your throat. Some of the most common symptoms that result are chronic throat clearing, post-nasal drip, coughing or hoarseness. This is also why most people with smaller jaws can’t sleep on their backs, since the tongue or soft palate can fall backwards due to gravity. Additionally, if you have a small mouth, you’ll also have a small nasal cavity (leading to breathing problems due to a deviated nasal septum and flimsy nostrils), and more narrowed sinus passageways, which predispose you to sinus problems with even simple allergies or colds.
Due to modern man’s shrinking faces and epidemic rates of dental crowding, it’s not surprising that we are all more sensitive to normal substances in our environment. Yes, there are probably more toxic chemicals in our environment and food supply, which can literally “rev-up” the immune system, but having a smaller airway can also heighten the immune system, due to the chronic state of physiologic stress. At the other extreme, obstructive sleep apnea is known to cause massive amounts of systemic inflammation, as evidenced by much higher levels of CRP, amongst many other documented inflammatory markers.
For all the reasons mentioned above, this is why I always tell my patients to avoid eating 3-4 hours before bedtime, and to make sure you’re able to breathe optimally through your nose. If you’re not already doing these two things, you may be missing out on the potential for a much better night’s sleep.