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The Link Between Allergies, Nasal Congestion, & Sleep Problems

Allergies are commonly blamed for poor sleep. But does it really? Researchers from Japan found that allergies alone are not enough to cause sleep disturbances, but a combination of allergies and nasal congestion lead to increased reports of sleep difficulty.

This finding isn’t surprising, since any degree of nasal congestion can aggravate your soft palate or tongue to fall back more easily when you’re in deep sleep. Even if you’re completely normal, you’re more likely to toss and turn when your nose is stuffed up from a cold.

This also implies that the more narrow your jaws, the more susceptible you’ll be to any form of irritation or inflammation in the nose which can lead to nasal congestion. The more narrow the space between your upper molars, the less space there will be in your nasal cavity, and the more likely your septum will buckle (deviated nasal septum). Plus, the angle between your nasal septum and your nostrils will be more narrow, which makes it easier to cave in with even a little bit of internal nasal congestion.

If you suffer from allergies, and you have nasal congestion, it’s important to treat the congestion as well. Simple steps you can take include using Breathe Rite strips, nasal saline irrigation, and avoiding eating or drinking alcohol close to bedtime. If you must take an over-the-counter antihistamine, make sure that it includes the letter ” -D”, which stands for decongestant. Usually, it’ll have a variation of pseudoephedrine (the generic name for Sudafed). If pseudoephedrine makes you hyper or jittery, you can always use oxymetazoline (Afrin) very sparingly (not more than 3 days).

If these conservative options are not enough, then prescription medications can be used. As a last resort, surgery can sometimes help.

Do allergies cause you to sleep poorly?

 

An Insider’s Guide to Septoplasty

The septoplasty operation is one of the most misunderstood surgical procedures that lay people, and even many physicians have. Some people even equate septoplasty with having a nose job, which is not true. Although, some people use having a crooked septum as 

an excuse to undergo a rhinoplasty, septoplasty, done correctly, can help patients breathe better, and more importantly, sleep better.

Understanding the Anatomy

In order to fully appreciate if septoplasty is the right procedure for you, you must understand the anatomy of how it’s done.

The nasal septum is the midline cartilaginous structure that divides the two halves of your nasal cavity. The part in the back of the septum is made of bone. Whenever the septum is crooked to a significant degree, your nose can be stuffy, and a septoplasty can be offered if medical therapy doesn't work.

However, having a crooked septum doesn't mean that you'll have a stuffy nose, or that you'll need a septoplasty. No one has a perfectly straight septum. There are other parts of your nasal anatomy that contributes to your ability to breathe, which includes your nasal turbinates and your nostrils. The turbinates are wing-like structures that jut in from the side-walls of your nose that look like wings. They normally warm, filter, smooth and humidify the air that you breathe. Inside this structure is the bone and the outside is a mucous membrane lining. The middle part is made of very vascular tissues that can swell tremendously when filled with blood. This is regulated by your involuntary nervous system. This nervous system normally swells and shrinks the turbinates, alternating from side to side, every few hours (called the nasal cycle).

Do You Have Flimsy Nostrils?

The other structure that is often overlooked is your nostrils. For most people, breathing in causes a mild vacuum effect that causes a mild collapse and a constriction of the nostrils. But in some people with either flimsy or weakened nostrils (from a prior rhinoplasty), they collapse very easily, even with a slight bit of inspiration. If you are one of these people, you may benefit from nasal dilator strips (Breathe-rite is one brand). Sometimes these strips are not strong enough, or it can irritate the skin. Another option is to use internal nasal dilators which work much better. Some of the more common brands are Breathewitheez, Nasal Cones, and Nozovent.

What's Involved with Septal Surgery? 

The septoplasty procedure can be done in conjunction with a turbinate procedure. There are many ways to perform a septoplasty, but the most important point is that it should be done well. The septum is covered on both sides by a mucous membrane. After an incision is made inside the nose on the mucous membrane, this layer is peeled away from the septal cartilage. The other side is also entered, which creates two tunnels on either side of the septal cartilage. The crooked part of the septal cartilage is next removed. Some surgeons either soften the cartilage or flatten it out and place it back, and others leave it out completely. In many cases, a small portion of bony spur that juts out at the base of the septal cartilage is also removed. The last part of the operation is where different surgeons use different techniques. Traditionally, thin plastic sheets with or without soft sponge-like packs are placed against the septum on both sides to keep the mucous membrane together for proper healing. If a large clot of blood forms between the two mucous membrane layers, the remaining cartilage may lose it's blood supply and literally melt away. 

Because the entire procedure in done inside the nose (or endoscopically), there is no swelling, bruising or changes to the outside of the nose or face (unless a rhinoplasty is done simultaneously).

What to Expect After Surgery

Nasal packing, if placed, are removed anywhere from 1-3 days after the procedure. Many patients report that this is one of the most uncomfortable parts of undergoing this procedure. Some surgeons, like myself, don't use any packs or splints using the following method: compressing the two mucous membrane layers by sewing the two layers together using an absorbable suture, like a quilting stitch. This way, nothing needs to be removed, and you're breathing much better right after the surgery. It's expected with this procedure that your nose will get clogged up after a day or two with accumulation of blood, mucous and debris.

This operation is usually performed as an outpatient procedure, so you'll go home a few hours after surgery. It's usually performed under general anesthesia, but can also de done under local anesthesia with sedation for certain situations. Most people can go back to work after a day or two. Heavy straining or lifting should be restricted for about one week. In my practice, I see the patients about 2 days after the surgery, when the nose is cleaned of all the accumulated debris. Some people need a second cleaning 1-2 weeks later.

Typically, it may take a few weeks to months to feel the full benefits of this operation. During the first few weeks, crusts will build up and fall out as wounds heal. This is also the time when the swelling from the surgery goes away. Afterwards, scarring and tightening of the soft tissues can take weeks to months. You may have your ups and downs in the first few weeks, but you should see consistent improvement by 3-4 weeks. 

Most people don't use any pain medications, but one is prescribed just in case. You'll probably be more bothered by the sore throat from having a breathing tube placed during intubation.

What Are The Risks?

Complications are rare, but with any surgical procedure, there is a small chance of infection or bleeding. There is also a small risk any time someone undergoes general anesthesia, which includes, allergic or medication reactions or airway problems. In terms of overall risk, it's riskier when you cross the street. Other very rare complications such as smell loss or a hole in your septum have been reported. 

A septoplasty, if done properly, is one of the most gratifying procedures for both the patient and the surgeon. Success rates are very high. However, there are a few percent of patients where nasal congestion still persists, or it comes back after a few weeks to months. In this situation, there are two main possible reasons: there is persistent turbinate swelling due to inflammation, or you have flimsy nostrils. There are treatment options for both theses conditions.

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Attention All Mouth Breathers – 5 Important Reasons Why You Must Breathe Through Your Nose

If you’re a chronic mouth breather because of a stuffy nose, you’re not alone. As the weather chills and allergies and colds abound, and nasal congestion becomes a common trend, mouth breathing inevitably follows-especially when you’re sleeping. I’m sure you’ve seen many passengers asleep on the subways and trains, head and pitched back, mouth wide open, and snoring louder than a diesel engine. Mouth breathing can surely ruin your social image, but that’s nothing compared to the havoc it can wreak on your health.

 

5 Potent Benefits of Breathing through Your nose

One of the most important reasons to breathe through your nose is because of a gas called nitric oxide that’s made by your nose and sinus mucous membranes. This gas is produced in small amounts, but when inhaled into the lungs, it significantly enhances your lung’s capacity to absorb oxygen, increasing oxygen absorption in your lungs by 10-25%. Nitric oxide also can kill bacteria, viruses and other germs. This is why you often hear fitness and yoga instructors emphasize inhaling and exhaling through your nose during workouts.

Also, if you can’t breathe well through your nose, your sense of smell will suffer and therefore your sense of taste, since your smell and taste buds are connected. This can lead to disturbances in your appetite and satiation levels, wreaking havoc on those struggling with weight issues.

Your nose also has vital nervous system connections to your lungs and heart. Not breathing well through your nose can alter your heart rate and blood pressure, as well as increase your stress responses.

Your nose makes about 2 pints of mucous every day. If your nose isn’t working properly and mucous isn’t cleared, the stagnant mucous can lead to infections such as sinusitis or ear infections, not to mention bad breath.

Lastly, not breathing well through your nose can aggravate snoring or obstructive sleep apnea. Nasal congestion alone doesn’t cause obstructive sleep apnea, but it can definitely aggravate it. If your palate and tongue structures are predisposed to falling back easily due to sleeping on your back and muscle relaxation in deep sleep, then having a stuffy nose can aggravate further collapse downstream. Untreated obstructive sleep apnea can lead to chronic fatigue, depression, anxiety, weight gain, high blood pressure, heart disease, heart attack and stroke.

Knowing all these benefits of breathing through your nose, however, doesn’t help much if you don’t know why you’re not able to do so.  To stop mouth breathing, the first thing you must do is to figure out what’s blocking up your nose.

What Can Stop Up Your Nose

Nasal congestion is something everyone experiences now and again. Yet, if you’re trying to prevent this from happening it’s important to explore the various reasons behind why and when this occurs.

Here are five of the most common reasons for a stuffy nose:

"I Have a Deviated Septum"

By definition everyone has a slightly crooked (deviated) nasal septum. There are various reasons for having a deviated septum, including trauma, but the most common reason is no reason at all. It’s just the way your nose developed. What’s more important than how deviated your septum is is what’s happening in front of an around your septum.

Wings in Your Nose

Turbinates are wing-like structures that attach to the sidewalls of the nasal cavity, opposite the midline nasal septum. They normally smooth, warm, humidify, and filter the air that you breathe, but they also become enlarged and produce mucous when inflamed. Turbinates also swell and shrink alternating from side to side, which is a normal neurologic process called the nasal cycle.

Is It An Infection or Allergies?

If you have allergies, a cold or any kind of infection, then your turbinates will swell up, clogging your nose with lots of mucous production. Contrary to popular belief, the color of the mucous has no relation to bacterial vs. viral infections.

Flimsy Nostrils

Once you have inflammation and swelling inside your nose, for some people, depending on the configuration of your nose, your nostrils can literally cave in as you inhale. Different noses have differently shaped nostrils with various nostril thicknesses. The more narrow your nose, the more likely your nostrils can cave in. People who undergo cosmetic rhinoplasty are more at risk years later, since narrowing the nose can weaken the support structures of the nose.

A Nervous Nose?

Some people’s noses are extra sensitive, especially to weather changes, like temperature, humidity, and pressure changes. Certain chemicals, scents and odors can set off a reaction as well. Many people mistakenly think this reaction is an allergy, but it’s really your nasal nervous system over-reacting to the weather or to odors. One of the most common reasons is from poor quality sleep, which causes a low-grade stress response, which can heighten your senses.

It’s All Under Your Nose

A chronically stuffy nose doesn’t happen by itself. Usually it’s part of a bigger picture, where the entire upper and lower jaws are more narrow and constricted, in addition to more narrow nasal cavities. I’ve described this process in my book, Sleep Interrupted, where due to modern human’s eating soft, mushy, processed foods, our jaws are much more narrow than normal, with dental crowding. Bottle-feeding, which is another modern, Western phenomenon, is also thought to aggravate this problem.

If you have a stuffy nose, it can also aggravate soft palate and tongue collapse when in deep sleep, due to muscle relaxation. With more obstruction, more stomach juices are suctioned up into the throat and nose, causing more swelling and more nasal congestion. All this from smaller and more narrow jaws.
 

The Deviated Septum Myth

Dr. Park debunks one of the most common myths about the nose.

The Deviated Septum Myth

7 Tips to Breathe Better Through Your Nose

Most people take breathing through their nose for granted. But for many chronic mouth breathers, breathing through the nose is a struggle, if not impossible. Not only is their quality of life diminished, but they’ll also have a variety of other health-related conditions such as dry mouth, snoring, fatigue, and poor sleep. In my last article I addressed 5 reasons why it’s important to breathe through your nose. In this article, I’ll talk about 7 ways that you can breathe better through your nose naturally. 

Before I discuss the various ways to breathe better, a short anatomy course in in order. The nasal septum is a thin piece of cartilage and bone that splits your nasal cavity right down the middle. No one has a perfectly straight septum; everyone’s septum is slightly curved. Sometimes, nasal trauma can shift or move the septum away from its’ midline position. The nasal turbinates are wing-like structures that line the sidewalls of your nose. It’s covered with a mucous membrane, and normally it helps to smooth, warm and humidify air. The turbinates and sinuses also produce about 2 pints of mucous every day. The turbinates swell and shrink, alternating from side to side every few hours. This is called the nasal cycle. 

The front side walls make up your nostrils, which are soft cartilages covered on the inside and outside with skin. The back of your nose is one big cavity (called the nasopharynx), and the passageway turns down 90 degrees into the back of your throat. The nasopharynx is also where your ears connect via the Eustachian tubes. 

If any part of the anatomy that I described becomes obstructed partially or completely, you’ll feel stuffy in your nose. Usually it’s not one thing, but usually due to a combination of different reasons. For example, if you have a mildly deviated septum, suffering from mild allergies will swell up your nasal turbinates, narrowing you nasal passageways. This may not be enough to clog up your nose, but if you have flimsy nostrils or had rhinoplasty in the past that weakened the nostrils, then breathing in with a stuffy nose may trigger your nostrils to collapse. 

Starting from the tip of your nose, the first thing you must do is to find out if you have flimsy nostrils. If you have a very narrow nose, or if your nostril openings are very narrow and slit-like, then you may be prone to having flimsy nostrils. Try this experiment: Take both index fingers and press them just besides your nostrils on your cheek. While firmly pressing on your cheeks, lift the cheek skin upwards and sideways, pointing towards the outer corners of your eyes. Take a deep breath in. Can you breathe much better through your nose? Let go and try it again. If this maneuver works for you, you may benefit from using nasal dilator strips at night (one brand is called Breathe-Rite). Sometimes, the adhesives on these devices are not strong enough, or end up irritating the skin. Another way of treating this condition are various internal dilators (such as Nozovent, Breathewitheez, Nasal cones) that you can find over the counter or over the internet. 

Second, try using nasal saline sprays. You can use the simple spray bottles that put out a fine mist, to more sophisticated methods such as aerosol cans or even using a Water-pik machine (there’s a nasal adaptor that you can buy for this). Another popular variation is something called a Nedi-pot, which uses gravity to pour salt water into your nose and sinuses. You can either use prepared saline packages, or mix your own recipe (one cup of lukewarm water and 1/2 teaspoon of sea salt or Kosher salt with a pinch of baking soda). Whatever method you use, you’ll have to do it frequently to get maximum results. Besides cleansing out mucous, pollutants and allergens, saline also acts as a mild decongestant. 

Third, try not to eat anything within three hours of going to bed. If you still have food or juices lingering in your stomach when you go to bed, it can leak up passively into your throat and not only prevent a good night’s sleep, but these same juices can also leak up into your nose, causing swelling and inflammation. In addition, many people will also stop breathing once in a while, which creates a vacuum effect in the throat which actively suctions up your stomach juices into your throat and nose. 

Fourth, try to avoid drinking alcohol close to bedtime. Not only does alcohol irritate the stomach, it also relaxes your throat muscles as you sleep, which aggravates the process described in the previous paragraph. 

Fifth, if you have any known allergies, especially if it’s something in your bedroom, try to either remove it or or lessen your exposure to it. For example, many people are allergic to dust or molds, and if you have carpeting, or an area rug, it can harbor these allergens. Frequently washing your bed sheets in very hot water also helps. Investing in a quality HEPA filter should help even more. If you have any pets, consider keeping them out of your bedroom. If conservative measure to control allergies is not good enough, consider seeing an allergist for a more formal evaluation. 

Sixth, get regular exercise, especially outdoors. Not only are you exercising your heart and your muscles, you’re also exercising the nervous system in your nose. Vigorous physical activity activates your sympathetic nervous system, which constricts the blood vessels that supply your nasal turbinates. This allows you to breathe better through your nose, with all the added benefits described in my previous article. 

Lastly, slow down and relax. Modern society has removed all the natural built-in breaks throughout the day. Along with all the information overload and constant stimulation, going nonstop all day only adds to the increased stress levels that everyone experiences. In between major activities, take a minute or so to stop what you’re doing and stretch, get up and move around, and do some deep-breathing exercises. Stress can tense up the muscles, causing you to breathe shallower, which causes physiologic changes that can ultimately aggravate nasal congestion. 

These simple 7 steps won’t help everyone, but If you can go down the list and apply all the steps, many if not most of you should feel some improvement in your ability to breathe through your nose. If you’ve tried all these steps and still can’t breathe through your nose, then seek medial help. An otolaryngologist (an ear, nose and throat doctor) is the best doctor to take care of this condition. 

If you are a chronic mouth breather, in addition to what I described above, your jaw is probably more narrow than normal, with some degree of dental crowding. Chronic mouth breathers also tend not to sleep well at night due to various degrees of breathing difficulty.

I discuss how you can breathe better in my free report: How to Unstuff Your Stuffy Nose. Please click the Like button below to access your free E-book:

 

 

 

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