Allergies and Sleep Apnea Update

Snoring is not an uncommon symptom in patients with allergic rhinitis (i.e., hay fever). Snoring is the harsh sound that arises when air flows past the relaxed tissues in the throat. The actual snoring sound is a result of the vibration of the throat’s tissues as one breathes. Mild intermittent snoring is quite common and occurs in almost everyone. Chronic moderate or severe snoring however is not normal and may indicate a serious health malady. It may also point to an underlying health condition such as sleep apnea, allergic rhinitis, nasal polyps, obesity, enlarged tonsils, etc.

Sleep apnea is a condition in which one’s breathing is continually interrupted. The result is the inability to get enough deep sleep that is essential to revitalize the body. The characteristic symptoms of this condition include extreme daytime somnolence which often results in falling asleep at inappropriate times. Sleep apnea should not be taken lightly as it can be very serious and is a potentially fatal disorder. In addition to falling asleep and daytime sleepiness, other symptoms may include snoring (as mentioned above), fatigue, depression, diminished productivity at work and/or school, decreased memory, decreased quality of life, and a reduced ability to learn. As mentioned above, allergic rhinitis (i.e., hay fever) has also been linked to many of the same symptoms. Allergic rhinitis in combination with sleep apnea can have harmful effects including heart disease, stroke, sexual dysfunction, and an increased risk for motor vehicle accidents. As a result, sleep apnea should be taken seriously. Although it is estimated that roughly 25 million adults in the U.S. have sleep apnea. The actual numbers are probably much higher since cases are underdiagnosed due to a variety of reasons. In addition, many individuals with sleep apnea are simply unaware that they have the condition.

There are 2 types of sleep apnea, “obstructive sleep apnea” and “central sleep apnea.” In obstructive sleep apnea, the breathing or air flow is blocked or “obstructed.” The obstruction is often caused by the tongue sliding back in the throat. In addition, the relaxed airway that occurs during sleep changes shape to a more oval shape. This change in shape of the airway contributes to the decrease in air that reaches the lungs. In essence, the muscles of the throat relax and fail to hold the airway open during sleep. As a result, oxygen levels are decreased in the tissues. In central sleep apnea, the normal unconscious breathing basically stops, usually due to the brain not sending the normal signals to the muscles that control breathing. Central sleep apnea is much less common than the obstructive type of apnea and not associated with allergies. For the purposes of this blog article, only obstructive sleep apnea is discussed.

The severity of the sleep apnea can be put into 3 categories: mild, moderate, and severe. The severity is based on the number of episodes or events of apnea that occur per hour of sleep. An episode or event is described as a complete stoppage of breathing for at least 10 seconds or shallow breaths for at least 10 seconds. Sleep apnea is considered “mild” when there are 5-14 episodes of apnea or hypopnea (i.e., shallow breathing) per hour. It is deemed “moderate” when there are 15-29 episodes of apnea or hypopnea per hour. It is called “severe” when there are 30 or more episodes of apnea or hypopnea per hour.

The diagnosis of sleep apnea is best done with a sleep study. Historically, patients were asked to come to a sleep center for an overnight sleep study. During the sleep study the individual’s blood pressure, heart rate, respiratory rate, oxygenation level, and brain electrical activity is monitored throughout the night. More recently, the sleep study is often done in the patient’s home with some of these measures closely monitored and recorded. In addition allergy skin testing or blood testing may be performed in individuals exhibiting allergic rhinitis symptoms. Some of these symptoms may include sneezing, itchy nose, runny nose, nasal congestion, post-nasal drip, snoring, sinus pressure, sinus headaches, fatigue, itchy throat, itchy eyes, watery eyes, and/or redness of the eyes.

The most efficacious management of sleep apnea is the use of CPAP (continuous positive airway pressure) while sleeping. CPAP machines are used in order to deliver a continuous flow of pressure which as a result forces open the obstruction in the airway. The patient has 3 options how to receive the continuous airflow delivered by the CPAP machine which includes a full face mask, a nasal mask, or nasal pillows or prongs. The full face mask is the most cumbersome whereas the nasal pillows or prongs are the least awkward. The choice is completely up to the patient and many individuals try all 3 until they find the best match for themselves. It should be pointed out that the main obstacle in the treatment of sleep apnea is compliance, as more than half of patients do not use CPAP when prescribed, mostly due to it being uncomfortable and annoying.

The use of dental or mouth devices are controversial but may help lessen symptoms in patients with mild obstructive sleep apnea. Surgery can also be performed in order to improve obstructive sleep apnea. The “Inspire Sleep Apnea Innovation” is a form of upper airway stimulation (UAS). It is a surgical procedure in which a monitoring device is implanted into one’s chest and a neurostimulator device is implanted below one’s chin in order to monitor one’s breathing and send a gentle pulse to the nerve that controls tongue motor function, moving it forward and out of the way so one can breathe properly. This treatment received FDA approval in 2014. Other surgical procedures are somewhat controversial in regards to their efficacy. One of these is a uvulopalatopharyngoplasty which is one of the most common surgical procedures for treating obstructive sleep apnea, although as mentioned above, not necessarily the most effective. It is performed to remove excess tissue in the throat such as the uvula, adenoids, tonsils, and parts of the soft palate.

Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The board certified allergy doctors at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of snoring and sleep apnea. In our practice we also treat patients with environmental allergies (i.e., allergic rhinitis or hay fever), eye allergies (allergic conjunctivitis), asthma, eczema (i.e., atopic dermatitis), hives (i.e., urticaria), contact dermatitis, medication allergies, generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), insect sting allergies, food allergies, eosinophilic esophagitis, Mast cell disorders, and immune disorders. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been serving the greater Washington, DC metropolitan region for more than 50 years and we look forward to providing you with exceptional allergy care in a welcoming and professional environment.