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Avatar universal

Horrible Sleep Disorder/Nocturnal Asthma: Please Help.

I am a 26 year old male of average height and weight. (5'8" and 160 lbs.) My medical history was unexceptional until 1997, when I contracted mononucleosis. When my energy levels and appetite returned, I began to notice that my body was reacting in odd ways to allergens that I had previously not had a problem with. If I was around a dog - even if I just saw one and then went home - I found my sleep to be completely unrestorative. I would move my legs and wake up feeling as though I had not slept at all. The fatigue was noticeable in my appearance and behavior.

In 2002, I finally saw a sleep physican and was scheduled for a sleep study. After recording apeaneic events in the first half of the night, I was titrated on CPAP to 3cm. This began an arduous and contentious relationship with the specialist, as I complained that CPAP was not helping at all. I went on to try 4cm, 5cm, 8cm, an AutoPAP, and three more studies, all of which showed mild apnea and "unexplained arousals."  

My "amateur" hypothesis is this: the mono triggered some sort of immune system dysfunction that has my body reacting harshly to trace amounts of allergens in the air. This manifests itself as some kind of nocturnal asthma in the evening, and CPAP is ill-equipped to help because the apnea is caused by an allergic reaction and not muscle relaxation. Has anyone ever heard of allergy-induced apnea? I get no deep sleep at all. Benadryl helped for a short time, but no longer. Prednisone helped only briefly. I have tried several inhalers to no benefit. Please advise if possible. Thank you.
13 Responses
251132 tn?1198082422
MEDICAL PROFESSIONAL
Yes, allergic rhinitis has been documented as a trigger of obstructive sleep apnea.  This is especially true for people who routinely snore (even when not triggered by an allergen).  You should be evaluated by another experienced sleep physician.
Avatar universal
The "Unexplained arousels" might be some kind of sleep related laryngospasmus (Vocal Card Dysfunction) - you wake up due to closure of the vocal cords when you inhale during sleep.
Herrhausen
Avatar universal
In my 15 years of experience, I have never heard of a chronci allergic reaction that caused sleep apnea. Further more, I'm sick and tired of hear about VCD on this website. Also in my 15 years of practive have I ever worked on a patient with VCD. No idea where this "ailment" sprung up. But it sounds like a diagnosis idiopathic in origin. (Meaning, "unknown")


First off, a CPAP setting of 3cmH2O is a joke. ITs not nearly enough pressure to maintain a patent airway if you have documented OSA. I'm glad to see you escalated your CPAP settings, but sorry to see they didn't work. Even 8cmH20 isn't all that theraputic. I have patients on as much as 15cmH20 of CPAP. Even higher!

I would recommend you getting ANOTHER sleep study in another facility. I feel that you need a higher setting. Another thing that needs to be addressed is if your sleep apnea is not obstructive but Central based. If it is central based...the nSPAP isnt going to do a thing for you.

Andy, RRT, CPFT
Avatar universal
Andy,

Thank you for commenting.

I did not find out until later that 3cm of CPAP was barely even enough to expel Co2 (?) from the mask, and that no machine even GOES down to 3cm! Needless to say, my faith in this practicioner went down quite a bit after that.

I have had a total of four studies, with the last indicating that 8cm of pressure resolved my few apneic events while leaving the "spontaneous" arousals untouched. I attribute these to UARS and do not know how to address them. No central apnea was indicated during the studies. If the apnea is caused by allergic swelling, CPAP is useless, correct? Can any test discern between a breathing cessation due to muscle relaxation and one due to allergic inflammation?

Avatar universal
You mentioned asthma, allergies, and RLS [restless leg syndrome].
My own experience is that allergies [rhinitis] and asthma can sometimes produce an apnea like condition. I had the symptoms of sleep apnea, as verified by people who slept in the same room;
ie gasping etc. My GP referred me to an ENT who had me fill out a questionaire including numerous questions on snoring. I don't snore!. He ran a scope up my nose, mentioned there was a lot of mucus there, and prescribed a steroid nasal spray, to control the rhinitis and post nasal drip. [my nose tends to clog up at night from tree pollen and cold air, thus contributing to breathing problems]

I also have asthma, treated with long acting bronchodilators and steroid nasal spray. Asthma is worse at night, and contributes to another breathing problem.

And suspected GE reflux, which can get into the lungs, worsening the asthma--also postnasal drip can do that. I now sleep on a MedSlant foam cushion, which elevates the upper part of my body 6", to minimize GERD at night.

So you might benefit from making sure your asthma, rhinitis, and any GE reflux is under good control; before putting all your eggs in the sleep apnea diagnosis. Also might be worth a 2nd opinion from a major teaching hospital.

The Restless Leg Syndrome is something else that may bear investigation. http://www.rls.org/
Avatar universal
I've been through every conceivable CPAP possibility out there...I displayed no signs of mouth breathing during my numerous studies, though I wound up taping my mouth shut and using a chin strap just in case. Also tried several different models at several different pressures. No effect. Obviously, the "unexplained" arousals recorded are still enough to fracture my sleep. I just have no idea how to address them...to this day, not sure if I should be pestering an allergist or a sleep physician. A combination of both would be best.
Avatar universal
Like I said, I never heard of a chronic allergic reaction that caused sleep apnea. This is highly doubtful...

I'm assuming you are using a nsal CPAP unit. Are you a mouth breather? Don't forget, if your mouth is ope when you sleep...the CPAP is completely useless. There are special chin-straps available to help keep your mouth closed while sleeping. Also, there are full-face masks available. I am not particularly fond of using these in the home setting however. Especially if you have a history of GERD. Reflux can actually be aspirated into the lung while you sleep, and that would be bad....

Try elevating the back of your head a bit. Try and tuck your chin twards your chest just a tad to keep your mouth closed while sleeping. Also, sleep on your side, not your back. Asure your mask is on nice and snug. If there are leaks...again, you're losing pressure and making the CPAP ineffective.

-Andy, RRT, CPFT
Avatar universal
Check out this link:
http://sleep-medicine.advanceweb.com/common/editorial/editorial.aspx?CC=4199
Sleep Disturbances Are Nothing to Sneeze At
Excerpts:
"Researchers have found that men and women with nasal obstruction, especially chronic nighttime symptoms of rhinitis, experience high incidence of habitual snoring and severe sleep-disordered breathing, leading to poor quality of life.
...........
Because nasal obstruction is a risk factor for sleep problems, clinicians should investigate this issue with their allergy patients, says Lanny Rosenwasser, MD, head of allergy at National Jewish Medical and Research Center in Denver.

Some may have signs similar to sleep apnea patients, he says. These include inability to get to sleep, easy wakefulness, early rising and difficulty with daytime sleepiness. Complaints of memory problems and recurrent headaches are also common.
...........
Physicians also need to be aware that some patients' sleep disturbances are related to asthmatic reactions initiated by allergies, adds Shari Angel Newman, RPSGT, manager of the Sleep Disorders Center and EEG Lab at the Spartanburg Regional Medical Center, Spartanburg, S.C.
...........
To treat allergy-related sleep problems, clinicians can take several approaches. The sleep lab can offer patients nasal CPAP and oxygen CPAP therapies. An allergist may recommend allergen immunotherapy or allergy shots. Or, the physician can prescribe nasal medications, such as antihistamines, decongestants, nasal sprays and washes, and nasal steroids"
Avatar universal
Ellis,

Thank you for corroborating my theory. It seems like my local doctors can't wrap their brains around a very simple concept. In plain English: nocturnal asthma can manifest itself as apnea on a PSG. If someone does not fit the more typical profile of an apnea patient, then "allergic" sleep-disordered breathing should be considered, ESPECIALLY when CPAP is proving to be ineffective.

What I don't understand is that article's contention that forced-air therapy should be indicated in this type of case. CPAP pushes air through to create a "splint" in the airway when it's collapsing due to sagging tissue. I don't think it has the same effect when the airway is swollen due to allergic reaction. How can you "force" the airway open when it's inflamed?

Avatar universal
Hello Everyone,

I have similar symptoms to the ones mentioned. I am 26, 6'3", 200lbs and have GERD, seasonal allergies, and asthma (although my athletic induced symtoms have disappeared in my 20's). I have this phenomenon where I will hold my breath in my sleep (and occasionally during the day when I'm watching TV or distracted). I will then slowly release the air in my lungs creating a noise that is similar to a low pitched hum (this is very annoying to my wife). The exaustion related to this seems to vary depending on seasons and stress levels. I have read online about Sleep Apnea and the causes they mention don't seem to mesh with mine (usually obesety related). Any thoughts???

Thanks,

Josh
Avatar universal
"and the sump pump quite raining during a bad storm."  I don't know how I mangled that so badly.  I meant to say something like "and the sump pump quit while it was raining during a bad storm." ;)

Avatar universal
I also meant to emphasize this point, but forgot:  "Clue number two: I could tell when the ceiling fan over my bed needed cleaning, because I would start to cough soon after lying down. Wiping the blades with static dust cloths (like Swifters) helped solve the problem."

Dust and mold control are important, but sometimes the cure is worse than the disease.  Never do anything that stirs the dust around, like using a feather duster or a vacuum cleaner that doesn't have a good bag that filters well.  Otherwise, you're just stirring the muck around, in which case you'd be better off leaving it alone.  

Ceiling fans are great, since they seem to attract dust to them.  Up to a point, when they become "saturated", and then start spewing dust into the room, and since no longer able to hold more dust, the air currents they generate keeps all the dust in the room stirred up and into the air.  When that happens either clean them with static or damp cloths to absorb the dust, not fling it around into the room by "dusting" them with a feather duster.  Or shut them off to avoid stirring up more dust.  A window fan forcing air out is an exception.

Similar logic applies to cleaning up mold.  In this case, it's the mold-killing chemicals themselves that can be as bad as the mold.  Their saving grace is that it only takes a one time shot to vent out the chemicals, whereas the mold if left unattended would require constant ventilation to avoid affecting allergies, if you are allergic to both as I am.



Avatar universal
I have no medical training, therefore hesitate to give medical advice, but the advice I have isn't strictly medical, rather it is to emphasize the need to do detective work if allegies is a possible cause for sleeping problems.

I was diagnosed with allergen-induced athsma about a year ago, but kind of dismissed it since I didn't have any wheezing or symptoms that are commonly associated with athsma. I just had a chronic cough and tickling in my throat that only became really troublesome at night.  I didn't even realize myself how bad it was until I met my boyfriend.  One morning, he told me how appalled he was that he almost killed me during the night.  He opened a window, which I never do, preferring to live in a fully temperature controlled environment.  He said that within 20 minutes or so, I seemed to hold my breath then started coughing which turned into choking which didn't subside until he shut the window.  I had no memory of it all.  Very scary.  Because I seemed to hold my breath, i.e., appeared to stop breathing before I started coughing, we self-misdiagnosed the problem as apnea, and assumed that the coughing and choking resulted from the lack of breathing.

OK, clue number one. Keep the windows closed.  ;)  Clue number two:  I could tell when the ceiling fan over my bed needed cleaning, because I would start to cough soon after lying down.  Wiping the blades with static dust cloths (like Swifters) helped solve the problem.  

Clue number three:  While I would have occasional problems sleeping at home, sleeping at my boyfriend's was guaranteed to set me off coughing after a few minutes of going to bed.  He figured out that he needed to wash his comforter more often to get rid of dust.  That didn't quite do the trick, but unbeknownst to me, my boyfriend was doing detective work.  He stopped using his shampoo and soap and started using mine, and he finally tracked it down to his deoderant.  Which left him in a quandry, because HE is allergic to anti-perspirants, although I am not as long as they are scent free, lol.  He said that deoderants are more inherently "scented", and things that are scented do seem to give me a problem.

Things were fine after that for well over a year or so.  Until I found this wonderful old farmhouse out in the country.  Next to a hay field.  You can probably guess what happened next, heh.  I moved in December, and things were fine, until about April.  There were days when I couldn't even manage to get out of bed.  My doctor diagnosed it as allergen-induced asthma, which really didn't make sense to me.  I'm a smoker, who can smoke 3 packs a day and be just fine.  I just can't tolerate the windows being open... ;)

She gave me some prescriptions for Advair, Albuterol, and Allegra.  The Allegra was great!  So this is what life is like without fluids constantly leaking out of my eyes, nose, and ears!  But it didn't stop the night time coughing, although the Albuterol helped when I started choking.  I was still chronically fatigued, gained lots of weight, and still not enough energy to get out of bed.  I saw an allergist who tested me for allergies (any type of plant life, especially molds, and my cat) prescribed a nasal inhaler and something for acid reflux (but I don't got heartburn!) I was prescribed Welbutrin to help me quit smoking, and was using nicotine patches.  I stopped smoking and that didn't help either.  So that led to thyroid testing, then ultimately medication for depression, although mentally I felt fine, although admittedly depressed because I had no energy to do anything.  It made my blood pressure shoot through the roof and my resting heartbeat was in the 90-100 range.

So I said "enough is enough!"  And stopped taking all medications.  Though I kept my Albuterol handy.

What really did the trick was when I moved out of the bedroom I shared with my boyfriend, and turned it into a "clean room".  I chose an upstairs bedroom, which has both hardwood floors, and is far away from the exposure to the outside doors, and hence outside air.  It already had a window air-conditioner in it, since the central air doesn't reach upstairs well (i.e., the room's ties to the air in the rest of the house is pretty weak.)  We put a good air purifier in it.  These things helped a lot, but wasn't a guarantee of a good night's sleep.  A bit more detective work, sneezing when doing the laundry, and I eliminated Bounce from my dryer (I guess that wasn't in my allergist's testing kit).  Success!  

We copied the same tactics in my boyfriend's bedroom, to the extent possible.  No dice.  So we moved the bookcases, and musty books out of his room, and that did the trick.  But not as safe as my "clean" room, since his room is on the first floor, and hence closer to the outside doors and tied into the central AC better, as well as as has beautiful carpet...

I ain't got no stinkin' asthma!  I was smoking again, dropped all medications, and was just fine!  Although I still kept my Albuterol handy, just in case ...

But by now it was winter again.  When spring time rolled around again, the problems came back.  The cough returned one night, and steadily got worse with each passing night, and I was once again unable to do much but lay on the couch watching TV.  I'm a computer game addict, but sitting at my computer to play was even too tiring, as well as made me queasy due to the fluid in my ears.  I asked my boyfriend to check the filter in my bedroom air pure filter, which he pooh-poohed as a cause, since we put little sticky notes on the 3 air purifiers we have in the house, as well as the central air, and change them regularly.  But he found I was right, and that the filter was clogged.  Replacing it helped immediately.  Apparently, the manufacturer's recommendations are based on average homes, not a 50-year old farmhouse with frogs in the basement, in the middle of hayfields. ;)  I'm not kidding about the frogs, they got in when we lost power a few months ago and the sump pump quite raining during a bad storm.  My boyfriend put a dehumidifier down there at that point, which generates an incredible amount of water.  I'm still debating on getting rid of the frogs, after all, the only food source they have are insects, another allergen source.  Yeah, we laugh about living in Green Acres, but love it and really don't want to move back to where everything is concreted over. ;)

Despite all this, and the successes so far, I recently ran into problems again.  So I started taking my Advair again a few weeks ago, and it's helped tremendously.

But I now know there is something still in the environment that is causing it, and more detective work is needed.

Yeah, maybe I do have allergen-induced asthma after all.  And if I quit smoking, it would eliminate a major source of bronchial irritation that would allow me to tolerate the effects of allergen exposure a lot better.

But my message here is for you and that IF you do have allergen induced-asthma, don't expect the wonder drugs to do it all.  They most certainly help, so be sure to listen to your doctor, unlike me. ;)  But that's only treating the symptoms, which isn't enough.  Find the sources, and at least eliminating them from your sleeping environment is also critical.

That requires a lot of detective work, which is why this response is so long (to illustrate how many possibilities for allergens there are) and is also why I showed up here.  I was trying to find an answer to the question of whether it's important to keep asthma symptoms under control by using Allegra? That is, when I don't use Allegra, I can detect irritants a lot quicker, mainly because my eyes water and I start sneezing, which Allegra seems to depress.  On the otherhand, since I seem to be allergic to so many things, Allegra might be helping to reduce the general "background noise", which might help me pick out the major irritants, before they set off coughing attacks when I'm trying to sleep.

Any thoughts?







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