Ep 11: Allergies and Sleep with Dr. Andrew Pugliese, aka The ID Doc


Dr. Andrew Pugliese, aka The ID Doc, is thrice board certified in Infectious Disease, Sleep, and Internal Medicine. He writes on chronic sinusitis, PIDD, sleep disorders, and more.

We talked about how allergies can impact your sleep and what you can do about it.

“When I started initially doing work with chronic sinusitis what i noticed off the bat was that chronic allergies can affect sinusitis,” Dr. Andrew Pugliese said. “We want patients with chronic sinusitis to be evaluated for allergies.”

Dr. Pugliese realized that many of his chronic sinusitis patients were also having sleep disturbances, which was having a negative impact on their ability to get better.

“Many of the patients that were coming in with complaints of chronic fatigue had some sort of sleep disorder which may have been the real culprit behind the chronic fatigue,” Dr. Pugliese said. He found that treating patients for the sleep disorder often cured the fatigue.

“All of the inflammatory byproducts from the [allergic reaction] can cause insomnia,” Dr. Pugliese said.

We talked about immunotherapy for allergies, as well as how responses to pollen and mold spores can create byproducts like interleukin 2 and psydokins which can congestion which can cause insomnia.

Another way allergies can disrupt your sleep is through mild heartburn. When your body encounters an allergen sometimes histamines will activate your H2 receptors, which stimulate your stomach to produce more acid. This can result in nocturnal gastroesophogeal reflux, which is enough heartburn to wake you up, but not enough to make you reach for the Tums. “Patients awaken during the night and don’t realize it,” Dr. Pugliese warns. Unfortunately OTC sleep aids only work on H1 receptors, so they’re not super helpful. For this problem Dr. Pugliese recommends trying medicine aimed at reducing your stomach acid.

We also discussed a study of 100 people with self-diagnosed sinus headaches actually had migraines. Dr. Pugliese starts determining whether headaches are sinus headaches or migraines by looking at the cervical spine. “A lot of the innervation in face comes from the neck,” Dr. Pugliese said. “If you have some kind of cervical spine disease, bulging disks, arthritis, or something like that. It can referred pain to the face or the sinuses and make you think you have a sinus infection.” He also likes to send people to the ENT get a negative cat scan and endoscopy of sinuses.

“If you have a negative cervical spine, cat scan… and an endoscopy.. Then i’d say the diagnosis… is related to a facial migraine. Unfortunately there is typically a quantum leap to a facial migraine without ruling these problems out.”

“It all depends on what is the underlying cause… if it’s a bacterial or mold infection [allergy medication] will not help and may cause more problems.”

“For most patients we recommend antihistamines… but the main state i’ve found that a saline sinus rinse is helpful in terms of moving everything [in the sinuses] in and out.”

On seeing a primary care for advanced testing, Dr. Pugliese says they’re just too busy to give you the care you need. “In most of these cases, you’ll need to see an allergist or an ENT who has seen these conditions,” Dr. Pugliese said.

Then we talked about reducing allergies through lifestyle modifications. “There are several things you can do to help with reducing allergies,” Dr. Pugliese said. “If there is carpeting, how old is that carpeting? If the carpet is several years old, depending on how much travel there is on that carpet, if there are pets involved, that carpet could be the major source of sleep disturbances in terms of allergies. People will say, ‘I just had it cleaned,’ Great. But the problem might not be the carpeting, it could be carpet padding underneath. Because everything leaks down to the padding. I know, it gets gross. If you’ve ever seen carpet padding that’s several years old, it really grosses out people. Get the carpeting out, switch over to hardwoods or a hard surface that can be cleaned on a regular basis. Put a dehumidifier in the bedroom. If you can eliminate any source of moisture, you really will have a negative influence on the mold and help with other allergens. If you have pets, they can’t be in bed with you. Smoke inhalation is another one. Burning candles at night is not the greatest thing in the world. You have to be careful with plant life. It might not even be the plants that you’re allergic to, the soil might have some mold growth in it. I would also suggest if you do have problems with allergens prior to going to sleep to irrigate with a saline solution to see if you can evacuate a lot of the bioburden out of your sinus cavities before you go to bed. Some patients I recommend they use something like a topic nasal steroid, you don’t have to do it every night, but two or three nights a week, it may help reduce inflammation in your sinuses so you get a better night’s sleep.” Topical doesn’t have all the side effects of the oral steroid.

For reducing insomnia due to reflux, Dr. Pugliese recommends putting at least three to four hours between your last meal and bedtime. Avoid caffeine products and chocolate at night, they can relax your lower esophageal sphincter. Don’t drink alcohol after dinner.

Follow Dr. Pugliese on Twitter. Or check out his excellent blog.

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