The Nose and Sleep
Written by Dr Louis Chan on August 28, 2021
In this blog, I am going to discuss in detail regarding the relationship between sleep and nasal breathing, as well as treatment modalities from Western and Chinese medicine.
Breathing is an essential function to keep us alive; most of us would not be able to not breathe for 2 minutes. The nose is designed for breathing; its function is to filter, warming and humidify the air. Nasal obstructions can lead to chronic health issues such as sleep apnoea, impaired cognitive function, and poor posture due to mouth breathing (Lee, Guilleminault, Chiu, & Sullivan, 2015). The comorbidities associated with nasal obstruction can also have a negative effect on the patient’s mental health and quality of life. (Dykewicz & Hamilos, 2010; Silva, Silva, Morales, Fernandes, & Pinto, 2009).
In the previous Blog “Introduction to common Sleep Disorders”, I mentioned Guilleminaulta et al. (2005) found that “nasal disuse” is commonly overlooked in the treatment of sleep-disordered breathing (SDB).
There are two common types of SDB; obstructive sleep (OSA) and upper airway resistance syndrome (UARS). OSA is caused by obstructions in the upper airway, while UARS is caused by the resistance of airflow in the upper airway, and they affect sleep differently. Both OSA and UARS patients have daytime sleepiness and nasal obstructions; OSA sufferers complain less about pain and onset of sleep, while UARS sufferers complain more about insomnia and pain. Patients with sleep apnoea are often unable to get enough air in the lungs to maintain their blood oxygen saturation from 10 seconds to over 3 minutes, causing their blood oxygen saturation (SPO2) down to a dangerous level of below 80%. When we are awake, our SPO2 is 98% to 100%; during sleep, the average SPO2 is 95% or above, the lowest SPO2 during sleep should be 90% or above. Patients suffering from UARS often have normal SPO2 during sleep, but they have pain and insomnia (Guilleminault et al., 2001; Pépin, Guillot, Tamisier, & Lévy, 2012).
Obstructions of the nose can be caused by collapsed nasal valves, a deviated nasal septum, enlarged turbinates, and a swell body on the septum. The most common obstruction is caused by inflammation of the nasal mucosa due to allergic rhinitis; common symptoms are sneezing, itching and runny nose. The prevalence of allergic rhinitis is increasing, and estimated up to 40% of the population is affected (Dykewicz & Hamilos, 2010; Singh, Axelrod, & Bielory, 2010).
The Western medical treatments for Allergic rhinitis can have unwanted side effects (Cheng et al., 2018; Sohn, 2018).
1: Pharmaceuticals: (antihistamine tablets and nasal sprays, nasal steroid sprays and decongestants)
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Side effects: drowsiness, nausea, restlessness, dry mouth, nasal irritation, blood bleeds and headaches
2: Immunotherapy
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Expensive and require a long-term commitment
3: Trigger avoidance
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Can be difficult and limits activities
4: Surgical management
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Limited long-term results
Acupuncture treatment for allergic rhinitis has shown to not only be effective short term as well as long term (Chen et al., 2020). For evidence-based treatment, we would like to examine the quality of the scientific evidence on treatment modalities in the peer-reviewed scientific literature.
“System review of randomised controlled trials” is considered to have the highest level of evidence. Liang, Lenon, and Yang (2017) published an article on “Acupressure for Respiratory Allergic Diseases: A Systematic Review of Randomised Controlled Trials”, they found using acupressure points to relieve allergic rhinitis is more effective than 1% ephedrine nasal drop with thermal therapy. They also found that combination therapy of acupressure points with either Western medicine or Chinese herbal medicine can dramatically improve the efficacy of treatment. However, many studies did not have enough patients to be considered a good quality clinical trial. Most randomised clinical trials for acupuncture treatment also found having a high risk of treatme