During allergy season when your hay fever gets bad, you may find it difficult to sleep. Having trouble breathing through your nose can keep you awake. But be careful about the allergy medicine you take. Choosing the wrong one could equal insomnia.
Trouble Sleeping During Allergy Season:
Q. I have a hard time sleeping at this time of year because allergies make my nose so stopped up. I have tried over-the-counter products before bedtime but most keep me awake.
Is there anything you can recommend that will help me breathe without giving me insomnia?
A. Chances are, the allergy pills you have tried contained a decongestant. Some people find ingredients such as pseudoephedrine or phenylephrine quite stimulating. A “D” in the name of the product signals the presence of a decongestant. Some examples include:
- Allegra-D
- Benadryl-D
- Claritin-D
- Zyrtec-D
What Can You Take for Allergies That Won’t Equal Insomnia?
There are two options that might work. First, look for an antihistamine that has no decongestant. Pure antihistamines such as Benadryl (diphenhydramine) or Chlor-Trimeton (chlorpheniramine) help allergy symptoms and usually make people feel sleepy.
Antihistamine Withdrawal Warning:
Do keep in mind that we have been hearing from visitors to this site that they experience a kind of withdrawal reaction if they suddenly stop some oral antihistamines they have been taking for months. People have reported prolonged itching when they stop cetirizine (Zyrtec), for example. Here is just one story from Skip:
“I have had a miserable three weeks of uncontrollable after stopping Zyrtec (cetirizine). My tree pollen allergy had acted up, so I took the drug for just a few weeks. I had taken Claritin in past years and had no such withdrawal issues.
“My physician was unaware of the withdrawal symptoms. I noticed in the blog that someone asked about hives. I have had them regularly since I stopped taking the drug. They are random and accompany the itching.
“Also, I have some symptoms of BPH and the withdrawal from the drug has aggravated that problem also. I will not touch Zyrtec again and I think that these issues need to be related to the makers of Zyrtec, as it should be included with the information that comes with the drug.”
To read about other people who have experienced unbearable itching after stopping cetirizine (Zyrtec) or other oral antihistamines, check out this link.
When Antihistamines Alone Equal Insomnia:
Occasionally, individuals find that antihistamines do keep them awake. Some people are just wired differently. While Benadryl (diphenhydramine) makes most people drowsy, some people find that this kind of antihistamine has them wired for hours. If that is your situation, you may wish to try a long-acting nasal spray at bedtime. But please don’t use it for more than a few days at a time, as it may lead to dependency.
Tackling Allergies with Nose Sprays:
Dangers of Decongestant Nasal Sprays:
The other solution for allergic rhinitis would be a nasal spray. Vasoconstrictors found in most OTC nasal sprays cause blood vessels in the nose to shrink. That allows you to breathe, but after a few days those blood vessels become dependent upon the chemical. When you stop, you end up with rebound nasal congestion. That’s like jumping from the frying pan into the fire.
Here is an example of what can happen with a nasal spray like oxymetazoline (Afrin). John writes:
“How I got away from OTC vasoconstrictor nasal sprays that cause almost unbearable rebound congestion was to see my physician and get a prescription for one of the steroid nasal sprays such as fluticasone (generic Flonase) or similar. Some were available in both aqueous sprays and propellant based sprays.
“I found the aqueous versions more effective for me. They take a couple days to start to work, at which point I could drop the Afrin. There was still some rebound congestion, but, by then the steroid was working and the rebound was much more bearable for that few days. There is always some discomfort; the piper has to be paid.
“After about a week off the Afrin, I could drop the steroid spray. It doesn’t fix the original problem, but it gets me off the Afrin and I am free to look to the many alternatives available today. I keep some fluticasone around for when I have more severe nasal congestion, and now use that rather than reaching for something like Afrin.”
Saline Nasal Spray:
Because of the problems associated with vasoconstrictors, we favor saline (salt water) nasal sprays. They are refreshing and won’t cause addiction.
MMU shared this experience:
“I have used Ocean for years for nasal congestion, with good results and no adverse effects. It brings back memories of my dear aunts, who used to dunk us in the ocean for almost every ailment when we were children!”
One modest study indicates that irrigating the nose and sinuses with saline solution (such as NeilMed) offers acceptable relief of some allergy symptoms, possibly even better than steroid nasal spray (Lin et al, American Journal of Rhinology and Allergy, March 1, 2017).
Steroid Nasal Sprays for Allergies:
If all else fails, ask your physician about a prescription steroid nasal spray. It should ease symptoms and not interfere with sleep. Your doctor will have lots to choose from. Here are just a few examples:
- Beclomethasone (Beconase AQ)
- Budesonide (Rhinocort Aqua)
- Flunisolide (Nasarel)
- Fluticasone (Flonase)
- Mometasone (Nasonex)
- Triamcinolone (Nasacort AQ)
In the last several years, a number of steroid nose sprays have become available without prescriptions. ClariSpray Nasal Allergy Spray, Flonase Allergy Relief Spray, Nasacort Allergy 24HR, and Rhinocort 24 Hour Relief Nasal Spray are good examples of steroid medicines that have gone over the counter.
Drawbacks of Steroid Nasal Sprays:
Don’t rely on such drugs for too long, however. We recently received this message:
“I am 55 and have been taking fluticasone nasal spray year round for allergies since about ten years ago. (In California where I live, something is always blooming.)
“I was having vision problems recently, and the ophthalmologist discovered I have a posterior subcapsular cataract. That is the least common kind of cataract, but it affects vision the most.
“The doctor kept asking if I’d taken steroids or had trauma to my eye. I didn’t think so until I recalled that fluticasone is a corticosteroid. As I am generally healthy, I was shocked that I had a cataract. This type of cataract is most commonly caused by corticosteroids or injury or irradiation to the eye for a tumor.
“I have to conclude the Flonase was responsible. I will ask my internal medicine doctor to help me get off it. In retrospect, I’m not convinced the allergy relief was really worth this risk.”
Doctors have been debating how much nasal steroid sprays contribute to posterior subcapsular cataracts. Early placebo-controlled trials were reassuring, but there have been some reports of cases in which relatively young healthy people developed such cataracts after years of nasal steroid use (Journal of Cataract and Refractive Surgery, Aug., 2011).
Other side effects of steroid nose sprays include nosebleeds and an unpleasant taste.
Managing the Environment for Allergies:
To really get a handle on your allergies, you will want to think about improving your home environment! A really good HEPA-type air filter to capture pollen and other sensitizing particles can be a worthwhile long-time investment. In addition to outfitting your air conditioner with a HEPA filter, you may want one for your vacuum cleaner as well. We are partial to the Miele brand, but they are pricey.
You can survive the allergy season if you approach the congestion with a full court press that involves modifying your environment and using a variety of treatments thoughtfully. Armed with knowledge, you should be able to avoid allergy medicines that equal insomnia.
Doctors will soon be able to prescribe sublingual immunotherapy. Successful trials have protected people from grass pollen in Germany (Shah-Hosseini et al, Advances in Therapy, April 28, 2017) and cedar pollen in Japan (Hara & Iwasa, Journal of Theoretical Biology, May 5, 2017).
Revised 5/11/2017
