Can't Sleep? The Link Between Allergic Rhinitis and Sleep Apnoea

You wake up exhausted despite being in bed for eight hours. Your nose feels blocked, your throat is dry, and your partner mentions — again — that you were snoring heavily. Over-the-counter cold remedies have not helped, and you are starting to wonder whether something else is going on.

For many people, the answer may involve allergic rhinitis symptoms — persistent nasal inflammation driven by an immune response to everyday allergens like house dust mites, pet dander, mould, and pollen. When nasal congestion becomes chronic, it can disrupt breathing during sleep, contribute to snoring, and in some cases worsen a condition called obstructive sleep apnoea.

This article explores the connection between nasal allergies and sleep quality, explains how specific IgE blood testing can help identify the triggers involved, and outlines practical steps for improving your sleep environment. It draws on NHS guidance, Allergy UK resources, BSACI information, and the published allergy literature. This is general health information and is not a diagnosis.

How Allergic Rhinitis Symptoms Disrupt Sleep

Allergic rhinitis — commonly known as hay fever when caused by pollen — is an IgE-mediated inflammatory condition affecting the lining of the nose. When the immune system encounters an allergen it is sensitised to, it triggers a cascade of inflammation that causes the nasal passages to swell, produce excess mucus, and become congested.

During the day, this may be manageable — an occasional sneeze, a slightly stuffy nose. But at night, the effects intensify. Lying down causes blood to pool in the nasal blood vessels, increasing swelling. Exposure to bedroom allergens — particularly house dust mites, which thrive in mattresses, pillows, and duvets — peaks during the hours you spend in bed. The body's natural cortisol levels also drop in the evening, reducing their anti-inflammatory effect.

The result is a predictable pattern that many people recognise but may not associate with allergies:

• Nasal congestion that forces mouth breathing during sleep
• Snoring — caused by turbulent airflow through a narrowed airway
• Dry mouth and sore throat on waking (from breathing through the mouth all night)
• Frequent waking or restless, fragmented sleep
• Daytime fatigue, poor concentration, and irritability — even after apparently adequate time in bed
• Morning headaches — sometimes mistaken for sinus headaches

Research published in the Journal of Allergy and Clinical Immunology has consistently shown that people with allergic rhinitis report significantly poorer sleep quality compared to those without nasal allergy. A large European study (the GA²LEN survey) found that nasal obstruction was the rhinitis symptom most strongly associated with sleep disturbance (Léger et al., 2006).

Allergic Rhinitis vs 'Just a Cold': Pattern Recognition

One of the reasons allergic rhinitis goes unrecognised for years is that its symptoms overlap with those of the common cold. Many people assume they simply "catch colds easily" or have a "weak immune system." In reality, the pattern of symptoms often points clearly to an allergic cause.

Signs That Suggest Allergic Rhinitis Rather Than Repeated Colds

• Duration: Colds typically resolve within 7–10 days. Allergic rhinitis symptoms persist for weeks, months, or year-round.
• Pattern: Symptoms that follow a seasonal pattern (worse in spring/summer) suggest pollen allergy. Symptoms that are consistent throughout the year — particularly worse indoors or in the bedroom — suggest perennial triggers like dust mites, pet dander, or mould.
• Nasal discharge: Allergic rhinitis produces clear, watery mucus. Colds often progress to thicker, yellow-green discharge as the infection develops.
• Itching: Itchy nose, itchy eyes, and itchy palate are hallmarks of allergic rhinitis and are uncommon with viral colds.
• Fever: Allergic rhinitis does not cause fever. If you have a temperature, an infection is more likely.
• Response to antihistamines: If over-the-counter antihistamines improve your symptoms, this supports an allergic mechanism.

If your "cold" never fully goes away, returns every time you go to bed, or is noticeably worse in certain environments, it is worth considering whether allergic rhinitis may be the underlying cause. Identifying the specific triggers through IgE blood testing can help clarify the picture.

Sleep Apnoea Basics: What to Be Aware Of

Obstructive sleep apnoea (OSA) is a condition in which the upper airway repeatedly collapses or narrows during sleep, causing breathing to stop briefly (apnoeas) or become significantly reduced (hypopnoeas). These episodes disrupt sleep — often without the person being fully aware — and can lead to significant daytime sleepiness, reduced concentration, and long-term cardiovascular effects if left unassessed.

Sleep apnoea triggers and risk factors include excess weight (particularly around the neck), male sex, increasing age, alcohol consumption close to bedtime, sedative use, and — relevantly for this article — chronic nasal obstruction.

How Allergic Rhinitis May Worsen Sleep Apnoea

While allergic rhinitis does not directly cause OSA, it can contribute to the severity and frequency of apnoeic episodes. The mechanism is straightforward: when the nasal passages are chronically congested, the body compensates by breathing through the mouth. Mouth breathing during sleep changes the position of the jaw and tongue, narrowing the oropharyngeal airway and making collapse more likely.

A study in the Journal of Clinical Sleep Medicine found that patients with allergic rhinitis had a significantly higher prevalence of sleep-disordered breathing compared to controls (Young et al., 1997). Other research has shown that treating nasal inflammation in OSA patients can improve compliance with CPAP (continuous positive airway pressure) therapy and, in milder cases, may reduce the apnoea–hypopnoea index.

Signs That May Suggest Sleep Apnoea

• Loud, persistent snoring — particularly if a partner has witnessed pauses in your breathing
• Gasping or choking during sleep
• Excessive daytime sleepiness despite apparently adequate sleep time
• Waking with a headache or dry mouth
• Difficulty concentrating or memory problems
• Nocturia (waking frequently to pass urine)

Important: Sleep apnoea requires formal assessment, which typically involves a sleep study arranged through your GP or a sleep specialist. Allergy blood testing can identify whether allergic rhinitis may be contributing to your nasal symptoms, but it cannot diagnose or assess sleep apnoea itself.

Identifying Allergic Triggers That Worsen Congestion

If allergic rhinitis is contributing to your sleep problems, identifying the specific triggers is an important step. The most common indoor allergens associated with perennial nasal symptoms and night-time congestion include:

House Dust Mites

Dust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae) are the most common cause of perennial allergic rhinitis in the UK. They are microscopic creatures that feed on shed human skin cells and thrive in warm, humid environments — particularly bedding, mattresses, and pillows. Because exposure is highest during sleep, dust mite allergy is a frequent driver of night-time nasal congestion and snoring and allergies patterns.

Pet Dander

Proteins in cat and dog dander, saliva, and urine are potent allergens. If a pet sleeps in the bedroom — or if dander has accumulated in carpets, curtains, and upholstered furniture — exposure continues throughout the night even if the animal is not present. Cat allergen (Fel d 1) is particularly persistent and can remain airborne for hours.

Mould Spores

Indoor moulds — including Alternaria, Aspergillus, Cladosporium, and Penicillium — produce spores that are common triggers for allergic rhinitis. Mould thrives in damp, poorly ventilated environments: bathrooms, kitchens, window frames, and bedrooms with condensation issues. In the UK, mould exposure is a year-round concern, particularly in older or poorly insulated housing.

Pollens

Grass pollen (May–July), tree pollen (February–June), and weed pollen (June–September) are the main seasonal triggers in the UK. While pollen exposure primarily occurs outdoors, pollen grains can enter the bedroom through open windows, be carried on clothing and hair, and settle on bedding. People with seasonal allergic rhinitis often notice their sleep is most disrupted during their specific pollen season.

Why Targeted IgE Testing Helps

Many people with nasal congestion assume they know what they are allergic to — but assumptions can be wrong. A person who blames their cat may actually be sensitised to dust mites. Someone who assumes they have "hay fever" may be reacting to mould in their bedroom rather than outdoor pollen.

A specific IgE blood test measures the immune system's response to individual allergens. The Allergic Rhinitis/Asthma Profile tests for a targeted panel of the most common aeroallergens — including dust mite, cat dander, dog dander, birch pollen, timothy grass, and several mould species — from a single blood sample. This can help clarify which specific triggers are involved, allowing environmental changes and management strategies to be properly targeted.

Home Strategies to Reduce Night-Time Symptoms

While environmental changes alone may not resolve allergic rhinitis entirely, reducing allergen exposure in the bedroom can make a meaningful difference to sleep quality — particularly when combined with appropriate medical management guided by your clinician.

Bedding and Mattress Management

• Use allergen-proof (mite-proof) encasings on mattresses, pillows, and duvets. These have a pore size small enough to prevent dust mite allergens from passing through.
• Wash bedding at 60°C or above every one to two weeks. Dust mite allergens are not removed at lower temperatures.
• Consider replacing older pillows and duvets that may have accumulated years of dust mite allergen.
• Vacuum the mattress regularly using a vacuum cleaner with a HEPA filter.

Humidity and Ventilation

• Dust mites thrive in humidity above 50%. Use a hygrometer to monitor bedroom humidity and a dehumidifier if needed.
• Ensure adequate ventilation to reduce moisture and discourage mould growth. Opening windows briefly during the day (avoiding peak pollen times if pollen-sensitised) helps air circulation.
• Address any visible damp or condensation — particularly around windows, walls, and ceilings.

Pet Management

• If you are sensitised to pet dander, ideally keep pets out of the bedroom entirely — including during the day, as allergen accumulates on surfaces.
• Wash hands after handling pets, particularly before touching your face or bedding.
• Consider HEPA air purifiers in the bedroom to reduce airborne pet allergen particles.

Nasal Hygiene

• Saline nasal irrigation (using a neti pot or saline spray) before bed can help clear mucus and allergens from the nasal passages.
• Nasal corticosteroid sprays — available over the counter in the UK or on prescription — are the most effective treatment for allergic rhinitis according to BSACI and NICE guidance. Discuss their use with your GP or pharmacist.
• Avoid regular use of decongestant nasal sprays (e.g., oxymetazoline) beyond 5–7 days, as they can cause rebound congestion (rhinitis medicamentosa).

Sleep Position and Environment

• Elevating the head of the bed slightly (using a wedge pillow or raising the headboard) may reduce nasal pooling and improve breathing comfort.
• Keep the bedroom cool (around 16–18°C is commonly recommended for sleep quality).
• Remove or reduce soft furnishings that trap allergens — heavy curtains, carpets, and upholstered chairs in the bedroom all accumulate dust mite and pet allergen.

When to Seek Further Assessment

While allergic rhinitis is common and often manageable, there are situations where further assessment is important — particularly when sleep is significantly affected.

Consider Speaking to Your GP If:

• Your nasal congestion is persistent and not adequately controlled by over-the-counter antihistamines or nasal sprays
• You snore loudly and regularly, especially if a partner has noticed pauses in your breathing or gasping episodes
• You experience excessive daytime sleepiness that affects your work, concentration, or ability to drive safely
• You wake frequently during the night or consistently feel unrefreshed despite adequate sleep time
• Your child snores regularly, breathes through their mouth at night, or has difficulty concentrating at school

Your GP can assess whether a referral to an allergy specialist (for rhinitis management) or a sleep specialist (for suspected sleep apnoea) is appropriate. An allergy blood test can be a useful first step before your GP appointment, providing objective data about which allergens — if any — you are sensitised to.

What to Bring to Your Appointment

• A description of your symptoms: which ones, how long you have had them, and any seasonal or environmental patterns
• Information about your home environment: type of bedding, pets in the home, any damp or mould issues
• Details of any medications you have tried and their effect
• If available, your IgE blood test results — these give your clinician an objective starting point for discussion
• Any observations from a partner about snoring patterns, breathing pauses, or restless sleep

Questions to Ask After You Receive Your Report

• Which allergens am I sensitised to, and are these consistent with my symptom pattern?
• Should I be referred to an allergy specialist or an ENT specialist for further assessment?
• Would a nasal corticosteroid spray be appropriate for my symptoms?
• Are environmental changes (such as dust mite covers or removing pets from the bedroom) likely to make a meaningful difference?
• Given my symptoms, should I be assessed for sleep apnoea with a sleep study?
• Is immunotherapy (desensitisation) something I should consider in the longer term?
• How often should I be re-tested if my symptoms change or I start treatment?

Frequently Asked Questions

Can allergies cause sleep apnoea?

Allergies do not directly cause obstructive sleep apnoea, but they can contribute to it. Allergic rhinitis causes nasal congestion and swelling of the nasal passages, which increases airway resistance. In people who are already predisposed to OSA — for example due to anatomy, weight, or other factors — chronic nasal obstruction from untreated allergies may worsen the severity and frequency of apnoeic episodes.

Why is my nasal congestion worse at night?

Several factors combine. Lying down causes blood to pool in the nasal blood vessels, increasing swelling. Bedroom allergen exposure — particularly to dust mites — peaks during sleep. Additionally, the body's natural cortisol levels drop in the evening, reducing their anti-inflammatory effect.

What are the most common allergic rhinitis symptoms?

The most common allergic rhinitis symptoms include a blocked or stuffy nose, a runny nose with clear or watery discharge, repeated sneezing, itchy nose and throat, itchy or watery eyes, postnasal drip, and reduced sense of smell. When persistent and particularly noticeable at night, these can significantly disrupt sleep quality.

Can children with allergies develop sleep problems?

Yes. Allergic rhinitis in children is associated with sleep-disordered breathing, mouth breathing, snoring, and restless sleep. Chronic nasal congestion can also contribute to adenoid enlargement, further narrowing the airway. Poor sleep in children may present as behavioural difficulties, irritability, and difficulty concentrating at school.

Do I need to stop antihistamines before an allergy blood test?

No. Unlike skin prick testing, IgE blood tests are not affected by antihistamine medication. You can continue taking your regular antihistamines, nasal sprays, and other allergy medications before your appointment.

What is the difference between seasonal and perennial allergic rhinitis?

Seasonal allergic rhinitis (hay fever) is triggered by outdoor pollens and causes symptoms during specific seasons. Perennial allergic rhinitis causes year-round symptoms and is usually triggered by indoor allergens such as house dust mites, pet dander, and mould spores. Many people have both.

Can mould in the home affect sleep quality?

Yes. Mould spores are a recognised trigger for allergic rhinitis, and exposure in the bedroom — particularly in damp or poorly ventilated environments — can worsen nasal congestion at night. Specific IgE testing can identify whether you are sensitised to particular mould species such as Alternaria or Aspergillus.

How can I tell if my snoring is caused by allergies?

Snoring and allergies often have characteristic patterns. Snoring may be worse during certain seasons (if pollen-related), after exposure to specific triggers such as pets, or consistently present year-round if driven by dust mites. If your snoring is accompanied by other rhinitis symptoms — sneezing, itchy nose, watery eyes — an allergic component is worth investigating through IgE blood testing.

Will treating allergic rhinitis improve my sleep?

Research suggests that effective management of allergic rhinitis can improve sleep quality. A systematic review in the Annals of Allergy, Asthma & Immunology found that treating nasal allergy symptoms was associated with improvements in sleep-related outcomes. However, management decisions should be discussed with your GP or specialist based on your individual results.

Considering an Allergy Blood Test?

If persistent nasal congestion, snoring, or disrupted sleep is affecting your quality of life, identifying the specific allergens involved can be a useful first step. An IgE blood test provides objective data about which airborne allergens — if any — your immune system is sensitised to, giving you and your clinician a clearer starting point for management.

At Allergy Clinic, we offer nurse-led venepuncture and laboratory-analysed specific IgE testing, including the Allergic Rhinitis/Asthma Profile, House Dust Mite Components, Cat Components, and the comprehensive ALEX² panel. Our service provides a diagnostic blood sample and a detailed laboratory report. We recommend taking your results to your GP, allergist, or sleep specialist for clinical interpretation and personalised guidance.

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Sources

• NHS — Allergic rhinitis, Hay fever, Sleep apnoea. Available at: nhs.uk/conditions/allergic-rhinitis
• Allergy UK — Rhinitis factsheets and patient guidance. Available at: allergyuk.org
• British Society for Allergy and Clinical Immunology (BSACI) — Guidelines on rhinitis management. Available at: bsaci.org
• NICE — Clinical Knowledge Summary: Allergic rhinitis. Available at: nice.org.uk
• Anaphylaxis UK — Recognising and managing severe allergic reactions. Available at: anaphylaxis.org.uk
• Léger, D. et al. (2006). Allergic rhinitis and its consequences on quality of sleep: an unexplored area. Archives of Internal Medicine.
• Young, T. et al. (1997). Population-based study of sleep-disordered breathing as a risk factor for hypertension. Archives of Internal Medicine.
• Craig, T.J. et al. (2004). Allergic rhinitis and sleep disturbance. Annals of Allergy, Asthma & Immunology.