Q Dear Dr Josephson:  My intense coughing is keeping me up at night.  In fact, between my snoring and coughing my wife is now having me sleep on the couch.  My internist put me on a whole bunch of medicine which did very little.  He then sent me to a pulmonologist who put me on different antibiotics and an inhaler.  He said that I had a little asthmatic bronchitis. 

I used the antibiotic for a week or two and my coughing started to clear (not much improvement on the snoring), but when I went off, I was right back to where I started, hacking away.  My nasal congestion gets a little better with the medicines but I still breathe through my mouth and it gets worse when I get off the antibiotics.  I can't be on antibiotics for ever.   

My internist also sent me for allergy testing which showed that I have significant seasonal allergies.  I have just started on allergy shots.  In the meantime, I am still miserable and am not sleeping well.  And my wife is not letting me back in the bedroom because I am coughing all night and snoring.  I am also coughing at work and people think that I have something wrong with me.  And I am exhausted all the time.   Can you help me?

Coughing like crazy

Dear coughing like crazy:

It sounds to me like you suffering from both allergies and sinus problems.  The nasal congestion and obstruction may be causing you to snore.  Snoring is the number one medical cause for divorce and breakup of same and opposite sex partners.  Sleep apnea can cause heart attack or stroke, so it can be serious-at the very least, it can make you tired.   Your symptoms are real and make sense as I will describe below.  The sinus problems and allergies are causing your post-nasal drip to drip into your lungs and this is causing you to cough. 

I believe that your sinus problems are connected by what I call CAID--chronic airway-digestive inflammatory disease which connects sinus problems, allergies, asthma, snoring, sleep apnea, and gastroesophageal reflux disease (GERD).  Most important is that you are concerned about your wife.  They say a happy wife is a happy life.  She has to get her rest.  So let's get started.  First, sinus infection can give you yellow green or white and clear nasal discharge which can be thick and sticky.  This can cause you to cough, clear your throat and can upset your stomach.  There are a few more questions that you need to answer including do you suffer from gastroesophageal reflux and/or sleep apnea. GERD can reflux into your airway causing inflammation and this can cause you to cough.

So what can you do to resolve this? 

  • First you might want to start by irrigating your sinuses with saline solution.  You can use a netipot, a squeeze bottle, or a Grossan Hydropulse.  You can get these at any local pharmacy or on line. 

  • Next you should make sure that your environment is clean of dust and molds.  Clean the wet rooms in your home.  You bathrooms, wash rooms and kitchen may be areas where there is mold and will need to be cleaned with bleach.  This will kill the mold. And afterwards keeping these areas dry will help.

  • You should have your board certified ENT physician send you for a sleep study to determine if you have sleep apnea. 

  • If you have a weight problem than you should immediately find someone that can help you to lose weight.  This will help with the snoring and sleep apnea if you suffer from sleep apnea.  Most people know what they need to do to lose weight and this would include exercise so you can start immediately.  This is not easy, but it is very important.  This will help with the snoring and the sleep apnea. 

  • Your allergist should continue to give you allergy shots and you might want to take some antihistamines and clean up your environment.  My book Sinus Relief Now has a whole chapter on what to do for allergies including tips to reduce allergen contact in your home and environment.

  • Gargle with an 8 ounce glass of warm water with ¼ tsp salt twice a day.

Understand that your problem is complex and that you are going to need the help of a physician.  You will likely need to be on antibiotics for longer than a week or two.  Generally, patients with similar symptoms need to be on antibiotics for a minimum of 3-8 weeks, as well as on a host of other medicines. You should take holistic acidophilus and probiotics which are important to keeping your GI tract and body in balance and will help to prevent a yeast infection.  Alternative therapies like vitamins and nutritional support are paramount to keeping your body healthy and enhancing your immunity.  Your doctors will need to decide the best course of treatment.   Your doctor should also refer you to a board certified ENT (sinus specialist) who is a CAID or sinus specialist.  You should not take these problems lightly--if you suffer from snoring and sleep apnea, it is critical to know that they can have devastating consequences, for both your health and your relationships.

Other symptoms that people may suffer from include either nasal symptoms--nasal blockage, stuffy or runny nose, yellow, green or white discharge which can be thick and sticky, nasal bleeding (epistaxis), post-nasal drip, allergysneezing, runny nose, itching, sinus or facial pain, pressure or headaches, dental- gingivitis-gum disease, cavities, bad breath (halitosis), toothache, dental sensitivity, pain; ear problems- ear infections, hearing loss, ear pain, difficulty flying and diving and equalizing,  tinnitus-ringing in the ears, dizziness; headaches- sinus and or migraines,  eye problems like tearing- tear duct blockage (dacrocystitis), redness of the eye-conjunctivitis, burning or itching, swelling of the eye(s); chest problems-chronic cough, wheezing, asthma, bronchitis, shortness of breath; throat problems- throat clearing, hoarseness, laryngitis, sore throat, tonsillitis, and difficulty swallowing.

A big issue is that many physicians are unable to connect their symptoms to their sinuses and CAID--which may actually be the root of their problem.  Many patients call me from around the world after they read my book, Sinus Relief Now and say: How did you know?  Your book describes me to the tee and my docs don't understand.  Well I am a fellow sufferer.  And there are solutions.  Good sinus health equals good total body health, so get to the right doctor so that you can start feeling better.

So start irrigating and losing weight and cleaning up your environment.  You are going to have to address your allergies as well, and Sinus Relief Now will give you a lot of information about how to attack those offending allergens to make your allergies better and more livable.  I would certainly be interested in you letting me know what you think about the book after you read it.  And give us some follow up after you see a sinus specialist that understands CAID.

Good Luck and keep us posted.


Dr J


Dr. Jordan S.  Josephson is an internationally renowned nasal and endoscopic sinus surgeon. He also has a large experience with voice and treatment of voice disorders.  He has recently written a book for the public entitled Sinus Relief Now (www.sinusreliefnow.com) on sinus disease, allergies, asthma, snoring and sleep apnea and GERD (gastro-esophageal reflux disease) which he believes are all related inflammatory diseases and he has coined the term CAID -chronic airway-digestive inflammatory disease to describe this inflammatory process. He was recently on Oprah discussing a patient that he successfully treated for snoring and sleep apnea.  He was featured in NY Magazine as one of 13 innovators in medicine and is listed as one of Castle Connolly's Top Doctors in the United States.  He finished the first fellowship in Endoscopic Sinus and Nasal Surgery in the United States at the Johns Hopkins Medical Center.  He held the academic rank of an instructor at Johns Hopkins Medical School.  He was a consultant to the National Institutes of Health for six years where he did research on Wegeners Granulomatosis and nasal and sinus disease. 

 Presently, Dr. Josephson is in private practice in Manhattan. He is affiliated with prestigious institutions including Lenox Hill Hospital, Manhattan Eye, Ear & Throat Hospital and St Lukes Roosevelt Hospital. Beyond the traditional clinical treatment of his patients, he actively participates in the latest research and uses this knowledge as a medical educator, lecturing around the world.  He treats patients with difficult sinus disease, voice disorders, allergies, asthma, GERD, snoring/sleep apnea, and nasal deformities leading to airway obstruction. He performs nasal surgery including rhinoplasty for nasal breathing and deformity problems.   He treats voice disorders with the latest of medical treatment.  Dr Josephson utilizes a combination of the best of eastern alternative and western medicine treatment in conjunction to his expertise in Functional Endoscopic Sinus and Nasal and Voice/Throat  Surgery and Snoring Sleep Apnea Surgery to treat the most complicated cases.