To the Editor.—
Aldrich and Chauncey1 confirm an association of morning headaches with sleep disturbance. As I have often observed in my experience, the cause of both problems is nasal and associated sinus diseases. Indeed, the headache of sinusitis is generally described as one that is "worse when the patient awakens and improves during the day with the erect position."2Lavie3 has demonstrated that nasal obstruction can dramatically affect sleep patterns. In a study investigating male workers with sleep complaints, an increased number of apneic episodes were associated with both increased otolaryngological complaints and headaches.3 Experimental nasal obstruction is associated with more frequent apneas, arousals, and awakenings.4 Similarly, the beneficial effects of adenotonsillectomy and septoplasty on sleep have been demonstrated in selected patients.In a prospective study of 297 patients under the age of 40 years from my practice of general internal medicine, 22 patients
Chester AC. Sleep and Nasal Disease. Arch Intern Med. 1991;151(8):1669. doi:10.1001/archinte.1991.00400080149031
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