Dear Dr. Garner, 
I really need your help. My husband is driving me crazy. Every night when we get ready for bed, he starts to cough.  It goes on for a couple of hours, and is interfering with my sleep.
I don’t want to sleep in separate rooms, but it is heading that way. What should I do?
Sleepless in Sheepshead Bay
 
Dear Sleepless,
I am glad you asked this question. A  cough may be a manifestation of a serious medical problem. Some of the causes of a chronic cough include:

• Reflux of acid from the stomach into the chest area (esophagus).

• Heart disease

• Asthma – in fact it may be the only sign of asthma, particularly when one is exercising

• Post-nasal drip (PND) — the most frequent cause of chronic nighttime cough

• Smoker’s cough

• Medications – high blood pressure pills are the biggest culprit

• “Nervous habit cough” – usually some anxiety provoking event is occurring

• Hay fever and allergies – this is the time of year when they are most prevalent

• Viral infections – the common cold or other viruses

• Chronic kidney disease
 
The first thing to do is to exclude the above. Your doctor can determine if any medications or serious underlying medical conditions are the culprits.

If no obvious cause is found, the possibility of “psychogenic cough” or “emotional cough” must be considered.

Your doctor will want to know about any fevers that accompany the cough, whether or not you bring up phlegm with the cough, and if you have a history of allergies or hay fever.

There is a temptation to give a patient cough medicine to stop the cough, however, this merely covers up the problem, without getting to the root.

There are some things I suggest for my patients with this problem, which are helpful no matter what the cause:

• Obtain a humidifier – dryness in the atmosphere predisposes to scratchy throats and cough.

• Drink extra fluids – once again, the key is to avoid dryness, and drinking plenty of fluids, can be a big help.

• Vacuum pillow and mattresses frequently – a common cause of chronic nighttime cough are dust mites which can also be controlled by reducing clutter.

• If allergies (hay fever) are troubling a patient, it is best to take one of the new, non-drowsy antihistamines, such as Claritin one to two hours before bedtime.

• Make a list of all medications, both over the counter and prescription that you take, and have a pharmacist review the list to determine if any of medication has cough as a side effect.
 
I hope that the above discussion helps, and that you and your husband can continue to sleep in the same room, in peace for many more years to come.
 
Another issue reared its ugly head at a party I attended this past Saturday evening.

A good friend, without any punches to his nose, experienced bleeding from his right nostril.

This type of condition, while most times benign and self-treatable, can be quite disturbing, not to mention the effect on white shirts.

Nose bleeds occur when tiny veins in the lining of the nose, become fragile and burst.

The causes include, dryness, blowing the nose with great force, use of medications (aspirin) which decrease clotting, allergies (hay fever) which irritate the lining of the nose, picking the nose and scratching the veins with fingernails, trauma, and finally, high blood pressure.

The key treatment is pressure on the affected side of the bleeding. The pressure should be kept for at least 10 minutes. Please note that it should be 10 minutes straight – not releasing pressure in between to see if the bleeding has stopped.

Sit down quietly and lean forward, so as not to have blood dripping down the back of the throat.

Ice should be applied to the affected side with pressure. This should be placed up against the bridge of the nose.

After the bleeding has stopped, take precaution not to blow the nose hard or irritate the affected nostril for at least 24 hours.

Never pack the inside of the nose with gauze. It will not help the bleeding stop, and may aggravate it as you pull it out.

Apply some Vaseline to each nostril before bedtime to keep the lining moist.
Some final tips, include keeping the fingernails short, and if possible, using a humidifier at night. Of course, if you smoke, make sure to stop, as this can irritate the inside of the nose.

On rare occasions, it might not be possible to stop the bleeding at home, and a visit to the emergency room is warranted. Doctors may have to pack the nose, with special material, and on rare occasions, a procedure may be necessary to stop the bleeding.

If the bleeding cannot be stopped within 30 minutes, then I suggest making this trip.

Of course, make sure to check your blood pressure after the bleed has stopped to verify that this is not the cause.
 
I hope this helps others, as springtime is a common time of year to experience a  nose bleed. This is related to the hay fever that many experience in spring.

I wish you all a great week, and look forward to seeing you for the next live “Ask the Doctor Show,” on The Prayer Channel, on Tuesday, May 13, at 8 p.m.
Be well.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also is the host of the popular “Ask the Doctor” cable TV show seen on The Prayer Channel.