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Dear Asking for a Friend,
I can’t breathe through my nose very well when I’m sleeping. I have to prop up my head to get better airflow. Is this normal or a sign of something more serious? (nasal polyps maybe?)
—Congested Sleeper
Dear Congested Sleeper,
Stuffy noses are the worst, especially when they prevent you from getting a good night’s sleep. The result: a crappy morning that fails to set you up for a pleasant and productive day.
In fact, nighttime congestion has been linked to daytime fatigue, shortness of breath, headache, bad mood, drowsiness, and…you guessed it: sleep problems. Poor sleep has been further associated with a variety of health issues, including type 2 diabetes, high blood pressure, depression, a compromised immune system, and low sex drive. Not to mention, a stuffy nose at night forces you to breathe through your mouth, which may lead to dryness and bad breath, as well as brain fog and irritability when you wake up.
The most natural way to breathe during sleep is through your nose, according to Dr. Raj Dasgupta, a pulmonary and sleep medicine doctor and spokesperson for the American Academy of Sleep Medicine. Inhaling through your nose helps humidify and warm the air, prevents debris and toxins from entering your lungs, and can lower blood pressure.
It’s a well-established yet frustratingly confusing cycle: Why, if you can breathe through your nose perfectly fine during the day, does your nose clog up and betray you at night?
Before we get into the specifics, Congested Sleeper, know that nighttime congestion is common and not usually a cause for concern as long as it’s not accompanied with other symptoms, particularly ones that also affect you during the day, Dasgupta said. This can include green or yellow mucus with a bad smell, bloody mucus, fever, headache, pain in the face, and sleep disruptions that last for more than a week.
Try propping your head up while sleeping
The simplest reason for unexplained nighttime congestion is that when you lie in bed, blood flow increases to your head. More blood in your head also means more blood in the vessels that line your nasal passages, Dasgupta said, similar to what happens when you hang upside down.
When blood vessels become engorged, they push fluid into surrounding tissues, causing swelling and congestion, despite the absence of excess mucus. This inflammation of the nose is called rhinitis.
Lying horizontally also makes it hard for your sinuses, which will always have small amounts of mucus in them, to drain naturally because you’re fighting gravity, Dasgupta explained, “so you can imagine that might make your stuffy nose even worse.”
So, by propping your head up in bed, you’re already one step ahead of the problem. Manipulating your sleep positions with pillows, for example, is one of the best ways to avoid a stuffy nose at night, experts say.
If possible, you’ll want to avoid sleeping on your back as well because that could block and narrow your airways, making it harder to breathe, especially if you have obstructive sleep apnea. (Sleep apnea is a disorder where the upper airway collapses and blocks breathing — sometimes hundreds of times a night — and is linked to snoring, hypertension, and other health problems.)
Eliminate irritants and allergens in your home, especially your bedroom
Your home is filled with tiny and mostly invisible irritants and allergens that can aggravate your nose and make you congested at night. There’s pet dander (microscopic flakes of skin from your dog or cat), dust, mold, pollen, chemicals, and more that could be lurking on your mattress, pillows, bedside tables, window curtains — just about everywhere.
Researchers found that more than 99% of the nearly 7,000 homes they collected dust samples from had at least one of the eight common allergens they looked for: dog and cat dander; proteins shed by cockroaches, mice, or rats; mold; and two types of dust mites, according to a 2017 study. Overall, 74% of the homes had three to six allergens. Homes with animals and pests were most likely to have multiple allergens, as well as rental, mobile, and older homes, and those in rural areas.
Even if you’re not specifically allergic to any of these particles, your nose can still recognize them as foreign and ramp up mucus production to kick them out. This is called nonallergic rhinitis. The tissue lining inside your nose will become inflamed in the process, blocking mucus from draining and leading to even more congestion, as well as pain, pressure, and, in some cases, infection.
Allergic rhinitis triggers similar symptoms, but in this case your body has a specific type of inflammatory reaction to an allergen. Your immune system detects the invaders and pumps inflammation-causing chemicals such as histamine into your bloodstream that cause the blood vessels in your nose to widen and feel clogged.
Your first step to eliminate irritants and allergens from your home and specifically your bedroom:
- Don’t let pets sleep on your bed or in your bedroom.
- Run an air purifier throughout the night to improve air quality.
- Remove carpets or rugs in your bedroom because they tend to trap allergens more than bare wood or tile.
- Close windows and run an air conditioner during pollen season or when air quality is poor outside.
- Vacuum your mattress weekly.
- Wash bedsheets and pillowcases once a week, or every three to four days if you have allergies or asthma.
- Vacuum and dust your bedroom frequently.
- Run a dehumidifier in your bedroom. Dust mites thrive in high-humidity environments and survive by drinking moisture from the air, so aim to keep your house at less than 50% humidity. (Cockroaches love damp indoor environments too, so low humidity will help there as well.) During colder months, you can run a humidifier to help moisten your nasal tissues and ease the irritation that can happen when the air is too dry.
- Take an antihistamine before you go to sleep if you need to, but follow the manufacturer’s suggestions as to when and how long you should take it.
Ask your doctor about medication side effects
Certain drugs like ibuprofen and aspirin, beta blockers used to treat conditions like high blood pressure and heart arrhythmias, birth control, and antidepressants have been found to cause nasal congestion. If your nighttime congestion is seriously affecting the quality of your sleep, Dasgupta recommends speaking with your doctor about dosage adjustments or alternative medicines, as well as remedies to reduce stuffiness.
Pregnancy could also cause nasal congestion that can worsen at night for reasons already listed, Dasgupta said; it’s called pregnancy rhinitis, and it’s not caused by an infection or allergies, although those conditions can make it worse. It’s thought that an increase in sex hormones such as estrogen and progesterone play a role by triggering inflammatory processes in the body.
Birth control, menopause, and hypothyroidism could influence hormone levels enough to affect your nasal passages too.
You can have structural issues in your nose
Structural abnormalities in the nose, including nasal polyps, a deviated septum, or swollen turbinates (small structures that hang from the inside of your nose), could certainly make you congested at night.
However, Dasgupta said that if this was your problem, you’ll likely notice at least some congestion during the day as well. These abnormalities are prone to increased swelling at night, which is why people who have them experience worse congestion when trying to go to sleep.
Reduce stress
Once you’ve tried to eliminate allergens and irritants and addressed other conditions or medications you may be taking, it can make sense to address other issues like your stress levels.
You may feel relaxed when slipping into bed at night, but the stress you’ve accumulated throughout the day can still be silently wreaking havoc — yes, even on your sinuses, Dasgupta said.
There isn’t a clear cause–effect relationship between stress and nighttime congestion, but experts speculate that stress weakens the immune system, making you more vulnerable to allergens, bacteria, and viruses.
Practicing calming techniques like meditation or even playing a relaxing music playlist before bed may help prime your brain for sleep.
Other tips to prevent or alleviate a stuffy nose at night
- Drink plenty of water. Staying hydrated throughout the day will help thin your mucus and boost your sinuses’ mucus-clearing abilities. You can also try drinking warm teas before bed for similar effects.
- Take a warm or hot shower right before bed. The steam can open your nasal passages and make it easier to breathe.
- Avoid caffeine and alcohol before bed.
- Use an over-the-counter nasal spray, but pay close attention to usage instructions. Some nasal sprays are meant to be used for no more than three days due to a rebound effect that causes more inflammation and congestion.
- Irrigate your nose with a neti pot, but only with distilled bottled water or cooled boiled water. Rinsing your nose with tap water could expose you to rare but deadly organisms. (It’s not enough to filter water, you need to sterilize it.)
- Put a warm, wet towel over your face to help loosen mucus and relieve pressure.
- Apply a nasal strip to the outside of your nose, which can make it easier to breathe and reduce snoring.
- Avoid acidic foods and beverages like carbonated drinks, citrus fruits, chocolate, fried food, and fatty meats like bacon or sausage. Acid reflux has been linked to rhinitis.
If you can’t seem to remedy your stuffy nose, it’s probably a good idea to get it checked by an otolaryngologist (ear, nose, and throat doctor).
If you do plan on seeing a doctor to address your stuffy nose concerns, Dasgupta said it can be helpful to document the nights you feel congested alongside information like the foods you ate that day, whether you’re menstruating, if you had a stressful day at work, etc.
“It never hurts to be a Sherlock Holmes,” Dasgupta said.
