man with a clothespin on his nose

Do you breathe through your mouth when you sleep? A lot of people do. That’s because they experience nighttime nasal congestion. It’s not pleasant. Your mouth gets terribly dry and scuzzy. Nighttime mouth breathers go to great lengths to try to overcome this problem. Some over-the-counter solutions are not great as this reader so vividly points out.

Overcoming Nighttime Nasal Congestion Comes At a Price:

Q. I have tried everything for nasal congestion. Although some remedies work for a while, nothing has worked consistently over the years better than nose sprays. The problem–they are addictive.

My congestion is always at night, so I either have to use the sprays or I can’t sleep. I have tried oral decongestants. They clear up my nasal passages, but the ingredients keep me awake. I have also tried nasal strips with little success.

I wish there was a remedy that would help with my severe nighttime nasal congestion while letting me sleep through the night.

The Double Bind of Nighttime Nasal Congestion

A. You are caught in a classic double bind. Many people find that oral decongestants keep them awake.

Pseudoephedrine used to be widely available in OTC cough, cold and allergy medications. For example, you may recognize the familiar brand name Sudafed. Now, you have to ask the pharmacist if you want to purchase any product containing pseudoephedrine. It is only available behind the counter.

What Does It Take to Buy Pseudoephedrine?

The Patriot Act was signed by President George Bush on March 9, 2006. In this legislation there was the Combat Methamphetamine Epidemic Act of 2005. It banned OTC sale of pseudoephedrine because the drug can be used illegally to manufacture methamphetamine (meth).

The only way to obtain Sudafed or other products (like Aleve-D Sinus & Headache) containing pseudoephedrine is to present the pharmacist with photo ID. The pharmacy will keep your personal information for at least two years after your purchase. People are limited in the amount of pseudoephedrine they can buy each month.

Side effects of pseudoephedrine may include nervousness and difficulty sleeping as well as difficulty urinating, rapid pulse, increases in blood pressure and palpitations.

Other Oral Decongestants:

You can still buy oral decongestants containing phenylephrine (often abbreviated PE) on the consumer-side of the counter. No driver’s license or photo ID is required. You can buy Sudafed PE without challenge. Advil Sinus Congestion & Pain contains phenylephrine as does Mucinex Sinus-Max, Tylenol Sinus and Robitussin PE Head and Chest Liquid.

If you see the word “D” in the name, “PE” or “Sinus,” you can assume it contains an oral decongestant. It will likely be phenylephrine. Side effects may include nervousness, insomnia, high blood pressure and dizziness.

Nasal Sprays and Rebound Nasal Congestion!

For people with nighttime nasal congestion it is very tempting to use an OTC nasal spray. Many readers have reported that regular use (more than three days) led them to become dependent upon decongestant nasal sprays. Here are just a few examples:

Michael was, in his words, “addicted” to his nasal spray:

“I was addicted to Afrin for many years. In 2007 I had a septoplasty and turbinate reduction procedure done. This helped tremendously, and I kicked the habit for 4 years.

“In 2011 I got really sick, and used Afrin to be able to breathe through the night. I was once again hooked on into 2017. The addiction comes from my inability to sleep if I cannot breathe through my nose.

“Since we sleep every night, the addiction continues. This past week I was awake for four days. Since I wasn’t sleeping, I had no need for Afrin. By the time I actually went to sleep, my nose was semi-clear. I was so exhausted that I slept easily despite my nose still being a bit blocked. When I woke up this morning, my nose was completely clear.

“Staying up for 4 days isn’t healthy, but it helped me kick this addiction. I’m beyond happy that I’ve once again reached freedom, and I will do everything I can to never use Afrin again.”

Vick also had a long-term “relationship” with Afrin:

“I was also hooked on Afrin for about 30+ years. I had a major heart attack and the cardiologist pulled me off Afrin. I did it the same way I did smoking – just quit and that was that. Yes, for a while I thought I would not be able to breathe. Today, I flush my sinuses with saline water (about twice a week or when needed).”

Here are links to ways to get overcome nasal spray dependence:

Can You Overcome an Afrin Addiction?

Nose Spray Addiction Hard Habit to Kick

Can You Overcome Nighttime Nasal Congestion?

The most important question this reader needs to resolve is why is he suffering from nighttime nasal congestion? Perhaps an allergist could identify what is causing the stuffiness.

Some people cannot give up their beat-up old pillows. When a pillow collects dust mites it can lead to night time nasal congestion. That’s because people who are allergic to mite poop get direct exposure from their pillow (and their old mattress) (Clinical and Experimental Allergy, June, 2004). Pillows can also harbor fungi such as aspergillus (Allergy, Jan. 2006). Researchers have found that:

“…the typical used pillow contains a substantial load of many species of fungi, particularly Aspergillus fumigatus. Given the time spent sleeping, and the proximity of the pillow to the airway, synthetic and feather pillows could be the primary source of fungi and fungal products.”

An allergist can identify substances that might be contributing to nighttime nasal congestion. Such a specialist can recommend ways to reduce reactivity. Avoiding the triggers that are causing the congestion would be the best solution.

Non-stimulant treatment options include steroid nasal sprays like fluticasone (Flonase) or triamcinolone (Nasacort 24HR). Such drugs can help ease withdrawal stuffiness from decongestants like Afrin. They may also ease symptoms of congestion. Some people report relief by using a saline nasal spray.

Fred offers this less-than-perfect strategy:

“I have been plagued with allergies since I was a kid. My main problem is that my nose stops up at night. I always breathe through my nose, so when I get stopped up (usually at 2-3 AM), I wash my sinuses with a nasal wash. That will give relief for a couple of hours. I have tried washing before going to bed, but still get nasal congestion.

“I have a HEPA filter going continuously in the bedroom and we change sheets on a weekly basis.”

Peggy says Xlear has been helpful:

“One product that has no side effects and is very effective at clearing a stuffy nose is Xlear. It is available at Walmart and other stores. It is made with xylitol, the sweetener used in toothpaste. I use it whenever necessary and it quickly relieves congestion. I highly recommend it!”

Share your own technique for overcoming nighttime nasal congestion in the comment section below.

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  1. Kathy MH

    A few years ago I had nightly nasal congestion. I was taking Sudafed 12 hr. as well as Flonase just to sleep. I would toss & turn with these meds, & not get very good sleep. On chance, I tried drinking much more water during the days, as well as before bedtime. Suddenly, I was able to breathe out of my nose at night. I tried it over and over, giving up the 2 above meds. It has been about 2 years that I haven’t used the meds. I now drink more water than I thought I needed, but now I can breathe at night.

  2. Len

    I’ve been using Breathe-Right strips, and they work well for me. Since I have trouble falling to sleep, I was also taking Advil-PM, which also helped my post nasal drip and coughing. When my blood work came back out of range, my doctor asked me what OTC drugs I was taking. He advised me to get off the Advil PM and just take Benadryl, which contains diphenhydramine, the night time ingredient in Advil-PM.
    When I shopped for Benadryl at CVS, I also saw their brand of Sleep Aid pills, which contained the same amount of diphenhydramine as Benadryl. A check with their pharmacist told me the ingredients were the same, so I have been using that product for about a year and it works very well for me.

    • Terry Graedon

      Keep in mind that diphenhydramine has anticholinergic activity.

  3. Leslie
    San Antonio, TX

    Try Chromolyn Sodium Nasal solution; OTC but had to be special ordered. Found out about it through The People’s Pharmacy! Combined with saline washing, most issues were resolved within a month!

  4. dr charles
    cary nc

    with all respect you two blew this one; and decongestants should always be avoided; the solution to this problem is diet , specifically alkaline , possible short term ppi.

    see josh hartfords numerous articles on the in Health and Healing

    Dr Charles

  5. Sophie

    I have always been plagued with nighttime congestion. I’ve had great success with NasalCrom. If I forget to use it, the congestion comes right back. I start to use it again, congestion is gone!

  6. Bruce

    I use a homeopathic nasal spray called “Sinus & Allergy” by BioAllers, available at the health food stores. It works in about 2 seconds. 2 sprays in each nostril. Only limitation is that it doesn’t seem to last all night, so if I wake up I may have to spray again. I don’t notice any side effects. Whether or not you believe in homeopathic medicine, it’s worth a try.

  7. Sigrid
    Petoskey MI

    Not scientific but I put my pillows and blankets outside in the sunlight and even on cloudy days and in freezing temperatures in the winter, too. When possible I hang bedding outside to dry because it absorbs light. I make my own laundry detergent and do not use dryer sheets or fabric softeners. I use vinegar instead. I take my own pillow when traveling.

  8. Jim
    Florence, Oregon

    I’m a mouth breather, which contributes to nasal congestion and my severe sleep apnea. I’ve been using a CPAP (continuous positive airway pressure) machine for years and enjoy restful sleep. When I remove the mask in the morning my nasal congestion returns within minutes. I would suggest persons with chronic nasal congestion that affects sleep to try CPAP, even in the absence of sleep apnea diagnosis. That seems to make more sense than the various medications discussed. I try to minimize use of medications, especially long term.

  9. Kirk
    St. Paul

    Afrin and closely related prescription nasal sprays (Otrivin was one) are now OTC but were prescription-only back around 1978. Phenylephrine (Neo-Synephrine was the original brand name) is also available OTC, is NOT a 12 hour spray, can be dosed every 4 hours I think (Be careful, as there may be 12-hour formulations using the brand name, if it is still available). It originally was available in 1%, 0.5% (1/2%) , 0.25% (1/4%) and 1/8% (labeled for children).

    My father was a chemist, bought the 1% and diluted it with distilled water to 1/4% to save money as the lower strengths cost more per unit of concentration. Phenylephrine nasal spray can still be bought in the generic form, Walmart sells it in the 1% spray (you have to read the labels very carefully, as the generic boxes look VERY similar to the 12 hour Afrin generic). Beware however, it can also cause rebound congestion upon withdrawal (especially the 1% strength), although the duration and intensity of the withdrawal is generally less and more tolerable.
    I have food allergies, which manifest themselves as reflux and indigestion along with nasal congestion, or runny nose when I eat. At age 13 I had an “addiction” to Vicks Sinex Spray, had no idea it was causing a congestion problem until our doctor informed us. 12 hour sprays, if used indiscriminately will eventually result in relief of only a few hours or even minutes, with worsening sinus congestion and pressure. I found using Phenylephrine spray gave temporary relief and made the withdrawal from the 12 hour nasal sprays much more tolerable. I would start at 1/2% or 1/4% and progressively dilute the spray every few days until I was at 1/4 or 1/8% or less, then discontinue it.. I still currently use Phenylephrine spray for night time congestion, but take the available 1% generic in 1 ounce bottles and dilute it to 10 or 12 ounces total with distilled or tap water. It still works to relieve the night time congestion, but I don’t experience rebound congestion, and do not use it at all during waking hours with no congestion problems. Admittedly saline spray would probably be better, but I never got much relief from it.

  10. HeavyDrop
    Dallas, TX

    I have had sinus congestion for years. Removing some molars helped (growing in the sinuses), as did sinus surgery (reamed them out). Allergy voodoo medicine said no allergies. The Doc’s refrain is “I can’t do much about it, but try this…” with an Rx for Flonase, get a Neti pot. It doesn’t work for me. The problem is mechanical, and the ENTs don’t want to do surgery again.

    By happenstance I was prescribed amitriptyline for neuropathy. It is off-label for this antidepressant. Immediately my nighttime congestion stopped. I assume it dried my sinuses up.

  11. Catherine

    I’m learning a complicated lesson related to what I have THOUGHT was nighttime congestion: It might not be allergies of any sort at all. It might well be the result of acid reflux. Anyone else seeing a connection? It’s being talked about in the reputable media. Any thoughts, words of wisdom, People’s Pharmacy?

    • Terry Graedon

      We’ve heard of reflux causing cough that might be diagnosed as asthma. We are not aware of a link between acid reflux and nasal congestion.

  12. Elsa

    Fred, there are allergen pillowcases available. Put one over your pillow, and use a fresh pillowcase every night, preferably cotton and not microfiber. Organic cotton is best since the cotton is not sprayed with herbicides or pesticides or treated with formaldehyde and finishing sprays after weaving. Ever smelled them right out of the package? I have also recommended to
    many people to use unscented laundry soap and skip dryer sheets. My dog no longer had breathing attacks (back cough) after adopting this method.

  13. Connie
    Greensboro, NC

    To avoid congestion, I use allergy pillow protectors which can be unzipped and laundered regularly. It helps with dust mite allergies and germs from head colds, etc. Flushing sinuses with my Neti pot helps a great deal too. When I’ve had a blocked nose from a cold I’ve found that using Afrin in only one nostril at a time works to avoid the rebound congestion. Another remedy is my inhaler, available in most health food stores, which I keep in my nightstand.

  14. Carol

    Not ONE person mentioned a humidifier–no one should sleep in the winter without one. Yes, they can be a nuisance to keep clean, but a cool mist humidifier is a MUST. Flushing the sinuses, saline drops, etc. are all great ideas, but sleeping in a dry heated room is not.

  15. Allan
    Penrose, NC

    Nasal strips were given little press in this article, but they do work! I also was addicted to Afrin, until some horrible nosebleeds sent me to the emergency room twice. The doctors suggested raising the head of my bed (a big help!) and using nose strips. Some work better than others, but if you choose one that is good for you AND APPLY IT CORRECTLY they do work well. For me, they have replaced Afrin for several years now.

  16. Mitzi

    I suffered from nighttime nasal congestion for years. Tried various remedies as discussed above. Finally went to see an ENT physician who told me my left nostril was 95% closed, and the right one 75% closed due to a deviated septum. I finally decided to go ahead with nasal surgery (done as an outpatient). Recuperating from the surgery was no picnic due to the length of time it takes for the swelling to go down (about 6 weeks or so). But, after that was over, I was great and have had clear breathing at night ever since! It has now been 5 years since the surgery.

  17. Leslie
    Everett, WA

    I have found that using an essential oil called “Breathe” on the outside front of my nostrils is a big help. I also put one drop of Peppermint essential oil on my finger and apply it to the back of my tongue. The almost-instant result is incredibly helpful. I can breathe and the post-nasal drip is gone, so no coughing.

  18. Brian P. M.
    Lake View, NY

    Nasal congestion is terrible. Tried all the remedies with little success. Decided to stop all sprays etc and threw out my plastic container of green tea in the refrigerator that I have used for 2 years so that there was no more.

    Now nasal congestion is a thing of the past.

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