Why a Stuffy Nose May Get Worse at Night

If you're congested during the day, having a stuffy nose at night is not uncommon. In fact, you may notice that your stuffiness is actually worse right when you're trying to get some much needed sleep.

A stuffy (or stuffier) nose at night can occur for a variety of reasons, including blood flow changes, prolonged exposure to indoor allergens, sleep position, and more. Treatment depends on the cause and can include strategies ranging from using a cool-mist humidifier to taking an antihistamine.

This article discusses the reasons why you may have a stuffy nose at night. It also explains how nighttime congestion is treated and provides tips for easing bedtime stuffiness.

Reasons Behind a Stuffy Nose at Night

If your nose is stuffy at night, one or both of the following are to blame:

• Excess mucus is blocking your nasal passageways
• Blood vessels inside your nasal passages are swollen and/or inflamed

It's possible that congestion may feel worse at night because you are too distracted during the day to notice how stuffy you really are. But that's not the whole story. The following can contribute to excess mucus and nasal swelling that increases nighttime stuffiness:

• Gravity
• Blood flow changes (including during pregnancy)
• The nasal cycle
• Acid reflux
  

Gravity

When you are standing or sitting upright during the day, mucus is constantly draining naturally due to the force of gravity. It makes its way from your nose and sinuses into the back of your throat, where it is swallowed. You likely don't even notice it's happening.

However, when you are in bed or reclining in a horizontal position, your anatomy is working against gravity. Mucus can pool or back up instead of draining.

Many people notice that congestion starts to improve an hour or two after they get up in the morning.

Blood Flow Changes

When you lie down, blood flow to the upper part of your body increases. This includes your head and nasal passageways.

This increased blood flow can inflame the vessels inside your nose and nasal passages, which can cause or worsen congestion.

Natural alterations in blood flow due to pregnancy are also a common cause of congestion.

Alternate-Side Nasal Congestion

Many people find that one nostril is clogged at certain times of the day, but the congestion switches sides at night. 

This is alternate-side nasal congestion, which is due to a normal process known as the nasal cycle. The reason for the cycle is unknown, but it is not a disorder. 

The congestion occurs when a turbinate (a structure along the sinus wall that produces mucus) becomes swollen in one nostril. This blocks airflow on that side.

Acid Reflux

Gastroesophageal reflux disease (GERD) is a condition that causes stomach acid to flow back up into the esophagus, the tube that connects your mouth to your stomach.

Known as reflux, it occurs when the sphincter between the stomach and esophagus (esophageal sphincter) is weak and unable to stay closed. Acid reflux can cause nasal irritation that can lead to congestion.

People with GERD can experience acid reflux at any time of day. And when you lie down and lose the help of gravity, stomach acid is even more likely to come up the esophagus.

This is why GERD symptoms, including nasal congestion, sore throat, coughing, postnasal drip, wheezing, and hoarseness, tend to worsen at night and early in the day.

Reducing Nighttime Congestion

Studies show that a stuffy nose at night can have a big impact on sleep quality. In fact, people with chronic sinusitis are three to nine times more likely to experience sleep disturbances with frequent nighttime awakenings.

Try these tips to help reduce nighttime congestion and sleep better:

• Elevate the head of your bed instead of lying flat.
• Don't eat within a few hours before going to bed or lying down.
• Use a cool-mist humidifier at the side of your bed.
• Drink plenty of water throughout the day.
• Stop smoking.

If a medical condition is causing your stuffiness, your healthcare provider may recommend additional strategies and medications to ease your symptoms and help you sleep.

For example, allergies can be treated with antihistamines, nasal steroids, or immunotherapy. Medications such as antacids and proton pump inhibitors are commonly used to treat GERD.

Easing a Child's Stuffy Nose at Night

Saline nasal spray and a bulb syringe can help relieve bedtime congestion in babies and toddlers.

Treat one nostril at a time. First, use saline nasal spray or drops to thin mucus. Then, squeeze the bulb syringe to release the air, place the tip gently into the child's nostril, and slowly release the tension on the bulb.

As the bulb refills, it pulls the saline and mucus out of the nose. Continue until the nostril is clear. Then repeat on the other nostril. Stop if you notice blood in the mucus or nose.

Older children can benefit from the same tips as adults: Use a cool-mist humidifier, elevate their head in bed, and push fluids during the day to keep the child hydrated.

Children over the age of 4 can be given Benadryl (diphenhydramine) for nighttime congestion due to a cold or virus. Other cold medicine should not be given to children under 6 years old. Check with your pediatrician to find out if antihistamines or cold medicine should be given.

Summary

You're not imagining that your nasal congestion gets worse at night. There are a few different reasons you could be experiencing this, and more than one may be at play.

Some, like your sleep position, can be easily fixed. Others, like GERD, may need medical treatment.

Your healthcare provider can determine the cause of your nighttime congestion so that you can get restful sleep.