Why Congestion May Get Worse at Night

Congestion often seems to get worse at night. Part of the reason may be that you are too distracted during the day to notice how stuffy you really are. But that's not the whole story.

With some health conditions, lying down makes symptoms worse. Nighttime congestion could simply be a matter of human anatomy and gravity.

This article discusses the different causes of congestion at night. It also provides tips for easing nighttime stuffiness.

causes of nighttime congestion
Verwell / Brianna Gilmartin

Reasons Behind Nighttime Congestion

Many people think that a feeling of stuffiness is caused by excess mucus blocking the nasal passageways. But that is not the only reason.

The real culprit of congestion is swollen and/or inflamed blood vessels inside the nasal passages.

There are several possible causes of this that are unique to the nighttime hours.

Your Anatomy

Your body is designed to use the force of gravity to keep mucus draining properly.

When you are standing or sitting upright during the day, mucus is constantly draining. 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, it becomes harder to ignore. When you're in a horizontal position, gravity can cause mucus to pool or back up instead of drain.

Many people notice that their congestion starts to improve an hour or two after they get up in the morning. That's gravity being able to do its work once again.

Blood Flow Changes

When you lie down, your blood pressure changes. You may have increased blood flow to the upper part of your body, including your head and nasal passageways.

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

Increased blood flow due to pregnancy is also a common cause of congestion.

Alternate-Side Nasal Congestion

If only one nostril is clogged at night, it is likely due to alternate-side nasal congestion. This 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 structure along the sinus wall that produces mucus, known as a turbinate, becomes swollen in one nostril. This blocks airflow on that side.

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

Acid Reflux

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

Known as reflux, it occurs when the valve between the stomach and esophagus (esophageal sphincter) is unable to stay closed.

People with GERD can experience acid reflux at any time of day. However, when lying down, the valve is even less likely to keep stomach acid from coming up the esophagus because it doesn't have gravity to help.

This is why GERD symptoms including sore throat, coughing, postnasal drip, wheezing, and hoarseness tend to be worse at night and first thing in the morning.

GERD can lead to nighttime nasal congestion as well. This is because the back of the throat is connected to the nasal passageways. Acid reflux can cause nasal irritation that can lead to congestion.

Some medical professionals now believe there's a definite link between GERD, chronic sinusitis, and nasal congestion.

Recap

Acid reflux due to GERD can cause nasal congestion. Reflux symptoms tend to get worse at night when you lie down. As a result, your nose may become more congested at night.

Reducing Nighttime Congestion

Studies show that nasal congestion at night can have a big impact on sleep quality.

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 doctor may recommend additional strategies and medications to ease 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.

Summary

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

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

Talk to your doctor about your nighttime congestion. Your doctor can get to the bottom of the cause of your stuffiness, so you can get restful sleep.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med. 2010;3:47-57. doi:10.2147/ijgm.s8088

  2. Kahana-Zweig R, Geva-Sagiv M, Weissbrod A, Secundo L, Soroker N, Sobel N. Measuring and characterizing the human nasal cycle. PLoS One. 2016;11(10):e0162918. doi:10.1371/journal.pone.0162918

  3. Gaude GS. Pulmonary manifestations of gastroesophageal reflux disease. Ann Thorac Med. 2009;4(3):115-23.  doi:10.4103/1817-1737.53347

  4. Lin YH, Chang TS, Yao YC, Li YC. Increased risk of chronic sinusitis in adults with gastroesophgeal reflux disease: A nationwide population-based cohort study. Medicine (Baltimore). 2015;94(39):e1642.  doi:10.1097/MD.0000000000001642

  5. Mahdavinia M, Schleimer RP, Keshavarzian A. Sleep disruption in chronic rhinosinusitis. Expert Rev Anti Infect Ther. 2017;15(5):457-465. doi:10.1080/14787210.2017.1294063

  6. Institute for Quality and Efficiency in Health Care. Heartburn and GERD: Treatment options for GERD. 2018. 

Additional Reading