Persistent Nasal Congestion at Night: Causes and Solutions

Nasal swelling causing difficulty sleeping?

Hello, doctor.
I would like to ask why every time I lie down in bed to sleep, I feel nasal congestion, a sense of swelling, and a tingling sensation that prevents me from falling asleep.
I have visited several ENT specialists, and they found no significant issues with my nose.
The doctors have prescribed allergy medications and nasal sprays, but there has been no improvement.
What other possible causes could there be? Or which other specialty should I consult for a more thorough examination? Thank you.

Xiao Yu, 70~79 year old female. Ask Date: 2021/07/27

Dr. Ji Zhaoyun reply Otolaryngology

1.
Regarding allergic rhinitis, there are several important concepts: The individual's constitution and environmental allergens and irritants are the main triggering factors.
If one parent has allergic rhinitis, the likelihood of their children developing allergic rhinitis is four times higher.
The most common allergen is dust mites, followed by animals, insects, mold, and pollen.
Recently recognized fine particulate matter (PM2.5) is also an important irritant.
Treatment typically begins with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and intranasal corticosteroid sprays, with additional options such as topical antihistamines/vasoconstrictors or oral leukotriene receptor antagonists as needed.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, enlarged inferior turbinates, or nasal valve stenosis, appropriate surgical intervention may be warranted.
Recently, minimally invasive surgical techniques have been developed, which are quick and do not require hospitalization, and are widely applied.
To avoid allergens and reduce irritants, wearing masks, maintaining a clean home environment, regularly washing bedding, avoiding extreme temperature/humidity changes, and reducing outdoor activities during severe PM2.5 air pollution are key points for daily care.
2.
Common symptoms of sinusitis include nasal congestion, yellow-green nasal discharge, fever, facial pain, foul smell, and changes in smell, although not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.
If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is recommended to consult an otolaryngologist for bacterial culture.
If a more virulent bacteria is identified, a stronger antibiotic may be necessary.
It is advisable to purchase a "nasal irrigation device" (containing isotonic saline) and perform rinsing 1-2 times daily to enhance the treatment of sinusitis.
Additionally, avoiding staying up late, refraining from smoking, and controlling blood sugar levels for those with diabetes are important.
If sinusitis has not resolved after more than 2-3 months of treatment, it is highly likely to be "chronic" sinusitis, requiring further evaluation.
If necessary, surgical intervention may be needed.
If symptoms persist, it is recommended to seek assessment from an otolaryngologist.
Wishing you peace and health.

Reply Date: 2021/07/27

More Info

Persistent nasal congestion at night can be a frustrating and debilitating issue, especially when it interferes with sleep. Given your description of experiencing a feeling of swelling and numbness in your nose while lying down, it’s essential to explore various potential causes and solutions.

Possible Causes of Persistent Nasal Congestion
1. Allergic Rhinitis: This is one of the most common causes of nasal congestion, especially if you have a history of allergies. Allergens such as dust mites, pet dander, or pollen can trigger nasal inflammation, leading to congestion. Symptoms may worsen at night due to increased exposure to allergens in your bedding or bedroom environment.

2. Non-Allergic Rhinitis: This condition can cause nasal congestion without an allergic trigger. Factors such as changes in weather, strong odors, smoke, or even hormonal changes can lead to nasal swelling and congestion.

3. Structural Issues: Although you mentioned that previous ENT evaluations did not reveal any significant problems, it’s worth considering structural issues such as a deviated septum or enlarged turbinates. These can obstruct airflow and lead to persistent congestion, particularly when lying down.

4. Sinusitis: Chronic sinusitis can lead to ongoing nasal congestion, especially at night. This condition may be accompanied by facial pain, pressure, or a reduced sense of smell. If you have had recurrent sinus infections, this could be a contributing factor.

5. Gastroesophageal Reflux Disease (GERD): Sometimes, acid reflux can cause nasal congestion, especially at night. The acid can irritate the throat and nasal passages, leading to inflammation and congestion.

6. Sleep Position: The position in which you sleep can also affect nasal congestion. Lying flat may exacerbate congestion due to increased blood flow to the nasal passages, leading to swelling.

Solutions and Recommendations
1. Allergy Management: If allergies are suspected, consider consulting an allergist for comprehensive testing. They may recommend allergy medications, nasal corticosteroids, or even allergy shots (immunotherapy) to help manage your symptoms.

2. Nasal Irrigation: Using a saline nasal rinse or neti pot can help clear mucus and allergens from your nasal passages, providing relief from congestion.

3. Humidifier: Adding moisture to the air with a humidifier can help soothe irritated nasal passages, especially in dry environments.

4. Sleep Position: Try elevating your head while sleeping. Using an extra pillow or a wedge pillow can help reduce nasal congestion by promoting better drainage.

5. Avoid Irritants: Identify and minimize exposure to potential irritants in your environment, such as smoke, strong perfumes, or cleaning products.

6. Consult a Specialist: If your symptoms persist despite treatment, consider seeing a specialist in sleep medicine or an allergist for further evaluation. They may conduct sleep studies or additional tests to identify underlying issues.

7. Consider GERD: If you suspect that acid reflux may be contributing to your nasal congestion, consult a gastroenterologist for evaluation and management.

Conclusion
Persistent nasal congestion at night can stem from various causes, including allergies, structural issues, or even reflux. It’s crucial to work closely with healthcare professionals to identify the underlying cause and develop an effective treatment plan. By addressing the root of the problem, you can improve your quality of sleep and overall well-being. If you have already consulted multiple ENTs without resolution, seeking a second opinion or consulting with specialists in related fields may provide new insights into your condition.

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