asking for a friend: why do i get so congested when i sleep?

dear asking for a friend,  

as soon as i lay my head down to sleep, i get a stuffy nose, which makes it hard to breathe, harder to sleep and sometimes i snore. i am looking for some solutions.  

signed, tired and stuffed up  

dear tired and stuffed up,  

nasal congestion can be more than an annoyance when it starts to disrupt your sleep — or your relationship, if the sniffling and snoring wakes a partner sleeping next to you. the congestion happens when fluid builds up in the tissue and blood vessels in the nasal passages. your upper airway is essentially narrowed, making it difficult to inhale and exhale through your nose.   

what makes the stuffed up experience worse is when you lay down at night, there is naturally more blood flowing to your head, which increases the swelling and congestion of your nasal lining. the lying down position also slows the gravity-dependent sinus and nasal drainage, so you end up feeling plugged up and uncomfortable.   

part of the reason congestion may feel worse when you go to bed is that you might be busy and distracted throughout the day, not really noticing how stuffed up you actually are.   

“we often see if the congestion is only at night, patients are probably going around on a day-to-day basis where they have a little bit of constriction, but not enough to kind of push them over the edge,” says dr. christopher chin , an otolaryngologist or ent (ear, nose and throat specialist) in new brunswick and professor of otolaryngology at the saint john campus of dalhousie university. chin also chairs the rhinology group of the canadian society of otolaryngology .  

he confirms that as soon as you lay down, blood flow increases into the nose. “if somebody is already at about 50 per cent in terms of their nasal breathing, that can be all it takes to push them to where they start to feel that constriction.”  

if you don’t have clear nasal breathing, there’s a domino effect on your health, says chin. “you can’t really smell very well. and if you can’t smell, then often your sense of taste is impacted. and when you’re sleeping, if you’re not breathing well through your nose, then you have to open up your mouth. your mouth dries out and you get a sore throat and you have very disruptive sleep.”  

the underlying cause of a stuffy nose

  it can be allergies where the nose passages and sinuses swell because they’re trying to flush out allergens, like pollen and pet dander. but what’s also increasingly common in chin’s practice is a condition called chronic rhinosinusitis , which is ongoing inflammation of the sinuses that affects about 10 per cent of the population.   

nasal polyps, the soft noncancerous growths that can develop as a result, add to the obstruction of your sinuses.  

another possible cause of nighttime congestion is an infection that comes on relatively quickly where you also experience fever, facial pain and the runny discharge from your nose. the most common cause is viral — like covid-19 — that can also knock out your sense of smell. viral infections will heal on their own in a couple weeks. bacterial infections cause similar symptoms, but require antibiotics to clear up, so see your doctor if symptoms don’t improve.  

one cause of a stuffy nose that people don’t expect is a deviated nasal septum , where the bone and cartilage that divide the nasal cavity of the nose down the middle is off-centre, so there’s an imbalance in the size of your breathing passages that makes breathing difficult. this can lead to snoring and sleep apnea.  

“everyone thinks that means you must have been smashed on the nose or punched and broken your nose,” says chin. “but there’s a lot of people who actually have a little bit of a bend just in the middle part of the nose. as our nose develops from infancy to adulthood, it can start to bend and curve a little bit. and that by itself, can be a cause of nasal obstruction.”  

how to treat nasal congestion

chin says a humidifier in the bedroom can be helpful, as well as using a saltwater or saline flush in the nose to wash out irritants and help with the natural drainage of the nose.  

beyond that, he recommends seeing your doctor for medical therapy like prescription steroid sprays, for example, or a referral to a specialist to consider surgery. a small incision typically inside the nose is made to remove the deviated segment of cartilage which improves nasal breathing significantly.  

“you have to be very cautious because the nose can become addicted to them,” says chin. “if you’ve used them regularly and you stop using them, you’ll get significant congestion. that’s actually one of the causes of nasal obstruction — dependence on over-the-counter medication.”