Why a Stuffy Nose May Get Worse at Night

A stuffy nose at night can be caused by many different things, including a respiratory infection, allergies, asthma, sleep apnea, nasal polyps, dry air, and even your sleep posture. In some cases, the cause may be unknown.

Nighttime congestion often involves a combination of environmental triggers and abnormalities of the sinus and nasal passages that cause the swelling of tissues and/or build-up of nasal mucus (snot).

Most cases of stuffy nose are relatively harmless and easy to treat. But some may be a sign of a serious medical condition in need of specialist treatment.

This article describes the reasons why you may have a stuffy nose at night. It also explains how nasal congestion is treated and offers tips to ease nighttime stuffiness.

Reasons Behind a Stuffy Nose at Night

A stuffy at night is generally caused when nasal tissues become swollen and inflamed and/or nasal mucus is produced in excess. Structural problems in the nostrils or nasal cavity can also increase a person's vulnerability to nighttime congestion.

The causes of a stuffy nose at night can be broken down into the following broad categories:

Airborne Allergens

An allergy occurs when the immune system overreacts to an otherwise harmless substance called an allergen. When this happens, the body will release inflammatory chemicals that cause blood vessels to widen.

This causes fluid to leak from the blood vessels into surrounding tissues, causing swelling. The swelling of mucosal tissues in the nose is what causes congestion.

A stuffy nose can occur at night due to dust mites that thrive in pillows and mattresses. Airborne allergens like pollen also tend to settle in cooler nighttime temperatures.

Allergic conditions associated with nighttime congestion include:

• Allergic rhinitis: Also known as hay fever
• Allergic asthma: An obstructive respiratory condition triggered by an allergen
  

Gravity and Sleep Posture

When you are standing or sitting upright during the day, mucus is constantly draining from your nose and sinuses into the back of your throat due to gravity.

However, when you lying are in bed, gravity is working against you. In some cases, this can cause mucus to back up and pool in the nasal passages.

This is more likely to occur in people with structural problems in the nostrils and nasal cavities. Some of these conditions are congenital (meaning something you are born with), while others may be due to an injury to the nose or face.

Older age can also cause structures within the nasal passages to change, weaken, or collapse.

Conditions in which postural changes to your body trigger nasal congestion include:

• Sleep apnea: Characterized by the recurrent collapse of the upper airways during sleep
• Deviated septum: A defect that causes the sideway displacement of the nostrils
• Cleft palate: A defect that causes an abnormal opening or split in the roof of the mouth
• Concha bullosa; A normal anatomic variant of the nasal passages seen in half the population

Postural Blood Flow Changes

When you lie flat, blood flow to the upper half of your body increases, including to the head and nasal passageways. The increased flow can cause pressure that leads to nasal inflammation, swelling, and the increased production of mucus.

But gravity alone is not the only cause of this. Other conditions can directly or indirectly affect blood flow to the nasal passages and cause congestion.

Examples include:

• Vasomotor rhinitis: A poorly understood condition that causes swelling of nasal blood vessels
• Pregnancy rhinitis: A hormone-related symptom that increases nasal blood flow and pressure
• Alternate-side congestion: A phenomenon in which blood flow will shift from one nostril to the next every three to six hours
• Jugular vein compression: A condition associated with obesity that causes compression of the internal jugular vein of the neck and, in turn, increased nasal pressure

Nasal Obstruction

Anything that physically obstructs the nasal passages can lead to nighttime congestion, in part because of gravitational changes caused by lying down. The obstruction can be physical or the result of an obstructive pulmonary (lung) disease.

Examples include:

• Nasal polyps: Non-cancerous growths caused by inflamed mucous membranes
• Chronic obstructive pulmonary disease (COPD): A progressive disease strongly linked to smoking
• Cystic fibrosis: A genetic disorder that causes the excess production of mucus throughout the body
• Paranasal sinus tumors: A type of nasal cancer

Changes in Cortisol

There are a number of upper respiratory tract infections (URTIs) that can cause nasal congestion. These tend to get worse at night due to your horizontal sleep position.

But nasal congestion from a URTI can also worsen at night because levels of the stress hormone cortisol are naturally lower.

Cortisol is the hormone associated with the "fight-or-flight" instinct during which blood vessels, pupils, and airways will widen (dilate) in response to threats. These include actual physical threats and diseases that place your body on high alert.

The reduction of cortisol at night can make symptoms of URTIs more pronounced, including ones like:

• Common cold
• Influenza (flu)
• COVID-19
• Sinusitis (sinus infection)
• Respiratory syncytial virus (RSV)
• Strep throat

Climate

The nose warms and humidifies the air you breathe as it passes through the nasal passages. When exposed to cold and dry air, the lining of the nose becomes irritated and inflamed.

The inflammation leads to swelling, increased mucus production, and nasal congestion.

The risk of this is greater in winter, particularly at higher altitudes which inherently increase blood pressure.

Medications

There are many medications that can cause nasal stuffiness. These include commonly prescribed drugs, such as:

• Alpha-blockers: Including Flomax (tamsulosin) and Cardura (doxazosin) used to treat enlarged prostate
• Beta-blockers: Including Coreg (carvedilol) and Lopressor (metoprolol) used for high blood pressure
• Calcium channel blockers: Including Norvasc (amlodipine) and Cardizem (diltiazem) used to treat high blood pressure
• Hormonal contraceptives: Including the pill (estrogen/progesterone), mini-pill (progesterone), and hormonal intrauterine devices (IUDs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Including over-the-counter painkillers like aspirin, Aleve (naproxen), and Advil (ibuprofen)
  
• PDE5 inhibitors: Including Viagra (sildenafil) and Cialis (tadalafil) use to treat erectile dysfunction

Acid Reflux

Acid reflux occurs when the ring-shaped muscle between the stomach and esophagus (called the esophageal sphincter) is weak and unable to stay closed. This can cause acid to leak into the esophagus, triggering heartburn, nausea, chest pain, coughing, and an unpleasant taste.

Nasal irritation and nighttime congestion are two of the lesser-known symptoms. The risk of these is greatest at night because your sleep position allows acid to backflow closer toward the throat and nasal passages.

Acid reflux may be incidental, caused by something you ate, but there are also conditions that cause chronic reflux, such as:

• Gastroesophageal reflux disease (GERD): A more severe and long-lasting form of acid reflux
• Helicobacter pylori (H. pylori): A bacterial infection closely linked to stomach ulcers that also cause chronic reflux

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.

These tips can help adults 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 drops and a bulb syringe can help relieve bedtime congestion in babies and toddlers.

Treat one nostril at a time until it is clear, then switch to 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.