Updated August 31, 2015.
Have you ever noticed that congestion seems to get worse at night? Right about the time you'd like to go to sleep you notice that you can't breathe because your nose is too stuffy. Is it all in your head? Not really, although to some extent this phenomenon can be due to the fact that congestion is less noticeable during the daytime when you are busy and there are many things going on to distract you.
This definitely isn't the whole story, however.
One explanation has to do with gravity and the way that we tend to position our bodies at night. Many people think that congestion and a feeling of stuffiness is caused by excess mucous blocking the nasal passageways. While this may contribute to a feeling of stuffiness the real culprit in congestion is engorged and/or inflamed blood vessels inside the nasal passageways. This is a very simplified explanation, however, as congestion has many causes (more on some of those later). When we lay down our blood pressure changes, and we may experience increased blood flow to the upper part of our body including our head and nasal passageways. This increased blood flow can make the vessels inside our nose and nasal passageways even more inflamed. Increased blood flow also commonly causes congestion in pregnant woman.
A lying down position, (called a supine position), also makes it more difficult to clear mucous from our nose and sinus cavities. For example, while we are standing up during the day mucous is constantly running from our nose and sinuses into the backs of our throat and being swallowed - most of the time we don't even notice it.
At night, however, this mucous may pool or back up. Many people notice that their congestion starts to improve an hour or two after they get up in the morning That's gravity doing it's work.
Even if we aren't lying down in bed ready to sleep we tend to start lounging in more relaxed and more supine positions a couple of hours before bedtime. This is why you might tend to notice your congestion getting worse not long after the sun goes down.
This explains why people with conditions like a cold virus or allergies might feel their congestion increase at night but what if you're not sick and don't experience any symptoms during the day? Well, studies have shown that even without the presence of daytime congestion nasal resistance (the ability to breathe) is impaired when we are lying down. Also, another culprit you might not suspect could be to blame: acid reflux (heartburn).
Fairly common symptoms of gastroesophageal reflux disease (GERD) include sore throat, coughing, post nasal drip, wheezing, and hoarseness. These symptoms tend to be worse when you wake up in the morning. Many of these symptoms occur when individuals with an impaired esophageal sphincter (valve) and a stomach full of acid lay down at night the acid can migrate up the esophagus and irritate the back of the throat, which also happens to be connected to the nasal passageways. The really interesting thing is that some medical professionals now believe that there is a definite link between GERD, chronic sinusitis and even nasal congestion.
So now that you understand a little bit more about what causes nighttime congestion what can you do about it? Studies have shown that the negative effects of congestion on your sleep quality are significant so if you frequently suffer from congestion at night you should see a doctor. In the meantime you can try these tips to help reduce congestion and sleep better:
- elevate the head of your bed
- don't eat within a couple of hours before going to bed or lying down
- use a cool mist humidifier at the side of your bed
- drink plenty of water
- stop smoking
While these tips are helpful for anyone who suffers from increased congestion at night your doctor will likely recommend further treatments once the cause of your congestion is identified. 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.
Sources:
American Academy of Otolaryngology - Head and Neck Surgery. GERD and LPR. Accessed: August 31, 2015 from http://www.entnet.org/content/gerd-and-lpr
Health Day. Researchers Probe Link Between Acid Reflux and Sinusitis. Accessed: August 31, 2015 from http://consumer.healthday.com/gastrointestinal-information-15/heartburn-gerd-and-indigestion-news-369/researchers-probe-link-between-acid-reflux-and-sinusitis-518994.html
JAMA Internal Medicine. Chronic Nasal Congestion at Night Is a Risk Factor for Snoring in a Population-Based Cohort Study. Accessed: August 31, 2015 from http://archinte.jamanetwork.com/article.aspx?articleid=648438
National Sleep Foundation. Allergies and Sleep. Accessed: August 31, 2015 from:http://sleepfoundation.org/sleep-topics/sleep-related-problems/allergic-rhinitis-and-sleep
NCBI. Pathophysiology of nasal congestion. Accessed: August 31, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866558/
NCBI. Pulmonary manifestations of gastroesophageal reflux disease. Accessed: August 31, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714564/
Research Gate. Nocturnal Nasal Congestion and Nasal Resistance. Accessed: August 31, 2015 from http://www.researchgate.net/publication/227851583_Nocturnal_Nasal_Congestion_and_Nasal_Resistance
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