Long-term Nasal Saline Irrigation: Helpful or Harmful?

November 14, 2009

For many people with obstructive sleep apnea, nasal congestion and chronic sinus infections are a common problem. Nasal irrigation with saline is a natural way of clearing nasal and sinus passageways. The Neti-Pot is a yogic variation of saline irrigation that became much more popular after Oprah’s recommendation. Many of my patients that have tried this method report good results, with better breathing and less sinus pressure and headaches.

 

A recent study showed that contrary to popular belief, irrigating the nose on a daily basis over a long-tern period may actually make things worse. Researchers studied 68 people who used nasal saline irrigation every day for one year. In those that stopped after one year, 62% had a significant drop-off in the number of infections, compared with those that continued irrigating their noses. 

 

The authors of the study proposed that the likely reason for this finding is that frequent irrigation depletes nasal mucous, which contains several important defense mechanisms, including antibodies, lactoferrin, and lysozyme. It’s also known that the nose produces nitric oxide, which also has antimicrobial properties. 

 

These results are a bit conflicting with what many of my patients report, but there may be some good reasons to follow their recommendations. Besides the reasons mentioned above, saline acts as a mild decongestant, which is similar to the over-the-counter decongestant, Afrin, but not as strong. This is why you can breathe better after irrigation. One of the reasons why you can’t use Afrin for more than 3 days is because of the rebound effect, where after the medicine wears off, your nose gets stuffy again, making you use it more and more frequently. Nasal saline, although not as bad as Afrin, also has a mild rebound effect. This is why some people use it 2 to 4 times every day.

 

It’s also been shown that if the salt concentration is a bit saltier than your nasal membranes’ concentration, the cilia that help to move the mucous blanket down into your throat become paralyzed.

 

If used for short-term periods, such as during an acute sinus infection, it can be useful (just like Afrin), but this study’s result shows that long-term use may be more harmful.

 

My feeling is that if you feel better and you don’t get as many infections, keep doing it. After a few weeks or months, you can experiment by stopping the irrigation and see what happens. 

 

Since this study didn’t look at cultures or x-rays, there’s no proof that these were true bacterial infections. Recent studies also show that the vast majority of what may feel like sinus infections are actually a variation of a migraine headache. Furthermore, it’s been shown that nasal saline doesn’t really go into your sinus passageways. It works by decongesting your nasal passageways, which indirectly opens the passageways to your sinuses.

 

Do you irrigate your nose with nasal saline every day? If so, for how long? Are you having less sinus "infections" as a result of irrigating on a regular basis? Please enter your answers in the comments box below.


28 Responses to “Long-term Nasal Saline Irrigation: Helpful or Harmful?”

  1. Catherine Kolar on November 24th, 2009 9:30 am

    I have been using nasal irrigation with pre-mixed packages in a nasal squirt bottle daily for many weeks. I’m 21 weeks pregnant and find that I get congested. I also had a vague impression that it might make me less likely to get sick with colds and flu. As a first grade teacher, I’m constantly coughed and sneezed on. When H1N1 swept through my class getting most of the kids sick(only a couple cases were confirmed, but the others were assumed to be the swine flu), I managed to avoid getting sick with no vaccine. My immune system isn’t necessarily any better than average, in spite of all the years of teaching. Most years I get sick a lot. Last year I had the flu for 10 days, along with a few colds. I’ve been known to get my share of sinus infections. I don’t know that staying healthier this year is the result of nasal irrigation, but I think it’s possible. Lately I have been getting severe headaches in the morning after nasal washing in the shower. I don’t know if this is a direct consequence of nasal irrigation or not. It could be hormones from pregnancy.

  2. barb on October 8th, 2010 3:13 pm

    I love the the neti pot. Been using it for years. A friend who was suffering endlessly with migraines recommended it. It is great for staving off headaches, great for overall sinus/nasal feeling good, essential for traveling on a plane. Plus in today’s world it is essential to clean the nasal passages b/c of all the pollutants. I love it. It has been used for centuries in Ayurvedic medicine, so I trust it. I need it less when in clean natural air (i.e not in artificial air or heat and air with less pollutants) I would like to see more info on its harm as that seems strange to me. I also believe using Nasya is great to do for the sinuses/nasals (another ancient Ayurvedic wellness strategy.)

    Thank you for posting more info if you get it on this topic. Appreciated. Thank you for this site and what you do! By the way, the best thing I ever did to stop nasal/sinus problems is eliminate gluten! That stopped so many of my problems! I am shocked to hear people complain about nasal/sinus problems who have not eliminated all potential irritants (gluten, wheat, dairy, corn, soy, sugar) and do not try the neti-pot and exercise! (Getting out of artificial air also helps!)

    Thanks and have a great day I hope.

  3. Monica on December 4th, 2010 11:10 pm

    Hello, we use saline drops (Simply Saline) for my son. He is 3yo and almost since birth we’ve been using it to help clearing up his nose. He was born with choanal atresia in the right side. He has many problems that affect his sleep besides the atresia such us apnea, GERD, and he also has a G-tube …although we try to avoid night feedings so things don’t get worse.
    We don’t really have much options, we don’t know what else to do or use to help him with his stuffy nose. It usually happens after 2 hrs of him falling asleep. I don’t know if it is because of the turbinates cycle or because of his apnea which according to his ENT it has to do with his small jaw.
    The saline sometimes helps, sometimes it doesn’t but we still use it every time he awakes with his stuffy nose and as I said before it happens 2 hrs after he falls asleep. So it is very often. I don’t know if we have made things worst by using the saline so much but we don’t have much options. He is schedule to have a jaw distraction and the nose surgery next year. We really hope they will help him to have a good night sleep for first time in his life and for us since we take care of him every night!

  4. Steven Park on December 5th, 2010 5:18 am

    Monica,

    In your son’s situation, saline is probably a good idea. Notice that he wakes up around 2 hours after he goes to sleep, which is about the time it takes for him to reach REM sleep, when he’s dreaming. It’s also the state when his muscles are most relaxed, and more likely to stop breathing.

    Your planned surgery for your son sounds like the right thing to do. Good luck.

  5. Monica on December 5th, 2010 8:33 pm

    Thanks so much for your advise Dr. Park!

  6. S G Thomas on December 13th, 2010 9:17 am

    Just saying THANKS for taking the time to give us this website with all of it’s valuable info!!! I know how time consuming caring for a website can be :”)

  7. malvin on March 25th, 2011 9:10 pm

    I used to live close to beach in SF and also in a tropical island and never have any nose nasal congestion at all. This must be due to the natural sea salt mist that gives excellent natural cleansing of the nasal passages. After having living in south east area of down south the congestion happened for many years. One of my ENT suggested to go to beach and have a good swim how amazing the whole nasal never get congested for days. This is my personal experience as a patient with twice operated due to deviate septum, polyps etc on the right nasal. A Cpap user for last 3 years. Will be going for allergy test soon…suspect congestion could be due to dust mites or cats or pollens….will update more late after end of March. Stay healthy.

    Cheers

  8. Clifford Paulsen on April 7th, 2011 7:25 am

    Hi I used the nasal irrigator daily for a few months until I started having a yellow secretion coming out of my nose (“I believe the nasal irrigation use daily caused a infection!”) Stopped use and infection cleared up!

    My background Diagnosed with UARS in 1997 (“After seeing five sleep specialists” over a period of three years.) Also I developed Celiac Disease,and Dermatitis Herpetiformis in 2009 after caring for my wife she had a double Masectomy in 2008! I started having problems with raspy speech while wife was sick VCD ! I had also had surgery in 2009 for a Fissurectomy,and Fistulotomy in 2009! In 20010 developed a blood clot in left leg,and went to lungs
    had a IVT filter put in for five months! I have been on Coumadin since ! also had a UPPPs,Genioglossal Advancement,Hyoid Myotomy,and all in 1999!

    VA Clinic did a sleep test for me in 2010,and prescribed me a new respironics cpap at 7″ CM of H2O just was not helping me I felt like not getting enogh air flow,so clinic Doctor bumped pressure to 8″ CM H2O still. I complained to VA that still not getting enough air flow, they said I just need to get used to machine! I told them I had a Auto Cpap before using it at 10 to 12 CM of H2O!

    Finally frustrated I asked my Family physcian if he would write me in prescription for a Auto Cpap,he did,and my Sister In Law (Shes Korean,got me a machine from Korea it is a Vector ET Auto. Set it at 10 to 13 CM of H2O myself! Now Sleeping better not perfect but at least 75% better than VA machine!

    I was able to reduce my blood pressure med from 320 MG of Diovan HCT down to 80 MG,and Metoprolol from 2 X 50 MG down to 50 MG daily!

    All in all I believe my sleep problem,and stress of wife’s Illness caused most of my illnesses!

  9. Marilyn Sith on June 18th, 2011 2:37 am

    I use nasal irrigation with prepackaged saline in squirt bottle once at night followed with 2 kinds of prescription nasal sprays. It opens my sinuses at night and I sleep better. Been doing this for a year with no side effects…..really helps my allergies.

  10. Sagar on September 22nd, 2011 2:48 pm

    >>Do you irrigate your nose with nasal saline every day?

    i do it once per day in the morning using that waterpik sinusense thing. works really nicely. i use 1 of their saline packets each time. 2 packets gives too much of a stinging feeling for my nose due to the higher concentration, so i stick with 1.

    >>If so, for how long?

    i’ve been doing it for a few months now. been fine so far. my guts says that article makes sense though. always good to let your body’s natural defenses due to the main work. i might consider giving it a break for a week say each month.

    >>Are you having less sinus “infections” as a result of irrigating on a regular >>basis? Please enter your answers in the comments box below.

    yeah i think so. this really helps when i have a cold and my nose is not overly blocked. really helps to get everything out. gross a bit but works.

  11. Joel on October 8th, 2011 2:53 pm

    I use nasal irrigation almost every day, and I find that around 12 hours after I do it, my nasal passages feel very, very dry and I really crave another irrigation. I do worry whether this is Afrin-style rebound. I have been using simply saline-style nasal sprays and this helps with the dryness, but it’s not as good as an irrigation.

    Is it natural for your nasal passages to feel so dry and what else can I try for it? This happens wherever I am, at home, someplace else, or outdoors. I live in New England and the few times I’ve been in desert-type climates I’ve felt much better.

  12. Clare on February 15th, 2012 2:44 pm

    I started nasal irrigation 3 weeks ago after visiting an allergist for skin conditions. He found I had asthma (was not expecting that!) and nasal inflammation. I also had acute sleep apnea which I haven’t seen anyone for and coughing at night which I haven’t seen anyone for.

    Nasal irrigation stopped my sleep apnea and night coughing in its tracks. I stopped irrigating for 2 nights in a row, and my chest got really congested. However, I am afraid to do rinses every night, so I will probably stick to every other night. I don’t want to do long-term if necessary, but it looks like I will have to.

  13. Kathi on February 21st, 2012 9:33 pm

    i became an advocate of the Neti Pot and saline rinses about 2 years ago. My experience is of irritated sinuses and congestion with barometric changes in the weather. When this happens, I use the Neti Pot as often as I feel necessary, sometimes 3 or 4 times a day. When the weather passes (and sometimes this takes many days), I just stop using it. I have never had any sinus infections after using it. I had many a sinus infection prior to using the Neti Pot though. I make my own solution with 1/4 tsp of sea salt and enough water to fill the pot to the brim. It does not sting as some saline rinses that I have purchased do. Because of that, I also make my own saline nasal spray, sterilizing the water and bottles,etc.

  14. Jamie on March 6th, 2012 9:23 am

    I just finished a round of antibiotics for yet another sinus infection. When I saw the physician this time she mentioned something about only using Afrin for 3 days to avoid a rebound effect. That got me thinking….I wonder if Simply Saline causes a rebound also?? I am pretty prone to sinus infections and found that when I feel one coming on if I take the right regiment of vitamins and use simply saline/neti-pot sometimes I can avoid a full blown infection. However since then I started using the SS rinse almost everyday alternating with the neti-pot. Was doing that for about 3 weeks straight and started experiencing some light nose bleeding. Continued still for another week and then woke up out of the blue the other day with sinus infection (the kind you can’t ignore). I’m wondering if after I’ve finished the cycle of antibiotics I should give the nasal wash a break for a bit??

  15. Paula on March 22nd, 2012 7:46 pm

    I Love my Neti Pot, and so do my 3 kids (11, 7 & 5). I have chronic post nasal drip, seasonal allergies & bronichial issues. I take Flucotisone & Advair daily and Claratin as needed. When we have colds & stuffy noses, it is the best thing to clear out all the gunk. I go through periods (like right now) where I’m using the neti pot at least once a day to break up the mucus. I have never had a sinus infection. I’ve been using the Neti Pot for a year now, and prior to that I used Ocean Mist saline spray.

  16. Tamie on March 30th, 2012 3:57 pm

    What about the affects of Laryngopharyngeal Reflux (Silent Reflux)
    and the nasal solutions? I don’t have your normal GERD or heartburn….

  17. Tod Merley on May 12th, 2012 12:00 am

    Greetings Dr. Park — always love your site!!

    “Do you irrigate your nose with nasal saline every day?”

    For all the reasons you mentioned, no. I used to find myself running to the drugstore or at least getting back to using my nasal corticosteroid this time of year, however, during your Expert Interview with McKeown on “Buteyko Breathing” I discovered something that has kept my nose mostly clear and uninfected since.

    I tried the “nose clearing” exercise without doing the holding of the nose or the bobbing the head up and down – just the breath in lightly breath out and hold for ten seconds and repeat the process after three small breaths until clear. Not only did my nose clear up, but I could actually feel the blood rushing back into my feet and then to my further surprise the urge to breath as much as I had been breathing just went away leaving me breathing quietly. It got warm, moist, and feeling great inside my nose in just a few minutes. No stuffiness. My feet and other extremities felt warm and fuzzy as well. I was fascinated.

    I am still not sure what to think about Buteyko Breathing. I think the general idea of breathing less and enjoying it a whole lot more is right on, but the techniques suggested I simply do not know what to do with.

    It did occur to me, however, that using a pulse oximeter to find the lowest heart rate at a safe oxygen saturation level and using the information about SpO2 to kind of guide oneself back to those efficient places might work well. I think the heart beats less when the supply of oxygen is getting to the cells with the least effort – the most efficient point. So my pulse oximeter found itself on my arm for the next three months most of any given day!! It took me at least a decade to learn to play Trombone to where they wanted me in the Symphony after all so I think it will take at least that long to re-train my breathing reflexes to where I breath healthy again.

    So now during the spring season my nose does feel a bit of an itch but actual sneezing is very rare and stuffiness is rare. As it does occur it is now a reminder to breath more quietly. I love the smells I often missed during past seasons but do smell now.

    At night I have noticed that my tidal volumes (CPAP data) are less and much more stable. I believe this means less arousals and awakenings as well as a much happier cardiovascular system and body. Part of why I believe this is that a bad breathing night (high tidal volumes and erratic peaks therein) would often result in blood sugar levels 40 points higher and blood pressure readings 20 to 40 points higher.

    I really do wish the western medical community would look at this seriously but frankly most research I see where any technique of breathing retraining is tested involves so little actual practice of the techniques I am actually a bit surprised that they do show some modest positive results. It is kind of like saying we did not really look but seem to have found something anyway.

    Anyway, it makes my nose feel a lot better in every circumstance.

  18. khem on June 7th, 2012 12:12 pm

    Hi Dr. Park,

    about seven yrs. ago i had nasal polyps and had it removed. i been using the neti pot since, it really help clear up my nostril. i had lost my sense of smell and taste before i had the surgery to removed the polyps. it come back partial, probably because i was on the singulair and nasonex, but it seems to gone again, recently i been experiences some stuffy nose on my left nostril the same that had the polyps. in the night when i changed sides sleeping the stuffness switch from one nostril to the other. my ENT recommend some sinusplasty. i did some research on your sites and others, now i don’t feel like having the sinusplasty.

    do you think my loss of smell and taste is part of that or something else. i am tired of this feelings and really need my smell and taste back. this is not a good experience. i want to enjoy my food and smell the fresh air and all that natures offered. what is your advise for me. thanks for your time.

    regards,
    khem

  19. Rebecca Ramsey on July 15th, 2012 7:22 am

    I grew up with a father addicted to nose spray; eventually, he did stop.

    My husband uses saline, regularly. The gets sinus infections from time to time.

    I do not use either, nor do I get infections.

    My father, sibblings, and I have had deviated septums. Generally, one nostril would be stopped up at a time; fortunately, often the smaller side.

    Our strategy has been to be thankful for one side and “deal with it”.

  20. Leslie on October 8th, 2012 7:14 am

    My difficulty is…that when I try to do saline irrigation, my nose is so blocked on one side that I can’t even get the solution in. (And that is with taking oral allergy pill and nasal sprays). Then as a result I can’t breathe with my Cpap.

  21. Christina on December 18th, 2012 11:16 am

    I have been using the NeilMed Sinus Rinse bottle daily for a couple of years, maybe even longer. It seemed to really help me a lot with my alleriges which was great because I don’t react well to allergy medication. However just in the past few months I have been having a really horrible time with mucus in my throat. For a few days I stopped using my Sinus Rinse bottle because I had run out of distilled water. I felt like the mucus kind of got better. When I went back to using the Sinus Rinse, it seemed like it got bad again. I wasn’t sure if it was connected or just a coincidence. So I was really interested to find this article. I’m going to try stopping for a longer period of time and see how it goes.

  22. Jason on February 10th, 2013 1:44 pm

    First of all, thank you Dr. Park.

    About my physiology: I would like to note that I have a deviated septum, and was told I have a nasal occlusion and mild sleep apnea. I cannot tolerate a CPAP machine. My brother has one and it’s unbearable even for him. I am interested in nasal airway surgery and would like to avoid empty nose syndrome. Until then Nasal irrigation is my only source of relief.

    Here is a brief chronology of my use of nasal irrigation and my noted benefits.

    I started using the Neli Med squeeze bottle, but found the volume of saline being circulated through my nasal passages wasn’t enough. I upgraded to the SinuPulse Elite which is the best device I have against my nasal congestion. Like many others I experience relief for several hours, sometimes most of the day until the saline solution either drains out or dries up. I have noticed I get sick far less when I irrigate and my breathing is improved. To improve my breathing I irrigate before bedtime and it helps me breath better and therefore occasionally negate my mild sleep apnea.

    In conclusion I have seen tangible benefits to nasal irrigation, even when sick as it helps expel thick mucus and helps me breath. I do think a permanent solution would be better in the form of nasal airway surgery, but it’s just a theory I will have to invest money to explore. Do you think nasal airway surgery would help?

    Best Regards,
    Jason

  23. Greg Lobb on April 9th, 2013 9:25 pm

    I have been using the NeilMed Sinus Rinse bottle off and on for 7 to 8 years. I have never used it straight for no more than a couple of months. I prefer to use it as needed even though my doctor suggested every day. You stated ” Furthermore, it’s been shown that nasal saline doesn’t really go into your sinus passageways” I question this because since I had sinus surgery to open a blocked sinus. I find if I’m not careful the saline solution travels into my eye above the sinus that I had surgery on causing a burning sensation and redness. But I still find it helpful to use.

  24. John Hechtlinger on May 10th, 2013 5:19 am

    I have recurrent chronic sinusitis. It seems to be getting worse with each passing year. I use a nasal irrigator with a prepackaged solution. It has not solved my problem. My stuffy nose (always on the left side) has adversely affected my sleep and I often wake with dry mouth. I have a deviated septum but from what I can gather that’s not unusual. By mid to late afternoon I’m often exhausted. I exercise regularly, my weight is good, as is my diet. If my sinusitis was cured I believe I’d be a happy man. I’m 65 and otherwise in excellent health, but this is killing my quality of life.

  25. Pneumoboy on June 21st, 2013 1:14 am

    I’ve been using NeilMed squeeze bottles for over a year now, and in that time, I have had no respiratory infections and one sinus infection that required antibiotics which hit me immediately after a norovirus-like infection. I have an immune disorder and was regularly getting sinus and respiratory infections. The NeilMed was recommended by my immunologist and my doctor at National Jewish, and my wife and I are very thankful that I started using it.

    I have one major problem with this study: they had subjects using it twice a day. Normal recommendation, if I recall the instructions correctly, is to use it once daily, but I know the web site says you can use it twice daily if you need to. I’ll only use it twice daily if I feel a cold/sinus infection developing, on rare occasion I might double-up the salt mix packet for more punch.

    It seems to me their study was on the small side and didn’t have the greatest controls.

  26. Pawan on September 8th, 2013 10:26 am

    I have been using neti-pot for last one year and it helps but still been getting clogged up in nose. I have been recomended to to for septoplasty and will be going thru it. Nose irrigation definitely kept me off of any medication and infections for almost a year now. I adopted this because i felt it is natural and i will be able to stay off of medication dependabcy.

  27. Lillith on January 23rd, 2014 3:54 pm

    I’ve had sinus issues for 10+ years and have been addicted to nasal spray for prolonged periods. Both of my parents had the same issues and had surgery years ago. I now finally saw an ENT about it as my last addiction to Afrin lasted more than 5 months. I get a cold, I am so congested that I can’t even function without nasal spray, the cold goes away but by nose just swells shut several times a day without being snotty, so I keep having to use the spray to function.

    The ENT put me on sinus rinse (bottle) duty. The first day or so seemed find but then the rinses started to cause me debilitating headaches. I stopped doing them more than 24h ago and the headache still came back today. I feel like these rinses, while doing the trick of keeping my nose from swelling (haven’t needed to use spray since I started rinsing), they cause me extreme discomfort with these headaches to the point where I can’t work like that.

    Is this normal?

  28. Gerard Kind ( from Amsterdam) on August 10th, 2014 5:53 am

    Dear Dr. Park,

    I’m very grateful foor your website and the help it offers. I just received your letter about the saline irrigation. In Holland they just these days promote the dayly saline irrigation with a kind of plastic netipot:- the ”rhino-horn”- as beïng The Great Solution for stuffed nose from cold, allergies etc. They recommend it: do it every day This happens always: for thousands of years we think ; wheat is good for our health, now somebody tells us it is not ( Wheatbelly); now we are told: long term saline irrigation is not so good as we thought. It is difficult to decide what to do.
    For years there was the tale: long term use of oxymetazoline spray will ruin your membranes, now is it proven this is a myth. Therefore I am gratefull you give us the newest facts. I have read that a combination of Flixonase and Azelastine gives the best results in treating vasomotor rhinitis, as i have for years.
    May be you can write your thoughts about that.

    Thank you,
    Gerard Kind

Got something to say?





The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.



Flat UI Design Gallery


web hosting, website maintenance and optimization by Dreams Media