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.

Written by Steven Park · Filed Under Blog
Tagged: ,nasal congestion, nasal saline, saline irrigation, sinus headaches, sleep apnea

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

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

Thanks so much for your advise Dr. Park!
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 :”)
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
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!
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.
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.
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.