What You Can Do About Your Stuffy Nose

March 25, 2010

Although many people assume that big nosed people naturally breathe better, there's nothing further from the truth.  The shape and size of your nose is mostly cosmetic. How well you breathe actually depends on what your internal breathing passageways look like. And for many sleep apnea sufferers, a stuffy nose can make or break their treatment therapy.

Yet, opening up the nose through medical therapy or even surgery has been found to “cure” sleep apnea in only 10% of people. Patients will definitely feel and breathe better, but it’s unlikely that their sleep apnea is addressed definitively. However, I have seen many of the people in the “10%” group derive significant benefits from clearing up their nasal congestion. Besides breathing better for the first time in years, opening up the nose can allow the person to tolerate and benefit from other treatment options for OSA besides CPAP.

 

Why Is My Nose Stuffy?

Problem #1:  Deviated Nasal Septum

One of the more common reasons for a stuffy nose is due to a deviated nasal septum. A “septum” is a term that describes a structure that acts as a wall or separator between two cavities. Your heart has one too. No one has a perfectly flat or straight septum.

All septums, by definition, have slight irregularities or curvatures. A major reason for a crooked septum, unbeknownst to many people, even other doctors, is because your jaw never developed fully. Most people with sleep apnea have narrow upper jaws, which pushes up the roof of your mouth into your nasal cavity, which causes your septum to buckle.

If medical options don't help you to breathe better through your nose, then you may be a candidate for a septoplasty. To get a much more detailed explanation about this procedure see the accompanying article, Myth and Truths About Septoplasty.

Problem #2. Flimsy Nostrils

In some people, the space between the nasal septum and the soft part of both nostrils is either too narrow to begin with, or they collapse partially or completely during inspiration. In many cases, this can be seen years after reduction rhinoplasty, where the nose was made smaller or narrowed for cosmetic reasons. Occasionally, people can have naturally thin and floppy nostrils.

Another common reason for flimsy nostrils is due to a narrow upper jaw. The width of your nose follows the width of your jaw. If the angle between the midline septum and the nostril sidewall is more narrow than normal, then it’s more likely to collapse with any degree of internal nasal congestion. It’s not surprising that people with sleep-breathing disorders will typically have narrower jaws, and thus more susceptible to nostril collapse. Certain ethnicities are also more prone to this phenomenon than others.

One way that you can easily tell if you have this problem is to perform the Cottle maneuver: Place both index fingers on your face just beside your nostrils. While pressing firmly against your face and simultaneously pulling the skin next to the nostril apart towards the outer corners of your eyes, breathe in quickly. Then let go and breathe in again. If there is a major improvement in your quality of breathing while performing this maneuver, then you have what’s called nasal valve collapse.

The simplest way of correcting nasal valve collapse is by using nasal dilator strips, or Breathe-Rite® strips. If you do the Cottle maneuver and there is no significant difference in your breathing, don’t waste money buying these strips. If you perceive an improvement in your breathing, you can continue using the strips at night while you sleep. For some people, these “strips” are not strong enough to hold up the nostrils, or may cause irritation to the skin.

There are also many other “internal” options available over the counter, including metal springs or plastic cones that are placed inside the nostrils. People tolerate these particular devices differently, so the only way to know if you’ll like them is to try them. Three examples are Breathe With EEZ, Nozovent, and Sinus Cones.

To find out if your nasal valve collapse is from weak or flimsy cartilages or is aggravated by internal nasal congestion, you can spray nasal saline (which is a mild decongestant) into your nose. If your nostrils doesn’t collapse as much, then you need to address your internal nasal congestion first. A stronger over-the-counter medication that you can use is oxymetazoline, which is a topical spray decongestant. There are many brand name and generic versions that are sold that contain this ingredient. It’s very important that you don’t use this medication for more than two to three days—otherwise, you may get addicted to it.

If you want a permanent solution to this problem without having to use dilator strips or internal devices, the only option is surgery. The traditional way of dealing with this issue is to perform a kind of reconstructive rhinoplasty surgery, usually by taking small portions of your nasal septal cartilage or ear cartilage and placing in underneath the weakened portions of your nostril walls. A newer, simpler way of addressing this problem is by attaching a permanent suture just underneath the eye socket and tunneling the suture under the skin and looping it around the weakened area to suspend the nostril to prevent collapse.

Problem #3: Wings in Your Nose

Another common source of nasal congestion is from swelling of your nasal turbinates, which are the wing-like structures on the side-walls of the nasal cavity opposite the septum. Turbinates are comprised of bone on the inside and mucous membrane on the out- side. The area just underneath the mucous membrane is filled with blood vessels which can swell significantly. As the turbinates swell due to allergies, colds, or weather changes, the air passageways narrow further, especially if you have a mildly deviated nasal septum, and particularly if you have nasal valve collapse.

One of the most common misunderstandings that I see by both doctors and patients alike is that they think that swollen turbinates are polyps. The nasal turbinates can swell so much that you can sometimes see the reddish-pink, fleshy grape-like mass through your nostrils. Once decongested, they shrink dramatically and the air passageways open up again.

If conservative treatment including prescription allergy medications don’t work, various surgical options are available from very conservative 5 minute in-office procedures to more aggressive procedures that are performed in the operating room. These procedures are usually performed alongside a septoplasty to improve nasal breathing.

 Problem #4: Sinusitis

If you suffer from sinusitis, this can cause nasal congestion and inflammation combined with post-nasal drip, sinus pressure, and pain. Put simply, pure misery. Sinus infections typically follow either a routine cold or allergy attack; they cause both swelling and blockage of the sinus passageways, leading to negative pressure initially and, if allowed to progress, can turn into a full-blown sinus infection, with yellow-green discharge, fever and severe facial pain. Your teeth can also hurt since the roots of the upper molars jut up into the floor of the maxillary sinuses. Similarly, dental pain can sometimes feel like sinus pain.

Fortunately, most cases of sinus congestion will eventually go away. The body has a remarkable ability to take care of these issues without any intervention. Sometimes bacterial infections occur, and with proper conservative treatment using saline and decongestants, the infection gradually resolves. Rarely, you may need an antibiotic to control stubborn bacterial infections.

Problem #5: Poor Sleep

As you can see from the above discussion, there are a number of various reasons for having a stuffy nose. But the most common reason for nasal congestion that I see routinely is due to inefficient breathing and poor sleep. This is why sleep apnea sufferers, more often than not, suffer relentlessly from nasal congestion. 

Without a doubt, structural reasons like allergies or nasal polyps can definitely block your nose and these issues must be dealt with appropriately. But in general, it’s the inflammation that’s created by a combination of your hypersensitive nasal nervous system and possible stomach acid regurgitation into the nose from multiple obstructions and arousals, that causes nasal congestion. Without addressing this underlying source of inflammation, correcting a deviated nasal septum or treating for nasal allergies will only provide a temporary solution.

30 Responses to “What You Can Do About Your Stuffy Nose”

  1. John Vasko on March 26th, 2010 7:24 am

    For me, it's a combination of problems but I really think that #3 is a big culprit. The weather changes, wine, and diet soda seem to all my my "wings" swell.

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  6. barb on October 12th, 2010 9:26 am

    with all due respect how can you not be talking about eliminating congesting influences??? i really wish people with this problem would cut out ALL wheat and gluten and see what happens! Also cut out dairy, soy, corn and sugars… and use the Neti Pot and exercise. Then call me in the morning! AND YES in order to fly I must take preventaive measures: lots of neti and I take drugs which I normally do not do on the ground, just when flying: afrin OR sudafed and an aleve. Peace and healing to all – hts

  7. barb on October 12th, 2010 9:27 am

    PS thank you for your site – it is a terrific forum for learning and sharing!!! blessings to you – bts

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  9. travis on November 29th, 2010 12:37 am

    i have the neti pot, and i want to say that they work wonders for congestion

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  11. Lindsay Adams on June 8th, 2011 3:33 am

    I have flimsy nostrils. A few years ago ENT surgeon so he would take some fat from my body and put it in my nose to open airway. He said possibility of absorption by body of the fat and op. would not work. Was he wrong in referring to “fat” or has flimsy nose surgery improved in recent years.

  12. Steven Park on June 8th, 2011 3:44 am

    Ms. Adams,

    I’m not aware of any procedure using fat to stiffen the nostrils, since it’s to soft and malleable. The standard these days is to use cartilage or artificial implants. The nostrils can also be suspended to the facial bone under the skin. Widening your hard palate can sometimes help to various degrees, but it’s usually not enough. In the meantime, you can use Breathe Rite strips for one of the various internal nasal dilating devices such as Nozovent, Bres, or Sinus Cones.

  13. John on August 17th, 2011 1:24 am

    Dr. Park, I have alternating nasal congestion. Typically during the day I can breath 90% with one nostril and 10% with the other. Later the restricted nostril will become free and the previously free one will become restricted. Regardless, it seems that the total resistance to breathing through my nose remains constant. I also have OSA and use cpap. When I awake in the morning, after a night of cpap therapy I notice my nose is the clearest ever – like 90% one side and 70% other nostril. It will stay this way for only 3 minutes approx after I get up and then one side will close up. Why is this? My guess is it has something to do with the air pressure from the cpap or that the air is filtered and I am reaping the benefit of not breathing all the allergens all night. I don’t think humidity is a factor because I keep the house at 40% and I have nasal restriction winter/summer independent of humidity. If I blow my nose it is not productive – I think I just have swelling of the turbinates. Any thoughts very much appreciated. Most sincere thanks, John.

  14. Steven Park on August 17th, 2011 6:40 am

    John,

    It sounds like you are describing vasomotor rhinitis, which is commonly seen in people with obstructive sleep apnea. It’s an imbalance of the involuntary nervous system. Normally, there’s also something called the nasal cycle, where your turbinates cycle back and forth every few hours. But if both sides are congested, then you’ll notice it more. On top of these issues, you probably have anatomic narrowing, such as a deviated nasal septum or flimsy nostrils. You may want to see an ENT surgeon about these issues, especially if you wish to breathe better. Good luck.

  15. John on August 17th, 2011 4:27 pm

    Dr. Park, thank you for your very prompt reply. ENT did tell me that I had a deviated septum and that surgery may help. Allergist said that the septum deviation was relatively minor and that surgery was not indicated. So I am unsure what direction I should take. Allergist has told me that I have considerable swelling of the tissues and believes the swelling is allergy related (tested moderately positive for several allergens) and is recommending allergy shots.

    I have read that typically with a deviated septum the nasal breathing obstruction will manifest itself on the side that the septum is deviated. My septum deviates towards the left nostril but at times I can breathe freely through it – but only when the right side is restricted.

    I have no idea why the restriction in both nostrils frequently disappears after sleeping with the cpap but returns as soon as I get up to start my day. My cpap does have the very fine intake filter in addition to the standard foam filter.

    Four questions if I may:

    1) Are allergy shots ever effective for clearing up this type of alternating nasal restriction?
    2) Is it common that surgery is indicated to correct a deviated septum even though the patient can breathe perfectly clearly at times through both nostrils – just not at the same time?
    3) Any idea why both nostrils are clear after a night of cpap therapy?
    4) The nasal cycle you mention – what percent of restriction is normal? ie (do the majority of people have perhaps 0% restriction in one nostril and 20% in the other at any given time due to this cycle?)

    I really appreciate your help and dedication to your profession. The information provided by you is helping me choose what treatment direction I should take.

    Sincerely, John

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  17. Mary on January 21st, 2012 6:07 am

    I work in a Dental Sleep Clinic and currently using the Moses appliance, Breathe Right strips and Spry Zylitol nasal spray. The Zylitol nasal spray has been a great product for many of Dr’s patients.

  18. John Putriment on March 5th, 2012 8:02 am

    Still waking up chronically with a stuffy nose. When this occurs, I wake up feeling exhausted. Nose is typically completely blocked on left side; partially blocked on the right. I sleep on my stomach with my head turned to the right to accommodate my full face mask CPAP (with heated humidifier). I’ve had two surgeries for deviated septum; around age 7 and just again in my late 30′s. This last time they also did a turbinate reduction. Tried nasal cones with no success; it appears my turbinates get inflamed further up; not flimsy nostrils.

    The best solution I’ve found is taking 12 hr. sudafed before bed. Problem is this only works for a handful of days before I have to take a break from it. I’m considering going back to my ENT or driving into NY to get your opinion. Can my turbinates be safely reduced again? Any other ideas?

    Thanks!

  19. Steven Park on March 5th, 2012 9:16 pm

    John,

    It’s difficult to give you an answer without examining you, but it you still have very enlarged turbinates, it is possible to reduce even further.

  20. Gemma on September 21st, 2012 9:11 am

    Hi there,
    7 months ago I had a turboplasty & septoplasty done due to my nose being constantly blocked & infected! I had a badly deviated septum! Since my surgery… I have suffered more pain in my face/head/neck/teeth etc than I did before my op and I can constantly smell like medication/packing kind of smell! I have been to hospital on 20 seperate occasions In agony with it and ive been told something different everytime! I feel like there’s something stuck up my nose that shouldn’t be there but the hospital say it’s my imagination! After alot of hassle I was finally booked in to have an EUA done yesterday… As I was being admitted the surgeon said he wasn’t willing to do it because someone else had sent me there so he sent me home saying there is nothing more they can do for me! I now have no idea what to do in this situation! Is it possible that I’m right about it being some kind of rejection or that my operation simply hasn’t worked! Any advice would be greatly appreciated as I’m unsure what to do! The hospital don’t want to know but I’m at my wits end with it! please help! Thanx Gemma.

  21. Louis Brandt on September 29th, 2012 11:35 am

    I am 75. I only have breathing problems when sleeping but it does seem to be more of a problem than at a younger age. If I use Afrin before bed, I get a full restful night of sleep as long as I sleep on my side. There is no way I can sleep on my back with Afrin or with CPAP. I envy my wife who sleeps like a mummy on her back without any issue. I am wondering if you think one of he minor surgeries mentioned above in Problem #2 might help.
    Thank you,
    Louis Brandt

  22. ma on October 5th, 2012 8:11 am

    Thank you so much for the information. I recently got a septoplasty, actually, two days ago. I hope this procedure will work I have had this deviated nasal septum since my ex-first-husband broke it. I didn’t born with a deviated nasal septum. My nasal problem got worse when I moved to the USA, well, more specific in the state of Florida where there is lots of humidity and so many kind of pollen from which I get allergies and since my nasal septum used to be like a zig-zag when allergies attack the inflammation didn’t let my nostrils to drain and I used to get really bad sinus infections. Last year my sinus got really bad that the infection went up to my left eye and I ended in the emergency room with really bad fever and horrible pain on my whole face. Thank you so much for your article, I will share with my friends and family.

  23. Marilee Feldman on November 8th, 2012 9:56 pm

    I had a septal deviation repair and turbinate reduction about 3 years ago. I noticed slight improvement in my ability to clear my nose by blowing it, but I still have really reduced airflow on one side. I have the sensation that there is something in my nose and sometimes I get pain in my nose. I always have a headache on that side. Four weeks ago I had nasal somnoplasty on that side but still no improvement. I am very upset and losing hope. My doctor says it can take longer to see improvement but I am skeptical as I’m reading many people see improvement sooner. He also mentioned it may be a valve problem but it sounds like repair of this problem is controversial and also may not work. What do you think? Do I need to wait longer?

  24. Steven Park on November 8th, 2012 10:06 pm

    Mr. Brandt,

    A qualified surgeon should be able to tell you the exact nature of your nasal obstruction, as well as to give you different options as well as expected rates of success. Good luck.

  25. Steve on March 14th, 2013 11:13 pm

    Dr. Park:

    I really appreciated the info in your “Truth about OSA” report.

    Regarding your comments about “smaller jaws in modern humans”, “dental crowding and crooked teeth” and how they correlate to issues with the tongue and soft palate:

    Has anyone explored a possible correlation with orthodonture being a potential contributor to this condition? Might be an interesting statistic to explore….

    My OSA has increased in severity over the years and yes, I had braces on all teeth as a teen.

  26. deepak kumar on June 5th, 2013 1:10 pm

    Dear Dr,. Steven park.
    first of all i would like to thank you for your kind support which you have shown to all of us by uploading very useful info/material about the nasal congestion and other deceases.
    Sir i am 29 year old and suffering from nasal congestion for the last 8-10 years and the symptoms are always same since i am suffering from it. i had consulted 4-5 ENT surgeons here in my city and they all had done nasal endoscopy/CT(PNS) and told me that my inferior turbinates are hypertrophied and because of them i m facing this problem.
    doctor i used to take Otrivin® Saline Pediatric Nose Drops (http://www.otrivin.ca/en/products.shtml) since i was a kid during cold and congestion. every time i visited ENT specialist, they told me that OTRIVIN is addictive so i should not use it and instead of it i should take other nasal sprays like duonase of cipla compnay(http://www.youtube.com/watch?v=EMKcu4J_BKo http://www.dawabazar.in/products/duonase/146694).sir here i want to mention some symptoms of my nasal problem
    1. when i sleep at night and suppose i lie down from left side for 10-15 minuted my right nostril goes open and left goes jammed, this i feel whole night so i don’t take healthy sleep
    2. if i take only 1-2 drops of Otrivin® Saline Pediatric Nose Drops (http://www.otrivin.ca/en/products.shtml) i instantly feel relaxed for 5-7 hours.
    3. i don’t feel headache of don’t have sneezing or belch or any other problems
    4. if i speak i bit long i see very clean white mucus in lower side of my throat which i usually spit out.
    5.i have take several medicines like anti allergic and swelling reducing medicines but except nasal sprays and that OTRIVIN none of them worked.

    here finally want to hear from you that what should i do, shall i go for surgery like turbinoplasty/any other surgery?
    kindly help me sir as i am very much worried and in problem as i take my nose very serious because i know that after surgery if my case is become worst then no doctor can make it good.
    thanking you in anticipation
    deepak kumar

  27. Roberto Yunes on August 21st, 2013 4:46 pm

    I am a 51 year Old man, 5’5′, 150 pounds’ healthy (only with medical condition chronic allergic rhinitis) Athletic been recently diagnosed with severe sleep apnea.
    Clinically, and as far as I remember since my 12 years old I have been with symptoms of Narcolepsy (as Excessive Daytime sleep attacks, Cataplexy and Hypnagogy Hallucinations).
    I started looking for professional medical help went I was 18 year old ( described in medical visits in my own words to several -more than 10- ??doctors?? of different specialties/ Institutions/ Hospital/ countries) unfortunately been misdiagnosed as Depression, anxiety, etc….
    At the age of 34 year old by studying my symptoms I clinically diagnostic myself as Narcolepsy and went to a New Jersey Hospital (1996) at the age of 34 and by my request they perform Sleep study with MSLT and confirm the diagnosis of Severe Narcolepsy (REM with 5,6,8 & 12 secs)…prescribed with Ritalin 10 mg 4 pills daily. For the next 14 years I never been enough awake/oriented, until again I started looking for help I got the Provigil and finally seen myself awake/but not totally concentrated/focused/attend. The combination with 5 mg of Ritalin, make me feel like stable (Awake/oriented and with enough attention/concentration).
    By Health insurance medication coverage I was suggest to repeated the Sleep Study which was done in a Sleep lab at Columbus Georgia USA . The Tech decided to do only the sleep study due to I did 10 episodes/ 1er sleep hour of Sleep apnea (O2 sat. drop to below 80). and been diagnosed with severe Obstructive Sleep Apnea.
    The CPAP was used for around 45 days and nasal spray (steroid decongestive) and oral antihistamine (Allegra) for try to open my swelling adenoids (Dx. With ENT Dr. for right septum deviation and Chronic sinusitis…… ) make my symptoms worsening and not been help by the provigil/Ritalin.
    After 1 year complaining with my worse condition witch was never get attention, then the Doctor decided in April to complete the sleep/MSLT came with the results of Sleep Apnea and Narcolepsy.
    Now in August they started back on CPAP (ram 6 to 13 pressure, 6 humidity) and as today Date have been 14 days of consecutive used of the CPAP without any noticeable improve of the Sleep Apnea Symptoms (night bed wetting, wake up confuse, disoriented, poor concentration and still with more tired/sleepiness than the night before) and Narcolepsy symptoms(daytime Sleep attack) obviously get better after taking my dose of Provigil and Ritalin.
    The At the Starting use of CPAP, I have to wake up 1 to 3 times due to very dry mouth/throat (no matter I am using the Biotene= xylitol ( moisturizer mouth Spray) throat gel y/or ACT LOZENGES W/Xylitol and pills to water my throat passages and mouth.
    What else I should do to avoid my health deteriorate on this lack of medical advise?

  28. Stephen on June 4th, 2014 11:32 am

    Dr. Parks,

    Could you address the area of diagnosis please?

    Rather than throwing a dart at a dart board approach – the process of elimination as some have spoken to – what can one do to narrow down your specific ailment?

    One would hypothesize that you should focus on going to a specialist – perhaps someone like you – or at least an ENT, maybe a plastic surgeon.

    From there would it be recommended to have a CAT scan focusing on the sinuses/nasal cavities?

    With ALL of the technological advances available can we disavow the process of elimination and find the means to identify the specific source that creates the breathing difficulty.

    Will it be necessary to go to the Mayo Clinic to seek out a qualified physician or surgeon and has access to the necessary equipment and means or is there a local alternative and, if so, what is the process of identifying that party?

    I have been experiencing difficulty/discomfort for some time in breathing out of my LEFT nostril, I’ve tried OTC medications, nasal strips, homeopathy, ad nauseum and only want RELIEF and a good night’s sleep.

    After some careful deliberation I believe, at least to some degree, that the source of my problem is GERD/Acid reflux, but that may not be the only source (perhaps some allergic reaction to something – at this point unknown.

    I think one of my answers for relief is surgery, but in order to qualify that I want to have a CAT scan to establish whether a blockage exists.

    I do appreciate your comments in this regards,

    Respectfully,

    Stephen

  29. Steven Park on June 4th, 2014 3:55 pm

    Stephen,

    Thanks for contributing. Your best bet is to see your local ENT to see what’s going on. Most cases of nasal congestion can be addressed. Tyipically, imaging is usually not needed.

  30. Steven Park on June 4th, 2014 3:58 pm

    Deepak,

    The drops you’re using is the typical nasal decongestant that can be addictive. Typically, an ENT can usually help. Good luck.

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