Long-term Nasal Saline Irrigation: Helpful or Harmful?

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.

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78 thoughts on “Long-term Nasal Saline Irrigation: Helpful or Harmful?

  1. Also….I put coconut oil inside my nostril after each irrigation. If I don’t it gets dry but if I don’t irrigate the snot is like glue it’s so dry. I’ve been doing this for years, daily and I went from bimonthly infections to one every year or more. I usually avoid petroleum jelly. I use a qtip ….or my pinky (then wash my hands) I put coconut oil(or castor oil) in the first part of my nostril a few minutes after each irrigation. I only use a little bit, just a tiny bit to keep it moist…too much and the excess just runs. It’s helped me so much.

  2. I have been using “simply saline” quite often even though my nose often feels more dried out and I have more trouble breathing afterwards. Then about a short time later my nose becomes filled with caked dried blood and I really can’t breathe. Then I remove the dried Kate blood and the vicious cycle resumes. Perhaps I should just leave it alone and let nature take care of it. Thank you for your article.

  3. Dr. park,
    Thank for the free book. I only just downloaded it at 3am this morning. I only happened upon your site from another dental site. I have had sinus issues for a number of years, and have in the last 15 or so years been snoring. It’s not my weight,, Doctor confirmed. I have also had dental issues, which are now in the process of being fixed. Last fall, I lost my upper left molar, farthest back, and it seams that I am experiencing nasal/sinus problems. Along with that, I have had to take 3 rounds of Amoxicilin in order to clear up a nasty infection in my lower jaw. I friend had told me about getting a Nety pot to flush my nasal passages, but I can’t seam to bring myself to stuffing something up my nose. I am currently having all cavities and bridges taken care of, but really would like to take care of the snoring issue, found your site, and ebook. My husband says I don’t stop breathing, but I snore, even with my mouth closed. If I sleep in a reclined position, not flat, then I don’t snore, but it’s not very comfortable. Look forward to reading your book.

  4. 2-3 sinus infection a year until irrigation with salt water. Started on a daily schedule for several years. Than went to Monday Wednesday and Friday schedule. Presently only irrigate twice weekly. PROBLEM SALVED no more sinus infections.

  5. I have had frontal headache, head congestion, irritation in my nasal passage (one which is deviated) and several other vague and various symptoms for nearly a decade. I don’t have typical sinusitis. CT scan showed ‘minimal mucosal thickening’, which rules out sinusitis. ENT said I’ve allergic rhinitis.
    Meantime, I’ve been doing jal neti three times a day. Its now been 7 years. I do it more often if I have severe headache at night. I get good to mild relief for few hours at least after neti. I seem to have become dependent on it. Even slight exposure to AC in confined space brings on congestion & headache. Fluticone FT spray helps, but I understand one should not use it more than 3 months a year.
    My lifestyle has been affected and limited. I do not see any other solution.
    Please suggest if immunology treatment could help.

  6. About nasal irrigation, as a user of CPAP, I consider it indispensable. It is a soft way to clean the nasal via. As long as one keeps all clean, one believes there is not problem. After reading this and think in it again, perhaps salinity may cause some mucose damage, but it comes to surprise if salt concentration is the same as the one used in physiological solution. After reading the above, I will take care of using a bit of sodium carbonate to increase PH, Also, I do prepare my own solution with cooking granular salt. That salt my come with bits of added iodine and fluor. After years, that does not appear to cause me any trouble when awake, but I will take care of this. However, the CPAP cause me nasal valve collapse, frequently but not always. It looks random. The probability of the swelling increase with the time of CPAP usage, which is very low in the first three or four hours. Another factor to consider is inhaled vapor/air temperature and the purity of the water used in the CPAP humidifier, for example, I understand in some countries distribution water has fluor and/or chlorine added, while in my place, city water is very hard and alkaline. So, consider using only purified water in the humidifier.

  7. I have used NeilMed nasal rinse every day for 5-6 years now. The only infections I have had over that period of time occurred after this year’s transatlantic flights which occurred in February and in November. Although difficult to prove, I believe these infections were due to exposure to the airplanes’ air. Of course, I might have been more sensitive to the germs because of the daily rinse.

  8. Hello,
    I’m italian, so excuse me for any mistake in my English.
    It’s been 25 years I suffer from allergic rinitis (mice dust)… I also have a deviated septum (not fully convinced by the surgery I probably need…); but never suffered from sinuses infections.
    It’s almost 7 years I’ve been using a plain saline solution (spray), on a daily basis (1-3 times a day). No problems at all; it helped (and helps) me a lot.
    Kind regards

  9. my nose is all stuff up have sinus pressure which makes me lightheaded have had this for years. thank- you.

  10. I suffer from rhinitis and have a lot of caking of the mucus, which blocks my nasal passage. So, I irrigate with saline solution, which works like a charm by dislodging the blockage. My problem is, all this leaves my nasal passage very dry and I dont feel any relief from the inflamation and pain.

  11. I have tried irrigating my congestion with nasal saline sprays but it has not helped me. Currently I stopped using over the counter medications, Flonase and the saline sprays. I am not using anything now. Nothing I have tried has helped me be able to breathe easier. I can’t breathe out of one side of my nose and my upper teeth are sore on that side. I have had this issue for many years.

  12. I started using neilmed sinus rinse twice a day a month ago after a big surgery to remove the mucosa in the right side of my nose. It was to help to loosen and remove crusting on the right side and did the job really well.
    However after 4 days of use I woke up with what felt like a stuffy left side of my nose and very nasal sounding voice. That was over two months ago. I still sound like I have a stinking cold and now have to use decongestant every day to unblock the left side of my nose. The right side which had surgery is fine. Could neilmed have caused this?

  13. I use it 2 to 3 times a day and never get a sinus infection I have used it for years primarily in the cold dry months spring I lessen the use summer I never use it late fall I begine again threw winter. I have done this for about 5 years after I had many bloody noses from drying out

  14. i do nasal irrigation with warm water. no salt. what do you think will happen? im on cpap.

  15. Usually use a nasal saline spray once or twice a day. If I don’t feel congested, I won’t use it. I used to do irrigations with the Neilmed bottle but had trouble with water in my ears. As I’m now suffering with ETD (undiagnosed) I gave away the Neilmed irrigation as I’ve lots of popping and crackling noises in both ears. I’m going to be taking your advice about eating dinner early and not drinking alcohol at night to see if this helps.

  16. I have been using nasal Saline irrigation for at least six years or longer everyday.I used to wake up every morning with my nose stopped up and a lot of drainage in my throat. This product works great and I will continue to use it. Thanks for making such a great product.

  17. I have used a nasal saline rinse at least once daily for a number of years. I not only breathe easier, but have been free of sinus infections. I don’t use a neti pot, but rather a spray bottle like those that come with sodium packets sold at drugstores.

    One caution: It may be important not to allow the solution to trickle past the back of the throat and possibly into the lungs, as it becomes a vehicle for
    nasal bacteria.

  18. Thank you for the opportunity of an opinion. Being treated for staph in nasal cavities using saline irrigation and mixing with 1″ strip of Mupirocin ointment. [ it’s off label treatment 2x day for 30 days] Doing well as far as breathing in this first week but the salty saline is causing me severe edema in my feet and legs. I’ve been on water pills for years to keep it under control. My BP has also elevated.
    My question is how to continue to use the Mupirocin . I did read that the saline is beneficial to the nasal tissues because plain water could have a burning effect.

  19. This makes me feel better if/when I go through periods without washing with neil med sinus rinse (the added pressure works better for me). Maybe it is a practice to do for a period, than discontinue for a stretch, before repeating to possibly prevent the body from fully adapting one way or another.

  20. I have tried every thing I think, I wake up so often at night nose block up can’t breathe, mucus coming through my mouth. My doctor have me on ipravent spray doesn’t help much. I am afraid I am die one night from not breathing, had sinus surgery a few years ago. Do not know what to do

  21. I have used saline nasal rinses every day for many years. I do not get sinus infections. I have always had very dry and clogged nasal passages and need to clear out a lot of debris every day so I can breathe. I did have nasal surgery about seven years ago for a completely blocked left nostril. I do seem to have post nasal drip.

  22. I have been using the Neti-Rinse bottle daily for about a year with no infections. I also use a saline rinse. Before putting my mask at night I use one spray of Flolnase in each nostril. Sometimes, I am wondering if I am doing too much. I am going to stop all of the above and see what happens. I am frustrated that my AHI’s are still 8 to 12 even after switching to a full face mask. Higher pressures do not seem to help as I do wake up more during the night.

  23. Hi Dr Steven,

    I have frontal chronic sinusitis (and deviated septum) and have just started on the saline wash. Will let you know in a couple of weeks.



  24. My husband and I have found a significant reduction in colds since using a salt spray twice daily. This has been the case for several years…probably about 6 I think. I do however feel that I produce more mucous in my throat which is sometimes difficult and embarrassing to cough up. When I do, usually in the morning, it tastes rather salty. I notice my husband coughs a lot too.

  25. I have had sinus issues since I was twelve years old. I also have a deviated septum. I have to sleep on CPAP with a full face mask, whereas the mouth breathing is defeating the CPAP. I use saline solution spray when I feel a sinus infection coming on and generally I can ward that off.

  26. I have frequent sinus infections. The most recent was cultured out to be pseudomonas. In use sterile saline mist once daily and ipitropium bromide nasal spray and nasalcort. I have had rhinoplasty. Am I helping or harming?

  27. Yes, I have used a saline spray in my nostrils upon rising every day for at least the past 7 years. I did so because I remember reading that it was beneficial to do so. I do not use OTC nasal decongestants.

    Up to last month I had no negative effects. However last month (Dec. 2020) I started getting a headache in between my eyebrows. I mentioned it to my wife and after hearing that I used the saline for so long, she recommended that I discontinue it (due to the fact that salt is an irritant) and see what happens.

    Today is Jan.21, 2021 and I still note on and off headaches between my eyebrows and an almost continually stuffy nose. I have not gone to a doctor because I attribute it to the subtraction of the saline spray and the dry heat by my head at night since we live in the Northeast USA. The humidity in the house is at around 30% +/- 5 every day.

    I have not used any saline and only used a nasal decongestant last week as directed for three days. It helped, but the stuffiness in my nose returned.

    I chanced upon your site in my attempt to find out if using saline spray was good or bad to use.

    Frank S. Farello