Blocked nose at night: vasomotor/nonallergic rhinitis?

[reinvigorated]

Did any of you suffer from the blocked nose at night? Were you able to entirely resolve it?

The symptoms are having are likely due to blood vessel dilation or inflammation. I have zero mucus but my nasal passages become super narrow at night and this makes it very hard to breathe eventually leading to an awakening. This happens consistently almost every night, around four hours after I fall asleep.

The symptoms are very similar to the ones you probably experience when one of your nostrils gets blocked (which is normal). Only in my case, one nostril gets blocked almost entirely, so that there is no airflow at all, and another one is blocked like 90% which is enough to disrupt my sleep. If I try to blow my nose at this point, I feel very little airflow as it's blocked but there is absolutely no mucus. So most likely it's just that the passages get very narrow.

The only thing that helps consistently and reliably is decongestant sprays with oxymetazoline hydrochloride as the active ingredient: Zicam, Afrin, etc. The effect is immediate and very strong – my nose opens up completely in just a few minutes. Unfortunately, one cannot use these sprays indefinitely because of becoming dependent and worsening the problem in the long-term. I try to minimize the use by only spraying once and only in one nostril. This is usually sufficient but I'm afraid that even this usage can lead to a buildup in tolerance. If I don't use Zicam pre-bed, I'm almost guaranteed to experience blocked nose later at night.

Interestingly, my nose works almost perfectly throughout the day – no symptoms whatsoever. The only exception is when I'm dehydrated – I can experience similar symptoms in this case but I rarely do.

I've tried all of the following but NONE of these things helped much:
1. Flunisolide spray (corticosteroid)
2. Flonase spray (corticosteroid)
3. Azelastine (Astelin) spray (antihistamine)
4. Xlear spray
5. Saline sprays
6. Turbinate cauterization (I did it twice!)

I've also undergone skin allergy testing to rule allergies out. I've tested negative for everything except dust mites. This is kind of surprising since I never ever noticed any allergic reactions to dust. My home is very clean though and I took some extra steps to reduce dust. I saw no improvement after doing this either though.

What worked for you? I need some fresh ideas! Thank you!

[Goofproof]

Only day and night. OTC, Diphenhydramine Hydrochloride Tablets 25 mg, cheap works for me, I'm not suppose to take it with heart problems, but not breathing tends to make heart problems worse. I do the next best things, use the less amount, that controls the worse of problems. BTW: Sam's Club Members Mark 600 tabs under $ 10. Although mine is Allergies year around, breathing XPAP filtered air helps too.

[Pugsy]

Did the nasal issues start when you started cpap or did you have these issues prior to starting cpap?

Are you using a humidifier? If so at what setting?

[gwc2795]

I have had nasal congestion most of my life. I use a full face mask FFM. Surprisingly my nose clears after a few minutes and then I breath through my nose.

[Julie]

Have you experimented with different humidifier settings?

[reinvigorated]

I'm actually not using CPAP. I tested one last summer but ultimately decided not to purchase one. I saw no improvement in my fatigue symptoms from using CPAP and, later, I improved through other means.

The difficulty breathing at night remained though. I know it's not directly related to CPAP per se but I know that a lot of people struggle with sleep quality here and make effort to improve, so I thought you might some insights.

The sleep lab tests I did about a year ago showed only mild sleep apnea which, according to my doctor, would have been categorized as RERA in the past (as opposed to sleep apnea). My oxygen saturation never dropped below 90 but I experienced many respiratory arousals throughout the night. I suspect that these respiratory arousals are related to these symptoms of the blocked nose.

Thank you!

[chunkyfrog]

If you were using cpap, I would suggest using a hypoallergenic filter.

[DebM]

I have the same problem.

My ENT specialist said the nasal tubes are too narrow for an operation as the post op scarring would make the problem worse. He recommended a squirt of a regular nasal decongestant followed by a squirt of Flixonese before bed. The steroid component of Flixonese prevents the rebound effect of the devongestant.

About 3 years on now and still working well.

[reinvigorated]

I have the same problem.

My ENT specialist said the nasal tubes are too narrow for an operation as the post op scarring would make the problem worse. He recommended a squirt of a regular nasal decongestant followed by a squirt of Flixonese before bed. The steroid component of Flixonese prevents the rebound effect of the devongestant.

About 3 years on now and still working well.

That's a very interesting approach! I might want to try it! Are you only spray the regular decongestant into one nostril but spraying Fluticasone into both? Also, I'm assuming that the regular decongestant = oxymetazoline = Afrin/Zicam?

Thanks!

[ChicagoGranny]

I've tried all of the following but NONE of these things helped much:
1. Flunisolide spray (corticosteroid)
2. Flonase spray (corticosteroid)
3. Azelastine (Astelin) spray (antihistamine)
4. Xlear spray
5. Saline sprays
6. Turbinate cauterization (I did it twice!)

Gosh, why have you not tried pseudoephedrine (generic Sudafed)?

It's also worth mentioning, that a neti pot rinse immediately before using a corticosteroid spray, ensures that the "medicine" gets to the mucous membranes.

[reinvigorated]

Debm,
Also, I was able to find a study that seems to show that the rebound effect can be prevented with Fluticasone that: https://www.ncbi.nlm.nih.gov/pubmed/20203244

[reinvigorated]

Gosh, why have you not tried pseudoephedrine (generic Sudafed)?

How is it better than oxymetazoline? Thanks!

[SnoringInOregon]

in my case, one nostril gets blocked almost entirely, so that there is no airflow at all, and another one is blocked like 90% which is enough to disrupt my sleep.

You are not alone.

I've also experienced symptoms exactly like you described: "one nostril gets blocked almost entirely ... and another one is blocked like 90%". Fortunately mine aren't usually that bad, and they're also somewhat seasonal.

I've tried all of the following but NONE of these things helped much:
1. Flunisolide spray (corticosteroid)
2. Flonase spray (corticosteroid)
3. Azelastine (Astelin) spray (antihistamine)
4. Xlear spray
5. Saline sprays
6. Turbinate cauterization (I did it twice!)

I don't see Nasacort (triamcinolone acetonide) on that list. It is another corticosteroid. I don't know why it would work any better than Flonase, but perhaps you should try it. I've used it in the past and it's been OK for me.

In addition, try some of the other advice already given. E.g. I like to use: http://shop.neilmed.com/Products/Sinus- ... egular-Kit
It is similar to a Neti Pot but IMO more convenient.

One other piece of advice my ENT really stressed. Keep your nasal passages moist during the day. E.g. something like this which you can buy at Costco in 3 packs: https://www.armandhammer.com/personal-c ... ion-1-6-oz

Don't be tempted into doing a 3rd turbinate cauterization. You need to really be careful of Empty Nose Syndrome. It doesn't happen to everyone, but it's apparently horrific for a few: https://en.wikipedia.org/wiki/Empty_nose_syndrome

Oh, and by the way, maybe you should do CPAP. Many people claim that the machine "powers through" congestion. Those are probably not the right words, but the machine does help many people with congestion, including me (but only sometimes).

[DebM]

I have the same problem.

My ENT specialist said the nasal tubes are too narrow for an operation as the post op scarring would make the problem worse. He recommended a squirt of a regular nasal decongestant followed by a squirt of Flixonese before bed. The steroid component of Flixonese prevents the rebound effect of the devongestant.

About 3 years on now and still working well.

That's a very interesting approach! I might want to try it! Are you only spray the regular decongestant into one nostril but spraying Fluticasone into both? Also, I'm assuming that the regular decongestant = oxymetazoline = Afrin/Zicam?

Thanks!

I use Diflam, both nostrils, then Flixonese both nostrils.

I'm in Australia so the brands have slightly diffetent names but is the same compound.

The suggestion to use Sudafed is not a good one, in my opinion. It will give a rebound effect without the steroid to offset it.

Good luck.

[DebM]

Debm,
Also, I was able to find a study that seems to show that the rebound effect can be prevented with Fluticasone that: https://www.ncbi.nlm.nih.gov/pubmed/20203244

Thanks. Works well for me but I have to use the regular decongestant as well. Flixonese (Aust version) does nothing to help on it's own. It's only useful in my case to prevent the rebound.