Nasal Congestion

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What causes nasal congestion? How can it be relieved?

As the weather gets colder, nasal congestion has once again become a common concern for many of us. Although it often appears as a temporary symptom of a harmless common cold, it can also be a sign of an underlying problem that negatively affects our quality of life.

The direct impact of nasal congestion on quality of life is, of course, related to the disruption of one of life’s most fundamental and involuntary functions: breathing. However, its effects do not stop there. Nasal congestion can create a domino effect, affecting everything from sleep quality and energy levels to the ability to concentrate on tasks that require attention. Therefore, when addressing nasal congestion, our goal should not simply be to provide temporary relief but to identify the underlying cause and find a lasting solution.

So, why does this problem occur, and how can we get rid of it? Many different factors may contribute to nasal congestion, ranging from short-term viral infections and allergic reactions to structural obstructions inside the nose and environmental factors. The effectiveness of any treatment depends entirely on correctly identifying the underlying cause and the duration of the congestion.

In this article, we discuss nasal congestion, a problem frequently encountered during the winter months. In the following sections, we will examine the limitations of home remedies that can be used safely, the risks associated with improper nasal spray use, the situations in which consulting a specialist is essential, and the steps followed in modern medical diagnosis and treatment. With this introduction, let us continue by exploring the causes of nasal congestion.

What causes nasal congestion?

The most common cause of nasal congestion is viral upper respiratory tract infections. During a common cold or influenza (see: What helps with the flu?), the nasal mucosa becomes swollen, mucus production increases, and the nasal airways narrow. These symptoms generally tend to improve within a few days.

Allergic rhinitis is another common cause. Exposure to triggers such as pollen, dust mites, animal dander, or mold may lead to sneezing, watery nasal discharge, itchy eyes, and nasal congestion. Allergy-related symptoms may occur seasonally or persist throughout the year.

In some people, however, the problem is related more to the structure of the nose than to an infection. A deviated nasal septum, commonly referred to as a crooked nasal septum, enlarged nasal turbinates, polyps, or, less commonly, masses can cause long-term congestion. Pregnancy, hormonal changes, cigarette smoke, air pollution, and certain medications can also affect the nasal mucosa and trigger congestion.

Symptoms of nasal congestion

Nasal congestion can cause various symptoms and secondary complaints because it prevents sufficient airflow through the nose. These symptoms can mainly be examined under the following categories:

Changes in breathing habits:

• Breathing through the mouth because breathing through the nose is difficult
• Having difficulty speaking while trying to breathe through the mouth during the day
• Sleeping with the mouth open and snoring at night

Conditions associated with mouth breathing:

• Dryness and a burning sensation in the throat
• Cracked lips caused by dryness
• Bad breath

Other accompanying symptoms:

• Persistent fatigue and a feeling of weakness
• Runny nose and postnasal drip
• Itching inside the nose or in the eyes
• Frequent sneezing episodes

How can I relieve nasal congestion? What can I do at home?

For mild and short-term congestion, moisturizing the inside of the nose is generally a safe starting point. Sterile isotonic saline sprays or properly prepared nasal irrigation solutions can help remove thick mucus and keep the nasal mucosa moist. However, there are certain precautions to consider when performing nasal irrigation. The main points are as follows:

• The water used must be sterile, distilled, or previously boiled and allowed to cool.
• Tap water must never be used directly.

Drinking enough fluids, particularly when experiencing a fever or excessive nasal discharge, may help keep mucus thinner and easier to clear. Taking a warm shower may also provide temporary relief through the moisture in the bathroom environment. However, it is important to remember that exposure to very hot steam can cause burns. Therefore, inhaling steam directly over a container of hot water is not considered a safe method.

Slightly elevating your head while sleeping may help reduce nighttime congestion and postnasal drip. It is also important to prevent the room from becoming excessively dry. If you use a humidifier, you should clean the device regularly. Poorly maintained humidifiers may spread microorganisms and mold.

If an allergy is suspected, reducing exposure to triggers is an important part of symptom management. Measures you can take at home include:

• Washing your face and changing your clothes after spending time outdoors during pollen season
• Reducing dust-collecting textiles in the bedroom
• Avoiding indoor cigarette smoke and polluted environments

However, the effectiveness of these measures varies from person to person, and they do not replace medical evaluation when symptoms persist.

How can you manage nasal congestion that worsens at night?

The reason nasal congestion becomes more noticeable in the evening and at night is partly related to our daily routines. During the day, work and physical activity may help us temporarily shift our attention away from a blocked nose. However, as our pace slows down in the late evening, our attention returns to the congestion. Once we lie down to sleep, the discomfort often becomes much more pronounced.

In addition, when lying down, the effects of gravity alter blood flow and fluid accumulation in the nasal mucosa. This can make breathing more difficult, particularly at night, resulting in interrupted sleep, snoring, and waking up feeling tired in the morning.

You may be wondering whether anything can be done to reduce this nighttime discomfort and prevent it from repeatedly interrupting your sleep. Fortunately, there are several practical measures you can take:

• Elevating the head and upper body: Slightly raising the head of the bed, for example by using an additional pillow, may help promote sinus drainage and reduce postnasal drip.
• Bedroom ventilation and humidity balance: Excessively dry air in the bedroom can irritate the nasal mucosa and trigger congestion. It is important to ensure that the air is neither too dry nor too humid. If a humidifier is used, the device must be properly maintained.
• Cleaning the nose before bedtime: Moisturizing the nasal passages with isotonic saline sprays before going to sleep is another precaution you can take. This may contribute to more comfortable breathing throughout the night.

Medications for nasal congestion

Decongestant nasal sprays can provide short-term relief by constricting blood vessels in the nose. However, continuous and prolonged use of these products may cause medication-induced nasal congestion. In this situation, congestion becomes more pronounced when the spray is discontinued, leading to a cycle of repeated use. Therefore, decongestant nasal sprays should generally be used only for a short period, in accordance with the product instructions and the advice of a physician or pharmacist.

For allergic rhinitis, corticosteroid nasal sprays and antihistamine medications may be recommended by a physician. These treatments work differently from decongestant sprays. In particular, the effects of corticosteroid nasal sprays may become more noticeable after regular use. Proper spraying technique is important both for treatment effectiveness and for reducing the risk of irritation. The spray nozzle should be directed toward the outer wall of the nasal cavity rather than toward the nasal septum.

One particularly important point to emphasize is that medication use should be guided by a healthcare professional. For example, certain oral cold medications or decongestants may not be suitable for people with high blood pressure (see: What causes high blood pressure?), heart rhythm disorders, an enlarged prostate, glaucoma, or thyroid disorders.

Medication selection should also be carefully evaluated during pregnancy and breastfeeding. People who regularly take medications should consult a healthcare professional before using new products, particularly those containing multiple active ingredients, to avoid unnecessary risks.

When should I see an ear, nose, and throat specialist?

A medical examination is recommended if nasal congestion lasts longer than 10 days, occurs frequently, or gradually worsens. Evaluation for sinusitis and other possible causes may be necessary, particularly if congestion is accompanied by facial pain, high fever, discolored nasal discharge, a significant reduction in the sense of smell, or swelling around the eyes.

Persistent one-sided nasal congestion, recurrent nosebleeds, foul-smelling discharge, or facial numbness should also be investigated without delay. In children, prolonged mouth breathing, snoring, restless sleep, frequent ear problems, or changes in school performance may be associated with enlarged adenoids or other respiratory conditions (see: Upper respiratory tract diseases in children).

Nasal congestion in children and the risks of mouth breathing

Nasal congestion in children can have much more subtle and long-term effects compared with congestion in adults. Because children’s airways are narrower, even a minor infection or enlargement of the adenoids can quickly cause them to start breathing through their mouths. However, persistent mouth breathing in children may lead to a series of problems that extend beyond immediate discomfort and potentially affect their development.

The main risks associated with long-term nasal congestion and mouth breathing in children can be summarized as follows:

• Sleep and developmental problems: Inability to sleep continuously throughout the night may negatively affect growth hormone secretion in children. It may also lead to irritability, attention difficulties, or reduced school performance during the day.
• Changes in facial and jaw development (“adenoid facies”): Habitually sleeping with the mouth open may contribute to narrowing of the upper jaw, dental alignment problems, and long-term changes in the development of facial bones.
• Ear and hearing problems: Enlarged adenoids may obstruct the Eustachian tube, contributing to fluid accumulation in the middle ear, frequent ear infections, and temporary hearing loss.

Therefore, if you notice persistent snoring, constant mouth breathing, changes in your child’s voice (such as a nasal-sounding voice), or frequently recurring upper respiratory tract infections, it is advisable to consult an ear, nose, and throat specialist rather than attempting to manage the condition solely with home remedies.

What happens during a medical examination?

An ear, nose, and throat (ENT) specialist evaluates when the symptoms first appeared, whether they vary seasonally, any accompanying symptoms, and the medications being used. During the physical examination, the specialist assesses the nasal mucosa, septum, turbinates, and characteristics of nasal discharge. If necessary, nasal endoscopy may be performed to examine the nasal passages and nasopharynx in greater detail.

Imaging tests are not necessary for every case of nasal congestion. However, computed tomography (CT) may be requested for persistent sinus-related symptoms, suspected nasal polyps, or surgical planning. In individuals with a significant history of allergies, allergy testing may help guide an appropriate prevention and treatment plan.

Treatment is planned according to the underlying cause. Supportive care may be recommended for infections, medications and trigger avoidance for allergies, and surgical options when necessary for structural narrowing. Antibiotics should only be used when prescribed by a physician for specific clinical situations suggesting a bacterial infection. Not every case of yellow or green nasal discharge requires antibiotic treatment.

How to maintain nasal health in daily life

So, what precautions can we take in everyday life? First, it is important to avoid smoking and exposure to secondhand smoke. These measures help protect the mucous membranes of the nose and respiratory tract. If you work in dusty environments or areas with chemical exposure or poor air quality, you should take precautions by using appropriate protective equipment. Frequent nose picking and forceful nose blowing may increase the risk of irritation and bleeding inside the nose.

Although nasal congestion can be uncomfortable, the appropriate approach is to use temporary relief measures safely and avoid neglecting persistent symptoms. If you notice changes in your breathing patterns, disrupted sleep, or recurring symptoms, consulting a specialist is recommended to identify the underlying triggers and determine the most appropriate course of action.