Night-time sinus congestion

[LeanGuy]

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps? I've tried corticosteroid nasal sprays but not very effective. I've even had an outpatient turbinate reduction. My nose gets 100% blocked every night, and doesn't clear up until my morning workout. This problem is seriously affecting my sleep quality which I already have trouble with. I think it might be time for a full-on sinus surgery... even though the recovery is miserable.

[pmgamer18]

I have this every night so I ware noise strips and put a Halls in my mouth when I go to bed but the time I fall to sleep it's gone and I can breathe.

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps? I've tried corticosteroid nasal sprays but not very effective. I've even had an outpatient turbinate reduction. My nose gets 100% blocked every night, and doesn't clear up until my morning workout. This problem is seriously affecting my sleep quality which I already have trouble with. I think it might be time for a full-on sinus surgery... even though the recovery is miserable.

[Dadnatron]

The turbinate reduction would have been the main solution, if done adequately.

Basically, it isn't your 'sinuses' which are being plugged. Normal airflow is not through the sinuses but rather through the nasal vault. There are two major obstructions to normal airflow in the nasal vault.

One is septal deviation which can result in such convoluted airpassage, that you will have up to a complete blockage of airflow usually only through one nostril, leaving the other normally flowing USUALLY.

You can have polyps, which can slow airflow, but this does not change during day/night cycles.

What YOU have is mucosal engorgement on a diurnal time frequency. This is a poorly understood phenomena in which the NORMAL mucosal engorgement cycles, which occur throughout the day and night, become poorly cycled and you will have total engorgement of all nasal mucosa (typically of the turbinates) at the same time. Often, this occurs while recumbant (lieing down) and resolves when upright.

What happens during the day is that one side (nares) or the other will have less airflow. This is because the mucosal lining of the turbinates on that side will become filled with blood (similar to, but different, an erection) This allows for more 'heat transfer' to the incoming air, thereby prewarming the air prior to it reaching the bronchi of the lungs. This is the reason we have sunuses and turbinates in the first place... well that and to help filter crap out of the air, but that is another issue entirely.

Now... for some people, this normal one side or the other cycling gets goofed up at night, be that hormonal, positional, or whatever. (I think it is basic hormones myself) but for whatever reason, ALL of the mucosa becomes engorged at the same time. Therfore, the normal thickening on one side is NOT relieved by thinning on the other side.

It is very odd, because there are several mechanisms which work to change this. Placing your finger in your nose and pressing on the turbinates, can cause the 'engorgement' to decrease. Inhaling mentholated odors can decrease the engorgement. Obviously vasoconstrictors such as neosenephrine, can result in decrease, however, they typically result in what is known as 'rebound' in that when they wear off, you will have much WORSENED conjestion.

Turninectomies, if done thoroughly, usually completely resolve the issue, because it 'removes' the mucosal lining which causes the problem.

[LeanGuy]

Thanks for the replies... especially your detailed response, dadnatron. I'll probably go for another turbinate reduction.

[anyman]

The turbinate reduction would have been the main solution, if done adequately.

Basically, it isn't your 'sinuses' which are being plugged. Normal airflow is not through the sinuses but rather through the nasal vault. There are two major obstructions to normal airflow in the nasal vault.

One is septal deviation which can result in such convoluted airpassage, that you will have up to a complete blockage of airflow usually only through one nostril, leaving the other normally flowing USUALLY.

You can have polyps, which can slow airflow, but this does not change during day/night cycles.

What YOU have is mucosal engorgement on a diurnal time frequency. This is a poorly understood phenomena in which the NORMAL mucosal engorgement cycles, which occur throughout the day and night, become poorly cycled and you will have total engorgement of all nasal mucosa (typically of the turbinates) at the same time. Often, this occurs while recumbant (lieing down) and resolves when upright.


It is very odd, because there are several mechanisms which work to change this. Placing your finger in your nose and pressing on the turbinates, can cause the 'engorgement' to decrease. Inhaling mentholated odors can decrease the engorgement. Obviously vasoconstrictors such as neosenephrine, can result in decrease, however, they typically result in what is known as 'rebound' in that when they wear off, you will have much WORSENED conjestion.

Turninectomies, if done thoroughly, usually completely resolve the issue, because it 'removes' the mucosal lining which causes the problem.


An interesting proposition, but what about the dry nose syndrome some complain of and worse? Seems I read of many complaints for poorly done surgery. As a victim of what I perceive to be med mal (lied to about laser eye surgery and now have nasty nighttime issues for which I am still pondering how to deal with the bastard) I approach this cautiously.

[Massa]

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps? I've tried corticosteroid nasal sprays but not very effective. I've even had an outpatient turbinate reduction. My nose gets 100% blocked every night, and doesn't clear up until my morning workout. This problem is seriously affecting my sleep quality which I already have trouble with. I think it might be time for a full-on sinus surgery... even though the recovery is miserable.

I had the same problems after (ab-)using nasal sprays in a hey-fever period during puberty. Even after cessation of the sprays my nose would block completely as soon, as I lay down... being camping for 2 weeks and having forgotten to bring that shitty spray along was all it took to get back to a tolerable level (nose only slightly blocked) - it took month however for the problem to resolve completely

[chilln]

Thanks for the replies... especially your detailed response, dadnatron. I'll probably go for another turbinate reduction.

I agree, what an awesome response.

But one more look at cortisol before you opt for this, ie: if you also have puffy eyes, along with the blocked nose, then it could just be too low cortisol at night. Cortisol is our anti inflammatory, and obviously when cortisol it too low, we get inflammation at our "weakest link".

But if you don't get the puffy eyes, then it's unlikely to be too low cortisol.

.

[LeanGuy]

But one more look at cortisol before you opt for this, ie: if you also have puffy eyes, along with the blocked nose, then it could just be too low cortisol at night. Cortisol is our anti inflammatory, and obviously when cortisol it too low, we get inflammation at our "weakest link".

My wife does say my eyes often look puffy. But I'm already taking 20mg HC (30mg on workout days).

[canthavetoomanytoys]

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps?

Dadnatron gave a concise answer and thorough discussion. I have the same issues that you mention but have found some relief using a Neti-Pot.

After reading about Neti saline here, I went out and bought the newer type which is a soft squeeze bottle; you lean over a sink and squeeze the saline into your nose.

I use it before bedtime and when I awake. I must say it works so well that if I skip using it I can tell the differance. It's worth the $10 to give it a try.

[GirlyMan]

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps? I've tried corticosteroid nasal sprays but not very effective.

Yeah, I get it occasionally. But unlike you, when it gets severe Flonase has always been quite effective for me. And like Phil, I find that Breathe-Right strips help quite a bit when it's not bad enough to warrant Flonase. I stay the hell away from Afrin and the other OTC shit like that 'cause the rebound effect is often worse than my initial symptoms. Sometimes when I'm snoring intolerably my wife will slap a Breathe-Right strip on me without me even knowing it. More than once I've showed up at work looking like I'm ready for training camp.

BTW, another excellent clear, concise and comprehensible post, Dadnatron.

[cpeil2]

Anyone else with severe night-time sinus congestion? Have you found anything that truly helps? I've tried corticosteroid nasal sprays but not very effective. I've even had an outpatient turbinate reduction. My nose gets 100% blocked every night, and doesn't clear up until my morning workout. This problem is seriously affecting my sleep quality which I already have trouble with. I think it might be time for a full-on sinus surgery... even though the recovery is miserable.


I occasionally get it from seasonal allergies. I get a very good result from Nasal-Crom (cromolyn sodium). I'm fuzzy on the science, but it's some sort of immune modulator, not a corticosteroid, and you can buy it over the counter.

[chilln]

My wife does say my eyes often look puffy. But I'm already taking 20mg HC (30mg on workout days).

I suspect you may want to consider a small dose just before sleep.

.

[Drew]

My wife does say my eyes often look puffy. But I'm already taking 20mg HC (30mg on workout days).

I don't hear of very many people where 20mg does the trick. It's usually around 30, although some need upwards of 40mg. My wife feels best at 35mg of HC, I feel best at 6mg medrol. Usually women require less than men, but I won't argue with her results...at least not anymore, that is :wink: