Chronic rhinitis and snoring: why the nose blocks when you sleep

Types of rhinitis

Why it gets worse when lying down

Lying down narrows the nose even in people without rhinitis: in healthy volunteers, nasal airflow fell and resistance rose when they moved from sitting to lying down [5]. If the lining is already inflamed, that extra narrowing is enough to block the nose at night. In allergic rhinitis, the bedroom also plays a part: house dust is one of the usual allergens [1].

Rhinitis, snoring, apnea and CPAP

• Snoring: in a population study of almost 5,000 people, those with nasal symptoms at night on 5 or more nights a month were more likely to snore habitually [6].
• Apnea: people with a nose blocked by allergy were 1.8 times more likely to have moderate or severe sleep-disordered breathing [6], and in a meta-analysis of 12 studies sleep apnea was more frequent in people with allergic rhinitis (odds ratio 2.4) [7].
• Treating the nose: in snorers with rhinitis, four weeks of a steroid nasal spray lowered nasal resistance and slightly lowered the apnea index compared with placebo, although the snoring noise did not change [8].
• CPAP: the more nasal resistance when starting CPAP, the more likely it was to be rejected [10]. More on this in blocked nose, snoring and sleep apnea.

Medical treatment comes first

• Steroid nasal sprays: they are the most effective treatment for allergic rhinitis [1] and are also used in non-allergic rhinitis, together with antihistamine sprays [2].
• Antihistamines and saline rinses: antihistamines help with allergy, and saline rinses clear mucus [1].
• Avoiding triggers and allergy vaccines: avoiding the trigger is the first step in non-allergic rhinitis [2]; allergy shots are considered when allergic symptoms are hard to control [1].
• Decongestant sprays, only for a few days: no more than 3 days [1]. If you already depend on them, the first step is to stop them, and a steroid spray helps the lining recover [3][4].

Your doctor will tell you which treatment and for how long in your case.

When surgery is considered

If, despite proper medical treatment, the turbinates stay swollen and block the nose, their size can be reduced with a turbinoplasty (turbinate surgery). The surgery does not cure the rhinitis: with radiofrequency, about 8 out of 10 patients had not relapsed at 3 years, and allergic patients relapsed more [11], so the medication often has to continue. If the septum is also deviated, see septoplasty.

For a runny nose that does not respond to treatment, there are techniques that act on the nerves of the back of the nose, such as cryotherapy or radiofrequency of the posterior nasal nerve, or a neurectomy. In a review of 8 studies there is some evidence that they improve symptoms, but with few trials and short follow-up [12]; vidian neurectomy has more side effects, such as dry eye [13]. They are options for specific cases, to be discussed with your ENT.

CPAP with rhinitis

If you use CPAP and your nose blocks or runs, tell your sleep unit instead of giving up. A heated humidifier reduced a blocked nose, sneezing, dryness and runny nose in a randomised trial, although it did not increase hours of use on its own [9]. Treating the rhinitis and checking the mask are the other two steps; if the machine has become impossible, read I can’t tolerate CPAP: real alternatives.

Frequently asked questions