Stuffy Nose at Night: 11 Common Causes & What to Do

A stuffy nose at night can be caused by infections like the flu, common cold, COVID-19, or chronic sinusitis. These conditions increase nasal secretions, which tend to worsen when lying down because blood flow to the nose increases, and mucus has a harder time draining into the throat.

Other conditions, such as a deviated septum, nasal polyps, or gastroesophageal reflux, can also lead to nighttime congestion. This may cause difficulty breathing and sleeping, snoring, or even sleep apnea.

It is important to see an ear, nose, and throat (ENT) specialist to determine the cause of nighttime congestion. Treatment may include anti-inflammatory drugs, antihistamines, corticosteroids, or in some cases, surgery.

Main causes

The main causes of a stuffy nose at night include:

1. Nasal cycle

The nasal cycle is the natural alternation between blocked and unblocked nostrils. It is common for one side of the nose to feel congested while the other is clear, switching every 4 to 8 hours. This cycle can become more noticeable and bothersome at night.

Although the nasal cycle is normal, it can be more frequent in people with chronic sinusitis, a deviated septum, or non-allergic rhinitis.

What to do: sleeping with your head slightly elevated on pillows can help mucus drain more easily, making it easier to breathe at night. It is also important to consult an ENT specialist to identify the cause of a stuffy nose at night and recommend proper treatment.

2. Dry air and air conditioning

Dry air can cause the lining of the nose and throat to lose moisture, leading to irritation and increased mucus production. This often results in symptoms such as a stuffy nose at night, phlegm in the throat, dry cough, throat clearing, or hoarseness.

Air conditioning can make the air even drier, further irritating the nasal lining and contributing to nighttime congestion.

What to do: avoid air conditioning and very dry environments when possible. Drink plenty of water and use saline sprays to keep the nasal passages hydrated. Using a humidifier at night can also add moisture to the air, reduce irritation, open the airways, and make it easier to clear mucus.

3. Flu and common cold

The flu and common cold are among the most frequent causes of a stuffy nose. These viral infections cause nasal congestion and a runny nose that may worsen at night because lying down increases blood flow to the head and makes mucus drainage more difficult.

Learn more about the difference between a cold and a flu and how they can present.

What to do: stay hydrated and get plenty of rest. An ENT doctor may recommend medications such as acetaminophen, ibuprofen, or desloratadine to relieve symptoms.

4. Rhinitis

Rhinitis is inflammation of the nasal lining that leads to mucus buildup. It can cause symptoms like a stuffy or runny nose that worsens at night, watery eyes, and frequent sneezing.

It may be triggered by allergens such as dust, pollen, pet dander, or plants. It can also occur due to structural changes in the nose or from the overuse of nasal decongestant sprays.

What to do: treatment depends on the cause, frequency, and severity of symptoms. The doctor may prescribe antihistamines or corticosteroids. Decongestant sprays should be avoided or used only for short periods, typically 3 to 5 days.

5. COVID-19

COVID-19 is a respiratory infection that may cause sore throat, dry cough, fever, fatigue, loss of smell or taste, and a stuffy or runny nose. Congestion can worsen at night because of increased blood flow to the nose and difficulty draining mucus when lying down.

What to do: isolate, take a rapid COVID test or an RT-PCR test if advised by a doctor, and follow treatment to manage symptoms if the infection is confirmed.

6. Gastroesophageal reflux

Gastroesophageal reflux happens when stomach contents flow back into the throat, irritating both the throat and nasal lining. This can lead to nighttime nasal congestion, which is often worse when lying down since gravity no longer helps keep stomach contents in place.

What to do: treatment is guided by a gastroenterologist and may include antacids, proton pump inhibitors, or medications that improve stomach emptying. These help reduce acid reflux and relieve congestion. Read more about the GERD medications your doctor may suggest. 

7. Chronic sinusitis

Chronic sinusitis is inflammation of the sinuses that lasts more than 12 weeks. It causes symptoms like a stuffy or runny nose, difficulty breathing, and worsening congestion at night. Other symptoms may include yellow-green or bloody mucus, cough that worsens when lying down, facial pain, or headaches that intensify when bending forward.

What to do: treatment may include pain relievers, anti-inflammatory drugs, decongestants, or antibiotics prescribed by an ENT doctor. Nasal irrigation with saline or steam inhalation may also help thin mucus and relieve symptoms.

8. Enlarged nasal turbinates

Nasal turbinates are structures that warm and humidify inhaled air. When they become enlarged, often due to allergic rhinitis or chronic sinusitis, they can obstruct airflow and cause symptoms such as a stuffy nose at night, snoring, and dry mouth.

What to do: treatment depends on the cause and may involve nasal decongestants, corticosteroids, or, in severe cases, surgery.

9. Deviated septum

A deviated septum occurs when the cartilage that separates the nostrils is misaligned. This can cause breathing difficulties, sleep apnea, snoring, headaches, and nighttime congestion.

It may be present at birth or result from trauma or local inflammation.

What to do: an ENT specialist can evaluate whether treatment is needed. In some cases, surgery called septoplasty may be recommended.

10. Nasal polyps

Nasal polyps are abnormal tissue growths in the nose or sinuses. Large or multiple polyps can block airflow, leading to a stuffy nose at night.

They are more common in people with chronic respiratory conditions such as sinusitis, allergic rhinitis, or asthma.

What to do: treatment may involve nasal corticosteroid sprays to reduce inflammation, or in some cases, surgery to remove the polyps.

11. Nasal valve collapse

Nasal valve collapse may occur after extensive rhinoplasty surgery if too much support cartilage is removed. This can cause deformities, skin retraction, difficulty breathing, and chronic nasal congestion.

What to do: treatment is managed by an ENT specialist and may involve corrective surgery to restore airflow and reduce congestion.