A stuffy nose can turn bedtime into a frustrating cycle of repeated waking and tossing and turning. When sleep apnea and nasal congestion happen together, blocked nasal passages may make snoring and other sleep apnea symptoms more bothersome. They can also make continuous positive airway pressure (CPAP) harder to use.

Nasal congestion can add to nighttime breathing problems, but it usually isn’t the only cause of sleep apnea. Understanding what’s blocking your nose can help you and your healthcare team find ways to breathe more comfortably without losing sight of your prescribed sleep apnea treatment.

How Are Sleep Apnea and Nasal Congestion Connected?

Blocked nasal passages don’t affect everyone with obstructive sleep apnea (OSA) in the same way. The impact may depend on how narrow the rest of the airway is and whether congestion is occasional or ongoing.

Nasal congestion increases resistance to airflow through the nose. OSA occurs when relaxed tissues in the throat repeatedly narrow or close the airway. Nasal blockage is common among people with the condition. In one observational study, 70 percent of participants with OSA had nasal obstruction.

However, congestion is usually one contributing factor rather than the sole cause of sleep apnea. The airway may also be affected by the tongue, soft palate, tonsils, jaw shape, body weight, and other factors.

Treating nasal blockage may improve sleep quality and make continuous positive airway pressure (CPAP) easier to use, but nasal treatment alone usually isn’t enough to control OSA.

Airway Narrowing and Mouth Breathing

When congestion limits airflow through the nose, you may start breathing through your mouth during sleep. Mouth breathing can allow the lower jaw to move downward, reducing space in the throat. This change may worsen snoring and breathing problems in some people with OSA.

Sleeping with your mouth open can also contribute to dry mouth, which is already common among people with OSA. Mouth breathing may be especially troublesome when using a nasal CPAP mask or nasal pillows.

Difficulty With CPAP Use

When your mouth opens, pressurized air may escape instead of staying in your airway. This is called mouth leak. It may cause dryness, irritating noise or airflow, brief awakenings, and fragmented sleep.

A stuffy or dry nose can make a nasal mask uncomfortable and make it harder to use CPAP for the full night.

In a study of people just starting positive airway pressure therapy, nasal congestion was independently linked to greater odds of not using treatment as prescribed after three months. Congestion was more common and more severe among people who didn’t use therapy consistently.

CPAP itself can sometimes contribute to dryness or stuffiness, especially when the mask leaks or the air lacks enough moisture. But don’t stop CPAP or change the pressure settings on your own. Your sleep team can help adjust the mask, humidifier, tubing, or other parts of the setup.

What Can Help With Sleep Apnea and Nasal Congestion?

The best approach depends on why your nose is blocked. These steps may help you breathe more easily while continuing your sleep apnea treatment.

Treat Allergies and Inflammation

Limiting contact with triggers such as pollen, dust mites, mold, or animal dander may help. Some people need a combination of treatments before finding what works best.

Possible allergy treatments include:

• Nasal corticosteroid sprays — These sprays reduce inflammation and are often the first treatment recommended for allergy-related stuffiness.
• Saline nasal irrigation — Using a special saltwater pack in distilled water can help reduce the symptoms of allergies.
• Antihistamines — Pills or nasal sprays may help relieve sneezing, itching, and a runny nose, although pills tend to have less effect on congestion.
• Decongestants — These medicines may temporarily reduce swelling and stuffiness. Decongestant nasal sprays shouldn’t be used for more than two or three days because longer use may cause rebound congestion.
• Allergy immunotherapy — Allergy shots or tablets placed under the tongue may be considered when other treatments don’t provide enough relief.

Talk with a healthcare professional before starting a medicine, especially if you have other health conditions or take prescription drugs.

Allergy testing may be useful when the trigger isn’t clear or symptoms keep returning. Treating nasal allergies may improve airflow, but it shouldn’t be viewed as a replacement for prescribed OSA therapy.

Use Saline

A saline nasal spray is a simple way to add moisture to dry nasal passages and loosen thick mucus. Using it before bed or before putting on your CPAP mask may make breathing through your nose more comfortable. Premade saline sprays are available without a prescription and don’t require mixing a solution.

For heavier congestion, a saline rinse may flush out more mucus and allergens than a spray. Use a ready-made sterile product or prepare it exactly as directed.

For nasal irrigation, use only distilled, sterile, or previously boiled and cooled water. Clean the device after every use and let it air-dry.

Adjust Your Sleep Position

For some people, OSA and snoring are worse when sleeping on the back. In that position, the tongue and soft palate can move toward the back of the throat and narrow the airway. This may make nasal congestion feel worse.

Changing sleep position to sleep on the side or stomach may help keep the airway more open.

Fine-Tune CPAP

Contact your sleep team if your mask no longer fits, nasal congestion keeps you from using CPAP for much of the night, or daytime fatigue gets worse. Adjusting the mask, humidifier, tubing, or other parts of the setup may make treatment more comfortable.

If your mouth opens during sleep, a chin strap may help keep it closed and reduce air leaks when you use a nasal mask or nasal pillows.

A heated humidifier can add moisture to CPAP air and may reduce a dry or stuffy nose. Your care team can help you adjust humidity, check for mask leaks, or decide whether heated tubing would help.

A nasal pillow or nasal mask may be difficult to use during heavy congestion. One MySleepApneaTeam member asked whether a full-face mask might work better for mouth breathing after a chin strap and mouth tape hadn’t helped. A full-face mask may be more comfortable for some people because it delivers air through both the nose and mouth.

Your sleep team can help you compare mask options, check the fit, and decide whether added humidification may ease discomfort.

Seek a Medical Evaluation and Treatment

Make an appointment with a primary care doctor or an ear, nose, and throat (ENT) specialist if nasal blockage lasts for weeks, keeps returning, affects one side more than the other, or makes CPAP difficult to tolerate. Also mention frequent nosebleeds, reduced sense of smell, facial pain, repeated sinus infections, or congestion that keeps getting worse.

An exam can help identify a deviated septum, enlarged turbinates, nasal polyps, chronic sinus problems, or another cause. As discussed above, medicines may reduce swelling from allergies or inflammation. Structural problems may require surgery.

The type of nasal procedure depends on what’s blocking the nose:

• Septoplasty — Straightens a deviated septum
• Turbinate reduction — Shrinks enlarged tissues inside the nose
• Polypectomy — Removes nasal polyps
• Balloon sinuplasty — Widens blocked sinus passages
• Functional endoscopic sinus surgery — Uses small tools inserted through the nose to remove tissue or other blockages and improve sinus drainage
• Adenoidectomy — Removes enlarged adenoids, usually in children
• More extensive sinus surgery — May rarely be needed to remove a tumor or treat a complex blockage

Nasal surgery may improve airflow and make CPAP easier to use, but surgery on the nose alone usually doesn’t reduce breathing pauses enough to control OSA. Continue your prescribed sleep apnea treatment unless your sleep specialist changes the plan.