Chronic nasal congestion isn’t just inconvenient—it alters the way you breathe, sleep, recover, and function during the day. When nasal passages remain blocked for weeks or months, the body defaults to mouth breathing, which destabilizes the upper airway, increases snoring, disrupts sleep, and contributes to fatigue, headaches, and even TMJ tension.

Long-term relief requires identifying the root cause—structural, allergic, inflammatory, or functional—and correcting it with the right combination of medical, behavioral, and airway-focused interventions.

This guide outlines the main causes of chronic congestion, the most effective home and medical strategies, the impact on sleep, and when to involve ENT or an airway-trained speech-language pathologist.

Structural vs. Inflammatory Patterns

Understanding the type of congestion you have determines the correct treatment pathway.

Structural Causes

These change the physical space inside the nose:

• Deviated septum
  
• Inferior turbinate hypertrophy
  
• Narrow nasal valves
  
• Nasal polyps
  
• High-arched palate with reduced nasal volume
  
• Post-surgical scarring

Clues:

• Congestion consistently worse on one side
  
• Difficulty breathing even when not sick
  
• Little or no response to allergy medications
  
• Snoring or mouth breathing since childhood

Structural issues often require ENT evaluation and may benefit from surgical or procedural intervention.

Inflammatory Causes

Inflammation narrows nasal passages and increases mucus production:

• Allergic rhinitis
  
• Non-allergic rhinitis
  
• Chronic sinusitis
  
• Viral infections
  
• Environmental irritants

Clues:

• Seasonal patterns
  
• Itchy eyes or sneezing
  
• Thick or discolored mucus
  
• Pressure between the eyes or in cheeks
  
• Symptoms lasting >12 weeks (chronic sinusitis)

For a deeper comparison, see:
/blog/chronic-sinusitis-vs-allergies-vs-cold

Saline, Steroid, Antihistamine Protocol

Many people treat nasal congestion inconsistently. The key is using the right tools in sequence and long enough to work.

1. Saline Irrigation (Daily or Twice Daily)

• Clears mucus
  
• Reduces inflammation
  
• Improves responsiveness to medications

Use before any spray for maximum effect.

2. Intranasal Steroid Spray

Best for:

• Chronic sinusitis
  
• Turbinate swelling
  
• Long-term allergies

Steroid sprays require 2–4 weeks of daily use for full benefit.

Tips:

• Aim slightly outward toward the ear
  
• Do not sniff hard after spraying
  
• Consistency is crucial

3. Antihistamine Spray or Oral Antihistamine

Best for:

• Allergy-driven symptoms
  
• Clear, watery congestion
  
• Itching and sneezing

Antihistamine sprays work faster than oral medications and can be used during flare-ups.

4. Nasal Dilators

Internal or external nasal dilators mechanically widen nasal valves and improve airflow—especially at night.

5. Humidification

A cool-mist humidifier prevents dryness, reduces tissue irritation, and decreases nighttime congestion.

6. Addressing Underlying Contributors

• Dust or pet allergies
  
• Irritants (smoke, perfumes, cleaning products)
  
• Chronic mouth breathing habits
  
• Deviated septum or valve collapse

Long-term success often requires tackling more than one cause.

Sleep and Airway Impact

Nasal obstruction fundamentally changes nighttime breathing. When the nose can’t move air efficiently, the body resorts to mouth breathing, which:

• Increases snoring
  
• Increases upper airway resistance
  
• Worsens UARS and mild obstructive sleep apnea
  
• Promotes tongue collapse
  
• Triggers nighttime teeth grinding
  
• Reduces oxygen efficiency
  
• Causes fragmented sleep and morning fatigue
  
• Contributes to TMJ tension

Signs your nighttime breathing is affected:

• snoring remedies
  
• Dry mouth on waking
  
• Morning headaches
  
• Restless sleep
  
• Night sweats
  
• Teeth grinding
  
• Jaw tension
  
• “Wired-but-tired” mornings

Improving nasal airflow often dramatically improves sleep quality and daytime energy.

When to Involve ENT or an Airway-Trained SLP

See an ENT if:

• Symptoms last >12 weeks
• You cannot breathe through your nose most nights
  
• You experience recurrent sinus infections
  
• You have persistent loss of smell
  
• Nasal blockage is unilateral or structural
  
• You suspect polyps or significant turbinate swelling

ENTs evaluate and treat structural and chronic inflammatory problems.

See an Airway-Trained SLP if:

• You mouth breathe even after nasal treatment
  
• You snore despite addressing congestion
  
• Your tongue rests low in the mouth
  
• You experience frequent jaw tension or teeth grinding
  
• You have difficulty maintaining lip seal at night
  
• You notice poor coordination between nasal breathing and swallowing

Airway therapy focuses on:

• Tongue posture
  
• Nasal breathing mechanics
  
• Myofunctional strengthening
  
• Habit retraining
  
• Day and nighttime breathing patterns

Learn more:
/services/airway-therapy

FAQ

Why is congestion worse at night?

When lying down:

• Nasal tissues swell due to fluid shifts
  
• Gravity affects soft tissue
  
• Turbinates enlarge
  
• Dry air irritates nasal lining

Structural narrowing and allergies amplify nighttime congestion.

Can sprays be used long-term?

• Steroid sprays: Yes, often safe long-term under medical supervision.
  
• Antihistamine sprays: Safe for routine use.
  
• Decongestant sprays (e.g., oxymetazoline): No—limit to 2–3 days to avoid rebound congestion.

Is surgery necessary?

Not always.
Surgery helps when structural issues (septum deviation, valve collapse, enlarged turbinates, polyps) drive symptoms.
However, many patients benefit from:

• Nasal anti-inflammatory regimen
  
• Allergy management
  
• Myofunctional therapy
  
• Airway retraining

Surgery + behavioral/functional treatment offers the most durable results.