Which Nasal Decongestant To Use At Bedtime?

There are a number of alternatives to Sudafed and other oral decongestants.

Question

How can I get good night sleep when my nose blocks at night in bed? It usually is the left side.

Asked by Linda On Jan 01, 2019

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Jan 02, 2019

Overview

Nasal congestion can certainly make it difficult to get a good night's sleep. Worse still, it tends to become more severe at bedtime.

Unfortunately, oral nasal decongestants, such a Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine), have stimulating effects for many individuals, and therefore may not be an option for you at bedtime.

In fact, a variety of CNS (central nervous system) side effects have been reported with both pseudoephedrine and phenylephrine. They include:

  • Restlessness
  • Headache
  • Insomnia
  • Nervousness
  • Increased blood pressure
  • Irregular heartbeat

Clearly, none of these side effects are conducive to sleeping well.

Fortunately, there are some other options available over the counter which may help to relieve your nighttime congestion. These include:

  • Combination decongestant products
  • Decongestant nasal sprays
  • Saline nasal sprays
  • Nasal strips


I discuss these products in the coming sections, but it is also important to know that following good sleep hygiene practices can be effective as well.

Section Summary

Nasal decongestant pills, such as Sudafed (pseudoephedrine) and Sudafed PE (phenylephrine), can cause restlessness and insomnia. Alternative products may be a better option for nighttime use.

Combination Decongestants

Blue Gel Capsules

The first option would be to try a product that combines a decongestant and a sedating antihistamine. These products are often marketed as 'nighttime' or 'PM'.

While they do contain either pseudoephedrine and phenylephrine, the addition of a sedating antihistamine may offset the stimulating properties of the decongestant.

Example of these products include:

  • Sudafed PM: (Diphenhydramine HCl 25 mg; Phenylephrine HCl 10 mg)

  • NyQuil Severe: (Acetaminophen 650 mg; Dextromethorphan HBr 20 mg; Doxylamine succinate 12.5 mg; Phenylephrine HCl 10 mg)

  • Benadryl Allergy Plus Congestion: (Diphenhydramine HCl 25 mg; Phenylephrine HCl 10 mg)

Diphenhydramine, which is the active ingredient in Benadryl, is a sedating antihistamine. It is often used as the single active ingredient in OTC sleep aids, such as ZzzQuil.

Doxylamine is very similar to diphenhydramine and is also commonly used for its sedative effects.

There are a number of other combination decongestant products intended for nighttime use and nearly, if not all, will include diphenhydramine or doxylamine.

If you are taking a product that contains only pseudoephedrine or phenylephrine and having trouble sleeping, taking a combination ingredient product may be a more effective option.

There are of course other considerations with oral nasal decongestants, such as if you have high blood pressure or a history of heart disease so be sure to speak with your doctor to see if they are safe for you.

Section Summary

There are products available that contain a sedating antihistamine, such as diphenhydramine, to offset the stimulant effects of oral nasal decongestants.

Topical Decongestants

Decongestant Spray Bottle

Topical decongestants are extremely effective and fast-acting when it comes to relieving nasal congestion, but they also have their fair share of drawbacks.

Most OTC products contain either:

  • Phenylephrine
  • Oxymetazoline

Both ingredients have the same effect. They work by causing vasoconstriction in the nasal cavity, which reduces inflammation, promotes drainage and improves overall airflow.

If you have tried oral phenylephrine products (e.g. Sudafed PE) and it hasn't worked well, topical sprays that contain it are still an option. Phenylephrine is very poorly absorbed from the GI tract, but when used topically, is an extremely potent vasoconstrictor.

Topical decongestants often give amazing initial results. Congestion can clear within a matter of seconds, and the effects of the sprays can last up to 12 hours.

As mentioned, however, they have significant drawbacks.

Most importantly, extended use will likely cause rebound congestion, where your congestion will begin to get worse and worse, even with frequent use of a spray.

In general, topical nasal decongestants should be used for no more than 3 days in a row, with at least a 2-3 day break in-between use. Therefore, topical decongestants don't represent an extended use option.

Additionally, there is some controversy regarding whether or not topical nasal decongestants can raise blood pressure or increase cardiovascular risk like oral decongestants can.

One study reported that oxymetazoline can be systemically absorbed and cause significant side effects with long term use:

"Since the lipophilic drug like oxymetazoline is systemically absorbed by the vessels, easily passes the blood-brain barrier and enter into vascular and central nervous system...."

"...the complications of central nervous system and also cardiovascular system have been reported after use of the local sympathomimetic agents [e.g. oxymetazoline and phenylephrine]."

It would be prudent to discuss the use of topical decongestant with your doctor prior to use if you have any sort of cardiovascular disease or elevated blood pressure.

Section Summary

Nasal decongestant sprays are extremely effective, but have their share of side effects and shouldn't be used for more than 2-3 days in a row.

Saline Sprays

Saline Nose Spray

In terms of non-drug options for nighttime congestion relief, there are many. Saline sprays, although they contain no active ingredients, can be very effective.

There are a variety of saline sprays available on the market:

  • Hypotonic
  • Isotonic
  • Hypertonic

These names refer to the concentration of sodium chloride (NaCl) contained.

  • Isotonic sprays are 0.9% NaCl.

  • Hypotonic sprays are lower than 0.9% NaCl (typically 0.65%).

  • Hypertonic sprays are higher than 0.9% NaCl.

When it comes to relieving nasal congestion, hypertonic sprays are likely to provide the most benefit.

As stated, hypertonic sprays contain sodium chloride at concentrations higher than 0.9%.

Hypertonic sprays cause water to move out from cells, into the nasal cavity. In other words, these sprays draw fluid and mucus out. This has numerous benefits:

  • A reduction of nasal inflammation and edema.

  • A reduction in mucous adhesiveness, easing overall clearance.

Unfortunately, hypertonic may cause more side effects than regular nose sprays. They are more likely to cause:

  • Burning
  • Stinging
  • Irritation
  • Dryness

Isotonic sprays can be very beneficial for moisturizing the nose and loosening mucus but generally won't reduce inflammation as hypertonic sprays do.

The use of a Neti-Pot would fall into this area of saline decongestants. Neti-pots are quite versatile in that you can generally determine the salt content used.

Section Summary

Saline nose sprays can help to moisturize the nasals passages and certain ones, like hypertonic sprays, can help to relieve inflammation.

Nasal Strips

Nasal Strips

Nasal strips, such as Breath Right strips, work by opening nasal passages for better breathing. They don't lessen congestion, they just lessen airway resistance.

While they may not make a huge difference, they are drug-free and therefore, there are no interactions you need to worry about.

Numerous studies have reported that they can not only help to improve breathing due to congestion, but they can also help relieve snoring:

"This study confirmed the results of other studies that showed a reduction of about 10% in nasal breathing resistance, as well as supported the claim of the manufacturer that the nasal strips provide nasal relief. Several subjects who had nasal congestion reported some relief in nasal breathing when using the nasal strip."

Section Summary

Nasal strips are a safe and effective non-drug product to help you breathe easier at night.

References
  • ClinicalKey Drug Monograph: Pseudoephedrine (Accessed 1/2/19)
  • ClinicalKey Drug Monograph: Phenylephrine (Accessed 1/2/19)
  • Systemic side effects of locally used oxymetazoline. PubMed (Accessed 1/2/19)
  • AYR Manufacturer Website (Accessed 1/2/19)
  • The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. PubMed (Accessed 1/2/19)
  • Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. PubMed (Accessed 1/2/19)
  • Decrease of resistance to air flow with nasal strips as measured with the airflow perturbation device. PubMed (Accessed 1/2/19)

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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