Nasal Congestion & Snoring

Luke Rudmik, MD
Joe Brunworth, MD

What are common causes of nasal congestion?

Nasal congestion has a variety of causes, and is usually attributed to either a structural anatomic blockage or swelling of the nasal tissue. Both problems can narrow the nasal cavity and give a sensation of “nasal congestion”. The following is a list of potential causes of nasal congestion:
What are some treatment options for nasal congestion?
Treatment of nasal congestion typically begins with medical therapy along with conservative treatments such as avoiding known allergens and using nasal saline irrigations. Common medications used to treat the various causes of nasal congestion include:
  • Topical nasal steroid spray
  • Topical nasal antihistamine spray
  • Oral antibiotic (in case of bacterial infection)
  • Oral steroid
  • Oral antihistamine
The presence of a physical blockage does not necessarily mean that surgery is required. However, if the above treatments have been attempted and the symptoms persist, then surgery can be very helpful for the patient who suffers with chronic nasal congestion. Surgical treatments for nasal congestion can be performed in the office or in the operating room. Office treatments for nasal obstruction include radiofrequency turbinate ablation (Somnoplasty, Coblation) and laser turbinate surgery. Operating room treatments include:
How can nasal congestion cause snoring?
During sleep, the body naturally tries to breathe through the nose. When nasal congestion forces mouth breathing during sleep, greater negative pressure develops behind the uvula and soft palate. This negative pressure increases the vibration of these "noise-makers" (the uvula and soft palate) during sleep, helping to create the sound we know as “snoring”.

Although some patients will notice a decrease in snoring after nasal surgery, snoring itself is not a good sole reason to have nasal surgery. In fact, most people who undergo sinus surgery, septoplasty, or turbinate reduction will have improved nasal breathing without affecting their snoring. This is often due to the many other causes of snoring.
What are other causes of snoring?
Although improved nasal airflow can be very helpful in the treatment of snoring, the diagnosis and treatment of other contributing factors is often necessary to increase the probability for cure. Other major risk factors for snoring include:
  • Obesity
  • Large tonsils
  • Long uvula and palate
  • Large tongue with respect to the jaw size. 
In some cases, snoring is a sign of a medical condition called obstructive sleep apnea (OSA). Obstructive sleep apnea exists when significant breath holding or shallow breathing episodes occur during sleep. A sleep study is generally required to differentiate between snoring and OSA. Similar treatments are often beneficial for both snoring and OSA.

Snoring is generally considered the noisy breathing caused by vibrations of the upper airway during sleep. In contrast to snoring (noisy but otherwise normal pattern of breathing), sleep apnea is thought of as a disturbance of this pattern with interruptions and pauses in breathing. After a pause in breathing, there is often a gasp prior to the next breath.

Regular snoring is not considered a serious health risk. Snoring has not been proven to cause other medical conditions, and it is generally thought of as more of a nuisance (especially to sleep partners).

In contrast, obstructive sleep apnea causes both short and long-term consequences to the patient’s health. Signs of OSA include daytime sleepiness, restless sleep, periods of silence during sleep followed by gasps for breath, morning headaches, mood changes, and the tendency to fall asleep during the day while in the sitting-up position. Health risks include more than just the decrease in oxygen levels at night during the apnea episodes. They also include:
  • Increased risk of cardiovascular disease
  • Increase in blood pressure
  • Increase chances of stroke, diabetes, depression
  • Increase in weight (obesity)
  • Increase chances of congestive heart failure

Considering the severity of medical diseases that OSA can contribute, it is important to discuss your symptoms with your doctor. Once the diagnosis of snoring or sleep apnea is made, the treatment can be tailored to best treat the patient. The first line treatment for both snoring and sleep apnea rely mainly on lifestyle changes. These include:
  • Weight loss (dieting and exercise)
  • Avoiding alcohol and other sedatives (muscle relaxants, etc), especially prior to sleeping
  • Avoid sleeping on your back (side or stomach positions are better)
    • Some people even sew a tennis ball into the back of a T-shirt to prevent themselves from rolling onto their back at night
  • Some may try oral appliances or nasal dilator strips with variable results
The other types of treatment may be prescribed by your physician and include CPAP (continuous positive airway pressure), medications, and occasionally surgery. Unfortunately, there is no single drug or surgery that is a guaranteed cure for sleep apnea or even snoring, although there are surgeries under investigation that may help with this. This is why weight-loss and CPAP remain the two most important tools for controlling this disease process. For severe cases, some patients can even require a tracheostomy to bypass the upper airway obstruction.

If you suffer from nasal congestion, snoring, or suspect sleep apnea, contact your local Otolaryngology specialist. Considering the complexity of the upper airway, it is important to keep track of your symptoms and to write down what makes your symptoms better or worse. This may help your physician in choosing the right treatment for you.

Revised 02/17/2015
©American Rhinologic Society