Nasal sprays and insomnia

Nasal sprays and insomnia

29 Aug 2017 3:19 PMRosemary Clancy

How many of us know this experience? You’re awake at 3am, breathing through your mouth, your nose completely blocked. The feeling of suffocation rising, with shortness of breath, dry mouth and throat, and headachy feeling behind the eyes. You turn from one side to the other to see if one side of your nose can get some air in. The attention becomes helplessly focused on the rising sensations of suffocation, and with this, rising feelings of panic. No chance of sleep now....

  Only thing is to get up and use a nasal spray to try to clear the nasal passages.  And so the conviction grows that sleep will not work if there is no backup nasal spray on hand.  Alongside this, however, may be anxiety about the shortening periods of effectiveness after each spray, as tolerance to the medication increases. What seemed to be sufficient sleep on one spray per night initially, has now turned into 4-5 sprays over the course of a night.

Many more people than you would have guessed are dependent on nasal sprays, and in particular we are talking about nasal decongestant sprays.  These decongestant sprays work in the following way:

First, allergies make the lining of your nose swell, so decongestants help by shrinking swollen blood vessels and tissues (they don’t help with sneezing or itching, however).  Many of these decongestants contain pseudoephedrine-like substances, which can make your heart race, increase blood pressure, and make you feel jittery (also a factor in insomnia!)

You’re not advised to use nasal decongestant sprays for longer than three days, because longer term use increases your risk of rebound nasal blood vessel dilation, as soon as the medication effects wear off.  But once people see the initial effectiveness of the sprays, their attributions of treatment success change ("Maybe I can't breathe properly without decongestants?") and dependence grows, regardless of tolerance building.

But even with these sprays, over time fears of suffocation, and insomnia, grow.  A few people I’ve treated actually feared their mouths would unconsciously close during sleep, and with the blocked nose, have them dying quietly in their sleep!  (until they received some reassuring information about this).

Perhaps the best alternative is to wean yourself off these sprays slowly, gradually alternating them with saline sprays /flushing solutions that are gentler on the nasal lining and dont have any rebound effects upon withdrawal.  The saline solutions lubricate the nasal lining and clean the sinuses, giving users a sense of comfort and reassurance  that they can breathe freely enough for sleep to happen.  And once confidence comes back sleep  almost invariably falls into place.

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