Nasal spray junkie

(1) Dear Alice,

I have had many (over eight) sinus infections in the last three years. The pain and discomfort associated with sinus congestion and infection has been extremely disconcerting. However, I have also found that my sinus congestion prevents me from thinking clearly. My thoughts are actually "cloudy" and incoherent when I'm congested.

I have found that VICKS Sinex 12 Hour Nasal Spray is the only thing that really helps me. Trust me, I have tried almost every prescription or over the counter product that there is. Its active ingredient is oxymetazoline (0.05 percent). Although the warning states that it should only be used for three days, I have been using it regularly for the last two weeks. What are the risks involved? Do the benefits outweigh the risks? I have only been experiencing minor side effects like an itchy and burning nose. These are side effects that I willing to tolerate. But are there any more serious hazards?

— Nasal Spray Junkie

(2) Dear Alice,

I have been using nasal sprays for several years. It is the only thing that works for me on my swollen nasal passages. I've been to many doctors for this problem. I have yet to find one who can help me. I know that it is a bad idea to use nasal sprays for such a long time, but without it, I would not be able to breathe with my nose. I would love to get my nasal problem solved for good. I have had this problem all of my life and it is getting old.

Dear Nasal Spray Junkie and Reader#2,

Two squirts up each nostril might seem like the best treatment for masses of mucus and swelling, but when used over the long haul, nasal sprays can actually make runny noses and congestion worse. Over-the-counter (OTC) nasal sprays — the nasal decongestant or medicated kind — work by constricting the blood vessels in the nose, reducing swelling, irritation, and sniffling. As swelling in the nasal passages decreases, you have more room to get air in, and that uncomfortable, stuffy head feeling is gone. But, when the spray wears off, blood vessels dilate again, bringing swelling and congestion with the extra blood flow. This is when most folks reach for the spray bottle again. While the benefits of the spray may seem to outweigh the risks, exceeding the number of recommended dosages or using the spray for more days than indicated can result in a number of symptoms, including burning, stinging, sneezing, or increased nasal discharge. It can also have an impact on other areas of your life (more on this later). So, what can be done to relieve your nasal nuisance? Read on for more information!

Long-lasting nasal sprays can produce a decongestant effect of up to twelve hours, but overuse can create a vicious cycle that does more harm than good. With continuous use, medicated nasal sprays can cause rhinitis medicamentosa, or "rebound rhinitis," a condition where nasal passages become even more swollen than they were originally. Once you stop using the decongestant, the swelling will decrease, but it may take some time. Long-term use — several years in your case, Reader #2 — can actually lead to around-the-clock congestion, including when you’re trying to catch some z’s. This could make it difficult to get a good night’s rest, disrupting your cognitive processes — and, perhaps is a possible culprit behind your “cloudy” thinking, Nasal Spray Junkie. Overuse of nasal sprays can also raise heart rate and blood pressure levels. For these reasons, experts at the American Academy of Allergy, Asthma, and Immunology advise against using OTC nasal sprays for more than three or four days in a row.

Rather than reaching for the spray, consider trying a spray-free solution to help cure what ails you. Have you considered what could be causing the congestion in the first place? Perhaps existing or new allergies? Certain foods you eat regularly? Chronic cold symptoms? You might share your symptoms with your health care provider as they may be able to prescribe a decongestant (in non-spray form) to keep your head and nose clear while you wean yourself off of nasal sprays. They may also refer you to an allergist or ear, nose, and throat specialist (a.k.a., an Otolaryngologist or E.N.T.), who can address possible underlying issues causing your congestion or sinus infections.

What else can be done? Other possible solutions include using a non-medicated saline nasal spray that can moisturize and shrink nasal passages (and will not cause any rebound swelling). Saline sprays are available at drug stores; look for the type without any medications or preservatives to keep from forming a new nasal-spray habit. Another non-medicated option is using a neti pot with sterile water to flush out all of that mucus. Speaking of water, drinking plenty of non-caffeinated fluids can help relieve your stuffy nose, too. You could also try taking a steamy bath or shower as that can often loosen mucus.

Whichever option you try, be prepared with the knowledge that it might take some time to see results. Hopefully, one of these solutions will be the fix you need to keep you clear-headed.

Last updated Jun 24, 2016
Originally published Dec 16, 1994

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