Is Using Nasal Spray When You're Sick Bad For You?

Aug 02, 2023

No one enjoys having a cold or the flu, but the stuffy nose that comes with it can be one of the more annoying symptoms to cope with.

Not only is it difficult to breathe, it can affect your sleep quality. You find yourself tossing and turning as your nose turns into an hourglass ― with one nostril clearing up just for the other one to plug up when you switch which side you’re lying on. And when sleep suffers, recovery time lags with it, meaning it could take longer for you to feel better.

That's what makes nasal sprays so appealing. With just a couple of spritzes you can get immediate relief. However, rely on nasal spray for too long and you may be doing more damage than help. Read on to find out why nasal sprays are so effective at easing congestion and what may happen if you use them too often.

First, it's important to understand that there are several types of nasal sprays on the market. They all treat the same problem (congestion) but are used for different root causes.

"There are a few categories of nasal sprays, but the ones most commonly used are steroid-based sprays for allergies or long-lasting use and fast-acting nasal decongestants like oxymetazoline, or Afrin," said Dr. Omid Mehdizadeh, an otolaryngologist and laryngologist at Providence Saint John's Health Center in Santa Monica, California.

Steroid-based nasal sprays (such as Flonase and Nasacort) work by using steroids to help reduce the inflammation and mucus in the nose that is causing stuffiness.

"Decongestant nasal sprays work by constricting blood vessels in the nose," said Dr. Darria Long Gillespie, a board-certified emergency medicine physician and founder of Trueve. "This leads to less blood flow to the nasal tissue and with it less swelling and congestion."

There's been a long-standing claim when it comes to nasal sprays: Use them for too long and you can actually become addicted, resulting in getting stuffed up more frequently because your nose is waiting for its next sniff of medicine.

It's a common belief, Mehdizadeh said, and one that's not totally unfounded. "Many people are unaware of which nasal sprays increase the risk of rebounding and the ones [that] are safe to use for longer. Decongestant nasal sprays specifically increase a rebounding risk because they constrict blood vessels and tissues that cause swelling so rapidly," he explained. "If you use a medication like this chronically, as soon as you remove it, the tissue is now dependent on the chemical. That's what creates rebound congestion that could be even worse than the initial swelling was."

"Clinically, this is referred to as rebound mucosal hyperemia, which means that instead of reduced blood flow, you actually get an increase of blood flow, causing a persistent blockage that is no longer improved by decongestants," Long Gillespie added.

No one wants their congestion to carry on longer than it needs to, and you certainly don't want it to become a persistent symptom. So, how long is too long when it comes to using nasal decongestants to help get over a cold or the flu?

"Don't use nasal decongestants for more than three days," Long Gillespie said. Past that, you run the risk of dealing with rebound congestion. If you go well past three days into daily usage for weeks or months, you may damage the lining of the nasal cavity including thinning out the tissue, which may lead to rhinitis, Mehdizadeh added.

If you’re at your three-day mark on nasal decongestants and you’re still not feeling better, don't panic. Long Gillespie said there are additional steps you can take to clear up congestion without worrying about rebounding, such as:

For congestion that just won't quit, Mehdizadeh said it's a good idea to see a specialist to rule out allergies, not a cold as the underlying cause. "Especially if you have other symptoms like itchy eyes, eye watering, nasal drip and itching, and/or an itchy throat, a steroid-based, long-term nasal spray may be a better choice for you," he said.

"There's also a possibility that if your congestion is an isolated symptom and nasal sprays aren't working, it may be a structural issue such as a deviated septum or nasal polyps," Mehdizadeh added. "If you’re not getting relief from nasal sprays or other decongestants, and have pain, discomfort or recurring nose bleeds, seek out an evaluation from a specialist or your medical provider."

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