What Helps Nasal Congestion? My Favorite Home Remedies and OTC Medications

These Are a Few of My Favorite Things: Cold Edition, Part 2

As both a nurse and a doctor of East Asian Medicine, I use a combination of Chinese herbal medicine, acupuncture, Western over-the-counter medications, and good old-fashioned home remedies when I'm sick.

And because I am an absolute baby when I get a cold, I have a pretty extensive arsenal of things I reach for to make the experience a little less miserable.

In [Part 1 of this series], I shared some of my favorite East Asian Medicine treatments, including Chinese herbal formulas, acupuncture, acupressure, and cupping.

Today we're talking about one of my least favorite cold symptoms: nasal congestion.

You know that feeling when you lie down to go to sleep and suddenly realize you can no longer breathe through your nose? Absolutely miserable.

Luckily, I have a few favorite things for that.

A quick note: These are some of my personal favorites, not blanket recommendations for everyone. Herbs and OTC medications aren't appropriate for everyone, especially during pregnancy or breastfeeding. If you're unsure what's right for you, please ask me! For OTC medications, you can also check with your PCP, OB, or pharmacist.

First, a little sinus anatomy

Did you know that some of our sinuses drain through openings located fairly high up in the sinus cavities?

Interesting design choice, right?

The maxillary sinuses, which sit behind your cheeks, have drainage openings high along their inner walls. Fortunately, our bodies have a system of tiny hairlike structures called cilia that help move mucus toward those openings, so drainage doesn't depend entirely on gravity.

But when the lining of the nose and sinuses becomes inflamed during a cold, those drainage pathways can become swollen and obstructed. That's part of why we feel so much pressure and congestion.

Steaming: One of my favorite home remedies

One of my favorite home remedies is a long, warm shower.

Another is putting steaming water into a bowl with a few drops of peppermint or eucalyptus essential oil, leaning over it, and enjoying the warm vapor.

I sometimes flex my neck so my forehead is lower than my chin, which feels especially good when my face is congested.

Obviously, use your judgment about how hot the water and steam are. You want comfortably warm vapor, not something that's going to burn your face. And if essential oils irritate your nose or make you cough, skip them. Plain steam is fine.

It's not a cure, and evidence for steam inhalation relieving colds is limited, but sometimes temporary comfort is exactly what I'm looking for.

Saline nasal rinses

Another option is saline irrigation, using something like a neti pot or squeeze bottle.

Saline can help rinse out mucus and irritants and provide some relief from congestion.

One important thing: always use distilled, sterile, or previously boiled and cooled water. Not plain tap water. And make sure you're cleaning your irrigation device.

Flonase: The long game

I use Flonase (fluticasone) pretty much year-round because I have allergies.

Flonase is an intranasal corticosteroid. It works by reducing inflammation in the nasal passages and is primarily used to manage allergies and certain other chronic nasal conditions.

Here's what people sometimes misunderstand about it: Flonase isn't an instant decongestant.

Some people notice improvement within a day or two, but it can take several days of consistent use to get the full benefit.

So if you've never used it before and your nose is completely blocked from a cold, taking it once or twice probably isn't going to make much difference. It's not a treatment for the common cold itself.

But for people like me who have ongoing allergies, keeping that underlying nasal inflammation under control can make a big difference in day-to-day comfort.

I sometimes wonder whether having less chronic inflammation in my nose also means I experience less severe congestion when I do get sick. That's my personal observation, not something I'd claim is proven to prevent colds.

Flonase can be used long-term when appropriate, but it's still a medication. Potential side effects include nasal dryness, irritation, headaches, and nosebleeds. Rarely, more significant nasal injury or eye complications can occur. If you need it year-round, it's worth reviewing that use with your healthcare provider.

Afrin: For desperate times

Now let's talk about one that feels like actual magic when you're completely stuffed up.

Oxymetazoline HCl 0.05%, most commonly sold as Afrin, is a topical nasal decongestant.

It works by constricting swollen blood vessels in the nasal passages, which reduces swelling and allows air to pass through more easily.

And it works FAST.

I save this for those particularly awful nights when I lie down, realize I cannot breathe through my nose, and know that I'm not going to sleep unless something changes.

But here's the very important catch:

Do not use Afrin for more than three consecutive days.

Using oxymetazoline for longer than recommended can cause rebound congestion, also called rhinitis medicamentosa. Essentially, your nose can become increasingly congested as the medication wears off, and you end up in a frustrating cycle of needing more spray.

This is why it's a medication I reserve for short-term, occasional relief rather than something I use routinely.

It can also cause nasal dryness or irritation, so I especially appreciate having a humidifier running when I use it.

And by humidifier, I mean a CLEAN humidifier. Please don't turn your bedroom into a petri dish.

People with certain medical conditions, including high blood pressure and heart disease, should check whether oxymetazoline is appropriate for them before using it.

A quick word about Mucinex

I'm personally not a big Mucinex user.

Plain Mucinex contains guaifenesin, which is an expectorant. It works by helping thin and loosen mucus in the respiratory tract, making it easier to cough up.

So unlike an antihistamine, it isn't intended to dry out your mucous membranes.

That said, the evidence for how much guaifenesin actually helps with acute colds is mixed, and I haven't found it particularly useful for my own symptoms.

There are also lots of Mucinex-branded combination products containing additional ingredients, so always check the label to see what you're actually taking.

Which brings me to one of my general rules when it comes to OTC medications: I prefer single-ingredient medications whenever possible.

I like to know exactly what I'm taking and what symptom I'm trying to treat.

Coming next: Surviving the night

In Part 3, I'll share my favorite medications for coughs, sore throats, headaches, body aches, and the specific misery that seems to begin the second your head hits the pillow.

We'll also talk about why I'm not a huge fan of combination cold medications or using Benadryl just to knock yourself out.

Remember that COVID and influenza can initially look like ordinary colds. Testing and prompt medical care can be important, particularly if you're at higher risk for complications.

Dr. Brianna Darcey, DAIM, LAc, RN

Brianna Darcey Acupuncture | Oakland, CA