Nasal strips vs. saline spray: which helps a stuffy nose at night?

A nasal strip and a saline spray fix different parts of a stuffy nose, which is why they pair so well. A strip lifts the sides of the nose and holds the front of it open, starting the moment it goes on. Saline moistens the lining and helps clear mucus further inside. If your nose feels narrow, reach for a strip; if it feels dry, crusty or full, reach for saline; and on a bad night, use both, saline first.

How do nasal strips and saline spray work differently?

A nasal strip works from the outside. Its springy bands lift the sides of the nose and widen the nasal valve, the narrow passage just inside the nostrils. Nothing goes into your nose.

Saline works from the inside. It's salt water, and it rinses and moistens the lining of the nose. The FDA describes two main ways to get it there. An FDA doctor explains that nasal spray bottles deliver a fine mist that might be useful for moisturizing dry nasal passages, while irrigation devices such as neti pots, bulb syringes and squeeze bottles are better at flushing the nose and clearing out mucus, allergens and bacteria. Our guide to how nasal strips work covers the strip side in more detail.

This table compares a strip with the two kinds of saline.

What does the research say about nasal strips?

The research on nasal strips shows they open the front of the nose, and that's about where their reach ends. A 2007 study in the European Archives of Oto-Rhino-Laryngology measured 89 people with nasal blockage. A strip significantly widened the front 0 to 3 cm of the nose compared with a decongestant spray, but had no effect from 3 cm back. Both gave a similar improvement in airflow and in how blocked people felt.

That location matters for the saline comparison. A strip helps most when the tight spot is near the nostrils, and saline works along the lining further in, where a strip can't reach.

A 2016 meta-analysis in Pulmonary Medicine noted that nasal dilators have been shown to improve nasal breathing, although they didn't improve sleep apnea measures. For sleep specifically, a 2018 randomized, placebo-controlled trial of 59 people with chronic nighttime congestion found that strips worn every night for two weeks improved some measures of sleep and congestion on waking compared with placebo strips, though not all of them.

If a narrow nose is your main problem at night, the strips we recommend are TitanAir Nasal Strips. Titan says they're drug-free external nasal dilators with flexible spring-loaded bands.

What does the research say about saline?

The research on saline is modest but mostly points in a helpful direction, and three Cochrane reviews cover the main uses.

For allergies, a 2018 Cochrane review pooled 14 studies with 747 children and adults with allergic rhinitis. Saline irrigation, delivered by sprays, squeeze bottles and other methods, may reduce symptoms compared with no saline for up to three months, with no reported adverse effects. The evidence was low or very low quality and the studies were generally small, but the reviewers said saline could be a cheap, safe and acceptable option that deserves better research.

For chronic sinus problems, a 2016 Cochrane review found some benefit from daily large-volume (150 ml) rinses with a salty solution compared with placebo, with low-quality evidence at three months and very low at six. In that trial, 23% of people using saline had side effects, including nosebleeds. A low-volume saline mist did worse than a steroid spray.

For colds, a 2015 Cochrane review of five trials concluded that saline rinsing possibly helps symptoms, but the trials were small and at high risk of bias. Minor nasal discomfort or irritation was the only side effect reported.

None of these reviews compared saline with a nasal strip, and we didn't find any study that did. Nasal sprays explained covers how saline fits alongside medicated sprays.

Can you use a nasal strip and saline together?

You can use a nasal strip and saline together, and the order is simple: saline first, strip second. Neither contains a drug, so there's nothing to interact. Saline moistens and clears the inside, and the strip then holds the front open while you sleep.

A bedtime routine that works:

1. Use your saline spray or rinse over the sink.
2. Wait a few minutes and blow your nose gently. Cleveland Clinic ear, nose and throat specialist Swathi Appachi, MD, says drug-free saline sprays soften mucus so it clears with gentle blowing.
3. Wash and dry the outside of your nose. Titan's instructions say to start with clean, dry skin and skip moisturizer.
4. Put the strip just above the flare of your nostrils, on the soft part of the nose, and press both ends down.

If dryness rather than blockage is your problem, Dr. Appachi suggests saline spray and then some ointment before bed. Keep any ointment just inside the nostrils and off the strip's pads. Our guide to dry nose at night has more on that.

How do you use saline safely?

You use saline safely by getting the water right. The FDA says to rinse only with distilled, sterile or previously boiled water. Tap water isn't safe for nasal rinsing, it says, because it isn't adequately filtered or treated, and some tap water contains organisms, including amoebas, that may be safe to swallow but can cause potentially serious infections in the nose, which in rare cases can be fatal.

The FDA lists three safe options:

• distilled or sterile water, labeled "distilled" or "sterile"
• tap water boiled for 3 to 5 minutes, then cooled until lukewarm, which can be stored in a clean, closed container for use within 24 hours
• water passed through a filter designed to trap potentially infectious organisms

It also says to wash the device and dry the inside with a paper towel or let it air dry between uses, and to check with your healthcare provider before using any nasal irrigation system if your immune system isn't working properly. For children, it says rinsing devices can be used from as early as age 2 if a pediatrician recommends it. Our step-by-step guide to using a saline rinse covers mixing and technique.

A strip has its own simple precautions. Put it on clean, dry skin and use a fresh one each night. To take it off, Titan says to loosen it with warm water and peel slowly from the ends inward.

Which should you choose?

Which you choose depends on what your nose feels like at bedtime.

• If it feels narrow, especially near the nostrils, start with a strip.
• If it feels dry, crusty or sore, start with saline spray.
• If it's full of mucus from allergies or a cold, a saline rinse is the stronger clearing option.
• If it's a mix, use both, saline first.

If you've been leaning on a decongestant spray instead, both are drug-free alternatives worth knowing about. See decongestant spray rebound and our comparison of nasal strips vs. nasal sprays, which covers steroid and decongestant sprays too.

When should you see a doctor?

Strips and saline are simple aids, not treatments for an underlying problem. See a doctor if:

• your nose stays blocked for weeks, or one side is always blocked
• your symptoms aren't relieved or get worse after rinsing, or you get a fever, nosebleeds or headaches while using a rinse, which the FDA says are reasons to go back to your healthcare provider
• you snore loudly, your breathing stops and starts in your sleep, you make gasping or choking noises, or you always feel very tired in the day, which the NHS lists as symptoms of sleep apnoea
• you're pregnant and your nose or breathing at night has changed, in which case ask your midwife or doctor before trying new products

Our pick (paid partner): TitanAir Nasal Strips

To go with your saline, our pick is TitanAir Nasal Strips. This is our recommendation, not the result of testing or ranking strips ourselves, and Titan's strips weren't used in any of the studies above.

Titan says its strips are drug-free external nasal dilators with flexible spring-loaded bands. That makes them an easy nightly partner for saline, which is drug-free too. Titan's instructions are to start with clean, dry skin, skip moisturizer, place the strip just above the flare of the nostrils, and remove it with warm water, peeling slowly from the ends inward. Titan says every batch is third-party tested and certified PFAS-free, and under its 30-night guarantee, Titan refunds you if your sleep isn't better after 30 nights with TitanAir.

Read next

• Nasal strips vs. humidifiers
• The best nasal strips for congestion
• How to unblock your nose before bed

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.