Nosebleeds at night: common causes and prevention tips

Nosebleeds at night usually have ordinary causes: dry bedroom air, a cold or allergies irritating the lining of the nose, or picking and rubbing it in your sleep. To stop one, sit up, lean forward and pinch the soft part of your nose for 10 to 15 minutes. Keeping the inside of your nose moist with a humidifier, saline and a little ointment helps prevent the next one.

How common are nosebleeds?

Nosebleeds are very common. A 2020 clinical practice guideline from the American Academy of Otolaryngology says nosebleeds happen at some point to at least 60% of people in the United States. Most are limited in how much and how long they bleed, and only about 6% of people who have one seek medical care. The NHS agrees that they're usually not a sign of anything serious and can mostly be treated at home.

Cleveland Clinic explains why the nose bleeds so easily. It has many tiny blood vessels that help warm and moisten the air you breathe, and they lie close to the surface. Air moving through the nose can dry and irritate them until they break.

Most nosebleeds start at the front of the nose, on the lower part of the septum, the wall between the nostrils. Cleveland Clinic calls these anterior nosebleeds and says they're the most common type and usually not serious. Posterior nosebleeds start deeper inside, can bleed more heavily and may run down the back of the throat. These are more likely to need medical help.

Why do nosebleeds happen at night?

Cleveland Clinic says the reasons for nosebleeds during sleep are the same as during the day. Dry air, allergies and upper respiratory infections damage the delicate lining of the nose. It adds one nighttime factor: sleeping with your head to the side may put direct pressure on the nose.

Dry air is the big one. Cleveland Clinic calls it the most common cause of nosebleeds, because it makes the lining crusty or cracked and more likely to bleed when rubbed, picked or blown. Air tends to be drier in heated indoor spaces, hot low-humidity climates and at high altitude. In a separate Cleveland Clinic article, an ear, nose and throat specialist says humidity below 30% in your house can leave you vulnerable to nosebleeds, and that this is more common when the heat or air conditioning is running. MedlinePlus notes that nosebleeds are more common in winter, when colds are going around and indoor air is drier. Our guide to why your nose dries out at night covers the dryness side in more detail.

Picking is the other common trigger, and it can happen without you knowing. The same Cleveland Clinic specialist says adults pick their noses too, sometimes unknowingly while sleeping. The front of the septum, where several blood vessels meet, is sensitive and can crack and bleed when touched. Dry crusts make the urge to pick stronger.

Colds and allergies add irritation. A runny nose and frequent, forceful blowing can damage the septum. If allergies are part of the picture, why allergies feel worse at night may help.

What else makes nosebleeds more likely?

Cleveland Clinic lists other causes, including a deviated septum, sinus infections, frequent use of antihistamine or decongestant nasal sprays, which can dry out the lining, and blood-thinning medicines such as aspirin, NSAIDs or warfarin. MedlinePlus adds overuse of decongestant sprays and oxygen given through nasal tubes. If a decongestant spray has become a nightly habit, decongestant spray rebound explains why it's worth cutting back.

Some people are more prone. The NHS lists children, adults over 45, pregnant women and people with high blood pressure. Cleveland Clinic adds people taking blood thinners and people with clotting disorders such as hemophilia or von Willebrand disease. If a crooked septum might be involved, deviated septum symptoms covers how it's assessed.

How do you stop a nosebleed at night?

If you wake up bleeding, the NHS advises:

1. Sit down and lean forward, with your head tilted forward and your mouth open.
2. Pinch your nose just above the nostrils, on the soft part, for 10 to 15 minutes.
3. Breathe through your mouth.

The most common mistake is letting go too soon. The Cleveland Clinic specialist recommends pinching for at least five minutes without stopping, and notes that many people release pressure after a minute or two, before the blood has clotted. The clinical guideline also recommends firm, sustained pressure on the lower third of the nose for five minutes or longer. Most nosebleeds stop after 10 to 15 minutes of pressure.

Don't lie back down or tilt your head back while it's bleeding. MedlinePlus says lying down with a nosebleed isn't recommended, and leaning forward stops you swallowing blood. The NHS says an ice pack on top of the nose may help, though the evidence for it isn't strong.

How do you prevent the next one?

For the first 24 hours after a nosebleed, the NHS suggests avoiding blowing or picking your nose, hot drinks, alcohol, heavy lifting, strenuous exercise and lying down flat. Overnight, a couple of extra pillows to raise your head is an easy way to avoid lying flat. The best sleep position for breathing has more on setting up your pillows.

After that, prevention is mostly about moisture. Cleveland Clinic recommends:

• saline nasal spray or drops two to three times a day in each nostril
• a humidifier in your bedroom at night, or one added to your furnace
• a nasal gel or ointment such as petroleum jelly, spread just inside the nostrils with a cotton swab inserted no more than a quarter of an inch
• blowing your nose gently and sneezing with your mouth open
• not putting fingers or objects in your nose
• quitting smoking, since it dries and irritates the nose

The Cleveland Clinic specialist suggests using saline spray and then some ointment before bed for double protection, and a hygrometer to check your home's humidity. Keep it in a sensible range: the EPA advises against going above 50%, which can encourage mold and dust mites, and recommends cleaning portable humidifiers and refilling them with fresh water daily. Do you need a humidifier for sleep? covers choosing and caring for one.

If you take aspirin, ibuprofen or a prescribed blood thinner, Cleveland Clinic says to check with your healthcare provider before making any changes.

What about mouth tape?

Leave mouth tape off after a nosebleed. When a nosebleed starts, the NHS advice is to breathe through your mouth, so don't tape on any night when your nose has recently bled, feels crusted and blocked, or you can't breathe comfortably through it with your mouth closed. Wait until your nose has healed. The safety page and our nose test cover who should hold off.

When should you get medical help?

Go to the emergency room or call for help if any of these apply. The NHS and Cleveland Clinic both list:

• bleeding that doesn't stop after 10 to 20 minutes of firm pressure
• heavy bleeding, or Cleveland Clinic's marker of more than a cup of blood
• swallowing so much blood that you vomit
• a nosebleed after a blow to the head or a serious injury
• difficulty breathing, or feeling weak or dizzy
• bleeding that won't stop while you're taking blood thinners or have a clotting disorder

Don't drive yourself. The NHS advises asking someone else to drive or calling an ambulance.

See a doctor at a routine appointment if you get nosebleeds often, if a child under two has had one, or if you have signs of anemia such as feeling weak, tired or short of breath with paler skin than usual. Cleveland Clinic also flags a nosebleed that starts around the time of a new medicine, or nosebleeds together with unusual bruising. MedlinePlus says to get checked if nosebleeds aren't linked to a cold or other minor irritation. The clinical guideline recommends that doctors look inside the nose with a small camera when bleeding keeps coming from one side, and check for an inherited blood vessel condition when someone has repeated nosebleeds from both sides or a family history of them.

Read next

• Why your nose dries out at night
• Do you need a humidifier for sleep?
• Deviated septum: symptoms and when to see an ENT

* 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.